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  • Subject Name : Nursing

Case Study: Mrs Alice Johannsson

The case study indicates the misbalance in the professional boundary is the major ethical issue that can lead to legal complication. The health care professionals are expected to maintain a professional boundary during the patient treatment to reduce the chances of ethical and legal action that can occur. The nurses are expected to not only maintain the confidentiality of the patient but they also have to maintain their professional integrity to reduce chances of the disclosure. The disclosure of the personal information of the nurse can lead to image destruction which can lead to a negative impact over the job (Slobogian et al. 2017). The nursing profession is considered to be an important profession as they are in continuous contact with the individual and thus they are required to maintain the professional boundaries with the client and maintain a therapeutic relationship with the client.

The sign that indicates inappropriate behaviour with the client includes sharing personal information, spending more time, show favouritism and exchanging number or gifts (National Council of State Boards of Nursing, 2020). The violation of the professional boundary occurs due to multiple reasons which include dual relation in which nurses goes beyond from the therapeutic relationship for any social, emotional or personal gain. The next aspect includes excessive self-disclosure that beyond the therapeutic relationship that leads to the breach of the professional boundary (Manfrin-Ledet et al., 2015). 

According to the Nursing and Midwifery Council (2017), the nurses are expected to reflect upon their action to understand their role in maintaining the professional boundary. Different aspects should be considered while working to reduce violation of the professional boundary. The first aspect includes the nurses should be clear about their professional role and responsibility. The second aspect is ensuring the behaviour of the nurse meet the professional need and interest of the client. The nurses should regularly reflect upon their practice to identify the issue in the practice that can be improved. The nurses are expected to ensure competency concerning the profession and understand the accountability of the profession.

The professional standards presented by the Nursing and Midwifery Board (2020) help the nurses to not violate the professional boundary by involving in the therapeutic relationship with the client to improve the quality of care. The professional standard includes three aspects which are standard of practice, code of ethics and code of conduct that lay a professional boundary for the nurses. The code of conduct help to provide the legal requirement, professional behaviour and practise the skill that helps in maintaining the quality of care. The standard of practice laid the basic requirement that is required to follow during the working practice and code of ethics help to provide the basic ethical value that should be considered during patient care.

The professional boundary helps to maintain a professional relationship with the client that helps in maintaining quality of care. The factors that can help to improve the quality of care include educating health professional about the professional boundary and their role that can help to improve the working practice. The professional association is considered to be another factor that can improve the quality of care by increasing understanding of the role while working in collaboration. The self-reflection should also be encouraged by the mentor to identify the issue in the practice that can be improved by to provide the quality of care (Barello et al., 2017). The therapeutic relationship helps to maintain rapport with the client that is required to provide accurate care by maintaining the professional boundary.

The senior staff of the hospital can help the nurse to develop the therapeutic relationship skill to improve the working practises of the individual (Kornhaber et al., 2016). The next aspect that helps to improve the skill that can be used to maintain professional boundaries include helping nurse to build and sustain the work that helps them to increase understating toward qualities that are related to the profession and different strategy that can be used to develop the professional skill. The senior staff can help nurses to maintain the work and personal life balance to which assist them to maintain the professional boundary during the care (Knight et al., 2017).

The changing scenario of the disease reframed the health care delivery system by that increase the responsibility of the nurses during patient care. The direct contact of the nurses with patient increase their responsibility toward patient health and they play a major role in patient understanding toward disease and treatment procedure. The nurse’s behaviour and working practise directly affect the patient health status because they are responsible to provide the safety and quality of care procedure (Allen-Duck et al. 2017). Nurses are responsible to direct the patient involvement in the care that directly improve the care process as it becomes patient-centred that lead to better health results. The patient and nurse relationship requires trust to maintain the accurate care which can decrease the recovery time of the patient and improve the quality of life of the patient (Farokhzadian et al., 2018).


Allen-Duck, A., Robinson, J. C., & Stewart, M. W. (2017). Healthcare quality: a concept analysis. Nursing Forum, 52(4), 377–386. https://doi.org/10.1111/nuf.12207

Barello, S., Graffigna, G., Pitacco, G., Mislej, M., Cortale, M., & Provenzi, L. (2017). An educational intervention to train professional nurses in promoting patient engagement: a pilot feasibility study. Frontiers in psychology, 7, 1-12. https://doi.org/10.3389/fpsyg.2016.02020

Farokhzadian, J., Dehghan Nayeri, N., & Borhani, F. (2018). The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses. BMC Health Services Research, 18(654), 1-13. DOI:10.1186/s12913-018-3467-1

Knight, C., Patterson, M., Dawson, J., & Brown, J. (2017). Building and sustaining work engagement – a participatory action intervention to increase work engagement in nursing staff. European Journal of Work and Organizational Psychology, 26(5), 634–649. DOI:10.1080/1359432x.2017.1336999

Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of multidisciplinary healthcare, 9, 537–546. https://doi.org/10.2147/JMDH.S116957

Manfrin-Ledet, L., Porche, D. J., & Eymard, A. S. (2015). Professional Boundary Violations. Home Healthcare Now, 33(6), 326–332. DOI:10.1097/nhh.0000000000000249

National Council of State Boards of Nursing. (2020). Professional boundaries. Retrieved from: https://www.ncsbn.org/search.htm?q=professional+boundaries

 Nursing and Midwifery Board. (2020). Professional standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursing and Midwifery Council. (2017). Managing Professional Boundaries: Professional v's Personal Relationships. Retrieved from: https://www.nursingandmidwiferycouncil.nsw.gov.au/managing-professional-boundaries-professional-vs-personal-relationships

Slobogian, V., Giles, J., & Rent, T. (2017). #Boundaries: When patients become friends. Canadian oncology nursing journal = Revue canadienne de nursing oncologique, 27(4), 394–396.

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