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Professional
Boundaries
BCCNM LEARNING MODULE WORKBOOK
In Nursing Practice
Introduction
ThisworkbookoffersactivitiesthatallowyoutoapplyideaspresentedintheModule.Itisorganized
inthreesections.
Part 1 includesWorkbook Activities thatarerelatedtovarioustopicareas.Asyouworkthrough
themodule,youwillbedirectedtocompleteaspecicWorkbookActivity.Thissectionalso
includespagesforyoutorecordyourreectivethoughtsandinsightsrelatedtoyourexploration
inthismodule.
Part 2, Applying My Learning”,includesacasescenarioandassociatedquestions.Completingthis
activityprovidesanopportunityforyoutoapplyalloftheinformationthathasbeenofferedinthe
moduleinthecontextofthispractice-basedscenario.Whenyouhavecompletedthiscase,youmay
wishtocompareyourresponseswiththoseprovidedintheApplyingmyLearning:Perspectives”
locatedinPart3.
Part 3 presentssample responses toWorkbookactivitiesandthecasescenarioinPart2.These
responsesprovidetheperspectivesofthecoursewriterandothersonthecasescenario.
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Part 1:
Workbook Activities
WorkbookActivity#1
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Considerthefollowingquestions.Recordyourresponsesinthespacesbelow.Thesethoughts,ideas,and
responseswillhelpyoudecidewhatyouwouldliketofocusoninthismodule.Theymayalsoformpartofthe
basisforyourprofessionaldevelopmentplanningaspartofyourqualityassurancerequirements.
Whataremystrengthsinrelationtotherapeuticrelationshipsandprofessionalboundaries?
WhataspectsoftherapeuticrelationshipsandprofessionalboundarieswouldIliketoknowmoreabout?
AmIawareoftheresourcesavailablethatcansupportmypracticeinrelationtotherapeuticrelationshipsand
professionalboundaries?
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WorkbookActivity#2
1. Thinkbacktothecasescenario,andpretendyouareSaira.Wouldyoudothesamethingshedid(purchasing
atoyforAnnie)?Whyorwhynot?Ifnot,whatwouldyoudo?Whatcontextualfactorsfromthescenarioare
inuencingyourchoicesanddecisions?Writeyourthoughtsinthespaceprovided.Youmaywishtocompare
youranswerswiththediscussioninPart #3, Perspectivesattheendofthismodule.
2. Reection Point
Thinkofatimeinyourownpracticewhereyoumadeadecisioninrelationtoprofessionalboundaries.Itcould
beanything….youmayhavedecidedtotakeextratimewithaclient,decidedtogiveaclientorfamilymember
ahug;youmayhavehadaFacebookfriendrequestfromaclientorfamilymemberoryoumayhaveconsidered
doingapersonalfavourtohelpaclient,etc.Onceyouhavethoughtofscenario,thinkaboutthecontextual
factorsthatinuencedyourthoughts,decisions,andactions.Wouldyouhavemadedifferentdecisions,ordone
thingsdifferentlyifcircumstances,orthecontext,weredifferent?Howdidthecontextinuenceyou?Record
yourthoughtsonthe“ThoughtsfromReectionPoints”pageofthisworkbook.Atthecompletionofthe
module,youwillhaveanopportunitytousetheinsightsandafrmationsgainedinvariouslearningactivities,
aspartofyourplanningforfutureprofessionalgrowthanddevelopment.
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WorkbookActivity#3
Inthisactivityyouwillexplorethedirectionprovidedwithinyourprofessionalregulatorybody’swebsite
resourcesforestablishingandmaintainingprofessionalboundariesinnursingpractice.Thedocumentsand
resourcescanbeaccessedfromtherelevantlinksbelow.
1. ReviewtheProfessionalStandardsforyourprofessionalgroup,forexample,RegisteredNursesandNurse
Practitioners.Asyoureviewthestandardsandassociatedindicators,considerhowtheyrelatetoyouruseof
professionalboundariesintherapeuticrelationships.
