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Professional BoundariesAn occupational therapist’s guide to the importance of appropriate professional boundaries
PO Box 9644, Wellington 6141, New Zealand
P +64 4 918 4740 | [email protected] | www.otboard.org.nz
Occupational Therapy Board of New Zealand Professional Boundaries 2016
Professional Boundaries
Professional Boundaries
3Occupational Therapy Board of New Zealand
PO Box 9644, Wellington 6141 | www.otbnz.org.nz
Contents Introduction 4
Theimportanceofmaintainingboundaries
inprofessionalrelationships 5
Acontinuumofprofessionalbehaviour 6
Pre-existingrelationships 7
WorkingwithMäoriconsumers 7
Caringforclosefriendsorfamily/whänau/hapü/iwi 8
Socialmediaandelectronicformsofcommunication 8
Workinginsmall,ruralorremotecommunities 9
Concludingprofessionalrelationships 9
Preventingboundarytransgressions 10
SignsofoverinvolvementinOccupationalTherapy–
Healthconsumerrelationship 11
Sexualrelationshipswithcurrenthealthconsumers 12
Sexualrelationshipswithcurrenthealthconsumer’s
partnersorfamilymembers 12
Relationshipswithformerhealthconsumers
andtheirfamilies 13
Gifts 14
Bequests,loansorfinancialtransactions 14
Financialtransactions 15
Actingasarepresentativeorpowerofattorney 15
Whattodoifyoubecomeawareofacolleague’s
boundarytransgression 16
References 17
Glossary 18
Occupational Therapy Board of New Zealand Professional Boundaries 2016
Professional Boundaries
4
Introduction
ThisguidelinehasbeendevelopedbytheOccupational
TherapyBoardofNewZealand(“theBoard”)to
provideadvicetooccupationaltherapists(and
thepublic)onoccupationaltherapistsmaintaining
appropriateprofessionalrelationshipswithhealth
consumers*.Occupationaltherapistsmustbe
awareoftheirprofessionalresponsibilitytomaintain
appropriatepersonal,sexualandfinancialboundaries
inrelationshipswithcurrentandformerhealth
consumersandtheirfamilies.
TheroleoftheBoardistoprotectthehealthand
safetyofthepublicbysettingstandardsofclinical
competence,ethicalconductandculturalcompetence
foroccupationaltherapists1.TheCode of Ethics for
Occupational Therapists(OccupationalTherapyBoard
ofNZ,2015)setsstandardsofprofessionalbehaviour
thatoccupationaltherapistsareexpectedtouphold.It
isexpectedthatoccupationaltherapistsmaintainthese
standardsofconductwithintheirprofessionalpractice
and,tosomeextent,withintheirpersonallives.The
Code of Ethics for Occupational Therapists,together
withthecompetenciesforoccupationaltherapists,
scopeofpracticeandotherBoardguidelines,provide
aframeworkforsafeandresponsiblepractice
thatprotectspublicsafety.Thisguidelinecontains
standardsofbehaviourfromtheCode of Ethics for
Occupational Therapistsandmoredetailedadviceon
professionalboundaryissuesandhowtheyshould
bemanaged.Itisnotpossibletoprovideguidance
foreverysituationandoccupationaltherapistsmust
developandusetheirownprofessionalandethical
judgmentandseektheadviceofcolleaguesand/or
theirprofessionalorganisationwhenissuesarisein
relationshipswithhealthconsumers.
Differentculturesmayhavedifferentexpectations,
andunderstandingofrelationshipsandboundaries.
Culturallysafecareinvolvesbalancingpower
relationshipsinthepracticeofoccupationaltherapy
sothateveryhealthconsumerreceiveseffective
treatmentandcaretomeettheirneedsthatis
culturallycompetentandculturallyresponsive.
AotearoaNewZealandisasmallcountryand
thisguidelinehasbeendevelopedrecognising
thatoccupationaltherapistsaremembersoftheir
communitiesandmayhaveexistingrelationships
withsomehealthconsumers.TheBoardisaware
thatforMäoriandothers,establishingconnections
andrelationshipsoftrust,areanimportantelement
ofprovidingculturallysafecare.Theprinciplesof
theTiritiOWaitangi/TreatyofWaitangi,partnership,
protectionandparticipation,areintegraltoproviding
appropriateoccupationaltherapyservicesforMäori.
Thisguidelineprovidesadviceonprofessional
boundarieswhenworkingwithMäorihealth
consumers.
ThisGuidelineandtheCode of Ethics for Occupational
TherapistscontaintheBoard’sadviceonprofessional
boundaries.
*Thetermhealthconsumerisusedthroughout
theseguidelines.HowevertheBoardrecognises
thatoccupationaltherapistsworkinothersectors
otherthanhealth.TheBoardexpectsthese
guidelinestoapplyinallsectors.
