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Exploring Professional Boundaries in AYA Nursing Care

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Nursing Adolescents and Young Adults with Cancer

Abstract

Professional boundaries are central for the establishment of therapeutic relationships for all healthcare professionals yet notably essential for nursing when caring for adolescents and young adults with cancer (AYA). Yet do tensions exist between the balance of involvement that is beneficial in the therapeutic relationship and one that is too close and potentially destructive? Is this challenge a common occurrence in AYA nursing, where prolonged involvement, caring and intimacy form the basis from which nursing care is delivered?

Despite efforts in recent years to place greater emphasis on the professional role within the patient/nurse relationship, the management of professional boundaries continues to be a routine concern for this group of nurses and for others in practice. This is becoming more so with the advent of social media and its ever pervasive presence in all our lives. This chapter explores the very real challenges facing AYA nurses in achieving a professional yet therapeutic relationship and offers insight into how education, supervision and an increased awareness that any professional, whatever the level of experience, may struggle with defining when ‘close is too close’.

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References

  1. Maunder Z. Palliative care for children and young people: a community paediatric nursing perspective. Int J Palliat Nurs. 2006;12(7):329–33.

    Article  PubMed  Google Scholar 

  2. Lopez E, Vargas R. Interpersonal communication in relation to the ill patient. IMSS. 2002;10(2):93–102.

    Google Scholar 

  3. Browning D, Solomon M. The initiative for pediatric palliative care: an interdisciplinary educational approach for healthcare professionals. J Pediatr Nurs. 2005;20(5):326–34.

    Article  PubMed  Google Scholar 

  4. Docherty SL, Miles MS, Brandon D. Searching for “the dying point”: providers’ experiences with palliative care in pediatric acute care. Pediatr Nurs. 2007;33(4):335–41.

    PubMed  Google Scholar 

  5. Pontin D, Lewis M. Managing the caseload: a qualitative action research study exploring how community children’s nurses deliver services to children living with life-limiting, life-threatening, and chronic conditions. J Spec Pediatr Nurs. 2008;13(1):26–35.

    Article  PubMed  Google Scholar 

  6. Bluebond-Langner M, Belasco JB, Wander MM. “I want to live, until I don’t want to live anymore”: involving children with life-threatening and life-shortening illnesses in decision making about care and treatment. Nurs Clin N Am. 2010;45(3):329–43.

    Article  Google Scholar 

  7. Meltzer LS, Huckabay LM. Critical care nurses' perceptions of futile care and its effect on burnout. Am J Crit Care. 2004;13:202–8.

    PubMed  Google Scholar 

  8. Rushton C. A framework for integrated pediatric palliative care: being with dying. J Pediatr Nurs. 2005;20(5):311–24.

    Article  PubMed  Google Scholar 

  9. Harding R, Higginson IJ. What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness. Palliat Med. 2003;17(1):63–74.

    Article  CAS  PubMed  Google Scholar 

  10. Seymour J, Clark D, Hughes P, Bath P, Beech N, Corner J, Douglas H, Halliday D, Haviland J, Marples R, Normand C, Skilbeck J, Webb T. Clinical nurse specialists in palliative care. Part 3. Issues for the Macmillan nurse role. Palliat Med. 2002;16(5):386–94.

    Article  PubMed  Google Scholar 

  11. Clark D, Seymour J, Douglas H, Bath P, Beech N, Corner J, Halliday D, Hughes P, Haviland J, Normand C, Marples R, Skilbeck J, Webb T. Clinical nurse specialists in palliative care. Part 2. Explaining diversity in the organization and costs of Macmillan nursing services. Palliat Med. 2002;16(5):375–85.

    Article  PubMed  Google Scholar 

  12. Department of Health. Invisible patients: report of the working group on the health of health professionals. London: Crown; 2010.

    Google Scholar 

  13. Clarke G. Reviewing professional boundaries in the NHS. Br J Community Nurs. 2000;5(1):5.

    Article  CAS  PubMed  Google Scholar 

  14. Davies R. Children’s nursing. Establishing need for palliative care services for children/young people. Br J Nurs. 2003;12(4):224.

    Article  PubMed  Google Scholar 

  15. Peterson E, Solomon D. Maintaining healthy boundaries in professional relationships: a balancing act. Home Care Provid. 1998;3(6):314–8.

