Chapter 2: Addressing work-related grief stress

Boundary challenges in palliative care

How do boundaries play out in a palliative care call in the midst of its intensity and a ticking clock? You may have little to no time to consider the finer points of professional boundaries when the medical need is extreme. 

In general, palliative care calls sometimes push you towards more fluid boundaries. A person is dying or has died, so you may be inclined to be more lenient or accept certain behaviors, or to act in certain ways you might not otherwise. Over time or due to especially intense circumstances, family members may have come to depend on your care and support. This can create a higher degree of intimacy between you and the family than is the norm in your other calls. 

Some family members may have difficulty saying goodbye to you or may wish to continue to have a relationship with you after the death. You may even have similar feelings yourself and may find yourself conflicted between the natural pull you feel toward the family and the boundaries your training prescribes.

You may feel uncomfortable about these feelings or the tension they create, and may notice that you want to dismiss or minimize them. At these times, you’ll need to be able to find a way to set boundaries while respectfully acknowledging the intimacy, which is real and yet specific to a period of time and particular circumstances.  

Conversation Prompts

“I feel truly honoured to have been part of this experience with you.”  

“I will never forget [patient’s name] and this family. Thank you.” 

“My work brings me into contact with some great people, like you, but my profession doesn’t allow me to become friends with those I serve.”  

 "I can stay only a few more minute and then I have to go."

For additional information, see Module 6, Supporting the patient and family - Chapter 5, After the death - Concluding the call. 

Rural practice

If you work in a rural setting, you may find it even more difficult to maintain these boundaries, especially when you have pre-existing relationships with the people you serve. For example, the family receiving care own the only gas station in town, and you have no choice but to tank up there every week.