1FunctionsofauthoritiesSection118(i)oftheHealthPractitionersCompetenceAssuranceAct
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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5
The importance of maintaining boundaries in professional relationships
Code of Ethics for Occupational Therapists Section 1.2
Occupational therapists shall ensure that people
receiving their services feel safe, accepted and
are not threatened by actions or attitudes of the
therapist.
Professionalrelationshipsaretherapeuticrelationships
thatfocusonmeetingthehealthorcareneedsof
thehealthconsumer.Occupationaltherapistsmust
beawarethatinalltheirrelationshipswithhealth
consumerstheyhavegreaterpowerbecauseof
theirauthorityandinfluenceasahealthprofessional,
theirspecialisedknowledge,accesstoprivileged
informationaboutthehealthconsumerandtheirrole
insupportinghealthconsumersandthosecloseto
themwhenreceivingcare.Thehealthconsumerdoes
nothaveaccesstothesamedegreeofinformation
abouttheoccupationaltherapistwhichincreasesthe
powerimbalance.Theoccupationaltherapistmay
alsohaveaprofessionalrelationshipwiththehealth
consumer’sfamilyandothersclosetothatperson
thatmayincreasethehealthconsumer’svulnerability.
Thepowerimbalanceisincreasedwhenthehealth
consumerhaslimitedknowledge,ismadevulnerable
bytheirhealthcircumstancesorispartofavulnerable
ormarginalisedgroup.Someparticularlyvulnerable
consumersarechildren,frailolderpeople,andthose
withamentalillnessordisability.Healthconsumers
mustbeabletotrustoccupationaltherapiststo
protectthemfromharmandtopromotetheir
interests.Occupationaltherapistsmusttakecareto
ensurethattheirownpersonal,sexualorfinancial
needsarenotinfluencinginteractionsbetween
themselvesandthehealthconsumer.Theymust
alsorecognisethathealthconsumersmayreadmore
intoatherapeuticrelationshipwiththeoccupational
therapistandseektohavepersonalorsexualneeds
met.Itistheoccupationaltherapistsresponsibilityif
thisoccurstomaintaintheappropriateprofessional
boundaryoftherelationship.
Theoccupationaltherapisthastheresponsibilityof
knowingwhatconstitutesappropriateprofessional
practiceandtomaintainhisorherprofessional
andpersonalboundaries.Thehealthconsumeris
inanunfamiliarsituationandmaybeunawareof
theboundariesofaprofessionalrelationship.
Itistheresponsibilityoftheprofessionaltoassist
healthconsumerstounderstandtheappropriate
professionalrelationship.Thereisaprofessional
onusonoccupationaltherapiststomaintaina
relationshipbasedoncareplansandgoalsthat
aretherapeuticinintentandoutcome.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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A continuum of professional behaviour
Thediagrambelowrepresentsthecontinuumof
professionalbehaviour,providesapictureofthe
therapeuticversusnon-therapeuticbehaviourin
arelationshipbetweentheoccupationaltherapist
andthehealthconsumer.
The‘zoneofhelpfulness’describesthecentreof
acontinuumofprofessionalbehaviour.Thiszone
iswherethemajorityofinteractionsbetweenan
occupationaltherapistandahealthconsumer
shouldoccurforeffectivenessandsafety.
‘Overinvolvement’ofanoccupationaltherapist
withapersonintheircareistotherightsideofthe
continuum;thisincludesinappropriaterelationships
withthehealthconsumerortheirfamilymembers.
‘Underinvolvement’liestotheleftofthecontinuum;
thisincludesdistancing,disinterest,coldness,
andneglect.Thesebehaviourscanbeseenalso
asboundaryissuesbuttheyarenotdiscussedhere
indetailasthefocusofthisdocumentisonthe
over-involvementendofthecontinuum.
Everyoccupationaltherapyclientrelationshipcan
beplottedonthiscontinuum.
• Maintainprofessionalboundariesintheuse
ofsocialmedia.Keepyourpersonaland
professionallivesseparateasfaraspossible.
Avoidonlinerelationshipswithcurrentor
formerhealthconsumers.Donotusesocial
mediaorelectroniccommunicationtobuildor
pursuerelationshipswithhealthconsumers.
• Textmessagingmaybeanappropriateform
ofprofessionalcommunication,e.g.reminding
healthconsumersaboutappointments.
Occupationaltherapistsmustbeaware
ofprofessionalboundariesandensure
communicationviatextisnotmisinterpreted
bythehealthconsumerorusedtobuildor
pursuepersonalrelationships.Refertoour
ProfessionalBoundariesGuidelinesformore
information.
• Allmessagesshouldbedocumented.
Disinterested Neglectful
Therapeutic Relationship
Boundary Violations
Under Involvement
Zone of Helpfulness
Over Involvement
(NursesCouncilofNewZealand2012)
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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Pre-existing relationships
Whenanoccupationaltherapisthasapre-existing
relationshipwithahealthconsumer,suchasbeing
aneighbour,acquaintanceorbusinessassociate,
theoccupationaltherapistneedstobeawareofthe
potentialforboundaryconfusion(bytheoccupational
therapistorhealthconsumer)andpossibleharm.