Inwhatwaysdothestandardsandindicatorsprovidedirectionforcompetencyrelatedtoprofessionalboundary
maintenanceinnursingpractice?WriteyouranswersdowninyourWorkbook.
2. Theprofessionalregulatorybodywebsiteshavemanydifferentresourcesavailableregardingprofessional
boundariesinnursingpractice.TakesometimetoexplorethewebsiteofyourCollegeandndwhatother
resourcesthewebsiteprovides.ListtheseresourcesinyourWorkbook.Youmaywishtoexploretheseresources
inmoredetaileitherinthefuture,orrightnow.
3. TheCanadianNursesAssociationprovidessomedirectionforprofessionalboundariesintheCodeofEthics
forNurses.Pleasetakesometimetoinvestigatewhatdirectionthisresourceprovidesforyouintermsof
professionalboundaries.Youmaywishtojotdownsomethoughtsandideasthisresourceprovidesforyou.
Alinktothiswebsiteandmanyotherrelevantresourcesmaybefoundbyclickingonthelinktothemodule
ResourceSectionbelow.
BC College of Nurses & Midwives Web Site: https://www.bccnm.ca/Pages/Default.aspx
Module Resource Section pdf: https://www.bccnm.ca/Documents/learning/modules/PBlearningresources.pdf
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WorkbookActivity#4
GotothewebsiteforyourRegulatoryBodyandreviewtheBoundariesintheNurse-ClientRelationship
PracticeStandard.Alinktoapdfofthisdocumentisalsoavailablebelow.Answerthefollowingquestionsin
yourworkbook.Remember,youdonotneedtoshareyouranswerswithanyone.Thisexerciseisintendedto
assistyoutobecomeawareofhowyouutilizethePracticeStandardPrinciplesforboundariesinthenurse-client
relationshipinyourpractice,andidentifyanyareasforfurtherlearningandgrowthinyourpractice.
https://www.bccnm.ca/RN/PracticeStandards/Lists/GeneralResources/RN_PS_Boundaries.pdf
1. HowfamiliaramIwiththePracticeStandardPrinciplesforBoundariesintheNurse-ClientRelationship?DoI
regularlyindependentlyapplytheprinciplestomypractice?How?Ifnot,whynot?Writethesethoughtsdownin
thespacebelow
2. Dotheseprinciplesofferinsightsorsolutionsforareasofprofessionalboundariesthatyouareunsureofornd
challenging?How?
3. WhatisbestpracticeifaclientasksifI’veeverhadthesametypeofmedicaltreatmentheorsheisaboutto
receive?
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WorkbookActivity#4(continued)
4. Doesmyagencyhaveapolicyaboutreceivinggiftsfromclients?WherecanIndthispolicy?
AmIfamiliarwithit?
5. WhatshouldIdoifmychild’sfriendbecomesmyclient?
6. MyclienthasaskedifIwillcareforhim/herprivately,outsidemyagency’ssetting.Whatdirectiondoesthe
practicestandardprovideinmakingthisdecision?
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WorkbookActivity#5
Eachagencyandemployermayhavedifferentpoliciesregardingnurses’practiceinrelationtoprofessional
boundariesinnurse-clientrelationships.Thisactivitywilldirectyoutofamiliarizeyourselfwiththespecic
employerpolicieswithinyourpracticesettingandhowtheseguide/restrictyourpracticeinrelationto
professionalboundaries.Recordthesebelow.
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WorkbookActivity#6
Reectonyourownpracticeintermsofrecognizing,establishing,andmaintainingboundariesinnurse-client
relationships.Hereyouareconsideringtheindividualnurselevelofcontrolonpractice.Whatknowledge,skills,
judgement,andattitudesdoyouholdthatmayaffectyourpracticeinthisrealm?Writetheseideasdown.
