Am I the only one who thinks this is wildly inappropriate?

elkpark · Jun 1, 2018

You're not the only one. I also think it's wildly inappropriate, whether you're talking about substance use, marital issues, or anything else. I'm an old fogey now and I know lots of people (inc. lots of people who post here) think that the traditional professional boundaries in nursing (which are shared by most of the helping professions) are silly and unnecessary, but I've not been convinced that there is any benefit to abandoning, or even weakening, them.

All of the examples of teaching/coaching the author of the article makes could be shared just as easily be communicated without the personal discosure. Instead of saying, "I take my niacin with applesauce to avoid flushing," it's just as easy to say, "Some people find taking niacin with applesauce prevents flushing." What's the difference between saying, "I've been through some rough times in my life and counseling has been really helpful" and "I've known people going through hard times in their lives who have found counseling really helpful"?

I've spent my career in psych nursing. It was impressed upon me in my original nursing program a kazillion years ago that, any time you engage in any personal disclosure, the conversation quickly stops being about the client and becomes about you, which is not therapeutic. The times that I've seen other nurses violate that boundary, that has been the result, whether is a small or large way. I'm surprised that the ANA magazine published the article.

allnurses Guide · Jun 1, 2018

The passage in question is a editorial not an article, thus reflecting a personal opinion. We all know opinions are like noses, because everybody has one. I recovery journey is pretty much an open book but I can almost certainly say that on the near fatal day when I overdosed if the doctor who treated me had not self disclosed - I would not be here today. Although I saw him at meetings we never spoke again.

Still I don't self disclose to patients as I want them focused on their own journey. I do tell them about how AA can be life changing for some but that's abput as far as it goes.

Hppy

catsmeow1972, BSN, RN · Jun 2, 2018

I do believe that there still needs to be some professional distance between nurse and patient. Just as between teacher and student, we are not friends. That being said, there are ways to word things so that the point is made without it being terribly clear that we are self disclosing. Sometimes however, in hppy's case it can be useful and appropriate. In the right place and time, yes. It is a judgement call that can only be made by the person. I personally would not make a habit of talking too much about myself.

dirtyhippiegirl, BSN, RN · Jun 2, 2018

I have a long history of mental illness and psych hospitalizations etc. I would say that as a patient, the most meaningful interactions I have had with the nurses caring for me came from (limited) self-disclosure on their part. It provided a sort of hope and inspiration that I needed at the time. Mental illness and addiction can be very isolating. One nurse, in particular, probably averted a serious suicide attempt that I had planned by sharing. She basically said something like "everyone gets sad from time to time and some people think about suicide. I thought about suicide once and went through a really dark time, but I got better. I know you can too."

I would never self-disclose just because you never know how your patient is going to take it. But thanks for saving my life, nurse Anne!

Long Term Care Columnist / Guide · Jun 2, 2018

From a patient's perspective:

I was hospitalized once for suicidal ideation/intent, and of all the nurses who cared for me I remember one in particular. She was the one who sat down with me 1:1 and talked about her experience with severe depression. It helped me so much to know I wasn't alone and that life would get better for me one day. Her compassion left an impression on me that I've never forgotten, even though I remember very little of my hospitalization.

As a nurse, I would be very hesitant to disclose my own psychiatric history because there's always the chance that a patient may use the information to manipulate me or throw it in my face. But if it's done right, it can make a difference.

Have Nurse, ADN, RN · Jun 2, 2018

You're not the only one. I also think it's wildly inappropriate, whether you're talking about substance use, marital issues, or anything else. I'm an old fogey now and I know lots of people (inc. lots of people who post here) think that the traditional professional boundaries in nursing (which are shared by most of the helping professions) are silly and unnecessary, but I've not been convinced that there is any benefit to abandoning, or even weakening, them.
All of the examples of teaching/coaching the author of the article makes could be shared just as easily be communicated without the personal discosure. Instead of saying, "I take my niacin with applesauce to avoid flushing," it's just as easy to say, "Some people find taking niacin with applesauce prevents flushing." What's the difference between saying, "I've been through some rough times in my life and counseling has been really helpful" and "I've known people going through hard times in their lives who have found counseling really helpful"?
I've spent my career in psych nursing. It was impressed upon me in my original nursing program a kazillion years ago that, any time you engage in any personal disclosure, the conversation quickly stops being about the client and becomes about you, which is not therapeutic. The times that I've seen other nurses violate that boundary, that has been the result, whether is a small or large way. I'm surprised that the ANA magazine published the article.

