Boundary Violation in Mental Health

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Boundary Violation in Mental Health
Boundary Violation in Mental Health
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Boundary Violation in Mental Health
Boundary Violation in the mental health nurse-patient relationship
The therapeutic nurse-patient relationship is a helping relationship that is built upon
mutual trust and respect. The nurse has to build hope and faith in the patient, nurturing dignity in
the nursing profession by using the skills and knowledge to address the needs of the patient.
(Peternelj‐Taylor, and Yonge, 2003, p.58) This should be done with regard to the patient’s
spiritual, emotional and physical needs and preferences. A healthy nurse-patient relation adds to
satisfaction to the patient medical experience, it also capacitates the nurse to offer customized
care plan. Therapeutic nurse-patient relations is key to positive psychiatric mental health nursing
practice, Mental health nurses are obligated to uphold professional boundaries with mental health
patients. (Baca, 2011, p.199) However, the definition of professional boundaries is difficult to
attain and is subject to the individual’s interpretation.
The lack of a clear definition may impair mental health nurses judgment and
understanding of mental health professional boundaries which may lead to a boundary violation.
Cases of unprofessional practices and boundary violations have been on the rise. The number of
Registered Nurses (RNs) being reported and disciplined on the event of patient exploitation
while administering medical health care has increased. Despite a zero-tolerance policy to sexual
tendencies with patients, there are still incidences tabled at the Board of Nursing which come
from various sources including family, employers, patients, and health care professionals. The
specific focus on this topic of boundary violation in the mental health nurse-patient relationship
is in providing a clearer guide to the professional boundaries with perspectives of psychiatric
mental health nursing.

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Boundary Violation in Mental Health
Professional boundaries in mental health are ambiguous since there are grey areas in
existence. The boundaries are to be put into perspective by the prevailing clinical setting and
some factors have to be taken into consideration. (Valente, 2017, p.48) These boundaries can be
informed by the patient’s age, they keep on changing throughout the mental health nurses career
and definitely, they are unique to mental health.
The professional boundary is acknowledged to be the gap between the power of the nurse
and the patient’s vulnerability. This is according to the National Council of States Boards of
Nursing (NCSBN). However setting boundaries is a complex task, therefore it is advised in the
Nurses Code of Ethics that ‘When acting within one's role as a professional, the nurse should
recognize and keep boundaries that establish a limit to personal relationships. This code of ethics
is important in sustaining the integrity of relations in the mental health nursing setting. Handling
mental health patients comes along with overdependence of vulnerable mentally ill patients
(emotionally or even physically with some requiring help with daily activities of living), the
development of trust and familiarity, the empathetic pull to offer aid, emotional luggage of the
patient, difficulties in medication administration to the patient and lack of proper understanding
of the professional boundary nursing guide.
Registered Nurses of both genders are vulnerable to acting on their emotions during
nurse-client relations which may lead to inaccurate judgment. (Campbell, Yonge, and Austin,
2016, p.37) This happens when inappropriate physical touch or unprofessional talk is initiated by
either party. Boundaries become vague. Culture, age, and ethnicity may influence how the nurse
or patients perceive certain behaviors and conversations; therefore it is highly recommended that
nurses should have a strong understanding of their environment.

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Boundary Violation in Mental Health
For healthy mental clinical practices, both the nurse and the patient ought to be aware of
the clarity between boundary crossing, boundary violation, and sexual misconduct. In our
context, special attention shall be accorded to boundary violation. Boundary crossing is normally
defiance of a set of therapeutic standards. It is normally harmless and not exploitative; in some
cases, it may be convenient for the performance of the therapy. A boundary violation happens
when the nurse crosses therapeutic boundaries set for reasons that are not related to the
administration of therapy to the patient. An instance of boundary crossing is when a nurse
discloses the client's personal information, including It, is harmful and exploitative to the patient.
(Radden, 2013, p.287) It may result in more serious misconduct. According to NCSBN, sexual
abuse is considered as a boundary violation on its extremity.
All therapists ought to consider the fact that there exists a differential state of power in
the process of psychotherapy. (Adshead, 2012, p.29) They are paid for their services offered
which institutes a fiduciary relationship between the nurse and the patient. Sexual boundary
violations have emerged with mostly women affected, who have been empowered to speak up
against the injustice. Other non-sexual boundary violations involve a change of meeting place
and time, financial engagements with the client, social relations inappropriate for therapeutic-
patient relations, interference of length of appointments with selfish interests, breach of clients
confidentiality, too much sharing of self by the therapist and reception of highly expensive gifts
from the client. Psychotherapists in their interactions with the patients have a set of the human
frame to guide them as well. They are required to be helpful and not judgmental and
understanding but not critical.
There is a controversy revolving around boundary violation. Some psychotherapists
misinterpret the boundary to mean that one has to be removed, remote and rigid in order for the