Ethics and Boundaries in Psychiatric Nursing – A Case Study and Position Paper

Ethics and Boundaries in Psychiatric Nursing – A Case Study and Position Paper
Learning Activity #4 Ethics and Boundaries
In this section I will direct you to a paper (attached) which was formulated by the three nursing regulatory bodies in BC. This was in response to the Health Professions Act of B.C., which was passed in the legislature at around the same time. One clause in the Act calls for the setting up of a patient relations program to deal with increasing ?sexual abuse of patients by nurses?. The group decided to broaden its focus and discuss all forms of potential abuse. In order to raise nurses? awareness of the issues and as a first step before advising patients of what to expect and what not to accept from nurses, this discussion paper was produced and educational sessions offered.
The paper outlines some of the ethical issues in nurse-client relations and how to anticipate situations of abuse. The hope is that, together with patient awareness, abuses can be prevented. A more serious problem on the rise in BC nursing generally is that of boundary violations in the nurse-client relationship.
While this is an issue of professional behaviour and ethical conduct on the part of nurses, it is closely related to the issue of nurse-client relationships and, more so, to the mores of relationships in society generally. While society has redefined, and continues to redefine, relational constructs and stratifications, the result has been individuals entering health care professions where they become confused by their previous learning and personal values or lack thereof. This learning and these values were developed in an ?open? society which boasts no boundaries. In healthcare, these values and behaviours lead to violation of the client through the healthcare professional-client relationship. The healthcare professional abuses the power of the relationship by behaving in ways generally accepted within everyday social life, yet antithetical (directly opposite) to the goals of a professional relationship. As more young people enter healthcare professions, this problem is likely to grow, yet there is no way to avoid the obvious conclusion ? the ways of relating we have come to accept in social life are detrimental, destructive and abusive in the context of healthcare.
Nurses and psychiatric nurses in particular, need to re-examine their values, ethics and boundaries when in relationships with clients and with each other for that matter, especially if they wish to continue to claim their intention to be therapeutic and healing.
Before completing the assignment below, read the PDFs and chapters in Potter-Effron: Potter-Effron, R.T. 1998 Working Anger: preventing and resolving conflict on the job Ch. 1, pp. 5-20; Ch. 2, pp. 22-26; Ch. 3, pp. 39-69; Ch. 4, pp. 71-103 Oakland, CA: New Harbinger Publications  
Assignment for Learning Activity # 4 Case Study #3 ? RPN Jen is an RPN at a 20 bed psychiatric unit in the local hospital. She has worked there for the last 10 years and is considered a competent nurse by her employer. Over the last year her colleagues have expressed concerns to each other that Jen is not ?as nice as she used to be?. They tell each other that she is putting staff down, when they are not on duty. She seems to do this to most of the nursing staff on the unit. Others say that they have heard her using swear words while on duty. One day, at coffee break in the staff room, a nurse stated that she heard Jen being rough with a patient. Another nurse quipped that ?she is always rough with the patients, especially in the morning.? Staff have also expressed concerns to each other that Jen speaks to patients and family members, and even staff sometimes, in a rude and aggressive tone. In the last two weeks, Jen has become aware that the nurses are talking about her. She has reported them to the manager, who has called a meeting today to discuss staff relationships on the unit.
1. Considering this scenario from the perspective of the various parties involved, describe the ethical considerations for each and discuss how they can reach an ethical resolution of the problem.
2. In your own right as a registered psychiatric nurse provide a position statement which relates to the issues and effects of this situation for nurse-patient relationships on the unit.
N.B. You should provide support for your statements and positions making use of the ethics and nursing literature and the readings in this module. In considering your response to this case, apply it to the context of practice in British Columbia and use the criteria provided in the assignment outline.
(Marks Available – 30) Allocation of Marks: ? Accuracy of Information………… 3 ? Other Awareness …………6 ? Self Awareness …………7 ? Able to Draw Parallels to NPR …………5 ? Appropriate Use of Literature ………..6 ? Orthographics …………3 (Spelling, punctuation, grammatical construction, referencing system) Note: All directly quoted statements must be in quotation marks and acknowledged both in the text and references. Statements based on what you read, and presented in your own words, should also be acknowledged in the text and references or bibliography

After you have completed the attached readings, please review the attached original assignment that was submitted.

Please modify the original assignment according to the instructor?s comments and suggestions

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