Understanding Professional Boundaries
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Care work requires a level of trust and intimacy that is unique to the profession.
In a single day, healthcare workers may touch, dress, shower, feed, toilet, speak, console, cheer-up, and listen to one, or several clients; no small feat.
Of course, the carer-client relationship also creates an inherent power imbalance. Someone receiving care must be willing to hand over much of their agency and trust to their carers, with the expectation that this relationship is not abused.
In care settings such as residential aged care, the expectation that clients will have a safe and trusting relationship with members of the care team is directly tied to Standard 7 of the Aged Care Quality Standards: Human Resources.
The client-carer relationship is a unique one and may be difficult to navigate at times. The following article is intended to help you understand your role as a care provider, and how to avoid overstepping both personal and professional boundaries, which may compromise your duty of care.
What are Boundaries?
We all have boundaries. These are the rules that govern how we interact in our relationships with others, indicating what we find to be acceptable and unacceptable behaviours (Bockarova 2016).
Everyone’s boundaries can be different. Knowing what your boundaries are comes from a personal sense of self-worth, and your personal values in life. Setting boundaries, however, is not always easy. It is a skill that can take time to get right (Bockarova 2016).
What is a Professional Boundary?
Professional boundaries are those rules and limits that prevent the lines between carer and client from becoming blurred.
Professional boundaries are set by legal, ethical and organisational frameworks to maintain a safe working environment for both the client, but also the caring staff too (Mable Technologies Pty Ltd 2015; Relationships Australia n.d.).
Some examples of professional boundaries may include:
- Not discussing a client’s private health information with others;
- Keeping work contact numbers separate to your personal contact numbers;
- Not performing additional favours for clients, outside of the scope of your role.
(Acquired Brain Injury Outreach Service 2017)
What is a Personal Boundary?
Personal boundaries may be less-explicit than professional boundaries. They may include physical, emotional and mental limitations, which care workers adopt to protect themselves from being drawn in or becoming overly-invested in their client’s lives (Relationships Australia n.d.).
Personal boundaries allow healthcare workers to maintain psychological safety for themselves and their clients. (Relationships Australia n.d.).
Some examples of personal boundaries may include:
- Not discussing your personal problems with your client (such as marital or financial issues);
- Not developing feelings of attraction for your client or their family members;
- Not worrying about your client once your shift has ended and you have gone home.
(Acquired Brain Injury Outreach Service 2017)
Crossing a Boundary
Realistically, boundaries will occasionally be crossed or blurred at various points in a carer-client relationship. This could be due to a particularly difficult situation, stress, bad luck or timing, or even manipulation by a client (Hardy 2017).
In these cases, it is your responsibility to avoid boundary crossings from becoming a pattern, and building into a harmful violation of the relationship (Clarke 2017).
Examples of Boundary Crossings Include:
- Receiving gifts;
- Inappropriately disclosing personal information (phone numbers, addresses);
- Agreeing to socialise outside of the clinical setting;
- Breaching confidentiality;
- Inappropriate verbal/physical aggression;
- Inappropriate touching/sexual contact;
- Keeping information to yourself (not documenting);
- Shopping for the person on your own time or with your own money.
Legal and Ethical Standards
Some violations are serious enough to become legal issues and reportable offences. All healthcare workers, including unregistered care workers, are subject to the National Code of Conduct for Health Care Workers. These ethical guidelines are essential to maintaining an adequate level of training and professionalism in the industry (Acquired Brain Injury Outreach Service 2017).
It is important to note that two sections laid out in the Code of Conduct, in particular, relate specifically to the following professional boundaries violations:
Giving and Receiving Gifts or Favours in Healthcare
12. Health care workers not to financially exploit clients
- A health care worker must not financially exploit their clients.
- Without limiting subclause (1):
- a health care worker must only provide services or treatments to clients that are designed to maintain or improve clients’ health or wellbeing
- a health care worker must not accept or offer financial inducements or gifts as a part of client referral arrangements with other health care workers
- a health care worker must not ask clients to give, lend or bequeath money or gifts that will benefit the health care worker directly or indirectly.
- (COAG Health Council 2015)
Sexual Relationships in Healthcare
13. Health care workers not to engage in sexual misconduct
- A health care worker must not engage in behaviour of a sexual or close personal nature with a client.
- A health care worker must not engage in a sexual or other inappropriate close personal, physical or emotional relationship with a client.
- A health care worker should ensure that a reasonable period of time has elapsed since the conclusion of the therapeutic relationship before engaging in a sexual relationship with a client.
