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Boundaries exist in every context whether it is professional or personal. As stated by Masters, professional boundaries draw a line between the nurse’s power and the patient’s vulnerability (2020). A nurse has power because of the knowledge and the role she plays in the patient’s care and the amount of information she has access to regarding their health. The balance must be maintained for the integrity of nurse-patient relationship to be intact (Masters, 2020).
A violation of a professional boundary occurs when said balance is altered from either part. This creates a lack of trust and puts in jeopardy the relationship. There are many ways in which a nurse can cross or violate professional boundary such as lying, disrespecting, altering information and more serious ones include sexual misconduct or exploitation (Masters, 2020).
Patients are often extremely grateful for the hard work nurses do. In their effort to show this they can engage in gift giving. However, nurses allowing or receiving compensation of some sort such as monetary for the services given constitutes a violation of boundary (Masters, 2020). Also sharing personal information, intimate details or behaviors such as flirting can be considered a violation or crossing of boundaries (NCSBN, 2018).
Terminal sedation is usually considered for terminal patients. As the term implies, these patients have reached a stage in their disease where relief of symptoms such as pain and agitation are not obtained despite attempts (van Delden, 2007). Along with other decisions, the decision to artificially feed or provide fluids has ben also withheld. Terminal sedation refers to a sedation that precedes an expected death (van Delden, 2007). Terminal sedation is another way of ensuring compassionate end-of-life care and not just hastening death (Masters, 2020).
Rational suicide differs from suicide in the sense that the person involved in it is not emotionally disturbed, understand the magnitude of the situation and would seem logical to anyone not related to her (Masters, 2020). This continues to be an ethical issue because the idea of encouraging suicide despite circumstances goes against a nurse’s oath. In understanding the situation as a nurse, we are honoring a patient’s right to decide what to do at the end of life.
Assisted suicide brings many negative connotations and outrage. Assisted suicide means to facilitate a patient’s death by providing a doe of medication that is lethal. In this case the patient administers the medication provided by a physician. The Oregon Death with Dignity Act was the first law that allowed for this method of dying to be used (Masters, 2020).
End of life care can be conflictive for many disciplines in the health care field. Personal philosophies and beliefs often seem to influence the way it is viewed. One of the many moral dilemmas experienced by nurses during end-of-life care is their perception that by sharing the truth they are taking hopes of recovery away from the patient (Masters, 2020). This affects how information is relayed.
A fundamental concern during end of life is pain relief. Many people die without proper relief because practitioners fear they are contributing to their death or aiding an addiction. Adequate doses are not provided in many cases because it is thought to contribute to a rapid decline and death (Masters, 2020).
Another moral dilemma and perhaps a very heavy one is the fact that nurses feel their moral integrity is at stake when these modalities contradict their own views (Masters, 2020). There needs to be a thorough assessment of one’s personal beliefs and ideas as to not have them impair or shape the experience of caring for a patient at the end of their life. However, if this becomes distressful for the nurse and alternative could be to have another nurse provide the care for the patient while assisting in other aspects that can benefit the patient.
A Nurse’s Guide to Professional Boundaries (2018). National Council of State Boards of Nursing, Inc. Retrieved from https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf
van Delden J. J. (2007). Terminal sedation: source of a restless ethical debate. Journal of medical ethics, 33(4), 187–188. https://doi.org/10.1136/jme.2007.020446
Masters, K. (2020). Role development in professional nursing practice (5th ed.) Burlington, MA: Jones & Bartlett Learning
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