I don't know. For some topics that certainly may be true. But nurses are also taught self disclosure in their Communications Class, at least I was, when I became both L.P.N. as well as a R.N. There's more than one way to look at it, that's all.

It has been my experience, that when sharing something with a patient, that person feels less alone. Granted, it wasn't in Psyche, it was on a Med/Surg floor. Many Med/Surg patients also deal with mental health issues, and sometimes their hospitalization can make those issues loom more than when they are at home.

Still, a gentle self disclosure can encourage, that's all. Thank you.

Ddestiny, BSN, RN · Jun 3, 2018

As in all things with patients, I think it depends upon the goal of the self-disclosure and whether or not it's an appropriate patient with which to self-disclose. If the goal of your statements is to turn the attention on you ("oh you're hurting after surgery, I know ALL about that. My hysterectomy was awful, the worse pain I've ever been in, can you imagine?! It was blah blah blah") then absolutely no, that's not your role. If your goal is to show that not only do you have academic knowledge but you have personal experience (which, for some people, means more) then it can be appropriate ("The Fentanyl is getting your pain down a bit from your hysterectomy, but the best thing I did after mine was to use a heating pad"). I think this is not really all that far off from saying "I've had SO many patients that get more relief from their heating pad than from the pain medicine after their hysterectomy, why don't I go get you one?"). The goal of that sentence is not to talk about all of the other patients, it's just giving maybe some added weight to the education you're providing.

With more personal things, I think the same is true but then you also have to consider if it's appropriate for that specific patient. If you have someone that's manipulative or that might have a negative perception change because of it ("I know I'm here with my anxiety but I don't want a crazy nurse") then avoid self-disclosure.

Since starting to work in critical care last year I've had a few patients that have attempted suicide. I have a very distant history of suicide attempt, depression and a couple hospitalizations. With one patient so far I've felt it appropriate to self-disclose in a 2-3 sentence blurb about waking up after a suicide attempt and still wanting to die, but having a much better life with the appropriate treatment. I felt it important to give this information because my patient had 2-3 decades of depression in his history and was feeling hopeless after one of several suicide attempts. No cluster B symptoms. I never suffered any ramifications from my statement and the patient seemed to appreciate, if nothing else, that I wasn't judging him and/or avoiding the topic.

I think I would feel uncomfortable about going into any kind of specifics about old treatment so something about the AA meetings comment does make me feel a little uneasy. On the other hand, I have a friend that's an alcoholic and I've gone to several AA meetings as a support. The knowledge of how the meetings worked proved useful with a few patients. Whenever I told them about it I mentioned I went as a support for a friend. Whether or not that truth was believed, who's to say.

KelRN215, BSN, RN · Jun 3, 2018

I am a brain tumor survivor who had severe seizures as the result of said tumor and I spent the first 5 years of my career in pediatric neurology/neurosurgery. I RARELY talked about it with patients. I do remember one time, a classmate of mine who worked in one of our ICUs, transferred a patient who I later took care of to my floor. The child's mother told me that my former classmate had told her about me- someone she went to school with was a nurse on the floor who had a brain tumor. Then this child's mother wanted to know all about my journey- which was going to be vastly different than her daughter's. Her daughter had a high grade tumor that was going to require surgery, radiation and chemotherapy. I had a low grade tumor that was fully resected and didn't require chemo or radiation.

At my last job, I did have a number of college aged CF patients who had to medically withdraw from school for a semester for various reasons. I did sometimes reassure those kids that I, too, had to take a medical LOA in college and that I went back, graduated and in the long run, it hasn't made a difference that it took me a year longer to graduate from college. But that's all I told them.

There was another time when I was doing a charity walk for the largest cancer hospital in my state and ran into the mother of one of my ALL patients from when I was a visiting nurse. My mother was doing the walk with me. I had taken care of this child for 2 years, visited her house 1-2x/week for the duration of her treatment and never talked about myself because it wasn't relevant to what she was going through. At some point in our conversation, my mom says to my patient's mom "well when Kel had her brain tumor..." and my patient's mom is just looking at me like "uhhh?"

