Psychiatric mental health nurses' perspectives on professional boundaries

Abstract

The therapeutic nurse-patient relationship is essential to psychiatric mental health nursing practice. Psychiatric mental health nurses must develop and maintain a positive therapeutic relationship with patients while upholding professional boundaries. The definition of professional boundaries is elusive and leaves much room for interpretation. Lack of a clear definition can impair nurses' knowledge and understanding of professional boundaries, which can lead to potential boundary violations. Currently literature does not represent the subjective definitions individual psychiatric mental health nurses have regarding professional boundaries. The purpose of this study was to explore the definitions of professional boundaries from the perspectives of psychiatric mental health nurses. All participants had a current registered nursing license, were currently employed at the sample hospital, and provided informed consent for participation. To address this purpose, answers to the following research questions were sought: 1) How do psychiatric mental health nurses define professional boundaries, 2) How does the psychiatric mental health nurse's definition of professional boundaries affect her or his practice, and 3) What challenges do psychiatric mental health nurses face in maintaining professional boundaries. To answer the research questions, a sample of seven psychiatric mental health nurses who practice at a hospital in Montana were interviewed using qualitative open-ended questions. Based on the participants response four themes relating to definitions of professional boundaries were identified. The themes were: (a) distinct to mental health, (b) changes throughout career, (c) relates to patient age, and (d) impact on practice. The results suggest the need for additional research on professional boundaries in a variety of psychiatric and non-psychiatric settings. The results of this study also offer many implications for future practice including regular staff training, thorough educational foundation, administrative attention to boundary violations and adequate self-care. The outcomes of this study can be used to guide psychiatric mental health nurses, nurse administrators, and healthcare organizations in promoting the therapeutic relationship while maintaining professional boundaries.