Maintaining Boundaries

Policy

Category: Control of Infectious Diseases
Subject: Maintaining Boundaries
Division: Health Protection
Policy Number: CA.82.01.125
Effective Date: October 1, 2015

POLICY STATEMENT

In order to perform duties or provide services on the Control of Infectious Diseases (CID) team, a CID team member establishes a relationship with a client. It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) that any relationship established with a client by a CID team member will effectively maintain the appropriate relationship boundaries, as outlined in the procedure CA.82.02.125 Maintaining Boundaries, policy CA.52.01.119 and procedure CA.52.02.119 Gifts, Favours, and Donations, and policy CA.52.01.101 and procedure CA.52.02.101Conflict of Interest.  In addition, regulated health professionals will also adhere to the CNO college practice standard “Therapeutic Nurse-Client Relationship” or applicable college standard.

SCOPE

This policy applies to all CID team members, students, and volunteers who establish client relationships within the scope of their CID duties

DEFINITIONS

Client – an individual, family, group, facility, or premises that receives a public health service either requested or mandated in the Ontario Public Health Standards.

Relationship – any WDGPH service a CID team member provides to a client.

Boundary – the point at which a relationship changes from professional to unprofessional or personal.

Crossing a boundary – where a CID team member behaves in an unprofessional manner with a client, or misuses the power in the relationship to meet his/her needs, rather than the needs of the client (the misuse of power does not have to be intentional to be considered a boundary crossing).

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.82.02.125 Maintaining Boundaries
CA.52.01.119 and CA.52.02.119 Gifts, Favours, and Donations
CA.52.01.101 and CA.52.02.101 Conflict of Interest
Therapeutic Nurse-Client Relationship (College of Nurses of Ontario Practice Standards, rev. 2006)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases and Tuberculosis

APPROVED BY

Director, Health Protection 


Procedure

Category: Control of Infectious Diseases
Subject: Maintaining Boundaries
Division: Health Protection
Procedure Number: CA.82.02.125
Effective Date: October 1, 2015

PROCEDURE

The Control of Infectious Diseases (CID) team member will:

1. Not provide their home telephone number or personal address to a client.

2. Not provide their personal cell phone number to a client unless the benefit outweighs the risk in the relationship.  Any CID team member who provides a personal cell phone number to a client will discuss this with their Supervisor and/or Manager and document the reason in the client’s file.

3. Establish and maintain the appropriate boundaries within the relationship and help the client understand when their requests are beyond the limits of the WDGPH service.

4. Ensure any approach or activity that could be perceived as boundary crossing is included in the CID team members’ accepted plan of care (e.g., meeting a Directly Observed Therapy (DOT) client for coffee may be an effective strategy that all CID team members will consistently use to watch DOT clients take their medications).

5. Recognize that there may be an increased need for vigilance in maintaining professionalism and boundaries in certain practice settings (e.g., when a CID team member provides service in a client’s home, they may become involved in the family’s private life and need to recognize when the conversation and/or actions of the CID team member with the client is no longer therapeutic and could cross a boundary).

6. Ensure that he/she will not interfere with the client’s personal relationships, unless there is a therapeutic reason to do so (e.g., if a CID team member recognizes a client may be suffering abuse in their personal relationship and encourages the client to get help or consider leaving the relationship).

7. Not enter into a friendship or romantic, sexual or other personal relationship with a client when a relationship of service exists.  It is strongly discouraged after termination of the client relationship to enter into a romantic or sexual relationship with the client. Any romantic or sexual relationship with a previous client shall be reported to the CID team member’s Supervisor and/or Manager.

8. Refrain from disclosing personal information unless it meets an articulated therapeutic need of the client (e.g.,  disclosing a personal problem may make the client feel as if his/her problems/feelings are being diminished or that the client needs to help the CID team member).

9. Continuously clarify WDGPH’s role in the relationship, especially in situations in which the client may become unclear about the boundaries and limits of the relationship.

10. Ensure that an existing relationship does not undermine the judgment and objectivity of the service. For example, a CID team member who provides service to a child who is a close friend of his/her own child needs to be aware of the potential effect the dual relationship has on service.

11. Not engage in financial transactions unrelated to the service provided with the client or the client’s family/partner.

12. Consult with colleagues and/or the Supervisor or Manager in any situation where it is unclear whether a behaviour may cross a boundary of the relationship, especially in circumstances that include self-disclosure or giving a gift to or accepting a gift from a client (see policy CA.52.01.119 Gifts, Favours, and Donations).

13. Ensure the relationship is developed for the purpose of promoting the health and well-being of the client and not to meet the needs of the CID team member, especially when considering self-disclosure, giving a gift to or accepting a gift from a client (see policy CA.52.01.119 Gifts, Favours, and Donations).

14. Document client information in the client’s record regarding instances in which it was necessary to consult with a colleague/Supervisor/Manager about a certain situation.

15. Consider cultural values of the client in the context of maintaining boundaries, including situations that involve self-disclosure and gift giving (refer to policy CA.52.01.119 Gifts, Favours, and Donations).

16. Recognize the warning signs of crossing a boundary with a client:

  • Spending extra time with one client beyond his/her needs;
  • Changing client assignments to give care to one client beyond the purpose of the service;
  • Feeling other CID team members do not understand a specific client as well as you do;
  • Disclosing personal information to a specific client;
  • Dressing differently when seeing a specific client;
  • Frequently thinking about a client when away from work;
  • Feeling guarded or defensive when someone questions your interactions with a client;
  • Keeping secrets with the client and apart from the CID team (e.g., not documenting interactions or conversations conducted while providing service);
  • Giving a client personal contact information (except in situations where giving a personal cell phone number may be needed (see point 2); and
  • A client is willing to speak only with you and refuses service from another CID team member.

17. Identify a colleague’s behaviour as crossing a boundary by discussing concerns with the colleague first.  If the CID team member cannot talk with the colleague directly, or the colleague does not recognize the problem, the CID team member should speak with the colleague’s supervisor. 

RESPONSIBILITIES

Management will:
  • Ensure employees are oriented and adhere to this policy;
  • Review the College standard on Therapeutic Relationships;
  • Monitor policy compliance on a regular basis; and
  • Address any boundary breaches by the CID team member, investigate what occurred to lead up to the breach, and explore options to avoid a similar breach in the future.
Employees will:
  • Adhere to this policy;
  • Follow procedures to maintain appropriate boundaries while establishing client relationships;
  • Recognize the warning signs of crossing a boundary;
  • Report any boundary conflicts to their immediate Manager/Supervisor; and
  • Recognize if a colleague may be crossing a boundary, and discuss concerns with colleague first.  Report concerns to colleague’s supervisor if concerns are not recognized or addressed.

DEFINITIONS

Client – an individual, family, group, or facility that receives a public health service.

Relationship – any service a CID team member provides to a client.

Boundary – the point at which a relationship changes from professional to unprofessional or personal.

Crossing a boundary – where a CID team member behaves in an unprofessional manner with a client, or misuses the power in the relationship to meet his/her needs, rather than the needs of the client (the misuse of power does not have to be intentional to be considered a boundary crossing).

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.125 Maintaining Boundaries
CA.52.01.119 and CA.52.02.119 Gifts, Favours, and Donations
CA.52.01.101 and CA.52.02.101 Conflict of Interest
Therapeutic Nurse-Client Relationship (College of Nurses of Ontario Practice Standards, rev. 2006)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection