The profession of nurses is perhaps the most dynamic and the most complex as it is very difficult to draw the lines of duty. Almost all the patients challenge the nurses to look after them and yet so many see them as either enemies or friends (Martin Teising, 1997). This is particularly true for certified psychiatric nurse assistants and this is mainly because drawing lines of duty for the psychiatric nurses have become extremely difficult as many theorists and practitioners, as well as physicians have not only proposed numerous work boundaries for the nurses, but also have instructed them to carry out these multi-disciplinary tasks. Some suggest that the psychiatric nurse should offer recognition and sympathy and assist the patient explain feelings; some suggest that they should assist the patient in communicating; others suggest that they should assist the patients in contributing socially in the healthcare settings; some think that nurses should make the patient conscious of his/her actions and how it influences other patients; some suggest that they should assist the patient in understanding his/her mind-set on the total state of affairs in which he/she finds himself/herself; and still some say that they should talk about alternating behaviors to assist the patient in working through his troubles (Suzanne Lego, 1999).
In light of the above mentioned facts, it is important to draw clear lines of duty for the psychiatric nurses so that this discrepancy can end and the nurses can focus on their every day chores instead of being preoccupied into matters that do not concern them. This paper provides an in depth review of the problem of nurses' treatment boundaries and used conflict resolution techniques to resolve the conflict.
An in-depth review of the Problem
Many theorists and practitioners, as well as physicians have undermined the importance of defining the work boundaries for the psychiatric nurses. This is because, they feel that the nurses, in general, are somewhat inferior in status and that they can be moved around. While, numerous scholars have pointed out the discrimination against the nursing profession, very few scholars have actually assessed the implications of manipulating the work boundaries of the psychiatric nurses. This subject is important not only for the nurses but also for the healthcare industry as psychiatric nurses form the backbone of the hospital services. By allowing them to drift away from their assigned tasks, the hospitals are at risk of not providing quality services.
As noted above that very few scholars have studied the impact of not defining work boundaries for the nurses. However, Cindy A. Peternelj-Taylor, Olive Yonge (2003) provide an in depth review on this subject. They reveal, "The ability to create and maintain treatment boundaries within the nurse-client relationship is one of the most important competencies required by psychiatricmental health nurses. However simple this declaration, in practice, boundary work is anything but straightforward. The familiarity and trust that develop between a nurse and a client, coupled with the seductive pull of helping, the complexity of the client's treatment needs, and a general lack of understanding of boundary theory, can threaten the integrity of the relationship and ultimately lead to boundary violations. Ironically, through engaging a client in a professional caring relationship -- the essence of psychiatricmental health nursing -- nurses are at risk of overstepping their professional boundaries (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)."
In the 21ST century, the psychiatric nurses may find themselves in a variety of workplace settings. Cindy A. Peternelj-Taylor, Olive Yonge (2003) write, "These settings demand various chores, sometimes familiar chores and other time not so familiar. Contemporary psychiatric-mental health nurses practice in a multitude of settings and embrace a variety of therapeutic roles. They may find themselves working autonomously in independent practice or collaboratively as members of interdisciplinary teams. They may be employees of the healthcare system and practice in traditional community- and hospital-based settings, or they may find themselves working within the criminal justice system, in a variety of secure environments such as prisons and forensic psychiatric units. Although the issues dealt with in practice may on the surface appear to be quite significant, in reality a clearly defined distinction is nonexistent. It is the therapeutic nurse-client relationship that is the foundation of psychiatric-mental health nursing, one that unites psychiatric-mental health nurses regardless of the settings in which they practice (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)."
