Oregon Nursing Edition 13 : Page 8

NURSING ASSISTANT CORNER By OSBN Nursing Assistant Program Consultant Debra K. Buck, RN, MS MAINTAINING PROFESSIONAL BOUNDARIES Sometimes, it can be difﬁcult to know where the boundaries between clients and caregivers lie. The following are two examples of boundary problems. that their most personal information and basic dignity will be protected by the nursing assistant (National Coun-cil of State Boards of Nursing, 2011b). Nursing assistants using social media must remain aware of professional boundaries and their client’s privacy rights (Hader & Brown, 2010). The nursing assistant must always act in the best interest of the client. Even though the clients or employ-ment setting are not identiﬁed, this misconduct can have problematic consequences for the client and his/ her family and friends. For example, an earlier post by the co-worker may have mentioned the employment set-ting. A client’s relative, while search-ing the internet for the facility in order to obtain its contact phone number, may ﬁnd the co-worker’s post, causing them and the client emotional distress. Nursing assistants must avoid situa-tions that could compromise the past, present, and future well-being of his/ her clients (Aylott, 2011). The nursing assistant has a responsibil-ity to report, to the appropriate authori-ties, unethical or illegal behavior of any healthcare provider. Failing to report unethical or illegal practice by any health care provider is conduct unbecoming for a nursing assistant (Oregon State Board of Nurs-ing, 2010). If the nursing assistant witnesses unethical or illegal behavior, he/she is obligated to report to their supervisor and/or the state agency that provides protective services. FAQs: Question: I am a CNA. Is it okay for me to “Google” my clients on my per-sonal time? Answer: Not a good idea. The inter-net can contribute to the blurring of professional boundaries. Any infor-mation gained could be perceived as inﬂuencing the care that you provide to the client. It is important to remem-ber that online behavior is traceable. Question: A family member of a recent client of mine in the hospital has sent me a request for an e-friend-ship. Should I accept this request? Answer: Accepting this request could have untoward consequences in the future. You have already started SCENARIO #1 A co-worker tells you that she has something to show you. The co-worker retrieves her cell phone from her pocket and brings up her Facebook page. Even though her photos don’t show anyone’s face, you recognize the photos on her page as having been taken at your place of employment, and involving uncomplimentary images of your clients. What principles guide the nursing assistant’s response to this situation? Nursing assistants have an ethical and legal responsibility to maintain their client’s privacy and confidentiality. Taking and sharing pictures of cli-ents has the potential for long-term consequences for the client, the nurs-ing assistant, and the employment setting. Violating a client’s right to privacy (not having his/her name, pic-ture, or private affairs made public without his/her consent) is a violation of the Nurse Practice Act; failing to respect the client’s rights and dignity is conduct unbecoming a nursing assis-tant (Oregon State Board of Nursing, 2010). Clients need to be conﬁdent 8 OREGON STATE BOARD OF NURSING

