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Boundaries And Ethics In Residential Settings 2


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Ethics in mental health residential settings by sue Kucklick, copyright 2009

Boundaries And Ethics In Residential Settings 2

  1. 1. Boundaries and Ethics in Residential Settings<br />A presentation by Sue Kucklick. PCC<br />With the assistance of clients who provided their valuable input<br />
  2. 2. Zone of helpfulness1<br />1. Revitalizing Professional Boundaries Policy Into Meaningful Practice Improvement<br />Shelly Bolin Morton, RN, BSN<br />Home Health Care Management & Practice / June 2004 / Volume 16, Number 4, 255-260<br />
  3. 3. elements<br />
  4. 4. Self disclosure: Ask--<br />
  5. 5. what others say<br /><ul><li>I’ve worked for years in home health care and never</li></ul>thought about why we should not share personal information<br />with patients. Now I realize the safety ramifications<br />and the fact that I’m meeting my own needs by<br />telling them my story and not keeping it on a therapeutic<br />level.<br /><ul><li>Now I have some suggestions for how to honor the</li></ul>patient by suggesting they donate the heartwarming<br />afghan they’ve been knitting to the shelter in need<br />rather than to me!<br /><ul><li>I’ve become too comfortable with my patients at</li></ul>times, and it is sure helpful to be reminded that we are<br />professionals in their homes.1<br />1. Revitalizing Professional Boundaries Policy Into Meaningful Practice Improvement<br />Shelly Bolin Morton, RN, BSN<br />Home Health Care Management & Practice / June 2004 / Volume 16, Number 4, 255-260<br />
  6. 6. boundaries <br />“Sometimes I feel <br />like I live in a <br />
  7. 7. boundaries<br />“What was I supposed to think? They gave me hugs, they talked to me and spent time with me. I thought they were my friends. They even told me where they lived.”<br />
  8. 8. boundaries and confidentiality<br />“There are no secrets here in this building.” <br />“I don’t expect to tell a staff member something in confidence and then be confronted with it by another staff member the next day.” “I don’t think staff knows how much we hear when they’re talking loudabout us.”<br />
  9. 9. guidance<br />Sometimes we all need a little bit of light!<br />
  10. 10. effective guidance<br />
  11. 11. “Case managers and other staff should feel free to be confused and to<br />seek counsel from their supervisors and peers. The multidisciplinary<br />team approach may mitigate boundary violations and guide successful<br />interactions by offering support, insight, practical assistance, and<br />training.”2<br />2. Community Mental Health Journal, Vol. 34, No. 3, June 1998<br />Case Managers and Boundaries<br />Robert E. Drake, M.D.<br />Nina Marlowe, M.D.<br />
  12. 12. role play<br />What religion are you?<br />Have you ever been depressed?<br />Where do you live?<br />Do you have children?<br />Are you married?<br />Can I buy you lunch?<br />Did you ever do drugs?<br />
  13. 13. dual relationships-appropriateness andrisk of exploitation3<br />Dual relationships often exist in one way or another<br />Cannot sell items to, or buy items from clients<br />Cannot request or accept compensation in addition to pay from clients<br />Cannot engage in relationships outside work with clients<br />3. Community Mental Health Journal, Vol. 33, No. 6, December 1997<br />ETHICS IN COMMUNITY<br />MENTALHEALTHCARE<br />Can We Bridge the Gap BETWEEN the<br />Actual Lives of Persons with<br />Serious Mental Disorders and<br />the Therapeutic Goals of<br />Their Providers?<br />Patricia Backlar, Editor<br />Portland, Oregon<br />
  14. 14. small group discussion<br />Client Carl is short on funds and sells his gently-used flat screen TV to Staff Celia for an excellent price so he can attend his sister’s wedding.<br />Staff Sara wants to help a resident who has no income gain job skills. She has Resident Randy to do some yard work at her home and pays him in cash.<br />Staff Stefan is short on cash for gas and borrows some money from Resident Ralph until day after tomorrow.<br />Staff Stan has a store and hires some clients to work there so they can get some job skills.<br />
  15. 15. What would you change?<br />Protecting health information<br />Interaction with staff<br />Interaction with clients<br />