Theoccupationaltherapistmustclarifyandif
necessarycommunicatethisnewprofessional
relationshipwiththepersoninordertoprovide
appropriatecare,andalsodeclareittotheother
membersoftheteamanddocumentitinthehealth
consumer’srecord.Thehealthconsumershould
beofferedthechoicetobeassignedtoanother
occupationaltherapist,ifpossible.Occupational
therapistsneedtoensurethatthepre-existing
relationshipdoesnotunderminetheirprofessional
judgmentandobjectivitywhenthepersonisintheir
careandtheymayneedtotakestepstohandoverthe
caretoanotheroccupationaltherapistifpracticable.
Ifpossibletheyshouldnotbetheprimaryoronly
healthpractitionerinvolvedinthisperson’scare.
Itiscriticalthatoccupationaltherapistsdistinguish
between‘beingfriendly’and‘beingfriends’.
Toachievethis,clearboundarieshavetobe
establishedidentifyingwhentheyareactingin
apersonalroleandwhentheyareactingina
professionalrole.Byestablishingtheseboundaries
occupationaltherapistsprotecttheconfidentiality
ofthehealthconsumerandprotecttheirown
personalintegrity.
Working with Mäori consumersEffectiveandculturallyresponsivepracticewithMäori
islikelytobebasedonanunderstandingoftikanga
(Mäoriprinciplesandvalues).Whanaungatanga
involvesestablishingarelationshipoftrustbymaking
connections.Thismayincludetheoccupational
therapistsharinginformationaboutwhänau(family),
whakapapa(ancestors)ortheirownpersonallife
toestablishtrustandrelationship.Itmayalsoinclude
establishingrelationshipswiththehealthconsumer’s
whänauandincludingthemindecisionsaboutcare.
Manaakiinvolvessharinghospitalityorkai(food)
toshowrespectandestablishrelationships.
Itisimportantthatoccupationaltherapistspartake
inritualsaroundfood
Establishing boundaries
protect the confidentiality
of the health consumer
and their own personal
integrity.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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Caring for close friends, family/whänau, hapü or iwi
Insituationswhereanoccupationaltherapisthas
toprovidecaretoclosefriendsorfamilymembers
itisrarelypossiblefortheoccupationaltherapistto
maintainsufficientobjectivityaboutthepersonto
enableatrulyprofessionalrelationshiptodevelop.
Inthesesituations,wherepossible,another
occupationaltherapistshouldbeassigned
responsibilityforthatperson’scare.However,
attimes,anoccupationaltherapistmayhaveto
careforafriendorfamilymemberinanemergency,
orwheretheyliveinsmallcommunitieswherethere
islimitedaccesstooccupationaltherapiststowhom
theycanhandovercare.Whenanoccupational
therapisthasnooptionotherthantocareforaclose
friendorfamilymember,careshouldbehanded
overtoanotherappropriatecareproviderwhenit
becomespracticable.Ifcarehasbeenassignedto
theoccupationaltherapistwhoisafamilymember
thisshouldbedocumentedinthetherapyplan.
Itisalsoimportantforoccupationaltherapiststobe
clearabouttheirrolewhenaclosefriendorfamily
memberisreceivingcare.Theyhavearoleasan
informedsupportpersonorfamilymemberbutare
nottheretomakedecisionsaboutthecare.
SomeMäorioccupationaltherapistshaveastrong
senseofaccountabilityinworkingwithandcaringfor
whänau/hapü/iwi.Mäorioccupationaltherapistsneed
tobeclearabouttheirroleasaprofessionalandtheir
roleasarelative.Theymustrecognisewhenthey
mayneedtopassoncaretoanotheri.e.whenthey
feeluneasyandarelosingclarity,theirprofessional
judgmentmaybecompromisedortheyexperience
strongemotionsasacloserelative.
Social media and electronic forms of communication
Maintainprofessionalboundariesintheuseofsocial
media.Keepyourpersonalandprofessionallife
separateasfaraspossible.Avoidonlinerelationships
withcurrentorformerhealthconsumers.Donotuse
socialmediaorelectroniccommunicationtobuildor
pursuerelationshipswithhealthconsumers.
Textmessagingcanbeanappropriateformof
professionalcommunicatione.g.remindinghealth
consumersaboutappointments.Occupational
therapistsmustbeawareofprofessionalboundaries
andensurethatcommunicationviatextisnot
misinterpretedbythehealthconsumerorusedto
buildorpursuepersonalrelationships.
FormoreinformationpleaseseetheBoardsguidance
onsocialmedia.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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Working in small, rural or remote communities
Thereisanaturaloverlapandinterdependenceof
peoplelivinginsmall,ruralorremotecommunities.