Consider:WhatdoIneedtondout,ordo,inordertoaddressanygaps?Thinkbroadlywhileyoudothis,and
remember,youdonotneedtosharethiswithanybody!Thislearningactivitywillformpartofyourongoing
professionaldevelopmentplan
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WorkbookActivity#7
Mostnurseswhoviolateprofessionalboundariesdonotintendtodoso,butendupinasituationwhere
theirviolationpotentialishigh,andtheyenduptravellingdowntheSlipperySlope.ConsiderLesley’s story
andanswerthefollowingquestions.YoumaywishtocompareyouranswerswiththediscussioninPart #3,
Perspectives at the end of this Workbook.
1. IdentifythefactorsthatcontributedtoLesley’sViolationPotentialinthissituation.Considervulnerability,risk
factors,andcontextinyouranswer.
2. LookingbackatLesley’sstoryagain,traceherpathdowntheslopetoboundaryviolation.Atwhatpointsdidshe
engageinboundarydrift,boundarycrossing,andboundaryviolation?
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WorkbookActivity#8
Ifyouareworkingwithacolleaguewhomyoubelieveiscrossingorviolatingaprofessionalboundaryyouhave
aresponsibilitytotakeaction.ConsiderSimone’s situationandanswerthefollowingquestions.Youmaywishto
compareyouranswerswiththediscussioninPart #3, Perspectives at the end of this Workbook.
1. ReferbacktotheBoundariesintheNurse-ClientRelationshipPracticeStandardandapplythePrinciplesto
Simonessituation.WhatguidancedoesthePracticeStandardgiveforSimone?
https://www.bccnm.ca/RN/PracticeStandards/Lists/GeneralResources/RN_PS_Boundaries.pdf
2. ListtheactionsSimoneshouldtakeinthesituation.
3. Findouttheprocedureinyouragencyfordealingwithaboundaryviolationbyacolleague.Ifthereisnowritten
policy,youmayneedtohaveaconversationwithyourmanagerinordertondoutyour’agency’sapproach.
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WorkbookActivity#9
Case One:
DoyourememberDaniel’s story fromearlierinthelearningmodule?Refreshyourselfonhissituationand
thenusethethinkingtooltohelphimdecidewhattodobyansweringthefollowingquestions.Onceyouare
done,youmaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of this
Workbook.
Daniel is the charge nurse of the emergency room in a small rural community. He is also well-known in
the community as he coaches his childrens sports teams and through other community events. Daniel
also plays recreational hockey on a local team. During one shift, one of Daniel’s hockey teammates, who
also happens to be one of Daniel’s sons high school teachers, arrives in the ER with a small laceration that
requires sutures. Daniel’s son has applied for a big scholarship, and this teacher is on the application review
committee. The ER is extremely busy and the teammate will need to wait a long time to have this done. The
teammate asks for his friend, Daniel, to fast track him so that he can get his injury attended to faster.
1. Ask,WHOwillbenetfromthisaction”?IfDanielfast-trackshisteammateandsonshighschoolteacher,who
benets?
Ask,WHOSEneedswillbemet?”Willtheclient’sneedsbemet?WillDaniel’s?Willtheneedsofotherclients
bemet?
2. Ask,WHY? Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfDanielfasttrackshis
teammate,willthishelporhinderthenurse-clientrelationship?How?
3. Ask,WHAT?Isthisactionconsistentwiththeclientcareplan?”Whatisthecareplanfortheclient?Doesit
includethisaspect?
4. Ask,HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith
theclient?”WouldDanielbecomfortablewithotherpeopleorcolleaguesknowinghefasttrackedtheclient?
5. IfyouwereDaniel,whatisyourdecision?Why?
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WorkbookActivity#9(continued)
Case Two:
Let’stryanothercasescenario.HereyouwillmeetScott,anursewhoworksinarehabilitationcentre.
Again,youmaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of
this Workbook.
