Professional Boundaries in Health Care

Transcription

1 Professional Boundaries in Health Care Film Support Notes by: Darren Wake R.N, B.A. Produced by: VEA Pty Ltd Commissioning Editor: Darren Gray Cert IV TAA Executive Producer: Edwina Baden-Powell B.A, CVP. Darren Gray Cert IV Training & Assessment Classroom Video Ltd 2012 Reproducing these support notes You may download and print one copy of these support notes from our website for your reference. Further downloads, copying or printing MUST be reported to The Copyright Licensing Agency (CLA) as per the Copyright, Design and Patents Act, 1988.

2 LEADER S GUIDE Introduction for facilitators Professional Boundaries offers health care professionals an introduction to the concept and regulation of professional boundaries. The film explores the origin of these boundaries, their relationship to the conceptual space between the care giver and the recipient of care, how such boundaries are transgressed and how transgressions can be recognised and avoided. With the majority of complaints to regulatory bodies evolving from the accumulation of minor transgressions, the film places particular emphasis on the ambiguities and subtleties that can emerge in professional relationships, and presents the information in a structured and easy to understand format that- in combination with the learning material- will clarify the topic and provide guidance to all health professionals. Who will benefit from the film? This film will be of benefit to all professions where the relationship between the client and the service provider has an imbalance of power. With particular relevance to the health and allied health professions, it explores the grey area that is so often subtly evident in today s informal health care environment, where informal encounters can lead to exchanges that ultimately are not of therapeutic benefit to the client. Timeline 00:00:00 Professional boundaries: why are they needed? 00:04:30 Legal and ethical boundaries 00:08:44 How are professional boundaries transgressed? 00:13:22 Professional boundaries: ambiguities and moral interpretations 00:16:59 Navigating professional boundaries: decision-making tools 00:21:51 Credits 00:22:26 End film 60 MINUTE SESSION OUTLINE The times suggested for these activities should be used as a guide only. Phase 1 (thirty minutes) Present the background information (verbally, using the notes as cues) View the film, Professional Boundaries Phase 2 (thirty minutes) Have the participants split into pairs or small groups of equal size and read the Professional Boundaries Case Study. Based on their own subjective values system, they should brainstorm an interpretation of the case study in terms of whether there is a transgression of professional boundaries or not (i.e. is the persons behaviour reasonable according to their own values system?). Allow 10 to 15 minutes for this, and then draw the groups back together. Have the group engage in a guided discussion using the Response Sheet provided, emphasising the conflict between the professional and the subjective attitude. Given the scenario, the potential for debate is high. If so, it should be emphasised that the ambiguities associated with the scenario in the case study will always be difficult to resolve. However, this is a very common scenario associated with formal complaints of transgressions of professional boundaries. 2

3 PROFESSIONAL BOUNDARIES PHASE 1 Duration: 30 minutes In this phase, participants will review the film and revise the key concepts. They will learn the concept of professional boundaries, and how they are perceived by the public, regulatory boards and the law. In particular, they will learn how these boundaries can be extremely nebulous, and this will be further explored and clarified in the Phase 2 exercise. Activities: Present the background information View the film, Professional Boundaries PROFESSIONAL BOUNDARIES Background information Health care professionals enter into a relationship with their client that often requires knowledge of a great deal of personal information about the people in their care. This entails a significant degree of trust on behalf of both parties, and with the contemporary health care environment favouring informal relationships between care givers and receivers, the edges of the therapeutic relationship can easily become blurred. When these boundaries become too obscure, they can expose the care recipient to exploitation. The expectation of the public, the law and the regulatory boards of the various professions is that the professional will only ever act in the best interest of those in their care. As such, even if no obvious exploitation is evident, a relationship that provides a framework for exploitation is viewed extremely seriously. Professional boundaries serve to define the borders between a professional therapeutic relationship, and a self-serving personal one, however subtle. Understanding how these boundaries are established, who defines them and how they influence the interactions between yourself and those in your care is a critical issue for all health care professionals. In particular, an understanding that most complaints of transgression emerge from minor, almost imperceptible favours provided over time is important, as this brings into focus the need carefully shape informal relationships within the bounds of therapeutic need. 3

