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Lecture 8

Nursing 1170A/B Lecture Notes - Lecture 8: Therapeutic Relationship


Department
Nursing
Course Code
NURS 1170A/B
Professor
Kim Jackson
Lecture
8

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Virginia Polihronova Week 8 – February 24th, 2016
Boundaries in the Nurse-Client Relationship
Lecture Notes
Week 8 – February 24th, 2016
Virginia Polihronova
Boundaries…
- Provide security and order
- Constrains
- Contains
- Limits
- Delineates the ‘edge’ of appropriate behaviours.
oGuides all behaviours
- Involve issues of power, influence and control
- May be blurred or ambiguous
- They are, however, everywhere
Why are they needed?
- Distinguishes roles of nurses, other HCPs, and patients
- Gives order and stability
- Constrains and limits behaviour, roles, and expectations of nurses
oPatients are often vulnerable
- Draws lines where appropriate behaviours exists
oIssues of power, influence, and control
Ethics of Therapeutic Relationship
- Patients
oVulnerability
- Nurses
oPower
oInfluence and professional status
oControl
When Helping Hurts
- ‘Seductive’ pull of helping
oMakes distinction between helping and not helping unclear
oHelping too much to the point that it is not to the benefit of the client
Moving from therapeutic to selfish behaviour of the nurse
oThe goal of the nurse-client relationship is increasing the patient’s independence
oMajority of cases where violation is found, the nurse does not even realize it
The nurse may very well think that he/she is helping
- Complexity of treatment
- Intensity of treatment relationship
oMay lead to potential for abuse of power
Boundary Questions:
- What is too helpful?
- What is not helpful enough?
- What facilitates healthy independence?
- What enables unhealthy dependency?
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Virginia Polihronova Week 8 – February 24th, 2016
Two Common Behaviours that Blur Boundaries
- Relationship ‘slips’ into a social context
oOften unintentional
- Nurse’s behaviour meets his/her own need at the expense of the patient’s.
Over-identification
- Feels good to relate to someone and sharing a story
oAsk the motivation
- “I have had breast cancer before…”
- “I have been in a terrible car accident just like you…”
- “I have had many bouts of depression so I know what you are going through…”
- “My father died last year too…”
Consider…
- Does the patient or the situation remind you of a person or situation that is similar?
oPositive/negative relationship reminder
- Is the therapeutic relationship goal-oriented?
- Am I taking over for the patient or helping them to assume healthier control?
- Am I keeping secrets?
- Do I feel like I am the only one who would understand the situation?
- Does the patient have the same feelings I have?
- Am I going to an extreme with this patient?
- Do I feel comfortable telling a colleague about the situation?
o“Yes” to any of these questions is a concern
Variables Affecting Boundaries
- Current local opinion on professional behaviours
- Theoretical orientation
- Needs / personality of the client
-Character / training of the nurse (skill, ability & knowledge)
- Treatment setting
-Status of treatment
Know Yourself
- Early detection and response – critical to prevent relaxing of boundaries
- Self-awareness
Variables Affecting Boundaries
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