Whensomeonefromthecommunityrequires
professionalcarefromtheoccupationaltherapist,
theoccupationaltherapistneedstokeepthemselves
safebyclarifyingtheshiftfromapersonaltoa
professionalrelationshipinanopenandtransparent
way.Theoccupationaltherapisthastoensurethe
person’scareneedsarefirstandforemostand
theymustmanageprivacyissuesappropriately.
Forexampletheoccupationaltherapistmightbe
approachedforinformationaboutthehealthconsumer
inalocalstorebyaconcernedneighbourandmust
maintainthehealthconsumer’sprivacy.
Ifpossiblethehealthconsumershouldbegiven
achoiceofcareriftheyknowtheoccupational
therapistfromapriorrelationship.Whenoff
dutytheoccupationaltherapistshouldreferthe
healthconsumertotheappropriateondutyhealth
practitioner.
Smallcommunitiesarenotlimitedtoruralandremote
communities:theyalsoincludesmallordiscrete
communitieswithinlargeurbancentres
(e.g.religious,gayormilitarycommunities).
Concluding professional relationships
Knowinghowandwhentoconcludeprofessional
relationshipsisasimportantasknowinghowto
beginthem.Theconclusionofarelationshipoccurs
whenahealthconsumerandtheirfamilyareableto
managetheirownhealthneeds.Orifneedsarestill
evident,areferralhasbeenmadetoanotherhealth
provider.Ortheclienthasmadeaninformeddecision
nottoparticipateinongoingservices.Anoccupational
therapistmaydecreasetheirinvolvementwithahealth
consumerormayactivelyencourageothersupportif
thehealthconsumerisbecomingundulydependent
ontheoccupationaltherapist.
Terminationritualsmaybeappropriateinsome
circumstanceswheretherehasbeenaclose
involvement.Thiscouldhappenindifferentways
dependingonthecultureofthehealthconsumer
e.g.attendanceataTangihangaorfuneralmay
beanappropriatewayofshowingrespectforthe
healthconsumerandtheirfamily/whänau.
Itisimportanttodocumentwhencareistransferredto
anotheroccupationaltherapistincludingadescription
onhowandwhytheprofessionalrelationshipwas
concluded.
Communities include small
and discrete communities
within large urban centres
(e.g. religious, homosexual
or military communities.)
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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Preventing Boundary Transgressions
Thissectionfocusesonboundaryissuesthatarise
whenanoccupationaltherapistbecomesover
involvedwithahealthconsumerorfamily/family
member.Theoccupationaltherapistmaybelieve
he/sheishelpingthehealthconsumer(orfamily
member)bydevelopingafriendshiporclose
relationship.Howevertheseboundarycrossings
havethepotentialtoharmthehealthconsumerby
changingthefocusfromthetherapeuticneedsof
thehealthconsumertomeetingtheoccupational
therapists’ownneedse.g.tobe“special”orhelpful
orneeded,ortobeclosetosomeoneortohave
otherpersonal,financialorsexualneedsmet.
Theyhavethepotentialtoharmthehealthconsumer
byincreasingtheirvulnerabilityordependencein
therelationshipwiththeoccupationaltherapistand
couldbedetrimentaltotheirhealthoutcomesby
compromisingtheoccupationaltherapist’sobjectivity
andprofessionaljudgment.
Theharmfulconsequencesmaynotberecognised
orexperienceduntilmuchlater.
Occupationaltherapistscanreducetheriskof
boundarytransgressionsby:
• Maintainingtheappropriateboundariesof
theoccupationaltherapist–healthconsumer
relationship,andhelpinghealthconsumers
understandwhentheirrequestsarebeyond
thelimitsoftheprofessionalrelationship.
• Developingandfollowingacomprehensive
careplanwiththehealthconsumer.
• Involvingothermembersofthehealthcare
teaminmeetingthehealthconsumer’sneeds.
• Ensuringthatanyapproachoractivitythatcouldbe
perceivedasaboundarytransgressionisincluded
inthecareplandevelopedbythehealthcareteam.
• Recognisingthattheremaybeanincreasedneed
forvigilanceinmaintainingprofessionalismand
boundariesincertainpracticesettingse.g.rural
andremotelocations.Forexample,whencare
isprovidedinaperson’shome,occupational
therapistsmaybecomeinvolvedinthefamily’s
privatelifeandneedtorecognisewhenhisor
herbehaviouriscrossingtheboundariesofthe
professionalrelationship.
• Usingsupervisiontodiscusspotentialboundary
issues.
• Consultingwithcolleaguesand/orthemanager
inanysituationwhereitisunclearwhether
behaviourmaycrossaboundaryoftheprofessional
relationship,especiallycircumstancesthatinclude
selfdisclosureorgivingagifttooracceptingagift
fromahealthconsumer.
• Documentingindividualisedinformationinthe
healthconsumer’srecordregardinginstances
whereitwasnecessarytoconsultwithamanager
orcolleagueaboutanuncertainsituation.
