Professional boundaries

Understanding your professional relationship 

Working closely with patients at the end of life can be very rewarding, but it can also bring challenges for health professionals. This is especially true in end-of-life care where patients and families are in crisis.

During this time, when therapeutic relationships are developing, the line between a professional and personal relationship can become blurred. [1] For example, it is very easy to become close to some patients and their families / carers – you may find that you have a lot in common; the patient or family may look to you for support and guidance and rely on you for certain things; they may take you into their confidence and into their family. You need to be careful not to become too involved.

Maintaining professionalism can be hard at times as you may feel invested in the situation and in the outcomes. It is a good idea to remember the power imbalance within the relationship between yourself as a health professional and the patient / family / carer. However, it is important to remember that you are part of a team and that together you share the care of the patient. Talk to colleagues if you feel that you may be over-involved in a case. Self-care strategies are also helpful in separating work and life issues. In addition, professional supervision can be invaluable in helping you to maintain boundaries and to identify ways to maintain these.

Questions that can be used to explore boundaries include:

• Is your relationship with the patient / family / carer adversely influencing your professional judgement?
• Whose needs are being met through the relationship?
• Would you feel comfortable or uncomfortable about colleagues or your manager observing your behaviour?
• If challenged, can you ground your actions and interactions in the theories and values of your discipline?
• Does the type of relationship you have with a patient or their family change your professional treatment or management?