Boundaries in the Nurse-Client Relationship
Aust N Z J Ment Health Nurs. Dec;9(4) Nurse--client relationships: the experience of community psychiatric nurses. O'Brien L(1). The therapeutic nurse-client relationship is a “planned, time-limited and goal- directed connection between a registered nurse (RN)1 and a client for the purpose. This caring relationship develops when you and your patient come together in the moment, which results in harmony Therapeutic nurse-client relationship.
Nurses do not enter into sexual relations with clients 4.
Nurse–client relationship - Wikipedia
Nurses are careful about socializing with clients and former clients, especially when the client or former client is vulnerable or may require ongoing care. Nurses help colleagues to maintain professional boundaries and report evidence of boundary violations to the appropriate person.
At times, a nurse must care for clients who are family or friends 5. When possible, overall responsibility for care is transferred to another health care provider. At times, a nurse may want to provide some care for family or friends. This situation requires caution, discussion of boundaries and the dual role 6 with everyone affected and careful consideration of alternatives.
Nurses in a dual role make it clear to clients when they are acting in a professional capacity and when they are acting in a personal capacity. Nurses have access to privileged and confidential information, but never use this information to the disadvantage of clients or to their own personal advantage.
Nurses disclose a limited amount of information about themselves only after they determine it may help to meet the therapeutic needs of the client. Nurses may touch or hug a client with a supportive and therapeutic intent and with the implicit or explicit consent of the client. Nurses do not communicate with or about clients in ways that may be perceived as demeaning, seductive, insulting, disrespectful, or humiliating. This is unacceptable behaviour. Nurses do not engage in any activity that results in inappropriate financial or personal benefit to themselves or loss to the client.
Nurses do not act as representatives for clients under powers of attorney or representation agreements. Generally, nurses do not exchange gifts with clients. Where it has therapeutic intent, a group of nurses may give or receive a token gift. Nurses return or redirect any significant gift. Nurses do not accept a bequest from a client.
Applying the principles to practice Be transparent, therapeutic and ethical with all your clients and former clients. When the issues are complex and boundaries are not clear, discuss your concerns with a knowledgeable and trusted colleague. Disclose your personal information only with a therapeutic intent, such as to develop trust and establish a rapport with a client.
Do not disclose intimate details or give long descriptions of your personal experience. Recognize that if you accept clients as personal contacts on social media sites, you may be crossing a boundary. You may also breach client privacy and confidentiality. Do not discuss clients even anonymously or indirectly or share client pictures on social media sites or in any public forum. Understand that nurses who work and live in the same community often have a dual role.
If you have a personal relationship with a client or former client, be clear about when you are acting in a personal relationship and when you are acting in a professional relationship. Explain your commitment to confidentiality and what the client can expect of you as a nurse.
Consider the difference between being friendly and being friends. Be cautious in forming a personal relationship with a former client. Consider the amount of time that has passed since the professional relationship ended; how mature and vulnerable the former client is; whether the former client has any impaired decision-making ability; the nature, intensity, and duration of the nursing care that was provided; and whether the client is likely to require your care again. The specific theories are: Knowledge of person explains that nurses must take the time to understand the client, and their world; what is meaningful to them, and their history.
Knowledge of Health and Illness is the knowledge that the nurse must attain about their client's health issue.
Knowledge of Systems explains that the nurse needs to know about the health-care system so they can help their clients access services. You cannot efficiently use one aspect without the other; they are all connected and work together to create a successful relationship.
Nurses assist clients to achieve their health related goals including improving their relationship with others.
The relationship between nurse and client is a powerful healing force by itself. Self-awareness Self-awareness is an internal evaluation of one self and of one's reactions to emotionally charged situations, people and places. It offers an opportunity to recognize how our attitudes, perceptions, past and present experiences, and relationships frame or distort interactions with others. An example of self-awareness would be acknowledging that showing anger is not a sign of weakness, because there were emotions outside of your control.
Nurses need self-awareness in this relationship to be able to relate to the patient's experiences to develop empathy. Attributes such as being genuine, warm and respectful are a few to mention. An aspect of respect is respecting an individual's culture and ensuring open-mindedness is being incorporated all throughout the relationship up until the termination phase.
