Maintaining Boundaries

Maintaining Professional
Boundaries
NURS322 Therapeutic Interventions &
Relationships
Nicola Reefe-Babb, B.Sc, M.Sc., Ed.D. (c)

Objectives
1.Understand what are professional boundaries
2.Understand the implications when professional
boundaries lines are crossed
3.Examine how it affect the nurse-client relationship.
Professional
Boundaries
Professional Boundaries
•According to Anne L. Scott (1993), boundaries serve as a filtering device that
protects people from being overwhelmed by their surroundings and becoming
disorganized as a result. She also stresses the importance of restoring,
sustaining and fostering boundaries in nurses and their patients. She then
connects the definition of boundaries to other essential ideas before providing
a simple theory of personal space boundaries.

Professional Boundaries Cont’d
•Nitka (2020) states that Peck (1997) is of the belief that when comes to
the physical, emotional, and spiritual worlds, we have limits and can
manage how permeable they are – that is, what we let in and out. Being
in control of your life in order to keep yourself safe and well is what
maintaining boundaries is all about.

Touch
•Some patients need more
therapeutic touch, such as hand-
holding and hugging, than others
and some patients prefer no
touching. Always respect
differences in cultures.
Space and Territoriality
This is described as the distance at
which an interaction takes place, and
the space and contents of the space
that the individual considers belong
to him or her
Space and Territoriality
Hall (1969) describes four (4) distances in which
interaction takes place:
• Intimate distance
• Personal distance
• Social distance
• Public distance
Intimate distance
Intimate distance (physical contact to 1 ½ feet)
Personal distance
Personal distance(1 ½-4 feet)
Social distance
Social distance (4-12 feet)
Public distance
Public distance (12 feet and beyond)
Touch
• As intimacy increases, the need for
distance decreases.
Touch
• Touching a client can be comforting and
supportive when it is welcome and permitted.
The nurse should observe the client for cues
that show whether touch is desired or
indicated. For example, holding the hand of a
sobbing mother whose child is ill is
appropriate and therapeutic. If the mother pulls
her hand away, how-ever, she signals to the
nurse that she feels uncomfortable being
touched. The nurse also can ask the client
about touching (e.g., “Would it help you to
squeeze my hand?”).
Knapp (1980) identified five (5) types of touch:
· Functional-professional touch is used in examinations or procedures such as when the
nurse touches a client to assess skin turgor or a masseuse performs a massage.
· Social-polite touch is used in greeting, such as a hand-shake and the “air kisses”
some women use to greet acquaintances, or when a gentle hand guides someone in the
correct direction.
· Friendship-warmth touch involves a hug in greeting, an arm thrown around the
shoulder of a good friend, or the backslapping some men use to greet friends and
relatives.
· Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.
· Sexual-arousal touch is used by lovers.
Privacy
•Make sure your patient has
privacy when you provide care.
Be sure that her basic needs are
met, including relieving pain or
other sources of discomfort.
When nurses begin to want the client
to “like them,” “do as they suggest,” “be
nice to them,” or “give them
recognition,” the needs of the client
cannot be adequately met and the
interaction could be detrimental
(nontherapeutic) to the client.
Examples of
Maintaining
Boundaries in
Nursing
Maintaining Boundaries in Nursing Eg. 1
•One of the boundaries within nursing is to not performing additional
favors for patients outside the scope of your role.

•Within this scenario we could can see how this was violated. It begins with
a patient asking the nurse to retrieve special food outside of the hospital on
the nurse’s lunch as the patient refuses to eat the meal that was being
served by the hospital. The nurse then begins to feel sorry for the patient
and accepts the request made by the patient, knowing that it is not
allowed .
•This action can be deemed as the favoritism by other patients .At this point
the nurse broke the boundary of professionalism.
•If the nurse did not accept, this would have shown that the nurse maintained
professional boundaries by not breaking the ‘no favors for any patients’ rule
and is keeping with maintaining professionalism and equality among patients.

