Does the “theraputic nurse/patient” relationship have to end at discharge?

Well this is a tough one, but I have been asked to blog about the therapeutic nurse/patient relationship, so I will.

I will be 100% honest, personally I say “yes, the nurse patient relationship ends at discharge”. That is what we are taught in nursing school. Then again is everything we are taught in nursing school actually “real life”?

So why is this topic so controversial and elicit such strong reactions?  Why does discussion lead to …”Well in this case, it is ok and in this case, it is not” type of conversations? There is much “grey” area and areas left up to interpretation and judgement.

Ask yourself if continuing a relationship after discharge from nursing services in these situations is acceptable or not.

  1. Old high school teacher, who has asked you to add her to Facebook as she is leaving the hospital after recovering from a heart attack.
  2. Mother of child who is dying of cancer and states she has a bond with you, you have been her rock. She wants you called and there when her child dies. You want to be there.
  3. Child with chronic condition who is “everyone’s favourite”, spends months and months on your unit. Has a smile that melts your heart. You buy him a birthday present.
  4. You have started your own Facebook page for mothers who have lost a child during childbirth. You share with a mother who delivered her baby stillborn that you have had a similar experience. You offer the Facebook page to her.
  5. A patient with whom you have spent many nights sitting and writing letters to her children for her, as her hands were too weak to write them herself before she died. The family expects you at the funeral.

So should any of these individuals both adults and a child be able to contact you personally after discharge? Do some of these relationships seem “harmless”? Do the patients and families we take care of sometimes begin to feel like family? Is that normal?

Ask yourself: do the patients and families need the interaction or do you need the interaction? If so why? Is it crossing a boundary?

The therapeutic nurse relationship- defined

This relationship is dynamic, goal-oriented and patient-centered because it is designed to meet the needs of the patient. Regardless of the context or length of interaction, the therapeutic nurse–patient relationship protects the patient’s dignity, autonomy and privacy and allows for the development of trust and respect.

 

RED FLAG BEHAVIORS

Some behavioral indicators can alert nurses to potential

boundary issues for which there may be reasonable

explanations, however, nurses who display one or more

of the following behaviors should examine their patient

relationships for possible boundary crossings or violations.

Signs of inappropriate behavior can be subtle at

first, but early warning signs that should raise a

“red flag” can include:

     Discussing intimate or personal issues with a patient

     Engaging in behaviors that could reasonably be

interpreted as flirting

     Keeping secrets with a patient or for a patient

     Believing that you are the only one who truly

understands or can help the patient

     Spending more time than is necessary with a

particular patient

     Speaking poorly about colleagues or your employment

setting with the patient and/or family

     Showing favoritism

     Meeting a patient in settings besides those used to

provide direct patient care or when you are not at work

 

Patients can also demonstrate signs of over involvement

by asking questions about a particular nurse, or seeking

personal information (NCSBN, 2014).

 

Please don’t think that I don’t understand. I worked palliative care/ hospice and many families wanted to keep in touch. Not only was I commonly invited to the funerals, but invited to family gatherings and memorials after as well. The patients and families do not have to hold up the other end of the therapeutic nurse/patient relationship, it is one sided, it is the nurses job.

I understand from the families’ perspective. I was there to help their loved one through the dying process. I provided comfort. Dying is a very intimate emotional moment. I do not fault the families.

I also work in pediatrics. I earn the trust of families as I take care of their very sick or injured child. The nurses in the PICU are sometimes the only faces some of these kids see, they are the only one that talks to them and holds them and provides a loving touch when their parents abandon them. Its hard not to get attached. (grey area)

I remember a father whose child passed after a battle with cancer. I had spent 3 consecutive nights with them. The father was the soul caregiver and wanted to carry him as he did many times before when his son was too weak to walk. He wanted to do it one last time. I made that happen, it wasn’t protocol, but I made it happen. We walked down to the morgue as he talked to his dead child. Then the father knew he could not go into the restricted area and handed me his child and said I trust you to take my child and lay him to rest now. We cried. The police officer escorting us secretly shed a tear as well.

I took the child from that loving fathers’ safe arms and thought I would never forget this child, what he looked like, things he said to me, his name…I would remember everything about this child. I learned from this experience, but I cannot tell you his name, what he looked like or things he said to me. Do I feel bad about that? No, some might. The relationship at the time was intense and emotional, but had to end…and it did.

Especially with social media, it is very easy and convenient to look up and contact staff, patients and their families. Keep your practice safe, keep your integrity safe use your good nursing judgement.

We grieve, we feel, we are nurses…we are human.

Support each other, don’t judge eachother, nursing is not just skill it is heart…

Jen

Sit down and have a coffee knowing you might have forgot their name, but you grew because of them…that is a gift.

Thank you Megan for bringing this topic forward.

References:

NCSBN. (2014). A Nurses Guide to Professional Boundries. Retrieved from http://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf

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