It is highly beneficial for the client to incorporate their family, as they may be the most effective support system. Revealing your whole self and being genuine with clients will accomplish the desired nurse client relationship.
In addition, the nurse may also reduce distance to demonstrate their desire in being involved, restating and reflecting to validate the nurse's interpretation of the client's message, directing the conversation towards important topics by focusing in on them.
Furthermore, being polite and punctual displays respect for the client in addition to remembering to be patient, understanding, also to praise and encourage the client for their attempts to take better care of their health.
One of the non-verbal factors is listening. Listening behaviours are identified as S. R; S-sit squarely in relation to client, O-maintain an open position and do not cross arms or legs, L-lean slightly towards the client, E-maintain reasonable and comfortable eye contact, R-relax. These behaviours are effective for communication skills, and are useful for thinking about how to listen to another person.
Empathy Having the ability to enter the perceptual world of the other person and understanding how they experience the situation is empathy. This is an important therapeutic nurse behaviour essential to convey support, understanding and share experiences. Patients are expecting a nurse who will show interest, sympathy, and an understanding of their difficulties. When receiving care patients tend to be looking for more than the treatment of their disease or disability, they want to receive psychological consideration.
During hard times, clients are looking for a therapeutic relationship that will make their treatment as less challenging as possible. Many patients are aware that a solution to their problems may not be available but expect to have support through them and that this is what defines a positive or negative experience. Past experiences can help the clinician can better understand issues in order to provide better intervention and treatment. The goal of the nurse is to develop a body of knowledge that allows them to provide cultural specific care.
This begins with an open mind and accepting attitude. Cultural competence is a viewpoint that increases respect and awareness for patients from cultures different from the nurse's own. Cultural sensitivity is putting aside our own perspective to understand another person's perceptive. Caring and culture are described as being intricately linked. It is important to assess language needs and request for a translation service if needed and provide written material in the patient's language.
As well as, trying to mimic the patient's style of communication e. Another obstacle is stereotyping, a patient's background is often multifaceted encompassing many ethic and cultural traditions.
In order to individualize communication and provide culturally sensitive care it is important to understand the complexity of social, ethnic, cultural and economic.
This involves overcoming certain attitudes and offering consistent, non-judgemental care to all patients. Accepting the person for who they are regardless of diverse backgrounds and circumstances or differences in morals or beliefs. By exhibiting these attributes trust can grow between patient and nurse.
It includes nurses working with the client to create goals directed at improving their health status. A partnership is formed between nurse and client. The nurse empowers patient and families to get involved in their health. To make this process successful the nurse must value, respect and listen to clients as individuals.
Focus should be on the feelings, priorities, challenges, and ideas of the patient, with progressive aim of enhancing optimum physical, spiritual, and mental health. It is stated that it is the nurse's job to report abuse of their client to ensure that their client is safe from harm.
- Nurse--client relationships: the experience of community psychiatric nurses.
- Components of the nurse-client relationship
- Uniqueness within the nurse-client relationship.
Nurses must intervene and report any abusive situations observed that might be seen as violent, threatening, or intended to inflict harm. Nurses must also report any health care provider's behaviors or remarks towards clients that are perceived as romantic, or sexually abusive.
Interviews were done with participants from Southern Ontario, ten had been hospitalized for a psychiatric illness and four had experiences with nurses from community-based organizations, but were never hospitalized.
The participants were asked about experiences at different stages of the relationship. The research described two relationships that formed the "bright side" and the "dark side".
The "bright" relationship involved nurses who validated clients and their feelings. For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalization. The client stated, "she's trying to be quite nice to me For example, one client stated, "The nurses' general feeling was when someone asks for help, they're being manipulative and attention seeking ". One patient reported, "the nurses all stayed in their central station.
They didn't mix with the patients The only interaction you have with them is medication time". One participant stated, "no one cares. It's just, they don't want to hear it. They don't want to know it; they don't want to listen". These findings bring awareness about the importance of the nurse—client relationship. Building trust[ edit ] Building trust is beneficial to how the relationship progresses.
Wiesman used interviews with 15 participants who spent at least three days in intensive care to investigate the factors that helped develop trust in the nurse—client relationship. Patients said nurses promoted trust through attentiveness, competence, comfort measures, personality traits, and provision of information. Every participant stated the attentiveness of the nurse was important to develop trust.