Scott works in a spine rehabilitation centre with clients who have sustained serious spinal cord injuries. Most
of Scotts clients are in the rehabilitation centre for at least several weeks, and Scott and his colleagues often
get to know the clients well. Scott is caring for Grant, a young lawyer who sustained a thoracic spinal injury
in a snowboarding accident. Grant has always been a very athletic man, and has had a difcult time adjusting
to his new disabilities. He is also an ardent hockey fan. Scott has many similar interests as Grant, and the
two men have established a very effective rapport. Grant trusts Scott and responds well to his treatment
and intervention regime with Scott as his caregiver. In conversation one day close to Grant’s discharge
from the rehabilitation centre, Grant and Scott discover they are both fans of the same local hockey team.
Scott expresses regret about being unable to attend any of the teams playoff games due to other nancial
priorities. At discharge, Grant gives Scott an envelope addressed to him. Inside is a handwritten thank you
note and a pair of hockey tickets to the local teams playoff games.
1. Ask,WHOwillbenetfromthisaction”?IfScottacceptsGrantsgift,whobenets?
Ask,WHOSEneedswillbemet?”WillGrant’sneedsbemet?WillScott’sneedsbemet?
2. Ask,WHY?Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfScottacceptsthetickets,
willthishelporhinderthenurse-clientrelationship?How?
3. Ask,WHAT?Isthisactionconsistentwiththenursingcareplan?”WhatisthecareplanforGrant?
4. Ask,HOW? IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith
theclient?”WouldScottbecomfortablewithotherpeopleorcolleaguesknowinghehadbeengivenexpensive
hockeyticketsbyaclient?
5. IfyouwereScott,whatisyourdecision?Why?WouldyourdecisionhavebeendifferentifGranthadgivenScott
theticketsduringhishospitalization?Why?
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page 15professional boundaries in nursing practice workbook
WorkbookActivity#10
Gothroughtheworkbookthatyouhavecompleted.Noticeareaswhereyouhavefurtherquestions,further
interest,orneedfurtherdevelopment.Noticeareaswhereyouhavestrengthsinrelationtoprofessional
boundarymaintenancetoo.Pickoneareathatyouwouldliketodevelopfurtherandcreatealearningplan
foryoutomeetyourownlearningneeds.Youmayndthefollowingframeworkhelpfulforyoutostructure
yourlearningplan.AProfessionalDevelopmentPortfoliothatcanbecompletedelectronicallyisalso
availableontheBCCNMQAWebpage.Alinktoapdfofthisdocumentisbelowandmakesurethatyou
saveittoyourcomputertocompleteit
https://www.bccnm.ca/Documents/quality_assurance/PD_plan_template.pdf
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page 16professional boundaries in nursing practice workbook
MyPlanforGrowth
Goals
1.
2.
3.
Action Plan
PeopleorplacesthatIcaninvestigateforlearningstrategiestohelpmemeetmygoalsforgrowthare:
1.
2.
3.
page 17professional boundaries in nursing practice workbook
MyPlanforGrowth
Strategy Resources I need to
implement this strategy
Target completion date Other thoughts
NotesfromReectionPoints
page 18professional boundaries in nursing practice workbook
ProfessionalBoundariesinmy
NursingPractice:AfrmationsandInsights
page 19professional boundaries in nursing practice workbook
Part 2: Applying
My Learning
page 21professional boundaries in nursing practice workbook
ApplyingMyLearning
Doyouwantmore?Inthissection,ApplyingMyLearning,thereisamorecomplexcasescenarioforyouto
workthroughinordertofurtherintegrateandapplytheunderstandingyouhavebuiltthroughoutthemodule.
Thissectionisoptionalforthosewhowantmorepracticeapplyingwhatyouhavelearnedtonursingpractice.
Case Study
PleasereadthefollowingcasescenarioaboutJanice,aRegisteredNursewhoworksinabonemarrowtransplant
unit.Whenyouhavenished,analyzethescenariousingtheinformationyouhavelearnedaboutinthismodule,
andmakeadecisionaboutwhatJaniceshoulddo.Whenyouhavecompletedthisactivity,youmaywishto
compareyourresponseswiththoseprovidedinthe“PerspectivessectionattheendofthisWorkbook.
