Chapter 2: Addressing work-related grief stress

The importance of boundaries

Boundaries in patient care are the somewhat flexible physical and emotional limits that exist between you and your patient/families. Boundaries are essential because they establish and maintain a trusting professional relationship and can help prevent compassion fatigue.

Ethical dilemmas

Many health care professions enshrine rules in their codes of ethics for maintaining the boundaries of the clinical encounter. However, ethics are never cut and dry. Ethical dilemmas are by nature highly nuanced and ambiguous, which means that sometimes the best  course of action may not be obvious. If your boundaries are too rigid, you may seem uncaring and detached. If your boundaries are too fluid, you may have difficulty separating yourself from the situation.

It’s critical to keep some degree of emotional distance from patients and their families in order to do your job well. Problems can occur when your personal and professional lives start to overlap (e.g., meeting informally with a family member after a call.) Family may also impose their expectations for more closeness than is appropriate. For example:

"You seem like such a nice person. I have a lovely daughter, AND she is single. Can I give you her number?"

Reflective exercise

These questions may help guide you BEFORE you’re confronted with boundary issues in the field: 

  • How far am I willing to go for a family?
  • What’s my bottom line of personal and professional comfort? 
  • What would feel like too much? 
  • What would I have to say no to? 
  • What would be a situation where I could not say no and what would be the justifiable reason (e.g. medical need is the priority)?

Ask yourself these questions if you’re facing a boundary dilemma: 

  • Am I behaving differently than I would in any other call? 
  • If I’m going the extra mile for a patient or family, is it in their and my best interest?