• Consideringtheculturalvaluesofthehealth
consumerinthecontextofmaintainingboundaries,
andseekingadvicefromculturaladvisors.
• Raisingconcernswithacolleagueifthe
occupationaltherapisthasreasontobelievethat
theymaybegettingclosetocrossingtheboundary
orthattheyhavecrossedaboundary.Sometimesa
newlyregisteredoccupationaltherapistmaynotbe
awarethathis/heractionshavecrossedaboundary.
• Discussingthenatureofatherapeuticrelationship
withahealthconsumeriftheybelievethatthehealth
consumeriscommunicatingorbehavinginaway
thatindicatestheywantmorethanaprofessional
relationshipwiththeoccupationaltherapy.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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• Consultingwithcolleaguesorthemanagerwhere
anothercolleagueappearstohavetransgressed
boundariesorahealthconsumerisbehavingin
aninappropriatemannertowardsanoccupational
therapist.
• Reducingprofessionalisolationbymaintaining
regularcontactwithoccupationaltherapistpeers,
reflectingonprofessionalrelationshipswithpeers
andparticipatinginformalprofessionalsupervision.
Signs of over involvement in an occupational therapist – health consumer relationship
Questions for reflection
Is the occupational therapist doing something
the health consumer needs to learn to do
themselves? Whose needs are being met –
the health consumer’s or the occupational
therapists?
Will performing this activity cause confusion
regarding the occupational therapist’s role?
Is the behaviour such that the occupational
therapist will feel comfortable with their
colleagues knowing they had engaged in this
activity or behaved in this way with a health
consumer?
Somewarningsignsthattheboundariesofa
professionalrelationshipmaybebeingcrossedand
thataninappropriatepersonalorsexualrelationship
isdevelopingare:
• Theoccupationaltherapistrevealsfeelingsand
aspectsofhis/herpersonallifetothehealth
consumerbeyondthatnecessaryforcare.
• Theoccupationaltherapistbecomesemotionally
closetoahealthconsumerorregardsthehealth
consumerassomeonespecial.
• Theoccupationaltherapistattemptstoseethe
healthconsumer(orthehealthconsumerattempts
toseetheoccupationaltherapist)outsidethe
clinicalsettingoroutsidenormalworkinghours
oraftertheprofessionalrelationshiphasceased.
• Theoccupationaltherapistfrequentlythinksofthe
healthconsumerwhenawayfromwork.
• Theoccupationaltherapistreceivesgiftsor
continuescontactwithaformerhealthconsumer
afterthecareepisodeortherapeuticrelationship
hasconcluded.
• Theoccupationaltherapistprovidesthehealth
consumerwithpersonalcontactinformation.
• Ahealthconsumerisonlywillingtospeakwith
aparticularoccupationaltherapistandrefuses
tospeaktootheroccupationaltherapists.
• Theoccupationaltherapistdeniesthatahealth
consumerwasinhisorhercareinthepast.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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• Theoccupationaltherapistaccessesthehealth
consumer’shealthrecordwithoutanyclinical
justification.
• Theoccupationaltherapistgivesoracceptssocial
invitations.
• Textingorusingformsofsocialmediato
communicateinawaythatisnotclinicallyfocused.
• Theoccupationaltherapisttouchesthehealth
consumermorethanisappropriate.
• Theoccupationaltherapistincludessexualcontext
ininteractionswiththehealthconsumerorin
relationtotheirpartners,familyandfriends.
• Theoccupationaltherapistchangeshisorherdress
styleforworkwhenworkingwithaparticularhealth
consumer.
• Theoccupationaltherapistparticipatesinflirtatious
communication,sexualinnuendooroffensive
languagewithahealthconsumer.
• Theoccupationaltherapistisunableorreluctantto
concludeaprofessionalrelationshipandpursuesa
personalrelationshipwiththehealthconsumer.
• Theoccupationaltherapistfostersdependencyin
thehealthconsumeranddoesnotencourageself-
management.
Sexual relationships with current health consumers
Code of Ethics 1.2.3
Occupational therapists may not enter into
or continue with any personal or professional
relationship with clients or their carers that will,
or have the potential to, exploit or harm the
client and/or others.
Sexualrelationshipswithcurrenthealthconsumers
areinappropriate.Theyareunacceptablebecause
theycancausesignificantandenduringharmtohealth
consumers,damagethehealthconsumer’strust
intheoccupationaltherapistandthepublictrustin
occupationaltherapists,impairprofessionaljudgment
andinfluencedecisionsaboutcareand
treatmenttothedetrimentofthehealthconsumer’s
wellbeing.Howeverconsensualtherelationship
appearstobe,thereisapowerimbalancethatwill
alwaysmeanthatthereisthepotentialforabuseof
theoccupationaltherapistsprofessionalpositionand
harmtothehealthconsumer.
