 | The examples and perspective in this article may not include all significant viewpoints .(December 2014) |
Professional boundaries are an important consideration in the relationship between any professional and their client.
| The examples and perspective in this article may not include all significant viewpoints .(December 2014) |
Professional boundaries are an important consideration in the relationship between any professional and their client.
Boundaries are an integral part of the nurse-client relationship. They represent invisible structures imposed by legal, ethical, and professional standards of nursing that respect the rights of nurses and clients. [1] These boundaries ensure that the focus of the relationship remains on the client's needs, not only by word but also by law. The College of Nurses of Ontario (CNO) Standards identifies that it is the nurse's responsibility to establish the boundaries and limits of the relationship between the nurse and client. [2] The boundaries have a specific purpose and health goal, and the relationship terminates when identified goal is met. [1]
Any action or behaviour in a nurse-client relationship that personally benefits the nurse at the expense of the client is a boundary violation. Some examples of boundary violations are engaging in a romantic or sexual relationship with a current client, extensive non-beneficial disclosure to the client and receiving a gift of money from the client. Abuse and neglect are extreme examples. They involve the betrayal of respect and trust within the relationship. This includes withholding communication from a client because it is considered to be an example of neglect. [3]
It is the nurse's job to be aware of signs that professional boundaries may be crossed or have been crossed. Warning signs of boundary crossing that may lead to boundary violations include frequently thinking of a client in a personal way, keeping secrets with a specific client, favouring one client's care at the expense of another's and telling a client personal things about yourself in order to make an impression. Anything that could comprise the client's well-being if the relationship with a registered nurse is continued or discontinued can be considered a warning sign. [3] Boundary violations are never acceptable and it is the nurse's job to handle any situation with any regards to it professionally and therapeutically regardless of who initiated it.
There are multiple boundaries that could be crossed between a client and a counselor, including physical, psychological, emotional, and social boundaries. Some of these boundary lines may be blurry. For example, there are differing opinions on whether touch is ever appropriate between a counselor and their client. Sexual intercourse, however, is uniformly agreed upon as inappropriate. Dual relationships, where a counselor holds two or more different roles within a client's life at the same time, are also typically avoided, as well as the acceptance of gifts of significant monetary value. [4]
Confidentiality involves a set of rules or a promise usually executed through confidentiality agreements that limits the access to or places restrictions on distribution of certain types of information.
Sexual misconduct is misconduct of a sexual nature which exists on a spectrum that may include a broad range of sexual behaviors considered unwelcome. This includes conduct considered inappropriate on an individual or societal basis of morality, sexual harassment and/or criminal sexual assault.
Counseling psychology is a psychological specialty that began with a focus on vocational counseling, but later moved its emphasis to adjustment counseling, and then expanded to cover all normal psychology psychotherapy. There are many subcategories for counseling psychology, such as marriage and family counseling, rehabilitation counseling, clinical mental health counseling, educational counseling, etc. In each setting, they are all required to follow the same guidelines.
Transference is a phenomenon within psychotherapy in which repetitions of old feelings, attitudes, desires, or fantasies that someone displaces are subconsciously projected onto a here-and-now person. Traditionally, it had solely concerned feelings from a primary relationship during childhood.
Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: neurodevelopmental disorders, schizophrenia, schizoaffective disorder, mood disorders, addiction, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm.
A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their jurisdiction.
Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. A section of the nursing assessment may be delegated to certified nurses aides. Vitals and EKG's may be delegated to certified nurses aides or nursing techs. It differs from a medical diagnosis. In some instances, the nursing assessment is very broad in scope and in other cases it may focus on one body system or mental health. Nursing assessment is used to identify current and future patient care needs. It incorporates the recognition of normal versus abnormal body physiology. Prompt recognition of pertinent changes along with the skill of critical thinking allows the nurse to identify and prioritize appropriate interventions. An assessment format may already be in place to be used at specific facilities and in specific circumstances.
