This document discusses professional boundaries in pediatric healthcare settings. It addresses factors that influence relationships between professionals and children, such as development, culture and past experiences. It also discusses attachment theory, developmental disorders, trauma and consistency. The document emphasizes that healthcare professional relationships are governed by inherent power imbalances and professionals must understand how this affects their practice. It provides examples of boundary issues and scenarios healthcare professionals may face, and stresses the importance of independence, fairness and contextually appropriate care.

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

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

8. Likely Boundary Issues
 Physical
 Emotional
 Sexual
 Verbal

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

14. The Conversation Continued
 Share the facts
 Tell your story
 Hear the opposite view

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.’

19. Questions???