Sexual relationships with health consumer’s partners or family members
Itisareasonableexpectationthattheprofessional
relationshipwillnotbeexploitedinanywaybythe
occupationaltherapisttohavehis/herownneeds
met.Onoccasionoccupationaltherapistsmayfind
themselvessexuallyattractedtoahealthconsumer’s
familymemberorcarer.Itistheoccupational
therapist’sresponsibilitytoensurethathe/shenever
actsonthesefeelingsandrecognisestheharmthat
anysuchactionwouldcause.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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Relationships with former health consumers and their families
Sexualrelationshipswithformerhealthconsumers
maybeinappropriatehoweverlongagothe
professionalrelationshipceased.Thereisnoarbitrary
timelimitthatmakesitsafeforanoccupational
therapisttohaveanintimateorsexualrelationship
withahealthconsumerwhowasformerlyintheir
professionalcare.Thereasonforthisisthatthe
sexualrelationshipmaybeinfluencedbytheprevious
therapeuticrelationshipwheretherewasaclear
imbalanceofpower.Thereisalsopotentialforthe
healthconsumertobeharmedbythisrelationship.
Inconsideringwhetherarelationshipcouldbe
appropriatetheoccupationaltherapistmustconsider:
• howlongtheprofessionalrelationshiplasted
(thelongertherelationshiplasts,theless
appropriateapersonalrelationshipbecomes).
Assistingahealthconsumerwithatemporary
probleme.g.abrokenlimbisdifferentfrom
providinglong-termcareforachroniccondition;
• thenatureofthatrelationshipintermsof
whethertherewasasignificantpowerimbalance
andwhethertheoccupationaltherapistcouldbe
perceivedasusingtheirpreviousinfluenceto
beginarelationship;
• thevulnerabilityofthehealthconsumeratthetime
oftheprofessionalrelationshipandwhetherthey
arestillvulnerable(includingthehealthconsumer’s
psychological,physicalandcharactertraits);
• whethertheymaybeexploitingtheknowledge
theyholdaboutthehealthconsumerbecauseof
thepreviousprofessionalrelationship;and
• whethertheymaybecaringforthehealth
consumerorhisorherfamilymembersin
thefuture.
Wheretherelationshipwasapsychotherapeuticone
orinvolvedemotionalsupport,wheretheoccupational
therapistwasprivytopersonalinformationthat
couldcompromisethehealthconsumerifusedout
ofaprofessionalsetting,orifthehealthconsumer
waspreviouslyamentalhealthconsumerorhasan
intellectualdisability,itmayneverbeappropriatefor
asexualorintimaterelationshiptodevelop.
Thesameconsiderationsapplytorelationships
withthefamilymembersofformerhealthconsumers.
Therecouldbepotentialtoharmthehealthconsumer
orotherfamilymembers.Insituationsthatareunclear
theoccupationaltherapistshouldseekadvicefrom
theirprofessionalorganisation.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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Gifts
Code of Ethics for Occupational Therapists Section 3.3, and 3.3.5
Occupational therapists shall not bring the
profession or other health practitioners into
disrepute.
Occupational therapists shall if offered tokens
such as favours, gifts or hospitality from clients,
their families or commercial organisations,
always respond in a manner commensurate
with contextual guidelines.
• Generallyspeakingoccupationaltherapistshould
politelydeclineanythingotherthan“token”gifts
fromhealthconsumerse.g.chocolatesorflowers.
Itismoreacceptableforagifttobegiventoa
groupasanyprovisionofgoodcareisbythe
wholeteamratherthananindividualoccupational
therapist.
• Smallconsumablegiftsforsharing,suchas
chocolatesmaybeacceptable.Largeritemsor
itemsofvalueareunacceptable.
• Healthconsumersshouldneverformthe
impressionthattheircareisdependentupon
giftsordonationsofanykind.
• Cashgiftsshouldneverbeaccepted.Health
consumer’swhowishtogivecashmaybe
permittedbytheorganisation’spolicytodonate
fundstoacharityortoaddtoafundtopurchase
itemstobenefitotherhealthconsumerorthe
staffasagroup.
• Theremaybesituationswhenrefusingagiftmay
bedifficult,impoliteorappeartobeculturally
insensitive.Thegivingofgiftsmaybean
expectationundercertaincircumstancesorwithin
somecultures.
• Mostorganisationshaveclearpoliciesconcerning
thereceiptofgifts.Anygiftmustbeopenly
declaredtoensuretransparency.Occupational
therapistsmaycontacttheirprofessional
organisationforadviceifnopolicyexists.
• Occupationaltherapistsshouldnotgivegiftsto
healthconsumersasthehealthconsumermayfeel
obligatedtogivesomethinginreturn,orinterpret
thegiftasanindicatorofapersonalrelationship.
Bequests, loans or financial transactions
Aswithagift,thebestoptionistorefuseabequest
withapoliteexplanationorrequestthatitbe
reassignedtoanappropriatecharitableorganisation
orthefamilyanddiscloseittomanagersorsenior
personnel.
