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WHY?!?WHY?!?

Samantha Leahy, MS, CCLS IIIEmily Steelman, BS, CCLS III

Credit to Cynthia DeFrancesco, MS, CCLS IIInova Health System

LetLet’’s Recap…s Recap…Quickly!Quickly!

“An invisible line that provides limits to a professional’s behavior that allow for a safe relationship with a patient based on the patient’s needs” (Fisher, 2008).

“Professional boundaries separate the therapeutic behavior of the nurse from any behavior, well intentioned or not, that could lessen the benefit of care to people…Boundaries give each person a sense of legitimate control in a relationship.” (ANMC, 2010)

LetLet’’s Recap…s Recap…Quickly!Quickly!

Child Life Operating Principle 10 -- Individuals shall use integrity to

assess and amend any personal relationships or situations that may interfere with their professional effectiveness, objectivity or otherwise negatively impact the children and families they serve. A minimum of two years following the conclusion of a professional role shall lapse before any personal relationship is permitted to develop with children or the members of families they serve (childlife.org, 2000).

Other Professions…no clear cut answers

InovaInova’’s s AdvancementsAdvancements

Policy - Must include written disclaimer on your Facebook page if you acknowledge that you work for the health system

When we left Florida When we left Florida in 2010…in 2010…

Came back and discussed implementation with our Child Life Director

Identified and contacted Nursing Education Coordinator – THIS IS HUGE! Explored options

Identify staff supporters Drafted a Professional Boundaries Policy

Guidelines Implemented Professional Boundaries into Nursing

Fellow Orientation Branched out to units

The Policy ProcessThe Policy Process Administration support Success with presentations Gaining the support of administration Research and Contacts Adapting to your hospital environment Identifying the approval avenue Patience

Research to Support Research to Support a Policya Policy

What is the research that’s out there and how does it help?

Most research is around nursing Mostly international references

New research is being conducted due to social media What are its effects? How are boundaries

threatened?

Research to Support Research to Support a Policya Policy

Best research found…. Joint Commission Registered Nurses Association of Ontario National Council of State Boards of Nursing Australian Nursing and Midwifery Council American Nurses Association’s Code of Ethics Cincinnati Children’s Hospital Social Workers Pediatric Nursing Journal. Rushton, Armstrong,

McEnhill 1996

Key Themes of our Key Themes of our PolicyPolicy

Include justification that will make your administrators take notice Joint Commission

Define a therapeutic relationship and provide examples of potential boundary issues.

Professionalism Receiving Gifts Instructions for gaining advice in potential

boundary situations

PresentationsPresentations Advanced Practice RN workshop Management Forum Nursing Fellow Orientation NICU Next steps and other areas

Struggles and Struggles and PushbackPushback

General Management Hospital culture HCAHPS Population differences

Struggles and Struggles and PushbackPushback

Specific Examples NICU Seasoned RNs Passive Aggressive Pushback Life experiences at work

LetLet’’s Talk About s Talk About It…It…

Group Discussion…

ReferencesReferences American Nurses Association’s Code of Ethics. (2001). Code of ethics for nurses with

interpretive statements. Retrieved form: http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Australian Nursing & Midwifery Council. (2010, Feb). A nurse’s guide to professional boundaries

Child Life. (2012). Operating principles of the child life profession. Retrieved from: http://www.childlife.org/The%20Child%20Life%20Profession/OperatingPrinciples.cfm

Joint Commission. (2001). Essential issues for leaders emerging: Challenges in health care.

Maas, A., Vargo, K., & Williams, S. (2011). Maintaining professional boundaries with families and tips for workings with staff who don’t. Presentation.

National Council of State Boards of Nursing (2011). A nurse’s guide to professional boundaries. Retrieved from: https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf

Registered Nurses Association of Ontario. (2006, March) Establishing therapeutic relations. Retrieved from: http://rnao.ca/bpg/guidelines/establishing-therapeutic-relationships

Rushton, Armstrong, McEnhill (1996). Establishing therapeutic boundaries as patient advocates. Pediatric Nursing Journal, 22(3), 185-189.