Professional boundaries are guidelines for maintaining a positive and helpful relationship with your
clients or residents. Understanding boundaries helps caregivers avoid stress and misconduct, recognize boundary
crossings and provide the best possible care.
The Caregiver-client Relationship
The caregiver has a powerful role in the relationship between caregiver and client. This power comes from:
- Control over the services provided to the client
- Access to private knowledge about the client
It is important not to let the balance of power slide heavily onto the caregiver’s side of the relationship. Maintaining
professional boundaries helps the caregiver maintain a helpful or “therapeutic” relationship with the client.
A good question to ask yourself: Are my actions more about my needs than about the needs of my client? If so, you may
be crossing a professional boundary.
TYPES OF BOUNDARY CROSSINGS AND STAYING IN BOUNDS
Sharing Personal Information – It may be tempting to talk to your client about your personal life or problems. Doing so may
cause the client to see you as a friend instead of seeing you as a health care professional. As a result, the client may take
on your worries as well as their own. Staying in Bounds:
- Use caution when talking to a client about your personal life.
- Do not share information because you need to talk, or to help you feel better.
- Remember that your relationship with your client must be therapeutic, not social.
Not Seeing Behavior as Symptomatic – Sometimes caregivers react emotionally to the actions of a client and forget that
those actions are caused by a disorder or disease (symptomatic). Personal emotional responses can cause a caregiver
to lose sight of her role or miss important information from a client. In a worst case, it can lead to abuse or neglect of a
client. Staying in Bounds:
- Be aware that a client’s behavior is the result of a disease or disorder.
- Know the client’s care plan!
- If you are about to respond emotionally to negative behavior of a client, step back and re-approach the client.
- Note that the client may think their action is the best way to solve a problem or fill a need.
- Ask yourself if there is a way to problem solve and help the client communicate or react differently.
Nicknames/Endearments – Calling a client “sweetie” or “honey” may be comforting to that client, or it might suggest a more
personal interest than you intend. It might also point out that you favor one client over another. Some clients may find the
use of nicknames or endearments offensive. Staying in Bounds:
- Avoid using terms like honey and sweetie.
- Ask your client how they would like to be addressed. Some may allow you to use their first name. Others might
prefer a more formal approach: Mr., Mrs., Ms, or Miss.
- Remember that the way you address a client indicates your level of professionalism.
Touch – Touch is a powerful tool. It can be healing and comforting or it can be confusing, hurtful, or simply unwelcome.
Touch should be used sparingly and thoughtfully. Staying in Bounds:
- Use touch only when it will serve a good purpose for the client.
- Ask your client if he/she is comfortable with your touch.
- Be aware that a client may react differently to touch than you intend.
- When using touch, be sure it is serving the client’s needs and not your own.
Unprofessional Demeanor – Demeanor includes appearance, tone and volume of voice, speech patterns, body language,
etc. Your professional demeanor affects how others perceive you. Personal and professional
Demeanor may be different. Staying in Bounds:
- Clients may be frightened or confused by loud voices or fast talk.
- Good personal hygiene is a top priority due to close proximity to clients.
- Professional attire sends the message that you are serious about your job.
- Off-color jokes, racial slurs, profanity are never appropriate.
- Body language and facial expressions speak volumes to clients.
Gifts/Tips/Favors: Giving or receiving gifts, or doing special favors, can blur the line between a personal relationship and
a professional one. Accepting a gift from a client might be taken as fraud or theft by another person or family member.
Staying in Bounds:
- Follow your agency’s policy on gifts.
- Practice saying no graciously to a resident who offers a gift that is outside your agency’s boundaries.
- It is okay to tell clients that you are not allowed to accept gifts, tips.
- To protect yourself, report offers of unusual or large gifts to your supervisor.
Over-involvement – Signs may include spending inappropriate amounts of time with a particular client, visiting the client
when off duty, trading assignments to be with the client, thinking that you are the only caregiver who can meet the client’s
needs. Under-involvement is the opposite of over-involvement and may include disinterest and neglect.
Staying in Bounds:
- Focus on the needs of those in your care, rather than personalities.
- Don’t confuse the needs of the client with your own needs.
- Maintain a helpful relationship, treating each patient with the same quality of care and attention, regardless of your
emotional reaction to the client.
- Ask yourself: Are you becoming overly involved with the client’s personal life? If so, discuss your feelings with your
Romantic or Sexual Relationships - A caregiver is never permitted to have a romantic or sexual relationship with a client.
Sexual contact with a client may be considered a crime. Staying in Bounds:
- While it may be normal to be attracted to someone in your care, know that it is never appropriate to act on that
- Do not tell sexually oriented jokes or stories. It may send the wrong message to your client.
- Discourage flirting or suggestive behavior by your client.
- If you feel that you are becoming attracted to someone in your care, seek help from your supervisor or other trusted
professional right away.
Secrets – Secrets between you and a client are different than client confidentiality. Confidential information is shared with
a few other members of a team providing care to a resident. Personal secrets compromise role boundaries and can result
in abuse or neglect of a client. Staying in Bounds:
- Do not keep personal or health-related secrets with a client.
- Remember that your role is to accurately report any changes in your client’s condition.
GETTING BACK IN BOUNDS
- Talk to a trusted colleague.
- Talk to your supervisor or manager.
- Consider a re-assignment.
- Explain to clients that you are unable to behave in certain ways due to professional guidelines.
- To protect yourself, draw a line between your work life and your private life.
Nurses need to practice in a manner consistent with professional standards. Nurses should be knowledgeable regarding
professional boundaries and work to establish and maintain those boundaries. Nurses should examine any boundary-
crossing behavior and seek assistance and counsel from their colleagues and supervisors when crossings occur. Nurses
also need to be cognizant of the boundary violations that occur when using social media to discuss patients, their family or
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