The Zone of Helpfulness Maintaining healthy boundaries By

The Zone of Helpfulness Maintaining healthy boundaries By Corina Fuhrer RN

Continuum of Professional Behavior Zone of Helpfulness Under Involved Over Involved

What are Professional Boundaries? Ø Clearly established limits that allow for safe connections between service providers and their clients Ø “Being with” the client, not becoming the client Ø Being “friendly”, not friends Ø The ability to know where you end and the client begins Ø A clear understanding of the limits and responsibilities of your role

The Importance of Boundaries Ø Helps to prevent compassion fatigue Ø Helps to keeps both the client and the service provider safe Ø Supports self management for clients Ø Role models to the client healthy communication and professional relationships

Potential negative outcomes of poor or loose boundaries. Ø Compassion fatigue can occur- the role may not be sustainable Ø Team splitting Ø Client can feel betrayed, abandoned or poorly served Ø Service provider may act unethically Ø Comprised reputation of agency and service provider

Signs boundary issues exist Ø You identify as friends Ø Gifts are exchanged Ø Client has service providers home phone number or is asking for it Ø Client asks or expects that service provider socialize outside of professional setting Ø Service provider over shares personal information Ø Service provider worries or experiences anxiety about client situation Ø Service provider talks about clients during social interactions with family and friends Ø Service provider offers assistance outside of role (ex: transportation or money) Ø Service provider vents with client about work or team members

Some difficulties in establishing and maintaining healthy boundaries Ø Dual Relationships- The service provider and client know each other in a personal context apart from work Ø Values conflicts- The client’s choices, history, relationships, feelings, lifestyle and or life circumstances conflict with service provider’s values and or knowledge about best practices Ø Vicarious trauma-The service provider experiences trauma symptoms from hearing about the client’s experiences. The service provider may be triggered due to having a history of similar circumstances Ø Playing the “hero” role- The service provider feels they need to “save” the client Ø Poor teamwork- The service provider does not trust that other team members are fulfilling their responsibilities to the client, or believes they can provide the service better. The service provider takes on the roles of the other team members.

How do we establish and maintain professional boundaries Ø As early as possible establish clear relationship expectations. Your role as the service provider, when you are available and the best ways to communicate Ø When boundary issues or warning signs appear, address these with the client. Be sensitive to their feelings. Ø Limit self disclosure. Ensure that is you share something it is in relationship to the client’s goals Ø Realize that how a client interprets your words and actions might not match what you were trying to communicate Ø Avoid nicknames or pet names. Not only can this be taken as being disrespectful, it blurs the professional relationship

Care Navigator role Ø Help patients navigate the healthcare system such as: benefit eligibility, appointments, referrals, transportation, promoting continuity of care through care coordination Ø Assists members in obtaining necessary equipment, or care giving supports to maintain highest level of independence and safety Ø Supports members goals through active listening and motivational interviewing Ø Identifies gaps, barriers, and potential safety concerns reporting back to CM to collaborate on care plan

Nurse Case Mangers role Ø Educate the patient and their families on the importance of lifestyle change; adherence to their medication regimes and recommended treatments Ø Find creative ways to increase compliance with medications Ø Identify gaps and barriers to adherence such as: education, safety, access to care, financial Ø Coordinate care across care settings, to include client’s goals and preferences Ø Promotes health and wellness Ø Referral to resources and services Ø Chronic disease management

Staying within your role or scope Ø Never recommend treatments, including over the counter or herbal remedies, encourage the member to talk to their provider Ø Avoid handling a members medications Ø Never give legal advice Ø Avoid making recommendations or commenting on providers or vendors Ø Do not provide wound care, take vital signs, blood sugars or assess the member medically

Thoughts? Questions?