Thissituationisparticularlydifficultforseveral
reasons.Theremaybefamilyconsiderationsinthat
thefamilymaynotbesupportiveofthebequest.
Thefamilyandtheoccupationaltherapistmay
notevenknowaboutthebequestuntilthehealth
consumerhasdied.Familymembersorcolleagues
mayperceivethattheoccupationaltherapisthas
exertedundueinfluenceonavulnerablehealth
consumerintheircare.
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Financial transactions
Healthconsumersmaydeveloparelationship
oftrustwithoccupationaltherapistsandseek
toinvolvetheminfinancialtransactionsorask
themtorepresentthem.
Financialtransactionsbetweenanoccupational
therapistandahealthconsumer(otherthanina
contractforprovisionofservices)maycompromise
theprofessionalrelationshipbyresultinginmonetary,
personalorothermaterialbenefit,gainorprofittothe
occupationaltherapist.Occupationaltherapistshave
accesstopersonalandconfidentialinformationabout
healthconsumersundertheircarethatmayenable
themtotakeadvantageofsituationsthatcouldresult
inpersonal,monetaryorotherbenefitsforthemselves
orothers.Anoccupationaltherapistcouldalso
influenceorappeartocoerceahealthconsumerto
makedecisionsresultinginbenefittotheoccupational
therapistorpersonallosstothathealthconsumerand
itisunacceptableforoccupationaltherapiststotake
suchactions.
Occupationaltherapistsmaybelegitimatelyrequired
bytheiremployertopurchaseitemsonahealth
consumer’sbehalforassistthemwithotherfinancial
mattersunderspecificconditions.Alltransactions
mustoccurwithinacceptableorganisationalpolicy,
bedocumentedinthehealthconsumer’srecordand
anotherappropriateperson/signatoryshouldalways
beinvolvedwhenmoneyorpropertyisinvolved.
Acting as a representative or power of attorney
Asageneralruleoccupationaltherapistsshould
notactforhealthconsumersintheircarethrough
representationagreementsoracceptpowerof
attorneytoamakelegaland/orfinancialdecisions.
Familymembersorcolleaguesmayperceivethat
theoccupationaltherapisthasexertedundue
influenceonavulnerablehealthconsumerintheir
care.Theremayoccasionallybeanexceptiontothis
principlewhenthehealthconsumerisalsoarelative
orclosefriendandnoalternativearrangementcan
bemade.Theoccupationaltherapistneedstodiscuss
thesituationwithboththeirmanagerorsenior
occupationaltherapistandotherfamilymembers
andcarefullyandclearlydocumentthediscussion.
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What to do when you become aware of colleagues’ boundary transgressions
Thehealthconsumer’swelfaremustbethefirst
concern.Someboundarytransgressionsmaybe
unintended,anoccupationaltherapistmaybe
unawarethattheyhavecrossedaboundary.
Undersuchcircumstances,itmaybeeasierforan
occupationaltherapisttoaddressacolleagueabout
aboundarytransgressionandeasierforindividual
occupationaltherapiststobeapproachedbya
colleague.Theissuesthatanoccupationaltherapist
couldaddresswiththecolleagueinclude:
• whatwasobserved?
• howthatbehaviourwasreceived
• theimpactonthehealthconsumer;and
• theemployer’sprofessionalpracticestandards.
Ifunabletospeaktothecolleaguedirectlyorifthe
colleaguedoesnotrecognisetheproblemthenext
stepisfortheoccupationaltherapisttospeakto
hisorherimmediatesupervisor.Theoccupational
therapistshouldputtheconcernsinwritingand
includethedate,time,witnessesandsometypeof
identificationofthepersonconcerned.Ifthesituation
isnotresolvedatthislevel,oriftheissueisaserious
boundarytransgression,furtheractionmayberequired
suchasreportingthemattertotheappropriate
regulatoryauthority.
Occupationaltherapistsobservingtheinappropriate
conductofcolleagues,whetherinpractice,
management,educationorresearch,haveboth
aresponsibilityandanobligationtoreportsuch
conducttoanappropriateauthorityandtotakeother
actionasnecessarytosafeguardhealthconsumers.
Failuretotakestepstopreventharmtoahealth
consumermayleadtodisciplinaryactionbeing
takenagainstthatoccupationaltherapist.
Iftheoccupationaltherapisthasobservedacolleague
whohasdisplayedsexualisedbehaviourtoahealth
consumer,thefirstpriorityisthesafetyofthehealth
consumerandtheoccupationaltherapistmust
taketheappropriatestepswithoutdelay,including
informingtheemployerand/orregulatorybody,or
eventhepoliceiftheoccupationaltherapisthasreason
tobelievethatacriminaloffencehasbeencommitted.