Be sure to consider:
thetherapeuticnurse-clientrelationship
thedirectivesforpracticeinrelationtoprofessionalboundaries
theslopeofboundaryviolations
violationpotential
thethinkingtoolforprofessionalboundaries
page 22professional boundaries in nursing practice workbook
ApplyingMyLearning
Janice cared for Mrs. Black, who was hospitalized on the bone marrow transplant unit following a transplant
for her acute leukemia. Janice, who graduated from her nursing program 18 months ago, really enjoys
working on the unit. She enjoys the acuity of care, but she particularly likes getting to know her clients and
their families. She nds the work both challenging and rewarding.
Mrs. Black was a client on the unit for several weeks, and had experienced many downturns in her condition.
In the periods of time when Mrs. Black’s condition stabilized, she talked frequently with Janice about
wishing she would live long enough to see grandchildren born. Mrs. Black reminded Janice of her favorite
aunt, Bonnie, and Janice developed a close, friendly relationship with her.
The frequent relapses in Mrs. Black’s condition made for a very tumultuous time for her close-knit family.
Janice got to know all the family members quite well, including Mrs. Blacks 32 year old son, Hugh, who
visited daily. Janice liked Hugh as he had a great sense of humor and Janice had an easy rapport with him.
Hugh requested to be Facebook friends with Janice, and she accepted. Hugh would send websites and jokes he
thought Janice would enjoy and Janice would occasionally do the same.
Eventually, Mrs. Black’s condition inevitably deteriorated and she ultimately passed away in the bone
marrow transplant unit. Janice and two other nurses from the unit attended Mrs. Black’s funeral. Janice felt
badly for the family members who had always been so hopeful about Mrs. Black’s condition. She let them
know at the end of the funeral that she would be available to support them if they needed her.
A few weeks after the funeral Hugh contacts Janice and asks if she could meet him for coffee. Janice agrees,
and she and Hugh have a nice conversation reminiscing about Hughs mother and generally catching up with
each other. As Janice stands up to go, Hugh asks if he can have her telephone number; hed like to ask her
out for a date sometime, saying “Even my mom wanted me to ask you out!”. Janice blushes as her heart rate
increases slightly….Hugh is very attractive, and she really enjoys his company.
Part 3: Workbook
Activities and Case
Perspectives
page 24professional boundaries in nursing practice workbook
WorkbookActivity#2
ThereareanumberofcontextualfactorsthatareinuencingSairasdecisioninthiscase.Herearesometo
considerwhenyouanswerthisquestion.Youmayhaveotherideasaswell.
Context:
Whataretherules,regulations,policies,standards,andguidelinesthatgovernmypracticeinrelationto
professionalboundaries?What,ifany,aretheexceptionstothese?
Whatismyunitspolicyongifts?Whatismyunit’spolicyonclients’birthdays?
Howdoesthistwiththeclientcareplan?
WouldIhavemymanager’ssupportforthedecisionImake?
ArethereothercolleaguesorpeopleIshouldinvolveinthisdecision?
Howwouldtheclientfeelaboutmyaction?Howwouldherfamilyfeelaboutit?
WouldIdothisforalltheunitclients?
HowcomfortableamIwiththevariousoptions?Whataremybeliefsabouteach?
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page 25professional boundaries in nursing practice workbook
WorkbookActivity#7
ConsiderLesley’s storyandanswerthefollowingquestions
1. IdentifythefactorsthatcontributedtoLesley’sViolationPotentialinthissituation.Considervulnerability,risk
factors,andcontextinyouranswer.
FactorsthatcontributedtoLesley’sViolationPotentialinthissituationinclude:
Vulnerability:Lesley’sclientshusbandisinavulnerablepositionasheiscopingwithhiswife’sillnessas
wellashischildren,job,andotherresponsibilities
Context:Lesleyhasworkedwiththeclientandclient’shusbandoveralongperiodoftimeandhascome
toknowthemwellviaacontinuouscaringrelationship.
Catalyst:Lesleyexperiencesadivorce,whichincreaseshervulnerability.
