Professional Boundaries: Relationships among Nurses, Children and Other Clients - Essay Example

Running Head: PROFESSIONAL BOUNDARIES Professional Boundaries: Relationships among Nurses, Children and Other Professional Boundaries: Relationships among Nurses, Children and Other Clients Introduction The ability to maintain professional boundaries in a patient/client- nurse relationship is among the key competencies in the nursing profession. This declaration is however simple in theory, but not as straightforward in practice. By working with each other, the nurse and the client develops familiarity, trust and the urge to help each other. If the nurse lacks a general understanding of what professional boundaries should be, then the integrity of the nurse-client relationship maybe jeopardized leading to boundary violations (nmc-uk.org.2008 p14). Many times during their careers, nurses find themselves psychologically involved with patients. This is because like everybody else, nurses too have emotions that respond to human suffering and/or acts of passion directed to them. To ensure that nurses do not suffer long term effects from their relationship with patients, these relationships are regulated by a set of professional boundaries, which has general outlines about handling clients and the general relationship that a nurse and a patient should have. Simply put, these outlines are known as "professional boundaries," further defined as the invisible but potent lines that define the territory of a nurse (Evans, Elder, & Nizette, 2004 p 6). Professional boundaries are maintained by a nurse in his or her therapeutic role to a patient The example of Peter Stevens and his client Tom William best illustrates just how professional boundaries can be blurred in the nursing profession. Tom aged 18 years is a patient at a Psychiatric hospital where Peter is a resident nurse. When Peter first started work in the hospital, he realized that Tom was very outgoing and liked to strike conversations with everyone. His argument about politics, the economy and the social setup in his home area were quite intelligent considering that he was suffering from Psychosis. On a bad day, Tom would be delusional and could not strike up an intelligent conversation. He would be confused and delirious. It is at such times that Peter knew he had stricken a lasting bond with Tom. He would check on him regularly, sometimes spending hours trying to calm him down. It was not until a fellow nurse pointed out that Peter had been spending too much time that he realized that he was guilty as accused. Every nurse in the facility liked Tom too, but he had to admit that he had been unusually concerned about Tom than other patients who had even worse conditions. . According to the National Council of State Boards of Nursing, nurses flout professional boundaries by acting as if they are the only nurse who can handle a clients case well despite the presence of other nurses. In addition, if the nurse spends too much time with a specific client, trades duties with other nurses in order to be with the client or spends his off duty days with the client (ncsbn.org. 2005). Peter may not have been guilty of all this, but he was guilty of feeling protective towards Tom and spending too much time with him. Just like Peter, nurses work in situations where their actions to the client whether intentional or not may compromise their professional integrity (Peternelj-Taylor, et al. 2003). How nurses treat acts of gratitude or gifts given to them by clients also poses a major risk to professional boundaries. According to Nursing & Midwifery code of ethics (nmc-uk.org. 2008), a nurse must "Refuse gifts, hospitality or favors which might be understood as attempts of gaining preferential treatment". Although nurses may argue that they never solicited for the gifts, the fact that such the nurse accepted the gifts is prove enough that they did not delineate and maintain the boundaries (ncsbn.org. 2005) In child health nursing, nurses have to handle a number of people in relation to the children they attend to. They include the child's parents, family members and friends. In this context, it is imperative that the nurse does everything required for the full recovery of the child and also be ready to explain each step of the care for the interested parents or relatives. This is because the network of people in the child's psychosocial field plays a role in his developmental needs and recuperation (Carr, A.2005 p3). This in turn creates an atmosphere where the parents/guardians are satisfied with the services that the child receives (Mott, Fazekas & James, 1985 p 33). As a newly qualified nurse, I am aware that as much as the nurses may be determined to abide by the professional boundaries, situations that arise during the provision of medical care may compromise this resolve. My experience has exposed me to circumstances where the line between professionalism and the human part of me is not very distinct. When carrying out therapeutic care for the mental health patients in the wards for example, I have learnt to set limits in how I relate with my clients, this is because I have realised becoming emotionally tied to the clients is not unlikely due to the complexity and the time I spend attending them. The limits ensure that my connection with the client is safe and therapeutic. At such, I ensure that I do not use my power as a nurse during a time when the client is vulnerable to betray trust or respect. I ensure that I am neither over involved with a client or under