I generally like to keep my personal and professional lives very separate and don't even share this information with my colleagues anymore. At my last job, I went almost 3 years without telling anyone. Then, I was looking to change jobs earlier this year in large part because I could no longer sustain having a health insurance plan with a $2000 deductible. I had interviewed for many jobs and knew I was close to getting an offer. I woke up on the morning of the 16th anniversary of my diagnosis and said "if I get a job offer today, it's the universe telling me it's the right job to take." Later that morning, my current job called with an offer that would give me a phenomenally better health insurance plan with no deductible. When I told the colleagues I'd work the closest with that I was resigning, I did then tell them that it was a significant day in my life and that I knew it was the right decision for that reason.

Eris Discordia BSN, RN · Jun 3, 2018

I've self disclosed once...and I still do not know if it was the right thing to do. I *think* it was...but I still question my decision to this day.

I was/am in inpatient substance abuse detox...of course, if anyone knows my story, I ended up having to leave my specialty of 16 years after being reported to the BON and entering monitoring. Now, at this point, I have dropped enough restrictions that I could go back, but I'm not at this time. Anyway...

I happened to be taking care of a very likable woman who had her nursing license suspended due to heroin addiction. She was detoxing on my unit. And one day, emotionally, she just hit rock bottom. I mean, bone-wrenching heaves and sobs, hyperventilating...the weight and full impact of what had happened just hit her like a ton of bricks. I pulled her into the case managers' office to help her de-escalate.

She was overwhelmed because she doubted her ability to stay clean without methadone or suboxone, which she had to do to enter monitoring. She was overwhelmed because she finally accepted that she was going to have to change "faces and places" to stay clean. And you know it, it's hard to cut ties with folks, even when they aren't any good for you. She had to set up long term rehab in another city. She was pondering moving straight up. She had so very many decisions on her plate that making even one was sending her into a tizzy. She confessed to now being passively suicidal. She fantasized about getting her license back but shame drove her to thinking she was too stupid and unworthy to ever succeed at that. And if her dream was impossible, what was the point of living? Or so she thought.

So I self disclosed some. Not every nitty gritty detail. I wasn't looking for her to be in awe of me...or to pity me. I'm not any more special than the next junkie. I just wanted her to know that yes, it's hard. It's expensive. I acknowledged that there are barriers. But in my own ways I was just as screwed up as her...but I had reclaimed my license and was able to find a job as a nurse.

I did this because she had never encountered a nurse who had been an addict and successfully recovered and worked again. She had only seen those who had not...so I wasn't trying to give her false hope, but rather show her that there is another side to the coin.

She hugged me, she cried. I don't claim to have fixed her addiction. Or her suicidality at the moment. But I do think I gave her a teeny bit of something she had none of before...hope that she could get clean and practice again, someday.

She ended up signing up with a 90 day program very far from home. She sent me a card at work, 6 months later, telling me she was still clean. She was living in that city now, far away from her dealers and usual hangouts. And she was getting ready to start working with the BON.

I don't know what happened to her...but in that moment seeing that card, I felt at least a little bit better that my self disclosure was the right move in that scenario.

That being said, I've never felt the need to self-disclose since.

Rainbow_RN, BSN, RN · Jun 6, 2018

Thanks everybody for weighing in. I do recognize that self-disclosure can have value, but I think I'm just afraid of any and all of it being read as me trying to bring the focus on myself. I'm also a very private person. I just know that anonymity seems like a serious matter (attending a meeting was 'homework' for one of my classes in nursing school--to see how it was run). And I wondered if breaking one's own anonymity would cause more harm than good. So I came here to see what nurses who had this experience, or similar experience, thought.

allnurses Guide · Jun 7, 2018

Thanks everybody for weighing in. I do recognize that self-disclosure can have value, but I think I'm just afraid of any and all of it being read as me trying to bring the focus on myself. I'm also a very private person. I just know that anonymity seems like a serious matter (attending a meeting was 'homework' for one of my classes in nursing school--to see how it was run). And I wondered if breaking one's own anonymity would cause more harm than good. So I came here to see what nurses who had this experience, or similar experience, thought.

Anonimity means we don't talk about or friends in recovery outside the rooms. Individuals can choose tp disclose or not as long as their disclosure does not bresk another's anonimity. As far as attending a meeting for research you are fine as long as it was listed as an open meeting,

Hppy