Professional Boundaries in Nursing Practice

This assignment delves into the complexities of professional boundaries in nursing practice. It examines various aspects of ethical dilemmas nurses encounter, such as boundary violations between nurses and patients, the influence of gender on these issues, and the ethical implications of social media use in healthcare. The analysis draws upon relevant codes of ethics and conduct for nurses, scholarly articles discussing factors affecting professional ethics, and guidelines provided by nursing regulatory bodies.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the student:
Name of the University:
Author’s note

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Introduction:
The nurse-client relationship is an important element of nursing practice and a therapeutic
relationship is maintained on the ground of trust, respect and maintaining the boundaries of
professional intimacy. Often the nurses are required to closely interact with patients to identify
their issues and support them during illness. However, as part of ethical code of conduct relevant
to different countries, it is necessary that nurses understand the boundaries that separate
therapeutic and non-professional behavior. Nurse-patient boundary violation is a serious issue,
which harms nurse-client relationship and in this may be seen by behaviors like physical contact,
socialization, intimacy and favoritism with patients (Campbell, Yonge, & Austin, 2016). This
report analyses a scenario of nurse-patient boundary violation in which the Nurse Jackie forms
close attachment with an elderly patient, Mrs. Isobel James and inappropriate judgment of nurse
results in the Mrs. James being found unconscious the next days. The report justifies how nurses
actions is not ethically appropriates and uses different nursing policies and ethical conduct
standards for nurse to explain how following the documents might have protected Jackie from
professional misconduct allegations.
Discussion of the nurse’s action with relevant to different policy documents
The case scenario is about Nurse Jackie, a student nurse on her first clinical placement
who develops a close attachment with Mrs. Isobel, a 97year old patient with several
comorbidities. The nurse took a photo of Mrs. James, posted it on her Facebook page, and
discussed about her condition on Facebook. The next day, Mrs. James presented the nurse with a
perfume and she took it without informing about it to the nurse unit manager. A serious violation
of nursing responsibilities is also witnessed next week when Mrs. James asked the nurse bring

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her a bottle of whisky and she ready did that without thinking about its effect on the health of
Mrs. James. The eventual outcome of such misconduct and violation of nurse-client boundary
was that following morning, Mrs. James was found unconscious. In this case, several
misconducts were seen. Firstly, the Nurse Jackie did not used her professional judgment to
control the boundaries of therapeutic relationship with Mrs. James. Secondly, several forms of
behavior like entering into friendship with patients, socializing with them and discussing them on
Facebook and giving more priority to personal needs of patients than health needs is strictly not
allowed in nursing practice (Zamanzadeh et al., 2014). However, Jackie was involved in all such
cased of ethical misconduct.
Jackie could have safeguarded herself from misconduct allegation had she followed the
guidelines mentioned in the Code of Ethics for Nurses in Australia 2008. This document is
specific for nurses working in Australia and outlines the nurse commitment to uphold the
fundamental rights people receiving care. The value statement 1 of this document defines that the
nurse should values quality nursing care for all people. This means that they should be
accountable for all decision regarding the care of patients and accept moral and ethical
responsibility of promoting safety of patient (Code of Ethics for Nurses in Australia 2008, 2017).
Hence, by adhering to this statement the nurse could have defended Mrs. James wish to have
whisky on grounds of poor health. She could have explained to her about the adverse effect of
whisky on her health and forbidden her to have it now. This could have saved the patients from
harm that had occurred to her and nurse would not be subjected to any ethical actions too.
Krautscheid, (2014) also defines that accountability is fundamental to professional practice and
the nurse should possess behaviors that is in congruence with nursing actions promoting quality
and safety in patients care.

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Nurse Jackie could also have fulfilled her professional responsibilities in care by
following the value statement 7, which is related to nurse commitment to value ethical
management of information. This means all patient’s related information should not be altered in
any way and the information should be managed by not sharing the information without the
consent of the individual or the lawful authorization (Code of Ethics for Nurses in Australia
2008, 2017). Hence, in accordance with this statement, the nurse Jackie’s action of sharing
client’s photo on Facebook and discussing her on Facebook page was not ethically correct.
Jackie should be careful regarding her actions on duty by recalling the value statements of the
Code of Conduct for nurses in Australia. Ethical issues related to social media usage has been
studied a lot and one research argued that patient’s well being and nurse-patient relationship is
jeopardized when nurses engage in inappropriate disclosure of patient information on social
media sites (Denecke et al., 2015). Hence, Jackie’s action of discussing the patient on Facebook
was breach of privacy against patients. In such situation, it is necessary for nurse to follow the
social media policy.
Students nurses like Jackie must also be aware of the Code of Professional Conduct for
Nurses in Australia because Nursing Australia expects the nursing profession to uphold a certain
minimum national standards of conduct. There are a number of ethical conduct statement
outlined in the document and the most relevant statement relevant to safeguarding the Nurse
Jackie from ethical allegations includes statement 1, statement 5, statement 6, statement 9 and
statement 10. For instance, statement 5 advices nurse to use personal and confidential
information of patients for professional use only. Following this statement would have restricted
Jackie from discussing Mrs. James condition on Facebook. Secondly, statement 6 gives the
insight that nurses must provide honest information to patients regarding nursing care and