involved. Whenever uncertain about a boundary related issue, re-evaluating the professional boundaries as indicated below is the next good thing General account of the professional boundaries In child health nursing, the nursing code of ethics lays special emphasis on the relationship between the nurse, the child, his/her parents and other family. This is because the innocent nature of children can attract admiration and fondness from the nurses. The nurses should be wary of parents who may want to strike a cordial relationship with the nurse with an aim of winning her/his child more nursing care. The nurse should not discuss his or her personal problems with the clients, in this case the parents or family of a child (NMC, 2008). This includes family life, finances or anything else that may lead to the parents wanting to help the nurse out. However, the blurring of this boundary can occur when the child or the parents wants to know about the nurse especially after telling their side of the story about family life. On the same level, the child health nurse should avoid behaving in a manner suggesting sexual flattery, telling sexual jokes to the child, parents or family members, even when the family members do so. In addition, it is unethical for a nurse to discuss his or her sexual attractions with clients, as this may arouse an intimate relationship with them (Acello, 2005 p 40). It is considered unethical in nursing for a nurse to have a confidential relationship with a client (for example a child's parent) (Evans, Elder, & Nizette, 2004 p 7). In addition, it is not in the interest of the nursing profession for a nurse to keep secrets concerning a relationship with a client. At such nurses should discourage their patients/clients from disclosing personal information touching on their families, unless it is related to the health condition they are getting care for. This is especially true when the nurse is attending to adolescents who are fond of divulging their relationships to nurses. The human nature of the nurses is addressed by the clause that prohibits nurses from feeling that they are immune to "unhealthy" relationships with their clients (Acello, 2005 p 41). It is also unethical for a nurse to think that only he or she can provide healthcare services to a particular client (Timby & Smith, 2005 p 48). While nurses are supposed to take care of their patients at all costs, this does not imply that they have to spend most of their time unnecessarily with clients. Thus, according to the NMC Code of Ethics, it is wrong for nurses to spend an inappropriate amount of time with clients, including off- time visits or creating one's own time to visit the clients (p 7). It is clear that the nature of the nursing profession requires the nurses to work in situation that test the nurse-patient relationship, which can either be through the nurse's actions or patient/client actions. How the nurse responds to the 'tests' is determined by personal integrity, professionalism and the code of ethics set forth by the various nursing councils. Many times however, the right way of conduct in nursing is open to personal interpretation. When this is the case, the professional boundaries are blurred. This is especially the case because different clients have different expectations, in the same way as the nurses do. In addition to the general conditions above, there are conditions that relate to specific situations. For instance, while treating patients, nurses have to respect people's confidentiality and collaborate with them at all levels. Before undertaking any procedure on the patients or other clients, nurses must first gain consent from them (NMC, 2008). With particular reference to professional boundaries, any form of induction provided by patients/clients to the nurses with the intention of soliciting preferential treatment should be turned down by the nurse. In addition, nurses should not accept loans from any one under their care or who is closely related to the patient under their care (NMC, 2008). Blurring the professional boundaries The professional boundaries are very clear that nurses should not accept gifts or any kind of favour from clients in exchange for providing better services. However, in a situation where child health nurses are so close to the parents of the children involved, the parents might consider rewarding them as a way of appreciating the nurses' good services. This may not necessarily be a strategy to gain preferential treatment. In a closely related case, a nurse may be so much used to a child's parent that they may be in a position to share soft loans and so on. This may be strictly on private terms and may seem to be ethical, but professionally, it is one form of blurring the professional boundaries (nmc-uk.org, 2008 p5). In essence, the professional boundaries can be observed more practically if a nurse and the client are strangers to each other, but with time, the boundaries are blurred. This because the nurse and client get used to each other and may develop a relationship not based on profession but on personal liking. Relationships in dealing with children and families When experienced nurses are left to attend to children for long periods of time, they provide the children with professional care that may arouse the children to like them more than they do for their parents (Hinchliff, Watson & Herbert, 2005 p 56). This is particularly true for parents who bestow care of their children upon childcare nurses (Hinchliff, Watson & Herbert, 2005 p 56). The nurses are trained