In many jurisdictions in the Western world, a mandated reporter is a person who is legally required to report observed or suspected abuse. Specific details vary across jurisdictions—the abuse that must be reported may include neglect, or financial, physical, sexual, or other types of abuse. Mandated reporters may include people working in professions perceived to be likely to expose them to vulnerable people, though it may also include unpaid people who have assumed full or intermittent responsibility for the care of a child, dependent adult, or senior citizen.
Sociotherapy is a social science and form of social work, and sociology that involves the study of groups of people, its constituent individuals, and their behavior, using learned information in case and care management towards holistic life enrichment or improvement of social and life conditions.
A mental health counselor (MHC), or counselor, is a person who works with individuals and groups to promote optimum mental and emotional health. Such persons may help individuals deal with issues associated with addiction and substance abuse; family, parenting, and marital problems; stress management; self-esteem; and aging. The United States Bureau of Labor Statistics distinguishes "Mental Health Counselors" from "Social Workers", "Psychiatrists", and "Psychologists".
A licensed clinical professional counselor (LCPC) is a professional who has been qualified to provide psychotherapy and other counselling services. LCPCs are trained to work with individuals, families, and groups to treat mental, behavioural and emotional problems and disorders. The main goal of LCPCs is to use counselling strategies to help people live a more satisfying life, which typically involves identifying a goal and finding potential solutions.
The nurse–client relationship is an interaction between a nurse and "client" (patient) aimed at enhancing the well-being of the client, who may be an individual, a family, a group, or a community.
Professional abuse is "a pattern of conduct in which a person abuses, violates, or takes advantage of a victim within the context of the abuser's profession." This typically involves a violation of the relevant professional organization's code of ethics. Organizational ethics or standards of behavior require the maintenance of professional boundaries and the treatment of people with respect and dignity.
Patient abuse or patient neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient. Elder abuse is classified as patient abuse of those older than 60 and forms a large proportion of patient abuse.
Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.
Sex surrogates, sometimes referred to as surrogate partners, are practitioners trained in addressing issues of intimacy and sexuality. A surrogate partner works in collaboration with a sex therapist to meet the goals of their client. This triadic model is used to dually support the client: the client engages in experiential exercises and builds a relationship with their surrogate partner while processing and integrating their experiences with their therapist or clinician.
The management of domestic violence deals with the treatment of victims of domestic violence and preventing repetitions of such violence. The response to domestic violence in Western countries is typically a combined effort between law enforcement, social services, and health care. The role of each has evolved as domestic violence has been brought more into public view.
Clinical mental health counseling is a healthcare profession addressing issues such as substance abuse, addiction, relational problems, stress management, as well as more serious conditions such as suicidal ideation and acute behavioral disorders. Practitioners may also assist with occupational growth in neurodivergent populations and behavioral and educational development. Clinical mental health (CMH) counselors include psychologists, psychiatrists, mental health technicians, marriage counselors, social workers, and family therapists.
In many parts of the world, mandated reporters are people who have regular contact with vulnerable people such as children, disabled persons, and senior citizens, and are therefore legally required to ensure a report is made when abuse is observed or suspected. Specific details vary across jurisdictions—the abuse that must be reported may include neglect, or financial, physical, sexual, or other types of abuse. Mandated reporters may include paid or unpaid people who have assumed full or intermittent responsibility for the care of a child, dependent adult, or elder.
Pia Mellody is a therapist, author, and speaker in the field of codependence, addiction, and recovery. She is the author of four published books, including Facing Codependence: What It Is, Where It Comes From, How It Sabotages Our Lives, which sold over 400,000 copies. In the treatment of addiction and codependence, Mellody is widely recognized for her contributions to and development of the field. The Meadows is a treatment center in Wickenburg, Arizona designed to treat a range of types of addiction and mental health problems, offering individual, group, and family counseling programs. Pia Mellody’s work with codependence and addiction at the Meadows in the 1970s led to her development of the “Meadows Model,” the therapeutic framework for all treatment programs at the center. As of 2023, Mellody is a Senior Clinical Advisor for the Meadows and a Clinical Consultant for Mellody House and Dakota.