Nursing Professional Boundaries
There are boundary issues in every aspect of nursing practice. Some of the issues range from stopping to purchase some groceries for a home-bound client, accepting gifts from clients, having friendship with clients and engaging in sexual relationships with clients. While there is substantial gray area compared to black and white in the study of professional boundaries, nurses can make appropriate decisions if they have the relevant information concerning fundamentals of professional boundaries (Kagle and Giebelhausen, 1994). Therefore, it is advisable for the nurses to read additional information and take part in discussions with their colleagues to widen their comprehension of the topic.
Professional boundaries refer to the limits that shield the liberty between the professional's authority and their client's susceptibility. This means that upholding proper boundaries will help in controlling the authority allowing for safe links between the nurse and client based on the client's wants. In addition, owing to the various researches on the topic, there are different definitions of boundaries and professional boundaries. According to Avis et al. (1983), the term boundary refers to the concept of limits, lines or margins. In addition, according to the outline of nursing practice, nurses meet the professional necessities for practice when they exhibit the knowledge, proficiency and attitudes, which are apparent in the practice standards and capabilities.
However, many studies have concentrated on therapeutic behavior. Therefore, they have come up with their own definition: professional boundaries refer to lines that separate the therapeutic behavior of nurses from any behavior, which could significantly decrease the benefits of nursing care to patients, clients and the society (Justice, 1995). Although, at some instances, it is possible to identify professional boundaries, prior literature on the topic and various surveys, suggest that professional boundaries are complicated issues. Therefore, maintaining appropriate boundaries arises from the nature of the client-nurse relationship. Similar to other professionals, the client trusts the nurse who has expertise, proficiency and power. However, this paper focuses on the nurse-physician relationship in a healthcare setting.
Changing Roles of Nurses
In the last decade, Malaysia has witnessed unprecedented increases in the number and variety of new nursing roles such as the acute care nurse practitioners, advanced case managers, and clinical nurse specialist practitioners (Puteri, 2009). However, the roles have substantially occurred in acute care hospital environments. In addition, research suggest that the increase in demand and change of nursing roles will continue into the 21st century, with expansion of other nursing roles in ambulatory and community environments. Several studies suggest that the main reason for the increase in nursing roles is the demand for nursing care and the advancing nursing practice (Offredy, 2000).
Recent changes in healthcare roles in Malaysia have called for maintenance of professional boundaries, in addition to upholding of nursing, laws and ethics. Litigation connected to negligence and confidentiality has affected the role of nurses (Puteri, 2009). This is because the Malaysian nursing law does not tackle numerous legal and ethical challenges that require a complete set of laws that identify the extensive junction between legal and ethical judgments. In addition, technological advances in healthcare have also contributed to issues in Malaysian nursing profession, which in turn has led to the changing roles of the nurses.
Nurses are central to the provision of healthcare services between patients and the hospital, communities and healthcare systems. Owing to the hastily changing health setting in Malaysia, this has led to the extended roles in nurses to supplement services provided by the healthcare professionals. In addition, the extension of roles has forced nurses in Malaysia to get involved in activities that may attract individual legal consequences. Subsequently, the nurses have influenced on their nursing practices and have identified the significance of a firm groundwork in legal and ethical codes, hence promoting competency when making complex decisions independently.
Evidence: Relevance of Professional Boundaries
Professional boundaries are vital elements in the nurse-physician relationship this is because they provide for sound personal connection. The difference in authority apparent between the nurses and physicians calls for the need to uphold safe professional boundaries to avoid the physicians disadvantaging the nurses. However, it is possible to breach the boundaries through relationships, giving or accepting gifts, abuse physical, verbal or psychological, romantic or sexual relationships and negligence (Hung, 1995). The boundaries are relevant in healthcare practice as an approach to avoid confusion in the daily practice.
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