Ethical boundaries for Healthcare Professionals

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1 Ethical boundaries for Healthcare Professionals Quote about boundaries A professional counselor is not the client s Wal-Mart. We may be the grocery side, but we can t offer every product they need. Unknown What Are Professional Boundaries? Being with the client, not becoming the client Being friendly, not friends The ability to know where you end and the client begins A clear 1

2 Ethical Boundaries a boundary describes that line that separates a professional relationship from one where there is a conflict of interest in social, sexual, religious or business interests boundaries between people. Ethical Boundaries A healthy professional interaction will involve the practioner providing a role as. Each of these roles allow the practioner to have influence and (in some manner) power over the client. The client is the consumer who is seeking to be taught, to have therapy provided and to be cared for. Where do we start? Professional boundaries begins with. is defined as a very active and powerful choice to engage in the activities that are required to gain or maintain an optimal level of overall health. And in this case, overall health includes not just the physical, but the psychological, emotional, social, and spiritual components of an individual s well-being. 2

3 Workplace or professional self care This involves activities that help you to work consistently at the professional level expected of you. For example: Engage in regular supervision or consulting with a more experienced colleague Set up a peer-support group Be strict with boundaries between clients/students and staff Read professional journals Attend professional development programs Physical self care Activities that help you to stay fit and healthy, and with enough energy to get through your work and personal commitments. Develop a regular sleep routine Aim for a healthy diet Take lunch breaks Go for a walk at lunch-time Take your dog for a walk after work Use your sick leave Get some exercise before/after work regularly Psychological self care Activities that help you to feel clear-headed and able to intellectually engage with the professional challenges that are found in your work and personal life. Keep a reflective journal Seek and engage in external supervision or regularly consult with a more experienced colleague Engage with a non-work hobby Turn off your and work phone outside of work hours Make time for relaxation Make time to engage with positive friends and family 3

4 Emotional self care Allowing yourself to safely experience your full range of emotions. Develop friendships that are supportive Write three good things that you did each day Play a sport and have a drink together after training Go to the movies or do something else you enjoy Keep meeting with your mothers group or other social group Talk to you friend about how you are coping with work and life demands Spiritual self care This involves having a sense of perspective beyond the day-to-day of life. Engage in reflective practices like meditation Go on bush walks Go to church/mosque/temple Do yoga Reflect with a close friend for support Relationship self care Is about maintaining healthy, supportive relationships, and ensuring you have diversity in your relationships so that you are not only connected to work people. Prioritize close relationships in your life e.g. with partners, family and children. Attend the special events of your family and friends. Arrive to work and leave on time every day. 4

5 What is a professional relationship? a is provided particular are required the relationship exists for a period of time the service has. codes of and exist you come together for professional reasons bears responsibilities and expectations regarding and. What is a professional relationship? Simplify our role help and responsibilities us? They help us endure the stress by knowing we are doing right by the client. Realize what we have control and influence over and what we do not so that we allow the other resources and practioners an opportunity to contribute to the solution. Allow for positive outcomes to occur and goals to be met by the client..not by us. Who is affected when boundaries are violated? The person receiving the service The caregiver The organization Harm is not always evident to all parties. 5

6 Appropriate vs Inappropriate examples Most common violations Intimate relationships Pursuit of personal gain or benefit How people respond to their own emotional and dependency needs Selfless non-work related gestures Responses to unanticipated circumstances Climate for boundary violations that may include feeling unwanted or unappreciated. Personal. Working for an agency that has oversight or who otherwise allow poor boundaries to exist between client and professional. Enabling inappropriate personality traits in your personal life. 6

7 Climate for boundary violations Feeling and not maintaining a healthy lifestyle. Revealing. Not following consistent with a client. Preoccupation with clients. Practicing outside your competence. Communication outside of the professional environment. Dual relationships Dual relationships or Multiple Relationships in Social Services refers to any situation where multiple roles exist between a Clinician and a client. Examples of dual relationships are when the client is also a student, friend, family member, employee or business associate of the Clinician. Dual relationships It is common when the client and the professional live in a rural environment, they will have an overlapping relationship. The acquaintance client may develop a relationship with your family and friends or vice versa. Either the acquaintance client or the professional may do business with one another s family members. 7

