1/15/2013. Professional Boundaries in the Chronic Dialysis Setting. Objectives. Professional Boundaries Defined ZONE OF HELPFULNESS

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1 Professional Boundaries in the Chronic Dialysis Setting Objectives 2 1 L I S A H A L L, M S S W, L I C S W 2013 HEARTLAND KIDNEY CONFERENCE OVERLAND PARK, KANSAS FEBRUARY 1, 2013 Why all of this emphasis on boundaries? Guiding principles Strategies for success Professional Boundaries Defined ZONE OF HELPFULNESS Professional boundaries define effective and appropriate interaction between professionals and the public they serve. Boundaries exist to protect both the professional and the client. UNDER INVOLVED - Ignore health info - Keep info from patient - Teach patients: - About dialysis - How to self-cannulate - Machine set-up - Tips to manage fluids - About home options OVER INVOLVED - Drive patient to a store - Hang out off dialysis - Loans or gifts How to tell if you are maintaining boundaries Professional Boundaries Professional Boundaries a major challenge for dialysis facilities and staff. State and federal regulations vary Professional ethics vary Cultural beliefs vary It is Challenging and Complex! The dialysis patient-provider relationship has an inherent imbalance of power. Can be emotionally challenging Requires thinking about unintended consequences 5 6 1

2 Why are boundaries important? Challenging situations are often the delayed result of professional boundary violations. Protect patients Protect YOU Define the professional relationship 7 5 Important Boundary Issues Developing Friendships Developing friendships Gifts and favors Self-disclosures Dual relationships Intimate relationships You know patients from a PROFESSIONAL setting Not mutual give & take Avoid spending time with patients outside the clinic Gifts & Favors Self-Disclosure Patients may think you owe them something They may think you want a relationship It may look like you play favorites Should be rare No personal details If you feel an emotion, your sharing is too personal not in the patient s best interests Would I do this for every patient? Would I feel comfortable telling a room of my peers what I did? Why am I sharing this information with the patient? Will it help him/her, or is it more about me? Is this info more like something I would share with a friend? 2

3 Dual Relationships Intimate or Sexual Relationships You know patients from a setting outside of dialysis (school, church, friends...) Avoid these if you can Am I taking advantage of the patient? Patients are vulnerable Even if a patient wants a relationship, it is not appropriate Could cost you your job/license Am I taking advantage of the patient? A patient has 2 tickets for a band you both enjoy. You know the patient pretty well. Is going along & using the extra ticket a boundary violation? You ve been helping a new patient understand dialysis. The grateful family wants to thank you with a gift card. Since it s a small amount, is it okay to accept it? A. Yes B. No A. Yes B. No Your patient had a hip replacement & wants to hire you to help with laundry, light cleaning, and some personal care. Since this will be short-term, it s okay. A patient you know well lost his Social Security check. He hasn t been able to buy food for 2 weeks & wants to borrow $25. It s not that much, so it s okay. A. True B. False A. True B. False 3

4 Discussing Professional Boundaries Ideas on How to Discuss Boundary and Professional Issues with Staff Encourage dialogue 19 Acknowledge their mixed feelings Increase their understanding of possible negative consequences concrete examples Communicate that you understand that these are difficult situations and decisions Discussing Boundaries with Patients Limit Your Focus 2 to 3 months after starting dialysis: Review with each new patient the top 4 boundary issues at your facility. What are your top 4? 20 Personal relationships Privacy Exchanging money Giving gifts * Individualize as needed Discussing Boundaries with Patients Boundary Discussion Use a handout to structure your conversation Have the discussion on the treatment floor it may be beneficial for other patients to hear the conversation (they are listening!) Briefly explain the policy Make it relate to the patient use realistic examples 21 Introduction Example 22 As a dialysis patient, you spend a lot of time at the unit and get to know the staff very well. These relationships can become quite close and make undergoing dialysis a little easier. In order to make sure your care remains a priority, we would like to review with you some of our patient/staff policies. Professional Practice Guidelines Conversations between staff and patients should be related to patient needs and not staff needs. Never tell patients about issues with your employer or other employees. This will cause patients to lose trust and confidence in those providing their care. 23 Professional Practice Guidelines Attendance at events should be examined closely. Do not do a favor for one patient that is not extended to all of your patients. 24 If you are uncertain about a particular situation, seek consultation (social worker, risk management, clinic manager). 4

5 Questions? Lisa Hall, MSSW, LICSW Patient Services Director Northwest Renal Network (Network 16) , ext