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The Practice of Building Fences
1. The Practice of Building Fences
A Conversation About Professional
Boundaries in the Pediatric Setting
Jeanine Clapsaddle, MA, LAMFT, CCLS
Cindy Walsh, MA, RN, CPON
2.
3. Influences on the Professional to
Child Relationship
Understanding of development
Personal style of interaction
Responsiveness to social and
emotional needs
Beliefs about the role of the
Professional
4. Influences on the Child to Professional
Relationship
Previous experiences with adults
Cumulative medical experiences
Culture
Temperament and Development
5. More Influences
Attachment Theory
Developmental Disorders
Trauma
Consistency, Consistency,
Consistency
Relational Ambiguity
6. Professional Relationships –
A Summary
Relationship is governed by the
inherent imbalance of power between
the provider and the patient and or
family
Onus is on the provider to
understand the implications of the
power differential and incorporate
that knowledge into daily practice
7. What Does That Look Like?
Terminate the relationship
Providers responsible to assure own
needs are met.
Independence
9. It’s a Quiz……
You are invited to a patient’s
birthday party. Is this a boundary
issue and if so, which category(ies)
does it fall into and why?
10. The Second Quiz Question
A patient or family member asks
you to be their friend on Facebook.
What do you say and do?
11. One More……
If you are concerned a colleague has
crossed a boundary, what do you do
first?
Talk to your manager
Address it with the colleague
Consult the Professional Board
Ignore it
12. How do I Start the Conversation?
Think about what you really want
out of the conversation.
How does this situation affect my
practice and or the patient’s progress?
Privacy
Location of the conversation.
Timing of the conversation
13. The Conversation Continued
“I’d like to talk to you about
something.”
“I am concerned this behavior is
interfering with your effectiveness
in providing good care.
Describe specific behaviors, followed
the possible results
15. Boundaries in the Context of Time
An action may seem harmless in the
short term
The long term implications may be
costly
What is the risk or benefit of this
action?
16. Things to Think About
Independence
Autonomy
Fairness
Contextually appropriate care
17. More to Think About
There are moments in time where the
medical and nursing care is more
important to the patient’s well being.
However, there are times when the
mental well being of the patient is a
bigger piece of the pie than the
medical and nursing piece.
18. CHOP’s Philosophy
‘Staff sometimes have a magnified
view of their important in the lives of
the families they serve. In reality,
the healthcare experience for most
patients represents only a
momentary episode in their lives.
Staff need to maintain perspective of
their role and function.’