•During a shift on the Surgical ward, a female nurse was allocated to a male
client who was very friendly and complimented her on her beauty. She was
unaware that the client was interested in her romantically because she was
used to clients complimenting her beauty. While assessing the client’s shoulder
dressing, the doctors were doing their routine rounds on the ward and told the
client he was in the clear to go home.

•While the nurse was giving the client his discharge information the
client asked the nurse out on a date and asked to kiss her. The nurse
stepped back in shock and immediately reported the incident to the head
nurse. Another female nurse was assigned to carry out the discharge
information.
• Above is an example of sexual misconduct by the client. The nurse
maintained professional boundaries by reporting the incident to the
head nurse (policy), not engaging in the client’s suggestion and
allowed another nurse to take over for her (referral).

Scenario
• 35-year-old John Hall came to the emergency room for severe wounds
due to physical assault from police officers. The brutal beating was due
to an alleged kidnapping of a minor. He was then assessed and then
taken to the ICU department.

Scenario cont’d
•One of the nurses attached to the ICU team that was assigned to Mr.
Hall, took a photo and posted it to one of her personal social media
platforms and wrote a post about the events that took place from his
arrival to when he was transferred to the ICU department.

•A nurse’s use of social media is another way that nurses can
unintentionally blur the lines between their professional and personal lives.
Making a comment via social media, even if done on a nurse’s own time
and in their own home, regarding an incident or person in the scope of their
employment, may be a breach of patient confidentiality or privacy, as well
as a boundary violation.
•In this case scenario, proper measures will be taken by her superiors and
the Nursing Council. Possible disciplinary actions can lead to suspension
or having their nursing license revoked along with termination of
employment.
Nurses must get their
needs met outside the
relationship.
The End!
References
• Nitka , D. (2020, August 7). The Importance Of Setting Boundaries. Connecte Psychology.
https://connectepsychology.com/en/2017/05/16/the-importance-of-setting-boundaries/.
• Popp, N. (2015, May). The Concept and Phenomenon of Psychological Boundaries from a
Dialectical Perspective. https://www.researchgate.net/publication/276732854_.
https://www.researchgate.net/publication/276732854_The_Concept_and_Phenomenon_of_Psych
ological_Boundaries_from_a_Dialectical_Perspective.
• Scott A. L. (1993). A beginning theory of personal space boundaries. Perspectives in psychiatric
care, 29(2), 12–21. https://doi.org/10.1111/j.1744-6163.1993.tb00407.x
• Gabbard. O.(2005). Paient-Therapist Boundary Issues. Psychiatric terms.com

• Thompson.A.(2019). What Does the Bible Say about Setting Personal Boundaries?. Treasure
ministries.com https://treasuredministries.com/blog/2019/11/22/what-does-the-bible-say-about-
setting-personal-boundarie/

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Maintaining Professional

Nicola Reefe-Babb, B.Sc, M.Sc., Ed.D. (c)

protects people from being overwhelmed by their surroundings and becoming

disorganized as a result. She also stresses the importance of restoring,

connects the definition of boundaries to other essential ideas before providing

a simple theory of personal space boundaries.

maintaining boundaries is all about.

•One of the boundaries within nursing is to not performing additional

favors for patients outside the scope of your role.

the nurse broke the boundary of professionalism.

and is keeping with maintaining professionalism and equality among patients.

client he was in the clear to go home.

• Above is an example of sexual misconduct by the client. The nurse

maintained professional boundaries by reporting the incident to the

head nurse (policy), not engaging in the client’s suggestion and

allowed another nurse to take over for her (referral).

to an alleged kidnapping of a minor. He was then assessed and then

taken to the ICU department.

arrival to when he was transferred to the ICU department.

•A nurse’s use of social media is another way that nurses can

employment, may be a breach of patient confidentiality or privacy, as well

the Nursing Council. Possible disciplinary actions can lead to suspension

or having their nursing license revoked along with termination of

• Gabbard. O.(2005). Paient-Therapist Boundary Issues. Psychiatric terms.com

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