    PubMed  CAS  Google Scholar 

  16. Aylott M. Blurring the boundaries: technology and the nurse-patient relationship. Br J Nurs. 2011;20(13):810–6.

    Article  PubMed  Google Scholar 

  17. Gabbard GO. Patient-therapist boundary issues. Psychiatric Times. 2005;22(12):28.

    Google Scholar 

  18. Gutheil TG, Gabbard GO. The concept of boundaries in clinical practice: theoretical and risk-management dimensions. In: Bersoff DN, editor. Ethical conflicts in psychology. 4th ed. Washington, DC: American Psychological Association; 2008. p. 222–30.

    Google Scholar 

  19. Fischer HR, Houchen BJ, Ferguson-Ramos L. Professional boundaries violations: case studies from a regulatory perspective. Nurs Adm Q. 2008;32(4):317–23.

    Article  PubMed  Google Scholar 

  20. Nursing and Midwifery Council. The code for nurses and midwives. London: NMC; 2015.

    Google Scholar 

  21. Health and Care Professionals Council. Standards of conduct, performance, and ethics. London: Health and care Professionals Council; 2016.

    Google Scholar 

  22. General Medical Council. Good medical practice. London: GMC; 2013.

    Google Scholar 

  23. Gallop R. Post-discharge social contact: a potential area for boundary violation. J Am Psychiatr Nurses Assoc. 1998;4(4):105–10.

    Article  Google Scholar 

  24. Sheets VR. Staying in the lines. Nurs Manag. 2000;31(8):28.

    Article  CAS  Google Scholar 

  25. Peternelj-Taylor C, Yonge O. Exploring boundaries in the nurse-client relationship: professional roles and responsibilities. Perspect Psychiatr Care. 2003;39(2):55–66.

    Article  PubMed  Google Scholar 

  26. Gutheil TG, Gabbard GO. The concept of boundaries in clinical practice: theoretical and risk-management dimensions. Am J Psychiatry. 1993;150(2):188–96.

    Article  CAS  PubMed  Google Scholar 

  27. Gutheil TG, Gabbard GO. Misuses and misunderstandings of boundary theory in clinical and regulatory settings. Am J Psychiatry. 1998;155(3):409–14.

    Article  CAS  PubMed  Google Scholar 

  28. Smith LL, Taylor BB, Keys AT, Gornto SB. Nurse-patient boundaries: crossing the line. Am J Nurs. 1997;97(12):26–32.

    PubMed  CAS  Google Scholar 

  29. Tariman JD. Where to draw the line: Professional boundaries in social networking. ONS Connect. 2010;25(2):10–3.

    PubMed  PubMed Central  Google Scholar 

  30. Hall K. Professional boundaries. Home Healthc Nurs. 2011;29(4):210–7.

    Article  Google Scholar 

  31. Strom-Gottfried K. Professional boundaries: an analysis of violations by social workers. Fam Soc. 1999;80(5):439–49.

    Article  Google Scholar 

  32. Maidment J. The quiet remedy: a dialogue on reshaping professional relationships. Fam Soc. 2006;87(1):115–21.

    Article  Google Scholar 

  33. Homan P. Staying fired up: how quality relates to professional boundaries. NHPCO Newsline. 2006:25–6.

    Google Scholar 

  34. Sanders S, Bullock K, Broussard C. Exploring professional boundaries in end-of-life care: considerations for hospice social workers and other members of the team. J Soc Work End Life Palliat Care. 2012;8(1):10–28.

    Article  PubMed  Google Scholar 

  35. McMillan M, Baker H, Bellchambers H, Bujack E, Harmon C, Keatinge D, Schultz L, Sharkey R. Guidelines for registered nurses, registered midwives and enrolled nurses - boundaries of professional practice. Report number: 1. New South Wales: Nursing Registration Board of New South Wales; 1999.

    Google Scholar 

  36. Pennington S, Gafner G, Schilit R, Bechtel B. Addressing ethical boundaries among nurses. Nurs Manag. 1993;24(6):36–9.

    Article  CAS  Google Scholar 

  37. Taylor PB. Setting your boundaries... personal and professional behaviour. Nursing 98. 1998;28(4):56–7.

    Article  CAS  Google Scholar 

  38. Barnsteiner JH, Gillis-Donovan J. Being related and separate: a standard for therapeutic relationships. Matern Child Nurs. 1990;15:223–8.

