By
Andrea Thomson, Jane Karpa, and Nadine Smith
February 2023
Print Version
What you need to know
The development of a therapeutic relationship is central to patient care in psychiatric nursing. Professional boundaries are used to maintain the integrity of a therapeutic relationship by creating space within the relationship for both the psychiatric nurse and the patient to co-exist.
Why this research is important
Psychiatric nurses report difficulty articulating and explaining professional boundaries. Given the difficulty describing professional boundaries, psychiatric nurses and student nurses are at risk of crossing professional boundaries in clinical practice. Incidents of reported boundary violations in nursing have ranged from giving and receiving gifts, inappropriate comments, and unprofessional use of self-disclosure to more serious issues, including intimate and sexual relationships with patients during care and/or following discharge. Far too often, psychiatric nurses learn about professional boundaries by making mistakes in practice through trial and error.
How this research was conducted
Interpretative description was applied to answer the question: What strategies do psychiatric nurse educators utilize to teach professional boundaries to undergraduate students? Eleven psychiatric nurse educators and nine practicing psychiatric nurses were interviewed to answer this question. Eight participants also attended a focus group to help refine data analysis and provide additional details on boundary education.
What the researchers found
The strategies utilized to teach boundaries involved engagement and interaction with students, along with supervision in clinical practice. Instruction took place in a variety of settings, including classroom, laboratory, and clinical practice, all with different purposes. Incorporating various types of strategies into the educational program will help cater to the diverse range of learning needs of students. Boundary instruction strategies included sharing stories, reflective activities, discussion in clinical settings, role modelling, and role play activities. Resources such as textbooks are useful for defining professional boundaries. Case studies were described as a resource available to help operationalize boundaries in psychiatric nursing practice. However, given the abstract nature of boundaries, there is a need for interactive resources such as simulation to demonstrate professional boundaries applicable to psychiatric nursing care.
How this research can be used
Educators’ use of self was an important aspect of boundary instruction. Examples of the use of self involved acting as role models and sharing professional stories. Given the complexities of boundaries, educators must act professionally and maintain boundaries with their students. The overall sense of professionalism associated with psychiatric nurses is demonstrated through the relationships fostered between educators and psychiatric nursing students. Role modelling in clinical settings was reported to be an effective method of helping students to understand the importance of boundaries in practice.
Boundary instruction should be incorporated into the psychiatric nursing curriculum in a deliberate manner to ensure students are exposed to the topic in meaningful ways throughout their academic careers. Topics of instruction should include boundaries in the therapeutic relationship, professional relationships with colleagues, personal boundaries, and risk of boundary crossings and violations to better prepare psychiatric nursing students for the complexities of clinical practice. The psychiatric nurse participants noted a need to increase instruction on the development of relationships with colleagues as they noted challenges in practice and were unable to recall if this topic was incorporated into the curriculum.
About the Researchers
Keywords
- professional boundaries
- psychiatric nursing
- undergraduate education
Publications Based on the Research
Thomson, A. E., Smith, N., & Karpa, J. (2022). Strategies used to teach professional boundaries psychiatric nursing education. Issues in Mental Health Nursing, 43(10), 895–902. https://doi.org/10.1080/01612840.2022.2083737
Editor: Christiane Ramsey
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