2. LookingbackatLesley’sstoryagain,traceherpathdowntheSlipperySlopetoboundaryviolation.Atwhat
pointsdidsheengageinboundarydrift,boundarycrossing,boundaryviolation?
Boundarydriftandcrossings:
Developingafriendshipovertime
Havingcoffeetogether,sharingphotosofkids,talkingaboutoutsidelifeandotherthings
Theseactivitieswerecrossingfromtheprofessionalrealmintothepersonalrealm.Theseactivitieswouldnot
beapartoftheprofessionalnursesrole,theclient’scareplan,and/orthenursesworktime.Lesleyshouldhave
rotatedclientassignmentswhenshefoundherselfwantingtospendmoretimewithLuke.
Unabletocopewithalltheemotionandstress”onherown,andprogressingtoseeingtheclients
husbandromantically.Thisisaclearboundaryviolation.
Lesleyneedstoseekoutanddeveloppersonalsupportnetworks.Shemayconsideremployeeassistance
programsofferedbyheremployer.
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page 26professional boundaries in nursing practice workbook
WorkbookActivity#8
ConsiderSimone’ssituationandanswerthefollowingquestions
1. ReferbacktotheBoundariesintheNurse-ClientRelationshipPracticeStandard,andapplythePrinciplesto
Simonessituation.WhatguidancedoesthePracticeStandardgiveforSimone?
Guidance from the Practice Standard includes:
Thenurse-clientrelationshipisconductedwithinboundariesthatseparateprofessionaltherapeuticbehaviour
fromnon-professionalandnon-therapeuticbehaviour.
Simoneiswitnessingbehaviourthatmakesherfeeluncomfortable,becauseshebelievesitisnon-therapeutic.
Thenurse,nottheclient,isalwaysresponsibleforestablishingandmaintainingboundaries.
Geoffisresponsiblefortheestablishmentandmaintenanceofprofessionalboundarieswiththeclient.
Nursesdonotenterintoafriendshipwithclients
Simoneiswitnessingbehaviourthatisexpectedwithinnon-professional,friendlyrelationships,butnotinthe
contextofaprofessionalrelationship.
Nurseshelpcolleaguestomaintainprofessionalboundariesandreportevidenceofboundaryviolationstothe
appropriateperson.
SimonemusthelpGeofftore-establishprofessionalboundaries;thismayincludejustashort,factual
conversationwithGeoffregardingthePracticeStandard,and/oritmayincludereportinghisbehaviourtotheir
manager.
Employersthatprovideeducation,supervision,andsupportrelatedboundaryissueswillhelpstaffrecognize
andresolveproblemsintheearlystagesSimonemayinvolvehermanagertohelpresolvetheissuebeforeit
becomesabiggerproblem.
Considerifaspectsforthenurse’srelationshipwiththeclientarehiddenfromothers,thenursedoesnotwant
othernursestohavethesamerelationshipwiththeclient,thenurseisgivingpreferentialcareortimetothe
client.
Geoffisgivingpreferentialcareandtimetothisclient
2. ListtheactionsSimoneshouldtakeinthesituation.
TheRegulatoryBody’swebsitesprovidespecificguidanceandresourceswhichcanhelpSimoneinthis
situation.AnexampleisawebmoduleontheBCCNMwebsiteentitles“TakingActiononConcernsAbout
Practice”.https://www.bccnm.ca/Lists/Learning_modules/taking_action/player.html
SimonecanalsotalktoamanageroraccessthepracticeconsultationandadvisingserviceofherRegulatory
Bodytohelpguideheractions.
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page 27professional boundaries in nursing practice workbook
WorkbookActivity#9
Case One: Daniel’s Story
1. Ask,WHOwillbenetfromthisaction”?IfDanielfast-trackshisteammateandsonshighschoolteacher,who
benets?
IfDaniel’sfast-trackshisteammate/sonshighschoolteacher,theteacherwillbenet.However,Danieland
hissonmayalsopotentiallybenetfrompossiblepreferentialtreatmentofhissonsscholarshipapplication.
