Week 10 - Establishing, maintaining, and navigating boundaries in the therapeutic relationship Flashcards Preview

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Flashcards in Week 10 - Establishing, maintaining, and navigating boundaries in the therapeutic relationship Deck (27)
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1
Q

Distinct from other types of relationships due to the inherent power differential that exists between a client and a practitioner

A

therapeutic relationship

2
Q

Why is the NC therapeutic relationship asymmetrical?

A

the nurse has more knowledge and expertise
The client may be distressed
the client has to provide personal health information

3
Q

Relationship directed with advancing best interests of client, not best interest of professional

A

therapeutic relationships

4
Q

What are the key elements of therapeutic relationships?

A

Trust, respect, professional intimacy, empathy, power

5
Q

When the patient feels safe in sharing information and feels comfortable with us providing personal care to them

A

Professional intimacy

6
Q

Expression of understanding, validating and resonating with the client and how their HC experience affects them

A

empathy

7
Q

What are the RNAO BPGs regarding therapeutic relationships?

A

Knowledge
reflective practice/self-awareness
Understand the process of building relationships
Learn about therapeutic relationships in BScN
Ongoing professional development

8
Q

Connects with the concepts of consciousness and energy, while intentions remind us of what is important and informs our choices and actions

A

intentionality

9
Q

Having an ethical awareness of our actions, expectations and beliefs

A

Intentionality

10
Q

What are organizational factors that influence therapeutic relationships?

A

Staffing and workload
FT vs. PT and casual positions
Leadership
Supportive clinical supervision and coaching

11
Q

What does RNAO suggest for FT complement of nursing staff?

A

70% of employees should be FT

12
Q

Indicates what is “out of bounds” in relationships; acts to constrain, constrict and limit

A

boundary

13
Q

Edge of appropriate behaviour between TR and boundary violation

A

boundary

14
Q

Confusion between needs of nurse and client

A

boundary violation

15
Q

If the patient breaks the therapeutic relationships, who does the onus fall on?

A

the nurse

16
Q

What is the purpose of the boundary?

A

protects client from harm and protects the nurse/professional

17
Q

What are some factors that influence boundaries, briefly describe.

A

Need and personality of patient - e.g. some patients need more reassurance or may lack support outside the hospital

Character and training of the therapist - innate ability to connect with others/desire to push boundaries

Status of the treatment alliance - e.g. palliative vs. high turnover floor

Treatment setting - home care more intimate than hospital care

Geography - e.g. dual relationships in rural settings

Culture - different boundaries in different cultures

18
Q

if a nurse daydreams, fantasizes, or considers crossing a line, this is referred to as drifting over the line. The nurse may not have actually crossed a boundary behaviourally, but what one can fantasize may come true

A

boundary drift

19
Q

excursions across the lines demarcating the professional relationship

A

boundary crossings

20
Q

Crossing the boundary line in a way that is clearly harmful or exploitive; often puts the professional’s needs ahead of the client’s

A

boundary violations

21
Q

Identify whether the example is a boundary crossing or violation.

A - Therapist provides a sweatshirt to a client to help motivate them

B - George Harrison’s doctor coerced him into autographing a guitar

C - Anything of a sexual nature

D - taking a patient down to the cafeteria because they like the food

E - giving and receiving gifts

F - financial involvement

G - improper social involvement

A
A - boundary crossing
B - boundary violation
C - violation
D - crossing
E - violation
F - Violation
G - violation
22
Q

What is the most common non-sexual boundary violation?

A

Improper social involvement

23
Q

Describe the slippery slope argument.

A

More personal disclosures often lead to progressively worse boundary crossing, until boundary violation occurs

24
Q

Describe accepting gifts.

A

Do not accept individual gifts unless refusal would harm the NC relationship
- accept team gifts if possible

25
Q

Describe giving gifts.

A

If giving gifts, ensure that the client is aware that reciprocity is not expected and that the relationship will not change as a result of gift giving

26
Q

Describe reporting and client abuse.

A

If another nurse is abusing a patient, must report to employer (not necessarily to college)
Must report sexual abuse to college (even if only suspected)
Must report child abuse to CAS (even if only suspected)

27
Q

How long does a nurse have to wait after the termination of the NC therapeutic relationship to engage in a non-professional relationship with a client?

A

1 year