By Megan Murdock Krischke, contributor
October 1, 2013 - The relationship between nurses and patients can be complex. A nurse is called to provide focused attention and care to a patient. Nurses are often present as difficult decisions are made, through family conflicts and at the bedside when a patient dies. Some nurses will work with a patient for years, dealing with a chronic health issue, and others enter patients’ homes in order to provide care.
In the midst of these very personal and often emotionally intense situations, it can be difficult to gauge an appropriate level of emotional involvement and to keep clear, professional boundaries.
In order to maintain professional boundaries, Dana Nelson-Peterson, DNP, urges nurses not to connect with patients via social media.
“Nurses are so privileged to enter into a relationship with patients during the most critical and fragile times of a patient’s life--those are intimate moments and the line of professional and personal boundaries can be blurred.” began Dana Nelson-Peterson, DNP, MN, RN, administrative director for ambulatory care nursing services at Virginia Mason Medical Center in Seattle, Wash.
“When you engage in both personal and patient relationships, many of the same characteristics mark those relationships--like being emotionally present, listening, conveying empathy and availability,” she continued. “The key difference is that with patients there is a timeline on the relationship and a specific setting where that relationship happens.”
Some patients are certainly memorable and leave a mark on a nurse’s heart.
In a 2012 study published in Perspectives in Biology and Medicine, titled “Reconsidering Detached Concern: The Case of Intensive-Care Nurses,” Wendy Cadge, PhD, and Clare Hammonds, PhD(c), MS, found that the patients nurses most remembered and felt most attached to fell into one of four categories: (1) a “first;” (2) a surprise; (3) a long-term of care; or (4) a death.
“Nurses tend to become closer with patients they had time to get to know well, either over one hospitalization or a series of hospitalizations,” remarked Cadge, associate professor of sociology at Brandeis University. “Patients and families who invest in caring for nurses are also a part of this, as real relationships could be built.”
“All nurses can tell you stories of memorable patients that touched a part of their heart and of moments that were so poignant that it marked their practice. Nurses also experience things that are incredibly traumatic to them in the course of delivering care. You remember things,” remarked Nelson-Peterson.
“Nurses who bring an open heart to the care they provide are left with little footprints on their hearts, and that is fine,” she continued. “But you want to be sure to protect both the patient’s privacy and your personal privacy.”
Nelson-Peterson notes that patients will often try to find a connection point with their nurse; they might ask, for instance, if you have children. She encourages nurses to think through what they will and won’t share with patients.
In order to maintain appropriate boundaries in the nurse–patient relationship, consider these guidelines provided by Nelson-Peterson and Cadge:
• Don’t divulge your personal cell phone number
• Don’t make or accept friend requests with patients on Facebook
• Don’t look through a patient’s chart for personal information that is not relevant to the care you are providing
• Provide closure for the patient--let them know that this may be the last time you see them and thank them for letting you care for them.
• Turn off work computers and phones at the end of the day and engage in life outside of the professional arena.
The National Council of State Boards of Nursing offers additional information in their brochure, “A Nurse’s Guide to Professional Boundaries.” According to the publication, the following situations indicate that an important boundary is being crossed or violated in a nurse–patient relationship:
• Excessive disclosure--the nurse shares inappropriate personal information with the patient;
• Secretive behavior--the nurse “keeps secrets” with the patient;
• “Super-nurse” mentality--the nurse exhibits behaviors that indicate a belief that only he or she can meet the patient’s needs;
• Singling out--the nurse pays special attention to the patient, or vice versa.
• Flirtations--the patient or nurse communicates in a flirtatious way with the other.
If a boundary is crossed, or you suspect a boundary was crossed--by you, your patient or another nurse--it is important to discuss the issue with a nurse manager to insure that the incident is handled appropriately.
“Some indications that you have become too emotionally involved are when you start thinking of that patient over and over, even when you are away from work. Or you start wondering about how you might contact them, or drive by their residence on the chance you might see them,” explained Nelson-Peterson. “These things happen more frequently than we really understand.”
In order to mitigate these experiences, she suggests taking the time to journal about your experience with the patient, employ reflective practices or share the experience with a trusted peer.
“Getting some exercise can provide a physical release for all the emotions involved with patient care,” remarked Nelson-Peterson. “It gives you a space to turn off the reel that goes through your mind while you are at work.
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