Ethical Boundaries and Practice: A Deep Dive into Healthcare Ethics

This essay delves into the critical aspects of ethical boundaries and practices within healthcare, specifically focusing on the challenges faced by mental health professionals. The student explores the complexities of maintaining professional boundaries, including the ethical dilemmas arising from dual relationships and boundary crossings. The assignment provides criteria for understanding ethical limits, such as avoiding personal attachments and maintaining patient confidentiality. It examines scenarios involving physical attraction and the ethical implications of touch, emphasizing the importance of therapeutic intent. The student reflects on their learning, highlighting the significance of cultural competence and the balance between over-involvement and under-involvement in care. The essay underscores the importance of therapeutic relationships and provides a comprehensive understanding of ethical considerations in mental health practice, supported by relevant references.

Running head: ETHICAL BOUNDARIES AND PRACTICE
Ethical boundaries and practice
Name of the student:
Name of the University:
Author’s note

1ETHICAL BOUNDARIES AND PRACTICE
Section 1: Boundary issues and dual relationship
Part A
One of the most important ethical dilemmas experienced by mental health professional is
to maintain appropriate professional boundary with patients. During the care of mentally ill
patients, nurses often need to give emotional comfort to patients. However, understanding and
maintaining professional relationship with patient is necessary to provide ethically safe care
(Ehrlich et al., 2014). The criteria to understand ethical boundary crossing limits include the
following:
 Ensuring the dignity and respect of patient
 Staying away from any personal attachment or communication with patients outside of
shift
 Avoiding exchange of gifts
 Treating personal information of patient as confidential
 Engage in professional way of touching patients during care
 Abstain from dual relationship (Gabbard, 2016).
If I came across a patient who is physically attracted towards me, then I would follow the
criteria of abstaining from dual relationship to maintain professional boundary. Although it will
be a complex situation, my strategy will be to engage in conversation that is related to health care
needs of patients and avoiding any personal communication with patient.
Any boundary crossing that is for the purpose of achieving positive health outcome will be
ethical action for me. For example, many patients requiring behavioral therapy endorse walking

2ETHICAL BOUNDARIES AND PRACTICE
with clients to know their issues. Hence, this is safe and ethical boundary crossing because the
activity is done to get information about patients that would facilitate identify client issues and
planning care for them.
Part B
1. The ethical issues surrounding dual relationship does not change on the basis of period of
termination of service. Hence, a mental health care professional cannot initiate a dual
relationship after passing certain time in service. This is extremely important as long as
mental health care professional is part of the mental health care service (Manfrin-Ledet,
Porche & Eymard, 2015).
2. After the termination of service, there is a responsibility for health care professionals to
maintain confidentiality of client information. However, they do not have any other
ethical obligations in relation to dual relationship, involvement in financial transactions
and extending time beyond agreed time of engagement with client.
3. In mental health care setting, there is one patient with mood disorder and there is another
medically non-compliant client with major depression receiving cognitive behavioral
therapy. In case of the first patient, walking with them and touching them to provide
physical support is unethical because inappropriate touch without any medical purpose is
prohibited according to ethics of professional boundary crossing. Touching may also
increase frustration and violence in such patients. For the second patient, providing to
comfort to patient by patting or touching hand is ethical because it is part of the
counseling process and such behavior helps people to freely express their issues during
the counseling process. However, the touch should be comforting and warm for patients
instead of invasive and violating.

3ETHICAL BOUNDARIES AND PRACTICE
Section 2:
The most important development about ethical practice that I have learned so far in the
course is that I am now aware about the ethical criteria to maintain and manage boundary
violation issues in health care practice. With this knowledge, I will be more cautious in handling
clients with complex illness. The course has also made me aware about the complexities
surrounding boundary crossing. For example, I have learned that in some situation, the boundary
crossing is ethical whereas in other situation, boundary is strictly violating ethical practice.
However, I am now aware about the difference in situation or critical point where engaging in
close relationship such as walking or visiting them is beneficial. These situations can be analyzed
by critically thinking whether the action is done for the therapeutic benefit of patient or not (Blair
et al., 2016). Hence, behaviors like walking with patient or touching them will be acceptable
only when there is a clearly identified therapeutic need for such behavior.
I have also learnt that in fear of any boundary violation issues, many mental health care
staffs are under involved in care. This results in neglect of patients and poor satisfaction with
care (Chiarella & Adrian, 2014). In the future, I will ensure that I keep my professional action
within therapeutic relationship limits so that it neither leads to over involvement or under
involvement in care. Campbell, Yonge & Austin, (2016) has also emphasized that therapeutic
relationship is essential in psychotherapy to alleviate symptoms and foster character change in a
client. However, while engaging in activities of hand shake or touch with patients, it is necessary
to understand the complex relationship with culture, values and ethics in mental health care.
Hence, for me developing cultural competence will also be important to manage therapeutic
boundary, confidentiality and informed consent related issues in mental health care.

4ETHICAL BOUNDARIES AND PRACTICE
Reference
Blair, W., Kable, A., Courtney‐Pratt, H., & Doran, E. (2016). Mixed method integrative review
exploring nurses’ recognition and response to unsafe practice. Journal of advanced
nursing, 72(3), 488-500.
Campbell, R. J., Yonge, O., & Austin, W. (2016). Intimacy boundaries: Between mental health
nurses & psychiatric patients. Journal of psychosocial nursing and mental health
services, 43(5), 32-39
Chiarella, M., & Adrian, A. (2014). Boundary violations, gender and the nature of nursing
work. Nursing ethics, 21(3), 267-277.
Ehrlich, C., Kendall, E., Frey, N., Kisely, S., Crowe, E., & Crompton, D. (2014). Improving the
physical health of people with severe mental illness: Boundaries of care
provision. International journal of mental health nursing, 23(3), 243-251.
Gabbard, G. O. (2016). Boundaries and boundary violations in psychoanalysis. American
Psychiatric Pub.
Manfrin-Ledet, L., Porche, D. J., & Eymard, A. S. (2015). Professional boundary violations: A
literature review. Home healthcare now, 33(6), 326-332.