Student Tutorial - Professional Boundaries

Ethical issue

Professional Boundary considerations

Confidentiality

Health professionals are legally obliged to protect consumer health information.  With growing technological changes like Social Media, use of electronic tablets and phones from work to/from home, it is becoming more difficult to maintain one’s privacy and students need to be mindful of their communications both in and out of the workplace.

Confidentiality is governed by the Information Privacy Act 2009 (Qld) and the Hospital and Health Boards Act 2011.

This is a vital component to working in health and only rare justification including danger to third parties or where special consent has been obtained from the client can the area of confidentiality be flexible.  It is an area that should be discussed with your clinical educator if any confusion is felt by the student.

Boundary Transgressions

More distinct areas of boundary transgressions include becoming involved in a romantic or familial relationship with clients or clinical educators and are considered a breach of professional boundaries.  Other considerations – picking up someone’s shopping for them or taking them to the bank on the way home from the hospital during a home visit may not be so easy to define.  Ongoing discussions with your clinical educator within the specific placement setting will assist to guide you through these possible areas of concern.

Informed Consent

Consumers have the right to choose health care based on the best information available to them at that point in time.  There are three components to consider when you are obtaining true informed consent from a consumer:

• You are providing the client with adequate information that is clear and relevant;
• The client has the capacity to understand the information;
• Consent is obtained without coercion from the therapist, family members or organisations.

These factors contribute to informed consent when a client is asked to make a health care decision.

Competence

Capacity or competence refers to the client’s ability to make decisions regarding their health care, living arrangements or financial situation.  Capacity can be formerly assessed by a multidisciplinary team including the treating doctor, OT, psychologist and psychiatrists.  If a client is deemed competent to make their own health care decisions, their ability to make sound decisions needs to be respected by you, regardless of what your belief of what the 'ideal' treatment recommendations might be.  A collaborative approach to care ensures mutually set goals and outcomes while working within professional boundaries.

Impairment of Autonomy

Client decision making needs to be self-governed.  As a health professional, one must take care not to impose their own beliefs or values, where possible.  Occasionally, decision making capacity is impaired for the client.  In this instance, clinicians still need to consider the rationale for any intervention from the client’s perspective and their guardian’s perspective as best as possible.

Vocational Aspects

Clinicians are provided with a multitude of therapy tools and resources to use to facilitate client care.  The sources of these resources and tools can be biased as businesses seek to drive their own profits within the health care field.  It is important that we maintain goal-focused, consumer driven interventions, based on objective evidence.  Wherever possible, health care professionals need to reduce bias associated with recommending particular medications, equipment options or organisations based on their own commercial or personal gain.

Resource Allocation

With many clients and a finite number of working hours, it is difficult to address all of the health care needs of every client in an immediate timeframe.  Prioritising appropriately is a learnt skill and the boundaries need to be set early in a placement.  The organisation may have a set of triage criteria available to start with or timeframes and goals set through negotiation with clients.  This is a key point to consider in any placement setting to ensure the right care is provided to the right client at the right time. 

Paternalism

Between clinical educators and students, there is often a power-relationship.  Given the clinical educator is often the assessor, they do hold more power than the student.  Likewise, a clinician can indirectly hold power in a professional relationship with a client.  This power can exist due to the clinician having a higher level of specific knowledge, the ability to decide regarding capacity or discharge from hospital or simply the ability to obtain access to other services.  It is vital to maintain equality in the therapeutic relationship through respect, trust and honesty so clients continue to actively participate and achieve their treatment goals.  At all times, clinicians must attempt to enable a consumer-driven service, facilitating recovery by identifying and reducing barriers where possible.