Ethics, Boundaries, and Professionalism Lois Sacher, RN, Principal Nurse Consultant Janet Negley, PhD, Center Mental Health Consultant, San Jose JCC Troy Davidson, CADC II, TEAP Specialist, Wolf Creek CCC

A Quick Review of the Concept of Boundaries

Boundaries are the lines between spaces or entities

Physical and social boundaries exist around individuals. There are also boundaries around every “dyad”, or twosome, that has a relationship. Families have boundaries around them. Other sub-units with boundaries include departments, JC communities, neighborhoods and countries.

Boundaries can’t be seen; in fact, the whole idea of boundaries is just a construct to help us make sense of human experience; but, you know when your boundaries have been violated and that is real!

Boundaries can be firm, mushy, diffuse, rigid, disengaged, flexible, impenetrable, flowing, jerky, strong or weak.

Each individual’s boundaries are affected by their culture, their general up-bringing and crisis events in their history, as well as the context of any given situation.

A person can have healthy boundaries in one arena of their life and unhealthy boundaries in another arena. Not all displays of a “lack of boundaries” are pathological. This tendency can also be a gift.

One rule of thumb about boundaries is that the better defined a boundary, the better the function of what or whoever is within that boundary.

Boundary violations are at the root of many ethical problems in the workplace. At Job Corps, we might struggle with confidentiality issues…

…dual relationships, confusion of roles and the amount to self-disclose. Each discipline has unique rules and ethical codes to guide our conduct in these areas.

Compassion and Respect for Each Student Regardless of individual differences Regardless of health problem Collaborate with other members of the health team Provide guidance to students

Commitment to the Student Care to reflect individual needs of the student Ensure students safety and protect the students’ best interests Ensure student receives sufficient information to give consent for treatment Maintain boundaries that establish limits to relationships between students and staff

Maintain Privacy and Confidentiality to Protect Student Rights HIPAA Use judgment regarding “need to know” Provide confidential environment

Incompetent, Unethical, Illegal or Impaired Practice Report questionable practice to protect student Maintain professional integrity Take responsibility for own actions

Medications Medical Professionals must be knowledgeable regarding medications Teach students 4 “R”s Ensure that recognized practice and procedures are followed Report suspicious behavior

Boundary Risk Management Protocol Reamer, 2003

Step #1: Be alert to potential or actual conflicts of interest

Step #2: Inform clients and colleagues about potential or actual conflicts of interest; explore reasonable remedies

Step #3: Consult colleagues and supervisors and relevant professional literature, regulations, policies, and ethical standards (code of ethics) to identify pertinent boundary issues and constructive/CREATIVE options

Step #4: Design a plan of action that addresses the boundary issues and protects ALL parties involved, to the GREATEST extent possible

Step #5: DOCUMENT all discussions, consultations, and supervision, and other steps taken to address boundary issues

Step #6: Develop a strategy to monitor implementation of action plan

Scenarios What are the ethical issues? How could you utilize the Boundary Risk Management Protocol? –Be alert to conflicts of interest –Explore reasonable remedies –Consult colleagues and supervisors and relevant professional literature, regulations, policies, and ethical standards –Design a plan of action –Document –Monitor

What are your dilemmas?