Boundary crossings and violations
Scenario 2 – Oversharing personal information
Mrs. Smith goes to see her nurse practitioner, Sandeep, because she is feeling overwhelmed. Mrs. Smith admits she is having marital difficulties with her husband. This is making her feel very anxious and unable to sleep. Sandeep acknowledges that ‘marriages can be hard work’, and begins to tell her about his own problems with his spouse. Sandeep becomes emotional speaking about his spouse, and asks Mrs. Smith if he can take a minute to compose himself. Mrs. Smith comforts Sandeep and says her problems seem insignificant in comparison, so she should just ‘get over it already’. Sandeep says he is running late for his next appointment, and asks Mrs. Smith to reschedule.
Questions for discussion
- Were Sandeep’s actions in this case appropriate? Why or why not?
- Would you consider this to be a boundary crossing or a violation? If so, which? Why?
- How might Sandeep’s actions influence how Mrs. Smith views him as a nurse practitioner?
- How can Sandeep re-establish professional boundaries with Mrs. Smith?
Key concepts this scenario illustrates:
- Oversharing personal information
- Boundaries and what constitutes an appropriate nurse-patient relationship
- Not putting the patient first
Sandeep’s disclosure of his personal struggles with his own marriage crossed a line into oversharing personal information. Sandeep’s decision to overshare placed his patient in a position where she felt it necessary to comfort her nurse practitioner. Her own needs were pushed aside and the care she sought was postponed to a future appointment in favour of Sandeep’s emotional needs. This is inappropriate and unprofessional.
The urge to relate to patients and comfort them is natural, but it is imperative all nurses know that, sharing too much personal information, can compromise the therapeutic nurse-patient relationship boundaries. Should Sandeep think his own story would help validate Mrs. Smith’s feelings, he could have spoken more generally about the challenges people experience in marriages. Such an approach allows Mrs. Smith to feel comfortable providing more information to Sandeep about her concerns without worrying her problems aren’t serious enough to warrant his help.
If Sandeep’s disclosure was more detailed than would be professionally acceptable, resulting from his own stressful he is experience, this indicates Sandeep needs to reflect on his own health needs and their impact on his practice. He needs to determine if time away from practice is warranted to focus on re-establishing his personal wellness, as recommended in CNO’s Code of Conduct and Self-Care Fact Sheet. Nurses cannot serve their patients effectively if they are not well themselves.
To re-establish boundaries after Sandeep crossed them, he could address his error with Mrs. Smith either before the end of the appointment or at the beginning of their next appointment. He could be direct and clear with the patient by saying, “It was not appropriate for me to share such personal information with you when you were seeking medical assistance from me. Please accept my apologies.” Sandeep could then move forward in a professional capacity with Mrs. Smith.
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