EXPLORING VULNERABILITY & POWER IN PROFESSIONAL BOUNDARIES

WENDY AUSTIN BSCN MED (COUNSELLING) PHD RN

RELATIONAL ETHICS

•

TRUMP’S PERSONAL DENTIST HIGHLIGHTS FRIENDSHIP WITH PRESIDENT TO OBTAIN FLORIDA DENTAL LICENSE BY ALEXANDRA GLORIOSO POLITICO 05/18/2018 06:58 PM EDT

“BOUNDARY”

DEFINITIONS

• Boundary crossing: brief crossing of an established professional boundary that may be

• unintentional or on purpose when made for a therapeutic goal.

• Boundary violation: “an act of abuse” (i.e. physical, verbal, emotional, sexual or financial abuse, misuse of power or betrayal of trust or dignity). Intimacy that may reasonably expected to cause physical or emotional harm. Insensitivity to religious and cultural beliefs and values. (CARNA, 2011, p. 8,

citing National Council of State Boards of Nursing & Appendix C).

LEVEL OF INVOLVEMENT

Over-involvement

Under-involvement

OVER-INVOLVEMENT IN SELF-DISCLOSURE

SOCIAL MEDIA

GIFT GIVING

UNDER-INVOLVEMENT

• Lack of authentic engagement with patient/client/family

• Compassion fatigue

• Lack of appropriate systemic support

VIOLATION OF SEXUAL

BOUNDARIES

RISK FACTORS

Unknown Author is licensed under CC BY-NC-ND

EXPLORING ANOTHER METAPHOR: TERRITORY

STRATEGIES • Be Vigilant

• Be Self-Aware

• Orientate Patient/Client to the Professional Relationship

• Know and Refer to your Standards of Practice, Code of Ethics, and Provincial Laws

• Be Transparent (note that reluctance to be so is a warning sign)

• Ask for Guidance

• Support Colleagues and Students

THANKS FOR YOUR ATTENTION. COMMENTS OR QUESTIONS?

• Austin, W., Bergum, V., Nuttgens, S. & Peternelj-Taylor, C. (2006). A re-visioning of boundaries in professional helping relationships: Exploring other metaphors. Ethics & Behaviour, 16(2), 77-94.

• Bauman, Z. ( 1993). Postmodern Ethics. Oxford, UK: Blackwell.

• Campbell, R. J., Yonge, O., & Austin, W. (2005). Intimacy boundaries: Between mental health nurses & psychiatric patients. Journal of Psychosocial Nursing & Mental Health Services, 43(5), 32-39.

• Canadian Medical Association (2001). The patient-physician relationship and the sexual abuse of patients (Update 2000). Edmonton, AB: Author.

• Canadian Medical Association Journal (2012). News: Social media outreach. Canadian Medical Association Journal, 187(11), E 587- E588. DOI:10.1503/cmaj.109-4207.

• College & Association of Registered Nurses of Alberta ( 2011, May). Professional boundaries for registered nurses: Guidelines for the nurse-client relationship. Author. Retrieved from: nurses.ab.ca/content/dam/carna/pdfs/DocumentList/Guidelines/RN_ProfessionalBoundaries_May2011.pdf

• Kullnat, M. W. (2007). A piece of my mind: Boundaries., Journal of the American Medical Association, 297(4), 343-344

• Lazarus, A. (1994). How certain boundaries and ethics diminish therapy. Ethics & Behavior 4(3) 255-261].

• Niebuhr, R. (1978). The Responsible Self. New York:, NY: Harper & Row.

• Plaut, S.M., Klein Brown, J. , Brancu, M. , & Wilbur, R.C. (2018). Professionals in a mandated ethics tutorial after violating sexual boundaries with Patients, Journal of Health Care, Law & Policy., 16, 353-374.

• Pope, K. & Keith-Spiegel, P. (2008). A practical approach to boundaries in psychotherapy: making decisions, bypassing blunders, and mending fences, Journal of Clinical Psychology, 64(5), 638-652.

• Schiff, G. D (2013). A piece of my mind: Crossing boundaries—violation or obligation? Journal of the American Medical Association, 310(12), 1233-1234.

• Vogel, L. (2018). Should doctors talk politics with patients? CMAJ April 23;190:E520-1. doi: 10.1503/cmaj.109-5589 .

REFERENCES