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Ethics, Boundaries, and Professionalism
Lois Sacher, RN, Principal Nurse Consultant
Janet Negley, PhD, Center Mental Health Consultant, San Jose JCC
Troy Davidson, CADC II, TEAP Specialist, Wolf Creek CCC
A Quick Review of the Concept of Boundaries
Boundaries are the lines between spaces or entities
Physical and social boundaries exist around individuals. There are also boundaries around
every “dyad”, or twosome, that has a relationship. Families have boundaries around them. Other
sub-units with boundaries include departments, JC communities, neighborhoods and countries.
Boundaries can’t be seen; in fact, the whole idea of boundaries is just a construct to
help us make sense of human experience; but, you know when your boundaries have
been violated and that is real!
Boundaries can be firm, mushy, diffuse, rigid, disengaged, flexible, impenetrable,
flowing, jerky, strong or weak.
Each individual’s boundaries are affected by their culture, their general up-bringing and crisis events in their history, as well as the context of any
given situation.
A person can have healthy boundaries in one arena of their life and unhealthy boundaries in
another arena. Not all displays of a “lack of boundaries” are pathological. This tendency
can also be a gift.
One rule of thumb about boundaries is that the better
defined a boundary, the better the function of what or whoever is
within that boundary.
Boundary violations are at the root of many ethical problems in the workplace.
At Job Corps, we might struggle with confidentiality issues…
…dual relationships, confusion of roles and the amount to self-disclose. Each discipline has unique rules and ethical codes to guide
our conduct in these areas.
Compassion and Respect for Each Student
• Regardless of individual differences
• Regardless of health problem
• Collaborate with other members of the health team
• Provide guidance to students
Commitment to the Student
• Care to reflect individual needs of the student
• Ensure students safety and protect the students’ best interests
• Ensure student receives sufficient information to give consent for treatment
• Maintain boundaries that establish limits to relationships between students and staff
Maintain Privacy and Confidentiality to Protect Student Rights
• HIPAA
• Use judgment regarding “need to know”
• Provide confidential environment
Incompetent, Unethical, Illegal or Impaired Practice
• Report questionable practice to protect student
• Maintain professional integrity
• Take responsibility for own actions
Medications
• Medical Professionals must be knowledgeable regarding medications
• Teach students 4 “R”s
• Ensure that recognized practice and procedures are followed
• Report suspicious behavior
Boundary Risk Management Protocol
Reamer, 2003
Step #1:Be alert to potential or
actual conflicts of interest
Step #2:Inform clients and
colleagues about potential or actual conflicts of
interest; explore reasonable remedies
Step #3:Consult colleagues and supervisors and relevant professional literature,
regulations, policies, and ethical standards (code of ethics) to identify
pertinent boundary issues and constructive/CREATIVE options
Step #4:Design a plan of action that
addresses the boundary issues and protects ALL parties involved, to the
GREATEST extent possible
Step #5:DOCUMENT all
discussions, consultations, and supervision, and other
steps taken to address boundary issues
Step #6:Develop a strategy to monitor implementation of action plan
Scenarios
• What are the ethical issues?• How could you utilize the Boundary Risk
Management Protocol?– Be alert to conflicts of interest– Explore reasonable remedies– Consult colleagues and supervisors and
relevant professional literature, regulations, policies, and ethical standards
– Design a plan of action– Document– Monitor
What are your dilemmas?