Professional boundaries
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Professional Boundaries. Mental Health Psychiatric Care. Continuum of Professional Behavior. What are Personal Boundaries?. A dynamic line separating an individual’s internal and external environment, which varies in permeability and flexibility (Scott, 1988) Includes: Physical Emotional

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Professional boundaries

Professional Boundaries

Mental Health Psychiatric Care


Continuum of professional behavior

Continuum of Professional Behavior


What are personal boundaries

What are Personal Boundaries?

A dynamic line separating an individual’s internal and external environment, which varies in permeability and flexibility (Scott, 1988)

Includes:

  • Physical

  • Emotional

  • Intellectual

  • Spiritual


Professional boundaries1

Professional Boundaries

The limits that allow a patient and nurse to connect safely in a therapeutic relationship based on the patient’s needs (Smith et al, 1997).


Appropriate therapeutic staff patient interactions

Appropriate/Therapeutic Staff/Patient Interactions

  • Potentially helpful

  • Based upon the planned treatment of the patient

  • Open for discussion with patient’s treatment team

  • Intended to meet the therapeutic needs of the patient not the personal needs of the staff


Boundary violations

Boundary Violations

  • The phenomena that occur when there is confusion of the professional’s needs with the client’s needs (National Council of State Boards of Nursing, 1996).

  • Behavior that harms the patient (usually by exploitation) and places the therapist’s needs ahead of the patient’s (Gutheil, 1994).


Inappropriate non therapeutic staff patient interactions

Inappropriate/Non-therapeutic Staff/Patient Interactions

  • Potentially harmful

  • Compromise a patient’s treatment plan

  • Violate policy, ethics and possibly the law

  • Are hidden from other staff or from the patient’s treatment team

  • May evolve into dual relationships where the staff member exploits the patient for personal gain.


Dual relationships

Dual Relationships

Two things going on at once:

1. care-giver role

2. something other than care-giver role

Unless the care plan specifically prescribes it staff should not engage in seemingly harmless activities.


Harmless activities

“Harmless Activities”

Seeking help from patients

Social conversation

Sharing books or music

Computer repair

Poetry and prose editing

Art criticism or art work commision

Philosophical debate

Spiritual counseling


Dual relationships1

Dual Relationships

Do not happen overnight.

They are the endpoint on an escalating continuum of boundary problems.


Boundary problems continuum

Boundary Problems Continuum


Boundary inattention

Boundary Inattention

Behaviors that suggest a staff member is oblivious to the setting:

  • Excessive social interaction with patients

  • Cavalier with physical distance

  • A ‘comrade’ style (e.g. sports buddies)

  • Misjudging cold threats

  • Open with information

  • Casual with dress code standards


Boundary crossing

Boundary Crossing

Behaviors that are on the verge of, or may lead to, rule breaking.

  • Sharing excessive personal information with patients

  • Non sexual touching

  • Confiding in and seeking comfort from patients

  • Too close emotionally


Boundary violation

Boundary Violation

Behaviors that break hospital policy, breach professional ethics and/or break the law.

  • Gift giving

  • Bringing in food for one or more patients without treatment team permission

  • Making non-treatment related phone calls or contacts for patient


Dual relationship

Dual Relationship

Interactions that are outside of the therapeutic boundaries that are for the personal gratification of the staff, and are either unethical, exploitive, and/or illegal.

  • Sexual relationship

  • Business relationship

  • Religious counseling by non-clergy staff


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