Observations on boundaries between Nurses and Patients (Psych)

toomuchbaloney · Oct 3, 2023

Hugging is awkward, often initiated by family or patients. Environment of care matters, I think.

Hoosier_RN, MSN · Oct 3, 2023

hppygr8ful said:

As many of you know I work in adolescent psych. I been doing this job off and on for about 20 years and believe I'm pretty good at it. I have noticed a trend lately that among mental health workers and younger nurses hug the patients. I mentioned that this was against policy and also a breach of professional boundaries. I am not trying to get anyone in trouble just to educate my fellow staff about the danger of this and how it can effect their professional future. Am I just old nd out of the loop?

Hppy

Not at all! It's going on in many settings, most of which I feel would be inappropriate, with some exceptions. I feel that psych would be the last place that this boundary should be crossed. If thr family or patient initiates in the right circumstance, no harm. But staff/provider initiated is creepy

JKL33 · Oct 3, 2023

hppygr8ful said:

I have noticed a trend lately that among mental health workers and younger nurses hug the patients.

Personal opinion based on experiences with people in general and understanding of nursing:

I say this is a short-cut in a few different ways:

1. It has the pretense of letting everyone feel good in the moment rather than continuing to plod through on a more therapeutic path that doesn't produce frequent in-the-moment results

2. Gives the appearance of being a caring nurse when more therapeutic skills are lacking/still being developed

3. People/patients do gauge some of their satisfaction (with services received) based on things like emotional soothing and the more superficial aspects of showing care/caring. Hugging them is a way of evoking feelings of being cared for, or at least giving the pretense of being cared for, (which I don't condone in the setting you're in)

4. It seems like lots of people/society is getting quite used to instant gratification and when things are going to be much harder than that it just seems unacceptable

I recall an orientee of mine hugging/patting/soothing/sitting on the bed with a suicidal patient in the ED and telling them "we care about you very much" while doing all of the above.

Now I understand what that orientee was trying to do, but they were not thinking of the patient or reality: For starters, our time with this person is limited to a matter of minutes, then we will never see them again. So it is immediately trite/hollow/just another disappointment when someone temporary flits through to say how much we care. Rather than conveying "you're safe here and we are working to get help for you...." (or some such), we immediately become just more people who disappoint and whose words are out of touch with reality.

*If anything, your coworkers might not have thought through the bigger picture and the downsides of what they are doing (which can be substantial for the patient). Maybe you can have some down-time opprtunity and bring these up for conversation.

Good luck

vampiregirl, BSN, RN · Oct 6, 2023

@hppygr8ful - Nope, I don't think you are old and out of the loop. Especially in the psych setting, professional boundaries are crucial as is following policies. Consistency amount staff is also crucial to maintain a therapeutic milieu in that environment.

While we aren't currently in the throws of a pandemic, there is a rise in RSV and influenza in some areas; infection control is also a consideration.

I'm not in any way diminishing the importance of physical touch. And I'm also not ignoring the current social norms of touch (and social distance).

I completely support your education approach - that's my preferred approach as well in comparative instances. Staff may not be aware of the implications of touch, specifically in this professional setting and how touch could potentially be misconstrued (intentional or not). Modeling and recommending appropriately/ alternative ways to convey reassurance, support, presence and other emotions that the staff are attempting to communicate via hugging etc. Treating others respectfully, active listening/ undivided attention, validating emotions, eye contact (as appropriate), and recognizing/ supporting appropriate coping strategies are just a few of the ways provide therapeutic support in this setting.

Career Columnist / Author · Oct 11, 2023

I think often hugging a patient in such circumstances is more about the low-level anxiety and discomfort of the staff/provider, and not about the patient.

FolksBtrippin, BSN, RN · Oct 12, 2023

I think a hug should generally not be initiated by the healthcare worker in the inpatient setting. In a home setting or long term care you sometimes develop a relationship that warrants that.

I have worked in inpatient adolescent psych and I think hugs are rarely okay in that setting. Adolescents do not necessarily have the experience and emotional maturity to have their own boundaries so we must be much more careful. Also adolescents in inpatient psych are a particularly vulnerable population. It is easy for misunderstandings to occur.

However, physical touch is a basic human need and I don't believe in no touching rules on psych units. I offer a fist bump when I feel a hug is inappropriate and a patient is asking for physical touch.

I think it is usually a bad idea to police coworker behavior though. Unless you feel there is a specific situation that needs to be addressed for patient well being, I would leave it alone.