It is clear that defining treatment boundaries within the nurse-client relationship has become extremely important not only for the nurses but also for the healthcare system, in general. Many nurses have turned to disciplines of psychology, medicine, and social work to seek guidance by understanding their working boundaries. While this approach has been successful in defining a vague treatment boundary for the nurses, still, proper strategies should be applied so that this conflict can be resolved. Cindy A. Peternelj-Taylor, Olive Yonge (2003) write, "Nurses frequently work in situations where the boundaries of the nurse-client relationship are tested, either by their own actions or through the actions of their clients. Their response to these 'tests' is a matter of professional integrity, and nurses, by virtue of the power inherent in their professional role, are expected to do the right thing, even when it is not always clear what "doing the right thing" might look like (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)."
They further write, "Through this discourse, nurse therapists will be faced with examining many of the hazards that have the potential to threaten the integrity of the therapeutic relationship. As a result, they will be challenged to reflect on the meaning of professional boundaries in their relationships with clients and, ultimately, they will be better positioned to navigate the slippery slope of the therapeutic relationship and work with clients in a competent and ethical manner. (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)"
Strategies and Tactics for Conflict Resolution
Many theorists have played down the importance of understanding and self-recognition. They believe that self-awareness and self-recognition of abusing work boundaries will not solve the problems for the certified psychiatric nurse assistants and that effective strategies have to be developed that focus on the behavior of the client. However, Cindy A. Peternelj-Taylor, Olive Yonge (2003) write, "Prevention of boundary violations in the nurse-client relationship requires open acknowledgment that the potential for abuse exists in all therapeutic relationships. However, professionals are often quick to separate those who violate boundaries from themselves by embracing what Gabbard has referred to as an 'us/them' scenario. In doing so, professionals delude themselves into thinking that boundary transgressions can only happen to others who might be described as 'addicted,' 'lovesick,' 'psychopathic,' or 'narcissistic,' leaving few opportunities for personal reflection and exploration of their own vulnerabilities (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)."
Self-Consciousness and Self-Screening
Self-Consciousness and Self-Screening strategy allows the certified psychiatric nurse assistants to also prevent crossing the treatment boundaries. Cindy A. Peternelj-Taylor, Olive Yonge (2003) write, "As a personal risk-management strategy, serf-awareness can assist therapists in appropriately managing treatment boundaries, by acknowledging boundary crossings and thereby avoiding the stepwise progression of boundary violations. In recent years a variety of self-assessment inventories have been developed that can be used to further nurses' (and other healthcare professionals') comprehension of treatment boundaries."
Many of the strategies and tools developed for Self-Consciousness and Self-Screening are questionnaires that the certified psychiatric nurse assistants should ask themselves. These tools provide a variety of benefits for the nurses. Cindy A. Peternelj-Taylor, Olive Yonge (2003) reveal, "These tools can provide opportunities for self-evaluation by increasing the therapist's awareness of boundary issues in general, and may specifically draw attention to particular areas of concern. By honestly answering the questions posed in these inventories, nurses may come face-to-face with personal behaviors that may derail or interfere with the establishment and maintenance of appropriate treatment boundaries (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)."
Peer Debriefing and the Group Method
Mediation and communication are considered to be the best form of conflict resolution for almost all work settings. This is also true for healthcare professionals, in general, and certified psychiatric nurse assistants, in particular. Many research studies have found open-ended communication has allows the certified psychiatric nurse assistants to establish clear working and treatment boundaries. Cindy A. Peternelj-Taylor, Olive Yonge (2003) reveal, "Perhaps the best form of prevention is a supportive work environment in which staff of all disciplines can acknowledge, discuss, and examine their feelings in relation to boundary dilemmas that occur in clinical practice. Being able to talk about one's thoughts and feelings with a trusted colleague can be a valuable growth experience for the nurse (Cindy A. Peternelj-Taylor, Olive Yonge, 2003)."
Clinical Care and Control
The concept of clinical care, control and supervision is an important aspect in defining working and performing boundaries for nurses. While nurses may be trying their level best to establish proper working boundaries, they may loose their concentration and crossover to the other side. Clinical care, control and supervision is perhaps one of the best ways to resolve this conflict. Cindy A. Peternelj-Taylor, Olive Yonge…