    CAS  Google Scholar 

  39. Pilette PC, Berck CB, Achber LC. Therapeutic management of helping boundaries. J Psychosoc Nurs Ment Health Serv. 1995;33(1):40–7.

    PubMed  CAS  Google Scholar 

  40. Peplau HE. Interpersonal relations: a theoretical framework for application in nursing practice. Nurs Sci Q. 1992;5(1):13–8.

    Article  CAS  PubMed  Google Scholar 

  41. Hochschild AR. The managed heart: commercialization of human feeling. Berkeley, CA: University of California Press; 2003.

    Google Scholar 

  42. Cohen MZ, Haberman MR, Steeves R, Deatrick JA. Rewards and difficulties of oncology nursing. Oncol Nurs Forum. 1994;21(8):9–17.

    PubMed  CAS  Google Scholar 

  43. Blomberg K, Sahlberg-Blom E. Closeness and distance: a way of handling difficult situations in daily care. J Clin Nurs. 2007;16(2):244–54.

    Article  PubMed  Google Scholar 

  44. Altun I. Burnout and nurses’ personal and professional values. Nurs Ethics. 2002;9(3):269–78.

    Article  PubMed  Google Scholar 

  45. Spooner-Lane R, Patton W. Determinants of burnout among public hospital nurses. Aust J Adv Nurs. 2007;25(1):8–16.

    Google Scholar 

  46. Jacobson GA. Faculty forum. Maintaining professional boundaries: preparing nursing students for the challenge. J Nurs Educ. 2002;41(6):279–81.

    PubMed  Google Scholar 

  47. Gardner McCutcheon H, Fedoruk M. Superficial supervision: are we placing clinicians and clients at risk? Contemp Nurse. 2010;34(2):258–66.

    Article  PubMed  Google Scholar 

  48. Zander M, Hutton A, King L. Coping and resilience factors in pediatric oncology nurses. J Pediatr Oncol Nurs. 2010;27(2):94–108.

    Article  PubMed  Google Scholar 

  49. Maytum JC, Heiman MB, Garwick AW. Compassion fatigue and burnout in nurses who work with children with chronic conditions and their families. J Pediatr Health Care. 2004;18(4):171.

    PubMed  Google Scholar 

  50. Ablett JR, Jones RSP. Resilience and well being in palliative care staff: a qualitative study of hospice nurses’ experience of work. Psycho-Oncology. 2007;16(8):733–40.

    Article  PubMed  Google Scholar 

  51. Cohen M, Sarter B. Love and work: oncology nurses’ view of the meaning of their work. Oncol Nurs Forum. 1992;19(10):1481–6.

    PubMed  CAS  Google Scholar 

  52. Olson MS, Hinds PS, Euell K, Quargnenti A, Milligan M, Foppiano P, Powell B. Peak and nadir experiences and their consequences described by pediatric oncology nurses. J Pediatr Oncol Nurs. 1998;15(1):13.

    Article  CAS  PubMed  Google Scholar 

  53. Schaufeli B, Leiter P, Maslach C. Burnout: 35 years of research and practice. Career Dev Int. 2009;14(3):204.

    Article  Google Scholar 

  54. Froggatt K. The place of metaphor and language in exploring nurses’ emotional work. J Adv Nurs. 1998;28(2):332–8.

    Article  CAS  PubMed  Google Scholar 

  55. Hinds PS, Oakes L, Furman W, Foppiano P, Olson MS, Quargnenti A, Gattuso J, Powell B, Srivastava DK, Jayawardene D, Sandlund JT, Strong C. Decision making by parents and healthcare professionals when considering continued care for pediatric patients with cancer. Oncol Nurs Forum. 1997;24(9):1523–8.

    PubMed  CAS  Google Scholar 

  56. Kushnir T, Rabin S, Azulai S. A descriptive study of stress management in a group of pediatric oncology nurses. Cancer Nurs. 1997;20(6):414–21.

    Article  CAS  PubMed  Google Scholar 

  57. Sinclair H, Hamill C. Does vicarious traumatisation affect oncology nurses? A literature review. Eur J Oncol Nurs. 2007;11(4):348–56.

    Article  PubMed  Google Scholar 

  58. Saunders C, Baines M. Living with dying: the management of terminal care. New York, NY: Oxford Medical Publication; 1989.