to hold, cuddle and interact with children during day care (Timby & Smith, 2005 p23). Such actions help to meet the child's needs for contact and affectionate simulation. This may appear as a violation of the professional boundaries but it is inevitable. A case such as the one mentioned above can be avoided if parents cooperate with nurses in bringing up children and providing the essential healthcare. While child health care nurses are important in providing essential care to children, parents should not delegate the role entirely to nurses. As child health care nurses interact with children whose parents are absent over long periods, they tend to be close to the parents too. As earlier discussed, nurses cannot assume that they are immune to unhealthy relationships. Neither can both parents be assumed imperturbable. Where human beings interact closely, relationships are bound to crop up; hence, childcare should be approached assiduously. If the role of childcare is left entirely to nurses, there is a likely compromise to the relationship between young children and their parents (Timby & Smith, 2005 p 24). In a situation where child health nurses are so close to the parents of the children involved, the parents might consider rewarding them as a way of appreciating the nurses' good services. This may not necessarily be a strategy to gain preferential treatment. In a closely related case, a nurse may be so much used to a child's parent that they may be in a position to share soft loans and so on. This may be strictly on private terms and may seem to be ethical, but professionally, it is one from of blurring the professional boundaries. In some cases, the nurse may find that they are too obsessed with toeing the professional line to the extent that they forget that the professional code of ethics also demands that they be human and considerate to the patients (ethics.iit.edu, 2007). This is because the unique aspects of nursing require that the nurse interacts multilaterally with the patient, his/her family and other health care provider in order to ensure the reliable and adequate administering of the required services. Working with Children especially creates some unique circumstances that require unique consideration. This includes devising how to engage the child into decision making and conversations regarding his/her health. In this day and age, children too have rights to decide w which medical intervention best fits them. However, this is done with the right guidance and full explanation of each of the medical interventions that may be applied (nmc-uk.org.2008 pg 8). The issue of touch and the difference between modest handling of the child in a therapeutic nature and sexual harassment is among the pertinent issues covered in the nursing code of ethics. Accordingly, sexual harassment is defined as touching clients in a way perceived as seductive, suggestive, derogatory, suggestive, humiliating or demeaning (CARNA, 2006 p 13) Conclusion Professional boundaries regulate the relationship between nurses and their clients by setting limits of contact or relationship between the nurses and their clients. Such regulations require that nurses should not accept gifts from gifts of any favours from clients in order to delver better service. Nurses are also not required to obtain services such as loans from their client. However, the professional boundaries get blurred over time if nurses and clients get used to each other. As such, nurses may accept gifts from clients not necessarily as bribes for service delivery. In cases where the nurse have noticed that the child has emotional needs that needs to be addressed, he/she can raise the issue with the parents or guardian who should be left with the responsibility of nurturing the child's emotional needs. . On a personal level, I believe the best way to keep the professional boundaries clear at all times is to be self disciplined. This will not only help me to abstain from the deleterious, mischievous and unprofessional. In addition, I believe that true to the nursing spirit, each nurse should strive to elevate professional standards by devoting him/herself to giving care to people under their care. While one does this, then the standards, boundaries, duties and responsibilities that come with nursing will be easy to keep and uphold. Comprehending the code of ethics is not a one time thing. As a newly qualified doctor, I can attest that I have been learning since I started training and still know that the learning does not end here. The fact that I will be mentoring students during my work assures me that the ethical doctrine will never depart from me. REFERENCES Acello, B (2005). Nursing assisting: Essentials for long term care. London: Cengage Learning p 40-41 American Academy of Paediatrics. Code of Ethics, retrieved 9 December 2008. < http://ethics.iit.edu/codes/coe/amer.acad.pediatrics.2007.html> Carr, A. (2005). The Handbook of Child and Adolescent Clinical Psychology. London: Psychology press. page 3 College and Association of Registered Nurses of Alberta (CARNA). 2005. Professional Boundaries for Registered Nurses: Guidelines for the Nurse-Client Relationship. Page 13 Retrieved on 13 January 2009 from http://www.nurses.ab.ca/pdf/Professional%20Boundaries%20Guidelines.pdf Dogra, N; Parkin, A & Gale, F. (2002). A multidisciplinary handbook of child and adolescent mental health for front-line professionals. New York: Jessica Kingsley Publishers p 7-8 Evans, K.; Elder, R & Nizette, D. (2004). 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