Occupationaltherapistsmaybemadeawareofa
colleague’sactionsbythehealthconsumer,either
thepersondirectlyaffectedbytheconductor
anotherhealthconsumer.Theoccupationaltherapist
shouldbeconsciousofhowdifficultitmayhave
beenforthehealthconsumertocomeforwardwith
thisinformation.Thebestcourseofactioninthese
circumstancesistoanswerthehealthconsumer’s
questions,provideinformationtoassistthehealth
consumerindecidingifabreachofprofessional
boundarieshastakenplace,andinformthehealth
consumeroftheavenuesformakingacomplaintif
heorshewishestodoso.
Ifthehealthconsumerdoesnotwishthematterto
bepursued,andtheoccupationaltherapistbelieves
thatthereisarisktopublicsafety,theoccupational
therapistmustactwithoutdelaysothatanyconcerns
areinvestigatedandthehealthconsumerprotected.
Ifindoubttheoccupationaltherapistshouldseek
advicefromacolleague,managerortheappropriate
professionalorregulatorybody.
Decisionsonseriousprofessionalboundary
transgressionscanbeaccessedontheHealth
PractitionersDisciplinaryTribunalwebsiteat
www.hpdt.org.nz.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
Professional Boundaries
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For more information please contact OTBNZ at [email protected]
References
�Ministry�of�Health�(2003).�Health Practitioners Competence Assurance Act.
�Occupational�Therapy�Board�(2015).�Code of Ethics for Occupational Therapists.
�Occupational�Therapy�Board�(2015).�Competencies for Registration and Continuing Practice.
Occupational Therapy Board of New Zealand Professional Boundaries 201618
Glossary
ColleaguesIncludesotheroccupationaltherapists,students,other
healthcareworkersandotherslawfullyinvolvedinthe
careofthehealthconsumer.
CommunityReferstoNewZealandsocietyasawholeregardless
ofgeographiclocationandanyspecificgroupthe
individualreceivingoccupationaltherapydefinesas
communityincludingthoseidentifyingasculturally
connectedthroughethnicity,sharedhistory,religion,
genderandage.
Cultural�SafetyTheeffectiveoccupationaltherapypracticefor
apersonorfamilyfromanotherculture,andis
determinedbythatpersonorfamily.Cultureincludes,
butisnotrestrictedto,ageorgeneration;gender;
sexualorientation;occupationandsocioeconomic
status;ethnicoriginormigrantexperience;religious
orspiritualbelief;anddisability.Theoccupational
therapistdeliveringtheservicewillhaveundertaken
aprocessofreflectionontheirownculturalidentity
andwillrecognisetheimpactthattheirpersonal
culturehasontheirprofessionalpractice.
Unsafeculturalpracticecomprisesanyactionwhich
diminishes,demeansordisempowersthecultural
identityandwellbeingofanindividual.
HapüAkinshipgroup,clan,subtribe–sectionofalarge
kinshipgroup.
Health�ConsumerAnindividualwhoreceivesanoccupationaltherapist
careorservices.Thistermrepresentspatient,client,
resident,ordisabilityconsumer.
IwiAnextendedkinshipgroup,tribe,nation,people,
nationality,race–oftenreferstoalargegroupof
peopledescendedfromacommonancestor.
Kawa�WhakaruruhauCulturalsafetywithintheMäoricontext.Isaninherent
componentofMäorihealthandoccupationaltherapy
especiallyinitscontributiontotheachievementof
positivehealthoutcomes.
ManaakiTosupport,takecareof,givehospitalityto,protect,
andlookoutfor.
PowerThecapacitytopossessknowledge,toactandto
influenceeventsbasedonone’sabilities,wellbeing,
education,authority,placeorotherpersonalattributes
andprivileges.
PrincipleAnacceptedorprofessedruleofconducttoguide
one’sthinkingandactions.
Professional�RelationshipProfessionalrelationshipsexistonlyforthepurposeof
meetingtheneedsofthehealthconsumer.
Theprofessionalrelationshipbetweenanoccupational
therapistandahealthconsumerisbasedona
recognitionthattheperson(ortheiralternatedecision-
makers)areinthebestpositiontomakedecisions
abouttheirownliveswhentheyareactiveand
informedparticipantsinthedecision-makingprocess.
Occupational Therapy Board of New Zealand Professional Boundaries 2016
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ResponsibilityAchargeordutythatarisesfromone’sroleorstatus
inaprofessionororganisation.
Therapeutic�RelationshipArelationshipestablishedandmaintainedwitha
personrequiringorreceivingoccupationaltherapy
bytheoccupationaltherapistthroughtheuseof
professionalknowledge,skillsandattitudesinorderto
provideoccupationaltherapyexpectedtocontributeto
theperson’shealthoutcomes.
TikangaMäoriprinciplesandvalues.
Tiriti�O�WaitangiIsthefoundingdocumentofAotearoaNewZealand
signedin1840bytheMäoripeopleandtheBritish
Crown.
WhakapapaAncestors
WhänauExtendedfamily
WhanaungatangaEstablishingrelationships,makingconnections.
PO Box 9644, Wellington 6141, New Zealand
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