Ask,WHOSEneedswillbemet?”Willtheclient’sneedsbemet?WillDaniel’s?Willtheneedsofotherclientsbe
met?
Theclient’sneedswillbemet,andDaniel’spersonal(notprofessional)needsmaybemet.However,thiswill
occurattheexpenseofotherclients’needs,sinceDanielwillnotbefollowingstandardizestriageassessment
protocols.
2. Ask,WHY?Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfDanielfasttrackshis
teammate,willthishelporhinderthenurse-clientrelationship?How?
IfDanielfast-tracksthisclient,hewillalsobeviolatingaboundaryintermsofbehaviourrelatedto
favoritism.Thiswillhinderthenurse-clientrelationship.
3. Ask,WHAT?Isthisactionconsistentwiththeclientcareplan?”Whatisthecareplanfortheclient?Doesit
includethisaspect?
Thisactionisnotconsistentwiththisclientscareplan,sincehedoesnotrequirefast-trackingaccordingto
triageprotocols.Thisactionisalsonotconsistentwithotherclients’careplans.
4. Ask,HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith
theclient?”WouldDanielbecomfortablewithotherpeopleorcolleaguesknowinghefasttrackedtheclient?
Danielwouldneedtoanswerthisquestionforhimself,however,wouldyoufeelcomfortableifotherpeople
andcolleaguesknewyouhadfasttrackedthisclient(ifyouwereDaniel)?
5. IfyouwereDaniel,whatisyourdecision?Why?
Danielshouldideallytransferthecareofhisfriendtoanothernurse(Principle#8BoundariesinNurse-
ClientRelationshipPracticeStandard).Ifthisisnotpossible,Danielneedstoclarifythatheisactingina
professionalcapacityandnotapersonalcapacitywithhisfriend(Principles#9and#10BoundariesinNurse-
ClientRelationshipPracticeStandard).Danielmayneedtoinvolvehismanager.
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page 28professional boundaries in nursing practice workbook
WorkbookActivity#9(continued)
Case Two: Scott’s Story
1. Ask,WHOwillbenetfromthisaction”?IfScottacceptsGrantsgift,whobenets?
Scottwilldirectlybenetfromthisaction.
Ask,WHOSE needswillbemet?”WillGrant’sneedsbemet?WillScott’sneedsbemet?
Scottsneedswillbemet.
2. Ask,WHY? Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfScottacceptsthetickets,
willthishelporhinderthenurse-clientrelationship?How?
Acceptingtheticketswillnotcontributetothetherapeuticnurse-clientrelationship.
3. Ask,WHAT?Isthisactionconsistentwiththeclientcareplan?”WhatisthecareplanforGrant?
Grantisbeingdischarged,however,acceptingtheticketswouldnotbeapartofthe
planofcareforGrant.
4. Ask,HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith
theclient?”WouldScottbecomfortablewithotherpeopleorcolleaguesknowinghehadbeengivenexpensive
hockeyticketsbyaclient?
Scottwouldneedtoanswerthisquestionforhimself,however,wouldyoufeelcomfortableifotherpeople
andcolleaguesknewyouhadacceptedthesetickets(ifyouwereScott)?
5. IfyouwereScott,whatisyourdecision?Why?WouldyourdecisionhavebeendifferentifGranthadgivenScott
theticketsduringhishospitalization?Why?
ScottneedstoexplaintoGrantthatheisunabletoacceptthesignicantgift,althoughhetrulyappreciates
thegesture.Hecannotacceptthem,butifGrantisinsistent,ScottcouldsuggestthatGrantspeakto
themanageraboutit.Theremaybespecicagencypolicyinplaceregardingsubstantialgifts;forexample,
agencypolicymayallowforsomethinglikeastaffdraw(Principle#17BoundariesinNurse-Client
RelationshipPracticeStandard).
