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Elder Care

Professional Boundaries – Becoming Over Involved

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Professional Boundaries - Becoming Over Involved

Recently a client contacted me to do training for their caregivers and it highlighted areas that caregivers need to know in their work.

So this month I am going to discuss becoming over involved.

The Risk Of Becoming Over Involved

Becoming over involved with clients/residents is a real risk and can have detrimental effects on the client/resident, their families and the caregiver.

Because once the relationship moves from carer to friend there can be many ramifications.

It is our professional boundaries define our responsibilities at work.

So what exactly are professional boundaries and why are they important? This short clip explains it well…

Professional Boundaries In The Healthcare Industry

The people you look after are vulnerable and open to exploitation.

So having professional boundaries is essential for their protection

It alos helps define the business you are in, it protects you and it helps the public know what they can expect from you.

This video explains why these professional boundaries are needed in our industry.

https://www.youtube.com/watch?v=gOHhCUWc0hw

Job Interference

Now I know it can be difficult to keep a relationship professional and not get attached to a client.

After all, when you look after a person for a long time you can become quite close.

They often share things with you and talk to you as a friend.

However, when you become over involved with your clients/residents it actually interferes with you being able to do your job.

Friends Vs. Residents

It may be that they start to expect special favors from you and expect you to do things, as you would for a friend.

These may be things that are not part of your job but could eat up a lot of your time.

…And because they think you are a friend you decide to give them special treatment.

It could also work the other way around where you could take advantage of them and their situation.

You tell your client little things about you and your life or family that takes your relationship over the line from being friendly to being friends and friends help each other don’t they?

Once this boundary is crossed it often leads to a slippery slope of disaster.

Safety First

Many people in care, be it at home or residential, become lonely.

A friendly face to take care of them makes their day.

Their professional caregiver may be the highlight of their day or week.

On top of this we all want to be liked – to feel special.

So to be told you are their favorite caregiver makes you feel good.

This can be sweet, or it can be a form of manipulation a person uses to get something they want.

So maintaining a boundary between you and the person in your care is paramount to keeping both you and your client safe.

Overstepping Boundaries

Now all of this may sound a bit harsh but you only need to become a victim to this sort of behavior once to realize the consequences it can have on the innocent.

Don’t ever put yourself in a position where boundaries are transgressed or violated.

Take a look at this video to help you understand a bit more about what boundaries are and how they can be transgressed.

Protect Yourself… Protect Your Residents

In order to protect both you and the client you need to maintain boundaries (as do all your caregivers).

If you think you can get away without being caught, think again.

Something is bound to happen to expose you…

And if the client/resident thinks they can get away with it, make sure they know they could end up with no carer at all if something goes wrong.

It is up to you, as the professional, to maintain a boundary between you and your client or resident.

Take your training to the next level… Get these printable Infection Control Protocols to share with your team and learn how to deal with 19 different infections & communicable diseases in your care facility.

Are We Inadvertently Killing Our Elderly?

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are-we-inadvertently-killing-our-elderly

While I don’t want to be an alarmist, this series that came out in 2002, albeit a while ago, it is still relevant today I believe: http://www.ccfj.net/NHSTLseries.html

So why should I bring this up now?

You will all be experiencing the heat wave we are going through at the moment and probably finding you are drinking more fluids than you would perhaps normally.

However it is good to remember that the older one gets the less likely they are to reach for or call for a glass of water. From the age of 60 thirst becomes blunted which quite simply means they don’t feel thirsty.

Therefore it is up to us as caregivers to think for our patients and offer fluids very frequently – at least 50 mls an hour, to enable them to remain hydrated.

Signs And Symptoms

To remind you of the signs and symptoms of dehydration check out this video:

However there are two early signs left off this list: falls and headaches.

Just think about how you feel when you are out in the hot sun and haven’t had a drink.

Now I know you get very busy and it is not easy to remember all the little things that need to be done.

But if a person does not ask for a drink, then it is likely to be forgotten or overlooked.

Failing to give a person adequate fluids is abuse though, as you will see in this blog article: http://www.nursinghomesabuseblog.com/dehydration/

Take Extra Care

On top of this, if a person dies as a result of dehydration, then you are likely to be culpable or blameworthy as the death could have been prevented as you can see in this article: http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11317558

Admittedly the nurse here appears to have had inadequate supervision.

But at the end of the day, two basics in the care of the elderly need to be understood by all your staff…

  • As people age their thirst becomes blunted
  • They are unlikely to ask for a drink

So if you don’t ensure they have enough fluid they may quietly slip away from you and die.

This can be labeled as abuse, and the neglect and death from dehydration is preventable.

Learn more here:

Get Creative In Providing Fluids

So how can you very simply provide fluid for those in your care?

  • Have fluid rounds in addition to the normal morning, afternoon tea and supper
  • Offer ice blocks sometimes as a variety
  • Watermelons are very inexpensive at certain times of year and it a very enjoyable way to help with hydration
  • Jelly is another easy way to get people to take fluids

Have a discussion among your colleagues and see what other enjoyable ways you can get fluid into people. You may be surprised at what you come up with.

More Resources

At a recent workshop I was at on fluid and electrolyte balance the presenter talked about an excellent book you may be interested in.  “Fluid & Electrolyte Balance – Nursing Considerations” by Norma Metheny which can be purchased here: http://www.jblearning.com/catalog/9780763781644/

And of course for Care Training Online members it may be timely for you to review, do or redo the Hydration topic online.

Have a parent that’s a little hard to handle? Download our free Challenging Behaviors Guide to discover how you can figure out what’s going on and maintain the relationship with your parent.

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