Developing Relationships While Maintaining Boundaries Handout Package

Developing Relationships While Maintaining Boundaries Handout Package

Developing Relationships While Maintaining Boundaries Objectives p Identify boundary issues in working with residents/clients p Differentiate between healthy and unhealthy boundaries Boundary Definition Is a limit or edge that defines you as separate from others (e.g. your skin as it marks the limit of you physical self) We all have another boundary that extends beyond our skin our personal comfort Emotional boundaries also exist 1

Factors affecting personal space p Familiarity p History with person p Gender p Environment (e.g., crowded vs open) p Stress level p Personality p Role p Physical size p Personal hygiene p Etc. Why should I think about boundaries anyway? p In our personal lives we need boundaries to establish our identity, maintain our privacy, and our integrity p Boundaries exist in all of our relationships: with our family members, mechanic, store clerk, our residents, etc. You cannot understand professional boundaries if you do not know your personal boundaries Dr. Olive Yonge Issue Touch Always Sometimes Never Disclosure Business Presents Lending Socializing 2

Boundaries relate to many issues in our daily lives Think about relationships you have with your co-workers Indicate if the following are or not for you by placing an in the appropriate box Now review the list again seeing the relationship as one of nurse/caregiver and resident Indicate what is and not for you by placing a in the appropriate box Boundaries provide the framework within which the staff/client relationship occurs Our responsibility is to make the relationship safe for the resident The relationship a caregiver forms with the resident is key to the success of the care plan (Geriatric Care, 32, July, 2000) Our focus is on the type of relationship we form with the resident we work with 3

Examples of boundary issues in our work Touch Examples of boundary issues in our work Power Inherent power imbalances in care-giving relationships As a caregiver, I am ultimately responsible to manage boundary issues How do I establish healthy levels of caring? How do I avoid fostering too much dependency on me? Having an empathic attitude toward one s residents sets the groundwork for a successful relationship (Geriatric Care, 32, July, 2000) 4

Defining Empathy As caregivers, how do we define empathy? Empathy p Empathy means being able to see the world through the eyes of someone else, stepping into their shoes as it were, and putting aside our own expectations and experiences as far as we are able. It is not the same as remembering how things were for us. It is what is referred to as entering another person s frame of reference, while holding onto a clear sense of our own identity (Stokes, 2000). Related Concepts p Sympathy p Pity p Condolence 5

Custodial care is: p Providing basic health care p Protecting the resident p Over care Therapeutic care is: p Providing basic health care p Supporting an enriched environment p Providing treatments/rehabilitation for problem by teaching, encouraging, and allowing the resident to perform as many activities as possible by himself/herself or as close to by himself/herself as he/she can p Encouraging autonomy Areas where it is difficult to draw the line or where boundaries potentially become blurred: 1) Physical contact Helpful to ask oneself if you would touch the resident in such a way if the resident s family were present or if your colleagues were observing 6

Areas where it is difficult to draw the line or where boundaries potentially become blurred: 2) Giving/receiving significant gifts Risk of changing the therapeutic relationship if gift of more than a token value is exchanged (whether you are the giver or receiver) Areas where it is difficult to draw the line or where boundaries potentially become blurred: 3) Dual Relationships Situations where the staff person also holds a different significant authoritive or emotional relationship with the resident Areas where it is difficult to draw the line or where boundaries potentially become blurred: 4) Self-disclosure Need to be certain that the information you are going to share about yourself is for the resident s benefit 7

Areas where it is difficult to draw the line or where boundaries potentially become blurred: 5) Becoming friends Likely to reduce objectivity when you become a resident s friend Impact on other residents if you are observed to be a resident s friend? Boundary Related Questions In examining potential boundary issues and in determining how to proceed, it may be helpful to consider the following: p Is this in the resident s best interest? p Whose needs are being served? p Will this have an impact on the service I am delivering? Boundary Related Questions p Should I make a note of my concerns or consult with a colleague? p How would this be viewed by the resident s family or significant others? p How would I feel telling a colleague about this? p Am I treating this resident differently? (e.g. spending more time with him/her) 8

Boundary Related Questions p Does this resident mean something special to me? p Am I taking advantage of this resident? p Does this action benefit me rather than the resident? p Am I comfortable in documenting this decision/behaviour in the resident s chart? (College of Psychologists of Ontario BULLETIN, volume 25, 1998) In Conclusion If you have questions related to boundary issues, you need to recognize that the primary concern in establishing and managing boundaries with each resident must be the best interests of the resident: Is what I am about to say/do in the best interests of the resident or my own? If you are uncertain about boundary issues, please talk to your colleagues or manager/supervisor 9

ROSEHAVEN CARE CENTRE 4612-53 Street Camrose, AB T4V 1Y6 Touch Issue Disclosure Business Presents Lending Socializing Always Sometimes Modified from Dr. Olive Yonge s on Understanding Boundaries (1998) Never ROSEHAVEN CARE CENTRE 4612-53 Street Camrose, AB T4V 1Y6 Touch Issue Disclosure Business Presents Lending Socializing Always Sometimes Modified from Dr. Olive Yonge s on Understanding Boundaries (1998) Never