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treatment procedures (Code of Professional Conduct for Nurses in Australia, 2017). Hence, when
Mrs. James had asked the nurse to bring her whisky, the nurse could have defended by
explaining the patient about the risk of alcohol on her health. Barne et al., (2010) has explained
that older adults may experience adverse health effects even when consuming moderate amount
of alcohols. This is because the effect of certain dose of alcohol increases due to the age
associated morbidity and alcohol use in older adults. Hence, nurse’s action to educate Mrs.
James about this effect was important instead to giving her whisky and causing risk to her health.
The Registered nurse standards for practice 2016 is also an important policy document
given by the Nursing and Midwifery Board of Australia (NMBA) to maintain the requirements
for professional and safe nursing practice in Australia. There are seven key standards of this
policy which includes critical reflection in nursing practice, getting involved in therapeutic and
professional relationship, updating the skills for practice, conducting detailed assessment,
developing nursing care plan, delivering safe and responsive care and evaluating outcome to
inform practice (Registered nurse standards for practice 2017). In the context of the Nurse
Jackie, it was important for her to comply with legislations and policies while making any
decisions in accordance with standard 1. For instance, when she was engaged in a therapeutic
relationship with patients, she should have understood her professional boundaries in care and
tried not to go outside of it to exchanges gifts and fulfill personal wishes of patient. Maintaining
professional boundary is also important because such violations lead to complaints about
professional misconduct. She could have tackled the situation by taking advice from her nurse
unit manager. Such form of professional mentoring or seeking advices from seniors would have
prevented her from turning small boundary violations to a major boundary violations (Chiarella
& Adrian, 2014). Poor attachment to professional ethics was the main reason for the issue in case

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of the Nurse Jackie and she should be serious about applying ethical knowledge in workplace
(Dehghani, Mosalanejad, & Dehghan-Nayeri, 2015).
Having knowledge about standard 2 related to engaging in therapeutic and professional
relationship would also have safeguarded the nurse Jackie from ethical allegations. As part of
nursing duty, the most important actions for Jackie was to maintain boundaries between
professional and personal relationship (Registered nurse standards for practice 2017). Instead of
changing the professional relationship into a friendly relationship, she could have given support
to patient in a professional way. While interacting with Mrs. James, she needed to have non-
judgmental attitude. Showing interest in patient during daily nursing care is good, but taking it to
personal level by taking photos and discussing about patients with others is not congruence to
professional responsibility of nurses. Other strategies that Jackie could have employed to
maintain professional boundaries include establishing clear boundaries between her and others
and developing self-awareness regarding her response to the needs of patients (Langendyk et al.,
2015). Although people from different culture and ethnic groups will have different rules for
interactions, however Jackie will have to set her own professional rules for interaction to
safeguard herself from professional misconduct and allegation.
As the scenario of the Nurse Jackie and patient Mrs. James is clearly a case of boundary
violation in nursing practice, the Nurse’s guide to professional boundaries would have been an
important document for her to protect herself from misconduct allegations. It defines therapeutic
relationship as a goal oriented and patient centered relationship where balance is maintained
between nurse’s power and patient’s vulnerability. The nurse Jackie violated the space between
her power and Mrs. James vulnerability by not protecting her from consuming whisky. As a
nurse on duty for Mrs. James, Jackie had all the power to control the inappropriate demand of

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patients on grounds of health risk. However, instead of exercising her power to protect the
patient from harm, Jackie herself was involved in causing harm to patient by building personal
relationship with her. The Nurse’s guide to professional boundaries also explains that use of
social media by nurses blurs the line between professional and personal lives. Even if a nurse
comments about a person on social media from home, then also it is a case of boundary
violation. Hence, Jackie could have conceptualized her relationship with Jackie on the continuum
of professional behavior. The continuum of professional behavior framework defines over
involvement by behavior of boundary crossing and professional misconduct. Secondly, under
involvement is defined by disinterest and neglect of patient (A Nurse’s Guide to Professional
Boundaries 2017). Therefore, Jackie could have used this frame to determine if she is over
involved or under involved in patient’s care and correct her actions accordingly. O’Keeffe et al.,
(2015) proposes nurse to adapt a flexible boundary or risk assessment to manage the relationship
with patient.
Social media is a widely used tool used extensively by people in their daily lives. By the
use of social medias, nurses and other professionals remain connected with their families and
friends. However, nurses need to have knowledge regarding the appropriate online behavior
needed by them and its implication for professional life. The social media policy 2008 informs
that nurses must be aware of organizational policies related to social media use. Secondly, while
uploading or posting any comment on social media, it is very important for them to analyze
whether it is offensive or not. According to the social media policy, there are two obligations for
nurses. Firstly, have professional obligation in relation to confidentiality of patients when using
social media. Jackie uploaded Mrs. James photo on social media and made comments about her
too and according to the policy, posting unauthorized photos of patients is a breach of patient’s

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privacy and confidentiality. Secondly, there are legal restrictions to any form of advertising by
means of social media (Nursing and Midwifery Board of Australia - Social media policy,
2017). Hence, if the Nurse Jackie was aware about this policy, she could have avoided posting
Mrs. James photo and save herself from breach of professional conduct.
Conclusion:
The report analyzed the case of the Nurse Jackie who was involved in serious breach of
conduct by getting involved in a close relationship with patient and causing harm to patient in the
process. The review of different policy documents like code of ethics for nurses in Australia,
Code of Professional Conduct for Nurses, the Registered Nurse Standards for Practice, the nurse
guide to professional boundaries and the social media policy gave the idea regarding several
breaches done by patients. However, with support from this policy document, it was also
explained regarding how knowledge about these guideline could have saved Jackie from
misconduct allegation. In the future, it is necessary that nurses understands and closely apply
these policies to maintain professional standards of practice.

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Reference
A Nurse’s Guide to Professional Boundaries. (2017). Retrieved 19 September 2017, from
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Barnes, A. J., Moore, A. A., Xu, H., Ang, A., Tallen, L., Mirkin, M., & Ettner, S. L. (2010).
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