    Google Scholar 

  59. Hinds PS, Oakes LL, Hicks J, Anghelescu DL. End-of-life care for children and adolescents. Semin Oncol Nurs. 2005;21(1):53–62.

    Article  PubMed  Google Scholar 

  60. Gemma PB. Can nurses care too much? Am J Nurs. 1989;89(5):743–4.

    PubMed  CAS  Google Scholar 

  61. Totka JP. Exploring the boundaries of pediatric practice: nurse stories related to relationships. Pediatr Nurs. 1996;22(3):191.

    PubMed  CAS  Google Scholar 

  62. O'Neill J. Professional insights. Professional boundaries in pediatric nursing practice. J Pediatr Healthc. 1998;12(4):225–7.

    Article  CAS  Google Scholar 

  63. Whaite BD. Interpersonal boundaries for pediatric nurses. Pediatr Nurs. 1999;25(6):656. 658, 660

    PubMed  CAS  Google Scholar 

  64. Simon RI. The natural history of therapist sexual misconduct: identification and prevention. Psychiatr Ann. 1995;25(2):90–4.

    Article  Google Scholar 

  65. Simon RI. Therapist–patient sex: from boundary violations to sexual misconduct. Psychiatr Clin N Am. 1999;22(1):31–47.

    Article  CAS  Google Scholar 

  66. Greysen SR, Kind T, Chretien KC. Online professionalism and the mirror of social media. J Gen Intern Med. 2010;25(11):1227–9.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Chen LD, Nath R. Nomadic culture: cultural support for working anytime anywhere. Inf Syst Manag. 2005;22(4):56–64.

    Article  Google Scholar 

  68. Hempel J, Lehman P. The MySpace generation. Bus Week. 2005;3963:88–93.

    Google Scholar 

  69. Avery GC, Baker E. Reframing the infomated household – workplace. Inf Organ. 2002;12(2):109–34.

    Article  Google Scholar 

  70. Bean CJ, Eisenberh EM. Employee sense making in the transition to nomadic work. J Organ Chang Manag. 2006;19(2):210–22.

    Article  Google Scholar 

  71. Stamnes JH. Social support, social network and health: presentation of findings, and integration of accumulated knowledge in the clinical field. Nord J Nurs Res Clin Stud. 2000;20(4):23–7.

    Article  Google Scholar 

  72. Dickinson D, Green G, Hayes C, Gilheany B, Whittaker A. Social network and social support characteristics amongst individuals recently discharged from acute psychiatric units. J Psychiatr Mental Health Nurs. 2002;9(2):183–9.

    Article  CAS  Google Scholar 

  73. Souza M, Souza I, Tocantins FR. The use of social network methodological framework in nursing care to breastfeeding women. Rev Latin Am De Enferm. 2009;17(3):354–60.

    Article  Google Scholar 

  74. Wilson M, Greenhill A. Gender and teleworking identities in the risk society; a research agenda. New Tech Work Employment. 2004;19(3):207–21.

    Article  Google Scholar 

  75. Turkle S. Alone together – why we expect more from technology and less from each other. New York, NY: Basic Books – The Perseus Books Group; 2011.

    Google Scholar 

  76. Teenage Cancer Trust. Competencies: caring for teenagers and young adults with cancer: a competence career framework for nursing. London: Teenage Cancer Trust; 2014.

    Google Scholar 

  77. National Institute for Clinical Excellence. Improving outcomes guidance for children and young people with cancer. London: HMSO; 2005.

    Google Scholar 

  78. Smith S, Mooney S, Cable M, Taylor R. The blueprint of care for teenagers and young adults with cancer. 2nd ed. London: Teenage Cancer Trust; 2016.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Teenage and Young Adult South West Cancer Service, Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

    Jamie T. Cargill RN, RNT, MSc, PGCE

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  1. Jamie T. Cargill RN, RNT, MSc, PGCE
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Correspondence to Jamie T. Cargill RN, RNT, MSc, PGCE .

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Editors and Affiliations

  1. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

    Pia Riis Olsen

  2. Head of Nursing and Clinical Services, Teenage Cancer Trust, London, United Kingdom

    Sam Smith

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Cargill, J.T. (2018). Exploring Professional Boundaries in AYA Nursing Care. In: Olsen, P., Smith, S. (eds) Nursing Adolescents and Young Adults with Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-73555-9_5

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  • DOI: https://doi.org/10.1007/978-3-319-73555-9_5

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