4 PHASE 2 Duration: thirty minutes In this phase, participants will deepen their understanding of the concepts and regulation of professional boundaries through the practical application of the principles involved to a case study. Activities: Prior to engaging the group in their discussion, spend 1 or 2 minutes setting the scene by asking for brief comments on the evolving scenario in the video between the OT and their client. This is a subtle exchange, but ask what aspects of the exchange might be of concern: 1. The providence of patient information where it is not relevant to the care of the client? 2. The exchange of personal information? 3. The acceptance of a gift. All of these are transgressions, and may elicit the comment So what, if it only happens once. The emphasis here should be: but how does this contribute to a therapeutic relationship, and is this setting a precedent with this and perhaps other clients? That is the concern. Distribute the Professional Boundaries Case Study Participants should split into pairs or small groups and interpret the case study. PROFESSIONAL BOUNDARIES CASE STUDY May Jones is a 72 year old former teacher with complex health problems who is a low-care resident in a nursing home. The nursing home is in a smaller rural town, where May has lived and worked her entire life. The former principal of the local school, she is well known and well liked, and many of those working in the home are her former students. She has deteriorating health, especially in terms of her mobility and eyesight, and has early onset dementia. Despite this, she is fiercely independent. Over the last 12 months, May has formed a good relationship with Jane Harley, one of the carers, who was also one of her pupils when she was a teacher. One day, May has particular difficulty walking, and asks Jane to pop out to the local newsagency and buy the day s newspaper and a couple of her favourite magazines. She gives Jane $20 for this, and Jane returns with the paper, magazines and the change. There is no regular newsagency service to the home, and soon, as May s mobility declines, Jane is asked by May to pick up the paper every morning on her way to work. May provides her with $2 a day for this, and every day Jane works she does this for May and gives her the paper and change. One day, May has no cash, and given she has known Jane for a good amount of time, and has no reason not to trust her, provides Jane with her debit card and pin number and asks her to draw $200 from the cash point machine, which she does and May once again provides her with a the funds to buy the daily paper for her, but from this withdrawal, gives her $50 to last for a while. Jane continues to buy the paper for May, and their relationship grows to a point where Jane comes in briefly on her day off to provide the paper for May, sitting with her for a cup of tea in the dining room, and even organises for her daughter to do this when she is away. 4

5 Does some or all of this represent a breach of professional boundaries? 5

6 Response Sheet Consider the setting Small community Relationships that existed prior to May being admitted to the home No newsagent service provided to the home Limited mobility Risk Factors Early onset dementia: problems with memory No witnesses Handling money without a formal arrangement Is Jane the most appropriate person to handle the money? Is there a policy about residents and cash? Access to highly sensitive financial information (bank account) Question: given the circumstances, do these actions contribute to a therapeutic relationship Subjective responses provided by audience There will likely be a mix of yes and no, which emphasises the ambiguity of some of the case Question: does this place May or Jane at risk? Jane could be accused by May of theft Jane could clean May out or take small amounts now and then A complaint could be lodged by another carer Question: Is this a precedent that could be maintained by another carer No It is unlikely that another carer would provide this service. Pre-emptive actions Training Collaborative policy development Formal arrangement for handling cash 6

7 RESOURCES Publications Australian Nursing and Midwifery Council, 2010, A Nurses Guide to Professional Boundaries. ANMC, ACT. Australian Nursing and Midwifery Council, 2010, A Midwives Guide to professional Boundaries, ANMC, ACT. Gallety, C. Crossing professional boundaries in medicine: the slippery slope to patient sexual exploitation, Medical Journal of Australia, 181(7): Online The following websites have extensive material on professional boundaries: Medical Council of New Zealand The American Medical Association The Australian Medical Association Jenny Bray Consulting 7