Last Updated Jun 2011
Maintaining appropriate boundaries in the workplace can be challenging—especially in the healthcare setting. Because of the inherent intimacy involved with becoming familiar with the physical and emotional well-being of another person, the relationship between patient and caregiver is unique. As a result, healthcare professionals must be acutely aware of proper behavior when dealing with patients, family members, and all individuals involved in the care process.
Upholding suitable colleague-to-colleague behavior is critical as well. When there is a breakdown in boundaries or an ethical violation between co-workers or in a supervisor-subordinate relationship, inappropriate conduct can snowball into a series of poor choices that ultimately results in a breakdown in patient care.
Because the lines between right and wrong can be blurred easily in such a highly emotional setting, it is important to understand the difference between what is appropriate and what is not. In addition to clearly setting boundaries at the beginning of the healthcare relationship, caregivers must remain vigilant. Paying attention throughout the relationship is critical to observe potential boundary crossings or violations.
What is Inappropriate Behavior?
Determining when and where boundaries are necessary is not an exact science, but there are certain key areas where boundaries must be considered—specifically those situations dealing with physical contact; language; the provision of money, gifts and services; and self-disclosure. To clarify, some “red flag” behaviors to be aware of may include:
- Inappropriate Physical Contact. Use touch appropriately, and in the proper context.
- Too Much Self-disclosure. Refrain from revealing excessive personal information to patients as well as colleagues.
- Horseplay. Horseplay is generally considered inappropriate workplace behavior, with the exception of the pediatric setting (and in nonsexual areas on the body).
- Inappropriate Clothing. Avoid clothes that are too tight or too revealing.
- Loaning/Borrowing Money to and from Patients
- Distributing/Accepting Gifts to and from Patients
Appropriate vs. Inappropriate Touch
Touch is one of our basic needs as humans, and touching can be an effective way to establish rapport and communicate caring. “Appropriate touch”—or touch in the right context—is a necessary and important part of the healthcare relationship. Physical therapists, for example, must touch their patients to assist with treatment and ensure safety. Likewise, nurses must have physical contact with patients to assess their condition and administer treatment.
“Inappropriate touch” occurs when touch is used to meet the needs of the healthcare professional rather than the needs of the patient or patient’s family. Because touch can be misperceived by patients, it must be carefully monitored. Erotic areas—breasts, genitals, thighs, or lips— must never be touched, unless medically necessary. Appropriate touch areas are generally the hand, shoulder, or forearm.
The Need for a Code of Ethics
The issue of ethics violations in the workplace is now more prominent than ever. In healthcare, as in any industry, establishing a clear and applicable Code of Ethics can help provide guidelines for proper caregiver-to-patient and colleague-to-colleague behavior, as well as ensure safety and structure in the clinical setting. For this reason, each discipline has its own code of ethics to serve as a guideline for healthcare professionals to fulfill the obligations of their jobs and provide optimal patient care.
Perhaps the Code of Ethics for the Physical Therapist (as outlined by the American Physical Therapy Association) says it best: “Physical therapist practice is guided by a set of seven core values: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life.”
Setting the Example
As stated in the Code of Ethics above, caregivers must act as educators—assessing and evaluating each situation in the clinical setting and choosing behavior that is in the best interests of the patient and society. In other words, their actions must be the most ethical, legal, and beneficial to the patient. Doing so begins with instructing patients as well as family members and becoming a role model for appropriate behavior with the community.
For more information on ethics and boundaries in the healthcare setting, view our comprehensive course Ethics and Boundaries in Healthcare.
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