- (COAG Health Council 2015)
Protecting Your Professional Boundaries
The key to managing many of these boundaries is understanding the difference between a professional and a personal relationship and ensuring that your behaviour always remains on the right side of the line (Hardy 2017).
If you are unsure if what you are doing is crossing a boundary, ask yourself these five questions:
- What is my role in this situation?
- E.g. are you acting as a caregiver or a friend?
- Am I sharing personal information for my benefit or for the benefit of the person I’m helping?
- Sharing information about yourself can significantly help the engagement process (building trust) however it depends on the information and the context of the disclosure.
- Are my emotions clouding the issue with the person I am caring for?
- Sometimes we develop a strong liking or dislike for a person we are helping (transference/countertransference). If your emotions are clouding your judgment, step back and if possible, consider having another person step in.
- Are the other person’s emotions clouding the issue with me?
- If you are setting off strong (positive or negative) emotions in the person you are helping, you might want to consider passing them to someone else, particularly if the person you are helping is expressing strong romantic, sexual, or aggressive feelings toward you.
- If in doubt, don’t!
- If you’re not sure whether you should say hi to someone you only know as their carer when you’re out with your family, don’t.
- If you’re not sure whether or not to put your hand on their forearm to comfort them, don’t.
- If you’re not sure whether sharing an anecdote about yourself would be helpful, don’t.
- Aged Care Quality Standards: https://www.agedcarequality.gov.au/...Aged%20Care%20Quality%20Standards.pdf.
- Code of Conduct: https://www.coaghealthcouncil.gov.au/NationalCodeOfConductForHealthCareWorkers.
M ultiple Choice Questions Q1 Which of the following examples may indicate a crossed boundary?
- A resident at your aged care facility comes up to greet you on your birthday and gives you a friendly hug.
- As your shift is ending, the son of one of your clients who visits each Saturday, extends you an invitation to come along while he takes his mother to a local restaurant for dinner. After dinner is over, he invites you for a drink alone.
- A resident asks if they may have their tea served outside of normal tea-break hours, so they don’t miss a television show. You manage to arrange this with the kitchen staff.
- Q2. Which of the following examples do not indicate a crossed boundary?
- The day after a particularly stressful break up with your partner of seven years, a client finds you crying at work, and asks you what is wrong. You proceed to tell them about the breakdown of your relationship and the emotional and financial stress it has put you under.
- A patient offers you a box of chocolates to say thank you, which you do not take home, but leave in the tea room for the entire staff to enjoy.
- One of your favourite residents, Mrs Moony, has run out of milk in her personal pantry to enjoy with her tea. Since you were on your way to the supermarket, you offer to pick up a bottle for her.
- Acquired Brain Injury Outreach Service 2017, Building Good Boundaries in Support Work, The State of Queensland (Queensland Health), viewed 29 August 2019, https://www.health.qld.gov.au/__data/assets/pdf_file/0018/381060/boundaries_pro.pdf.
- Bockarova , M 2016, ‘4 Ways to Set and Keep Your Personal Boundaries’, Psychology Today, 1 August, viewed 29 August 2019, https://www.psychologytoday.com/au/blog/romantically-attached/201608/4-ways-set-and-keep-your-personal-boundar ies.
- CareSearch 2019, Professional Boundaries, CareSearch, viewed 29 August 2019, https://www.caresearch.com.au/caresearch/tabid/2752/Default.aspx.
- Clarke, K 2017, 'Boundaries: Creating a Safe Space to Change', Ausmed, 13 December, viewed 29 August 2019,https://www.ausmed.com/cpd/lecture/workplace-boundaries.
- COAG Health Council 2015, A National Code of Conduct for Health Care Workers, The COAG Health Council, 17 April.
- Hardy, R 2017, ‘Top tips on managing professional boundaries in social work’, Community Care, 19 June, viewed 29 August 2019, https://www.communitycare.co.uk/2017/06/19/top-tips-managing-professional-boundaries-social -work/.
- Mable Technologies Pty Ltd 2015, ‘Whoa! Please mind my boundaries.’, Mable blog, 28 August, viewed 29 August 2019, https://blog.mable.com.au/blog/care-workers/whoa-please-mind-my-boundaries/.
- Relationsh ips Australia n.d., Maintaining Personal and Professional Boundaries, Relationships Australia Victoria, viewed 29 August 2019, https://www.relationshipsvictoria.com.au/resources/tip-sheets/maintaining-personal-and-professi onal-boundaries/.
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