Professional Boundaries: Is there such a thing as 'too close'?

The emotional boundary I establish with my patient is an aspect of care I provide. How much involvement is too much? Incidentally, some nurses don't care about how involved they become with their patients on an emotional level.

This is very short-sighted and has led to difficulties effecting both the nurse's professional colleagues, the patient and patient's family, and often the institution. There are other times that involvement with a patient and the patient's family is close yet remains professional. Following is a wonderful experience a nurse had while maintaining a delicate balance between over-involvement and allowing for a level of open and emotional connections and relationships.

The patient had been hospitalized on several occasions to receive treatment for cancer. This particular nurse would provide care for this patient. Over time a friendly relationship with the patient and the patient's spouse was nurtured. The relationship was essentially during times of admissions to the hospital. There were no dinner invitations to the home or any related overtures. Finally on the last hospital admission for this patient, this same nurse cared for the patient and the patient died during this admission.

Through the tears and expressions of love and comfort the wife made a strange request her husband had. Knowing that in addition to being a registered nurse, this nurse was also a licensed clergy-person and the patient had asked that this nurse conduct the funeral. This request was accepted and the funeral service, grave-side ceremony and home gathering to follow were filled with many memories and stories about this wonderful person who just passed.

One very poignant moment was when the wife shared, upon recollection, words spoken by the nurse during the service. The statement in the service concerned a comment about the impossibility of filling the shoes of the departed loved one. Unbeknownst to the nurse speaker this comment set off some low level humor and snickering during the service. It was related later by the wife that this was actually a very true statement as her husband had exceptionally large feet. This statement was comforting and healing to the family. This is the kind of serendipitous experience that can be had by a nurse and patient when appropriate judgment is used when forming professional boundaries.

Both the Nightingale Pledge and the American Nurses Association (ANA) address the responsibility nurses have for safe-guarding this trust with patients (Holder, K. V., & Schenthal, S. J., 2007). Therefore nurses must view gestures from patients like gifts, special attention, or physical touch with extreme caution and good judgment. It is wise for nurses to establish collegiality that will protect from accusation and misinterpretations (Holder, K. V., & Schenthal, S. J.). Holder and Schenthal recommend establishing an ongoing dialogue helping nurses to understand implications of nurse-patient relationships and boundary issues. While nurses must not be overly paranoid regarding relating with patients, they must exercise good judgement realizing a caring and helpful attitude is the overriding motivation for patient care.

Reference:

Holder, K. V., & Schenthal, S. J., (February 2007). Watch your step: Nursing and professional boundaries. Nursing Management. Retrieved from: nursingmanagement.com.