8 Dual relationships The client and the professional may have children who know one another and discuss personal issues about the professional and/or the client. Town gossip may lead the client to question your ethical standards Dual relationships Instances where a professional and the client are acquaintances prior to care it is important to establish so that the professional can be identified by the client based on their skill. Ensure that personal information you learn is not mixed up with the information the client shares with you. You may hear but base your counseling on,. Make sure that you discuss with the client the of your professional relationship with them so they can pre-determine if they want another professional to help them. Dual relationships Make sure not that client records are kept secured. Make it a habit to limit conversations that revolve around your client and/or their family within the community, while you are providing their care. Consider referring the client to another professional if the situation becomes uncomfortable or complicated. 8

9 Other suggestions 1. Respect cultural differences and be aware of the sensitivities of individual clients. 2. Do not use gestures, tone of voice, expressions, or any other behaviors which clients may interpret as seductive, sexually demeaning, or as sexually abusive. 3. Do not make sexualized comments about a client s body or clothing. 4. Do not make sexualized or sexually demeaning comments to a client. 5. Do not criticize a client s sexual preference. Other suggestions suggestions 6. Do not ask details of sexual history or sexual likes/dislikes unless directly related to the purpose of the consultation. 7. Do not request a date with a client. 8. Do not engage in inappropriate 'affectionate' behavior with a client such as hugging or kissing. Do offer appropriate supportive contact when warranted. 9. Do not engage in any contact that is sexual, from touching to intercourse. 10. Do not talk about your own sexual preferences, fantasies, problems, activities or performance. Other suggestions 11. Learn to detect and deflect seductive clients and to control the therapeutic setting. 12. Maintain good records that reflect any intimate questions of a sexual nature and document any and all comments or concerns made by a client relative to alleged sexual abuse, and any other unusual incident that may occur during the course of, or after an appointment. 9

10 How to resolve ethical boundaries conflicts? Make sure your true self-guides your other sub selves. Admit the conflicts without blame, shame or guilt. Identify your respective boundaries Apply the same steps you use to resolve value conflicts as mutually respectful teammates, not opponents. Ethical Scenarios Nurse who observes a patient prescription seeking, Do you tell her DR? A CNA witnesses another CNA being verbally abusive towards another patient? Nurse sees a patient present during risky behavior. Does she report what she saw to the Dr.? You learn a close friend s spouse is dying which will leave them a single parent with high needs children, do you tell them? You learn through your job, that your child s sports coach has been diagnoses with a contagious disease; do you tell your child or other parents? What if a friend s daughter is receiving an experimental high risk birth control drug, would you tell their parents? Ethical standard: Do good. Example of following ethical standard: Give someone a heart transplant. Possible dilemma: The family of another patient who is brain dead must decide whether to end Me support and allow that patient to die and provide a heart to the transplant patient. Ethical standard: Do no harm. Example of following ethical standard: Do not give fatty foods to a patient with a heart condition. Possible dilemma: This may conflict with the patient's right to choose and request the type of foods he desires. Ethical standard: Tell the truth. Example of following ethical standard: A physician informs a wife that her husband will not recover from his health condition. Possible dilemma: The wife feels very sad and it seems that telling the truth caused harm to the wife. 10

11 Ethical standard : Respect the right of others to make their own choices. Example of following ethical standard: A patient has an advance directive, so as a nurse, you do not resuscitate him when he stops breathing. Possible dilemma: A family may not agree with the patient's choice and may feel that the patient was harmed or "left" to die. Ethical standard : Following HIPAA guidelines, do nu release patient information except allowed. Example of following ethical standard: Respect privacy and personal property. Possible dilemma: A daughter says she wants to help her father, but needs information in order to do so. The patient has refused to release information. The patient may be harmed by not accepting the daughter's help. Shane Young MSW Facebook: Northwest Missouri Training Solutions 11

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