There are boundary issues in every aspect of nursing practice. Some of the issues range from stopping to purchase some groceries for a home-bound client, accepting gifts from clients, having friendship with clients and engaging in sexual relationships with clients. While there is substantial gray area compared to black and white in the study of professional boundaries, nurses can make appropriate decisions if they have the relevant information concerning fundamentals of professional boundaries (Kagle and Giebelhausen, 1994). Therefore, it is advisable for the nurses to read additional information and take part in discussions with their colleagues to widen their comprehension of the topic.
Professional boundaries refer to the limits that shield the liberty between the professional's authority and their client's susceptibility. This means that upholding proper boundaries will help in controlling the authority allowing for safe links between the nurse and client based on the client's wants. In addition, owing to the various researches on the topic, there are different definitions of boundaries and professional boundaries. According to Avis et al. (1983), the term boundary refers to the concept of limits, lines or margins. In addition, according to the outline of nursing practice, nurses meet the professional necessities for practice when they exhibit the knowledge, proficiency and attitudes, which are apparent in the practice standards and capabilities.
However, many studies have concentrated on therapeutic behavior. Therefore, they have come up with their own definition: professional boundaries refer to lines that separate the therapeutic behavior of nurses from any behavior, which could significantly decrease the benefits of nursing care to patients, clients and the society (Justice, 1995). Although, at some instances, it is possible to identify professional boundaries, prior literature on the topic and various surveys, suggest that professional boundaries are complicated issues. Therefore, maintaining appropriate boundaries arises from the nature of the client-nurse relationship. Similar to other professionals, the client trusts the nurse who has expertise, proficiency and power. However, this paper focuses on the nurse-physician relationship in a healthcare setting.
Changing Roles of Nurses
In the last decade, Malaysia has witnessed unprecedented increases in the number and variety of new nursing roles such as the acute care nurse practitioners, advanced case managers, and clinical nurse specialist practitioners (Puteri, 2009). However, the roles have substantially occurred in acute care hospital environments. In addition, research suggest that the increase in demand and change of nursing roles will continue into the 21st century, with expansion of other nursing roles in ambulatory and community environments. Several studies suggest that the main reason for the increase in nursing roles is the demand for nursing care and the advancing nursing practice (Offredy, 2000).
Recent changes in healthcare roles in Malaysia have called for maintenance of professional boundaries, in addition to upholding of nursing, laws and ethics. Litigation connected to negligence and confidentiality has affected the role of nurses (Puteri, 2009). This is because the Malaysian nursing law does not tackle numerous legal and ethical challenges that require a complete set of laws that identify the extensive junction between legal and ethical judgments. In addition, technological advances in healthcare have also contributed to issues in Malaysian nursing profession, which in turn has led to the changing roles of the nurses.
Nurses are central to the provision of healthcare services between patients and the hospital, communities and healthcare systems. Owing to the hastily changing health setting in Malaysia, this has led to the extended roles in nurses to supplement services provided by the healthcare professionals. In addition, the extension of roles has forced nurses in Malaysia to get involved in activities that may attract individual legal consequences. Subsequently, the nurses have influenced on their nursing practices and have identified the significance of a firm groundwork in legal and ethical codes, hence promoting competency when making complex decisions independently.
Evidence: Relevance of Professional Boundaries
Professional boundaries are vital elements in the nurse-physician relationship this is because they provide for sound personal connection. The difference in authority apparent between the nurses and physicians calls for the need to uphold safe professional boundaries to avoid the physicians disadvantaging the nurses. However, it is possible to breach the boundaries through relationships, giving or accepting gifts, abuse physical, verbal or psychological, romantic or sexual relationships and negligence (Hung, 1995). The boundaries are relevant in healthcare practice as an approach to avoid confusion in the daily practice.
Managing multicultural diversity is an essential part of the healthcare management in collaboration with the quality improvement. Into the bargain, nursing and medicine have a correlation in healthcare provision. Patient outcomes greatly rely on the physician's skills during diagnosis and subsequent treatment, as well as the nurse's observation skills and communicating the correct information to the physicians. Therefore, patient quality improvement will depend on an approach that secures continuous information and efficient nurse-physician relationship. Into the bargain, hospitals where nurses report good cooperation with physicians have reported higher job satisfaction. Additionally, the maintenance of professional boundaries between these professionals will lead to improved patient care.
Professional boundaries are relevant because the two professionals share a symmetrical relationship. This is because the two perceive cooperation differently on dimensions of patient care and the various levels in the status in the chain of command. The professional boundaries will determine the relationship between physicians, nurses and healthcare workers. It is vital to note that the boundaries can lead to positive or negative relationships between the nurses and physicians (Cohn, 2009). If they respect each other, it is likely they will share the same objectives and work in collaboration to accomplish their aims. However, if they have negative relations, it is likely they will work individually and this will affect the patients.
A recent survey evaluating professional liabilities suggested arose from NPs revealed that 1.4% of the allegations were from violations of professional boundaries. Additionally, a majority of the violations resulted from sexual misconduct. It is important to note that sexual misconducts are among the potential boundary violations between the nurses and doctors, but it is also major to realize that dating or showing preference is a violation of the professional boundary (Goolsby, 2004). Owing to the large number of women who work as NPs, it is appropriate to suggest there is vulnerability when addressing uncomfortable situations. In addition, research suggests that physicians tend to perceive themselves as qualified compared to the nurses, which may create a rift in their relations.
Overall, professional boundaries aim at creating a close professional relation between nurses, physicians and other healthcare workers. It is important to note that professional boundaries are relevant in NP practice as they are in any other professional practice (Watson and Foster, 2003). Therefore, the relevance of professional boundaries aims at supporting the significant aspects of the NP-patient relationship including trust, compassion, respect and empathy. Additionally, many studies suggest that NPs are good professionals because they listen to their patients, as well as take time with them. All the attributes are consistent with the professional boundaries (Goolsby, 2004).
Concepts and Theories: Professional Nursing Boundaries
The knowledge base of professional practice in nursing includes theory, concepts, principle and professional limits. It is possible to observe the limits and principles when the professionals translate them in nursing practice (Megginson et al., 1996). Concepts are ideas concerning a class of topics that are core in a discussion. There is a general believe that concepts hold a substantial content of truth, although they are not always true. On the other hand, principles are doctrines that form the basis of other concepts (Megginson et al., 1996). The principles offer guidance to concepts in a given situation. In the case of theories, research suggests that they must have the capacity to offer a wide range of nursing practice.
Additionally, if nursing will base its theory on principles, this will further act as a guide when it comes to professional boundaries. Therefore, there is a need for nurses to validate their professionalism through research (White, 1984). There is a general believe among nurses that for it to qualify as a real profession, it will require a theoretical base (White, 1984). Therefore, nursing is a professional practice based on physical and social sciences. Nurse Managers can learn to incorporate disciplines of human relations, personnel management and labor relations for effective practice. Adding the theory of nursing in the disciplines would promote employee commitment, enhanced competence and maintenance of professional boundaries (White, 1984).
Critical Theory and Critical Thinking
Critical theory is the basis of philosophy in social institutions. Nurses, nurse managers will require making decisions in their line of duty on a daily basis. Owing to their decision-making role, they will also have to translate most of the theories into professional practice (Steff and Grimes, 1986). When it comes to the nurse-patient relationship, the practitioners will require incorporating theory to enable them think critically for professional relationships (Steff and Grimes, 1986). One of the objectives of critical theory is to enable nursing practitioners to maintain appropriate relationships through critical thinking, with their fellow colleagues and their…