Nursing Assistant Corner

Debra K. Buck

Sometimes, it can be difficult to know where the boundaries between clients and caregivers lie. The following are two examples of boundary problems. SCENARIO #1 A co-worker tells you that she has something to show you. The coworker retrieves her cell phone from her pocket and brings up her Facebook page. Even though her photos don’t show anyone’s face, you recognize the photos on her page as having been taken at your place of employment, and involving uncomplimentary images of your clients. What principles guide the nursing assistant’s response to this situation? The nursing assistant must always act in the best interest of the client. Even though the clients or employment setting are not identified, this misconduct can have problematic consequences for the client and his/ her family and friends. For example, an earlier post by the co-worker may have mentioned the employment setting. A client’s relative, while searching the internet for the facility in order to obtain its contact phone number, may find the co-worker’s post, causing them and the client emotional distress. Nursing assistants must avoid situations that could compromise the past, present, and future well-being of his/ her clients (Aylott, 2011). Nursing assistants have an ethical and legal responsibility to maintain their client’s privacy and confidentiality. Taking and sharing pictures of clients has the potential for long-term consequences for the client, the nursing assistant, and the employment setting. Violating a client’s right to privacy (not having his/her name, picture, or private affairs made public without his/her consent) is a violation of the Nurse Practice Act; failing to respect the client’s rights and dignity is conduct unbecoming a nursing assistant (Oregon State Board of Nursing, 2010) . Clients need to be confident that their most personal information and basic dignity will be protected by the nursing assistant (National Council of State Boards of Nursing, 2011b). Nursing assistants using social media must remain aware of professional boundaries and their client’s privacy rights (Hader & Brown, 2010). The nursing assistant has a responsibility to report, to the appropriate authorities, unethical or illegal behavior of any healthcare provider. Failing to report unethical or illegal practice by any health care provider is conduct unbecoming for a nursing assistant (Oregon State Board of Nursing, 2010) . If the nursing assistant witnesses unethical or illegal behavior, he/she is obligated to report to their supervisor and/or the state agency that provides protective services. FAQs: Question: I am a CNA. Is it okay for me to “Google” my clients on my personal time? Answer: Not a good idea. The internet can contribute to the blurring of professional boundaries. Any information gained could be perceived as influencing the care that you provide to the client. It is important to remember that online behavior is traceable. Question: A family member of a recent client of mine in the hospital has sent me a request for an e-friendship. Should I accept this request? Answer: Accepting this request could have untoward consequences in the future. You have already started down the slippery slope of crossing the boundary by the giving the family member your personal information so that they could make this request. Establish clear, professional boundaries about who you connect with, and be cautious in disclosing personal information. Check out https://www.ncsbn.org/ Social_Media.pdf for more information on this topic. SCENARIO #2 Another common dilemma for nursing assistants is how to respond when the client or the family of the client wants to give a gift to the nursing assistant. Clients and their families are frequently very thankful for the genuine, competent care given by nursing assistants. They want to thank the caregiver(s). Nursing assistants cannot accept gifts or money from clients or their family members or friends (Alvare, Fuzy, & and Rymer, 2009; Dugan, 2008 and Oregon Home Care Commission, March 2009). What principles guide the nursing assistant’s response to this situation? Sick people may be dependent and vulnerable. When an individual is ill, they may feel upset and useless because that can’t do the normal daily activities that bring them pleasure and self-worth. These feelings tend to increase, the more they have to depend on others to help them. Being admitted to a health care facility separates the individual from the people that give them their sense of love and belonging. This separation may make the ill person vulnerable to the attention of a caregiver. No client should feel that they have to give gifts in order to receive care. The role of the nursing assistant is personal care. The nature of the nursing assistant’s job gets them close to the client. It is a position of power and control over an individual and great caution must be taken to not take advantage of the individual during this vulnerable time. Nursing assistants are not to use the client relationship to exploit the client by gaining property or other items of value from the client for either personal gain or sale, beyond the compensation for services. The nursing assistant is the one who establishes and maintains the