Aim This study explored the manner in which paediatric nurses and hospital play specialists set professional boundaries and the challenges they faced in maintaining a therapeutic relationship when caring for children and their families in hospital.
Methods A phenomenological approach was adopted, through a purposive sample of seven paediatric settings within one NHS Trust. Eight paediatric nurses and two hospital play specialists were interviewed. Thematic analysis, using field notes and transcribed tape recorded interviews, was used to identify emerging themes and generate a description of the respondents’ experience.
Results The study revealed that paediatric nurses had difficulty in defining the concept of professional boundaries, therapeutic relationships and self disclosure. Although no clear definition was given for professional boundaries, respondents agreed that they were important. Paediatric nurses could recognise when boundaries were being broken but lacked the confidence to address boundary violations. Using self disclosure was seen as a balancing act which could lead to boundary crossing and boundary violation. Nurses felt unsupported by senior colleagues particularly when faced with “manipulative families” and found their code of conduct1 helped guide their practice. Hospital play specialists had a greater understanding of therapeutic relationships then paediatric nurses.
Conclusions Health care professionals can recognise professional boundaries and boundary violations but they need support to address violations – especially in the paediatric intensive care environment.
Nursing and Midwifery Council. The code: Standards of conduct, performance and ethics for nurses and midwives. NMC. London; 2008
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