ThedecisionwouldnotbedifferentiftheticketswereofferedduringGrant’shospitalization.Scott
coulddiscusstheissuewithhismanagerandcolleaguestoensurethatthereisaconsistentunderstandingof
professionalresponsibilitiesandagencypolicy:Giventhecontextofrehabilitation,andthelongtermnature
ofthenurse-clientrelationships,itmaybeanticipatedthatthistypeofsituationmayariseagain.
9
page 29professional boundaries in nursing practice workbook
CasePerspectives
Trust: Trustiscriticalinthenurse-clientrelationshipbecausetheclientisinavulnerableposition.Hughtrusted
Janicetocareprofessionally,ethically,andcompetentlyforhismother.Hismotherwasinavulnerableposition,
andHughistoo.DatingHughwouldtakeadvantageofthisvulnerability.
Respect: Respectistherecognitionoftheinherentworth,dignity,anduniquenessofeachindividual.Atthis
point,respectseemstobeintactwithinthisnurse-clientrelationship.
Professional intimacy: Professionalintimacyincludesphysicalactivitiesthatcreatecloseness(forexample,
bathing,andalsopsychological,spiritual,andsocialaspectsofcare.JanicesrelationshipwithHughhasasense
ofintimacyfromaprofessionalstandpointbecauseoftheintimatecareshehasprovidedtohismotheraswellas
thepsychosocialnursingcareshehasprovidedtoHugh.DatingHughwouldviolatetheprofessionalnatureof
thisintimacy.
Empathy:Empathyallowsthenursetoprovidecompassionateandethicalcaretoclientsandfamilies.Empathy,
however,alsoincludeappropriateemotionaldistancefromtheclienttoensureobjectivityandanappropriate
professionalresponse.ThisemotionaldistancewillbenegatedifJanicedatesHugh.
Power: Thenursehasmorepowerthantheclientinthenurse-clientrelationship.JaniceandHugharenoton
equalfooting.
Levels of Control on Practice:
TheBoundariesintheNurse-ClientRelationshipPracticeStandardprovidesdirectionforJanice’spractice.
Principles#1,#3,#5,#6applyhere.
RN: https://www.bccnm.ca/RN/PracticeStandards/Pages/boundaries.aspx
NP: https://www.bccnm.ca/NP/PracticeStandards/Pages/boundaries.aspx
Violation Potential:
Janice’sviolationpotentialwasmostlyimpactedbythecontextofcaringforaclientoveraperiodoftime,in
emotionallychargedcircumstances.ThecatalystherewasMrs.Black’sdeath.
Slippery Slope:
Janicestarteddowntheslipperyslopewithoutmeaningto.Boundarycrossingsoftenstartoffasinnocuous.
Janicebegantocrossboundarieswhenshe:
- beganthinkingofMrs.Blackasheraunt
- developedaclose,friendlyrelationshipwithher
- acceptedFacebookfriendshipwithHugh
- sharedjokesandwebsiteswithHugh
- offeredtobeavailabletosupportthemiftheyneededher
page 30professional boundaries in nursing practice workbook
CasePerspectives
Thinking Tool
Who? IfJanicegoesoutwithHugh,Janicebenets.
Whoseneedsarebeingmet?Janice’ssocialneedsarebeingmetifshedatesHugh.
Why? Doesthishelporhinderthetherapeuticnurse-clientrelationship?Asnotedinthediscussionearlier,
Janicerisksalteringthetherapeuticnurse-clientrelationshipsothattheclientsneeds(Hughsneedsareno
longerinthecentreofsafe,appropriate,competentandethicalclientcare.
What? JanicedatingHughisnotconsistentwiththeclientorfamilycareplan.
How?WouldJanicebecomfortablewithcolleaguesandothersknowingshewasdatingHugh?
JaniceneedstorespectfullydeclineHugh’sinvitation,andre-establishaprofessionalrelationship.Janice
maywishtoinvestigateBCCNMresourcestohelpherwiththisaction,orpossiblydiscussthesituation
withhermanager.Thismaybeanopportunitytoinitiatesomediscussionandsharedlearningwith
colleaguesaboutprofessionalboundaries.