boundaries. It is the nursing assistant’s responsibility to set and maintain boundaries. Clients should be able to count on the nursing assistant to act in their best interest and respect their dignity. It is always the responsibility of the health care professional to establish appropriate boundaries with present and former clients (National Council of State Boards of Nursing, 2011a). Repeated boundary crossings over a period of time will contribute to confusion between the needs of the nursing assistant and those of the client. Boundary violations can be unintentional. The nursing assistant should examine all client encounters for potential boundary conflicts (National Council of State Boards of Nursing, 2011a). Boundary violations can be brief, subtle breaches of conduct that do not cause distress for the nursing assistant or client until harmful consequences occur (National Council of State Boards of Nursing). Always act in the best interest of the client. Nursing assistants, who are overworked, have poor relationships at home, or who are prone to substance abuse may be more susceptible for boundary violations with clients. It is important for the nursing assistant to be aware of factors that may make them a higher risk for boundary violations. If the nursing assistant is unsure how to maintain a proper emotional distance from clients, he/ she should seek help from their supervisor. FAQs: Question: I am a CNA working with a client in her home. My client has offered to loan me money for my unexpected car repairs to make it easier for me to get to her home. Since the client would benefit, can I accept this loan? Answer: No, do not borrow money or property from the client under any circumstance. 2. Question: I am a CNA. A recent client of mine in the nursing home has been discharged home. After the client was discharged, he sent flowers to me as a thank you for the care that I provided him. What should I do? Answer: Report the gift to your supervisor. Your supervisor can provide guidance with facility policies and appropriate options for response to client. It is possible that the client could be re-admitted and if you accept the gift, it could lead to conflict in the future. 3. Question: Is it ever appropriate for the nursing assistant to receive a thank you gift from a client? Answer: Report all offers of gifts to your supervisor. Your company policy may make it okay for a client to give a gift for the entire healthcare team to enjoy, e.g., a box of candy. Check out https://www.ncsbn.org/ ProfessionalBoundaries_Complete.Pdf for more information on this topic. References: Alvare, S., Fuzy, J., & and Rymer, S. (2009). Nursing Assistant Care: Long-Term Care and Home Health. Albuquerque, New Mexico: Hartman Publishing, Inc. Aylott, M. (2011, July 12). Blurring the Boundaries: Technology and the Nurse-Patient Relationship. Bristish Journal of Nursing, 20(13), 810-816. Dugan, D. (2008). Successful Nursing Assistant Care. Albuquerque: Hartman Publishing, Inc. Hader, A. L., & Brown, E. D. (2010, August). Patient Privacy and Social Media. American Association of Nurse Anesthetists, 78(4), 270- 274. National Council of State Boards of Nursing. (2011, October). A Nurse’s Guide to Professional Boundaries. Chicago, Illinois, U. S.A. Retrieved from https:// www.ncsbn.org /Professional- Boundaries_Complete.pdf National Council of State Boards of Nursing. (2011, August). White Paper: A Nurse’s Guide to the Use of Social Media. Chicago, Illinois, U.S.A. Retrieved from https://www.ncsbn.org/Social_ Media.pdf Oregon Home Care Commission. (March 2009). Keeping it Professional. In A Training for Homecare Workers on: Maintaining Professional Boundaries, Best Practices in Recordkeeping, and Confidentiality. Oregon State Board of Nursing. (2010, June 25). Nurse Practice Act. Portland, Oregon, U.S.A. Retrieved from http://www.Oregon.gov/OSBN/pdfs /npa / Div63.pdf PLANNING FOR THE FUTURE The current Certified Nursing Assistant (CNA) testing contract expires in April 2013. Employers and trainers of nursing assistants are invited to attend one of the following meetings to discuss current issues and trends in nursing assistant training and gather input for the next CNA Testing Contract. Baker City: Thursday, Sept. 6, at Blue Mountain Community College Baker City Campus, 3275 Baker Street, Baker City. Florence: Friday, May 18, at Lane Community College Florence Campus, Room 103, 3149 Oak Street, Florence. Hermiston: Wednesday, Sept. 5, at Good Shepherd Health Care, Conference Center 2, 610 NW 11th, Hermiston. Portland: Thursday, July 26, at the Board of Nursing conference room, 17938 SW Upper Boones Ferry Rd, Portland. Tuesday, Nov. 20, at the Board of Nursing conference room, 17938 SW Upper Boones Ferry Rd, Portland. Roseburg: Thursday, April 26, at Umpqua Community College, Wayne Crooch Building Room 10, 1140 Umpqua College Rd, Roseburg. All of the meetings will be from 9 a.m. to 3 p.m. You may register for one of the meetings by emailing penny. Patterson2@state.or.us. Each person’s attendance will be limited to one meeting only, to allow more individuals to provide input. There will be a limit of 20 participants for most of the meetings, so register early to reserve your preferred date.

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