Therapeutic Nurse-Client Relationship: Maintaining Boundaries

Overview

• Presented by the College of Nurses of Ontario
• Focus on maintaining boundaries within the therapeutic nurse-client relationship, as revised in 2006
• Importance of boundaries for balancing power and ensuring client safety

Standard Statements

• Therapeutic Communication
• Client-Centered Care
• Maintaining Boundaries
• Protecting the Client from Abuse

Maintaining Boundaries

Responsibilities of Nurses

• Establish and maintain limits/boundaries in the nurse-client relationship
• Crossing boundaries alters the relationship dynamics, increasing client vulnerability

Strategies for Maintaining Boundaries

• Develop and adhere to a comprehensive care plan centered on the client’s needs
• Remain vigilant, especially in practice settings like home care
• Avoid accepting gifts unless refusal harms the therapeutic relationship

Handling Gift Situations

• Consult with a manager if refusing a gift could harm the relationship
• Document consultation and clarify the client’s intent
• Assess the appropriateness of the gift in terms of timing and monetary value

Warning Signs of Boundary Crossings

• Spending extra time or changing assignments to care for one client
• Sharing personal information unrelated to client care
• Dressing differently or thinking about the client off-duty
• Spending off-duty time with the client
• Ignoring agency policies for the client

Addressing Colleague Boundary Crossings

• Speak directly to the colleague if a boundary crossing is suspected
• Assess the situation and discuss perceptions and impacts
• Refer to ethical guidelines and practice standards
• If unresolved, speak to a supervisor and document concerns, including details of the event and witness information

Conclusion

• Completion of Chapter Four on maintaining boundaries
• Return to the learning center for further chapters