MHM Magazine

Within the health professions, professional boundaries speak to the ‘edge’ of what is deemed acceptable professional behaviour. Such boundaries are typically associated with the psychological and social distance required between the healthcare professional and their patient. The enablement of such boundaries provides the patient with protection from the power differential whilst assisting the professional in making objective decisions for their patient. Indeed, given the power- differential, and fiduciary nature of relations between healthcare professional and patient, it’s the legal and ethical responsibility of the healthcare professional to enable and maintain appropriate boundaries. Internationally, many health care professionals are subject to ambiguous and sometimes non-existent standards to inform professional boundaries in practice, with some territories having frameworks and legislative mandates that are relatively scant when it comes to non-sexual professional boundaries. South African health care professionals are fortunate to have a robust system of ethical rules of conduct as per the HPCSA’s ethical rules of conduct and guidelines for good practice in the health care professions, amongst others. Yet, whilst the notion of professional boundaries is beneficent in definition, the meaningful application of the principle may be frustrated by the specific practice context of the healthcare professional. Some healthcare professionals face the challenge of unavoidable social relationships outside the professional context, consequent to their rural or remote practice, whilst others might have specialisations with relatively low numbers of practitioners, which would increase the likelihood of friends, family or even colleagues seeking out consultation. However, by trying to keep the peace by not setting boundaries or allowing patients and colleagues to cross professional boundaries is a known trigger for psychological burnout. Research indicates a connection between frequent experience of challenges related to professional boundaries and burnout. Pioneering researchers in the field of burnout describe the psychological syndrome as a product of prolonged exposure to chronic interpersonal stressors at work, and where boundary challenges are a known stressor for healthcare professionals. For the healthcare professional, burnout may lead to: • Cognitive outcomes: Which can include cognitive impairment such as a compromised capacity to concentrate, increased risk of errors, reduced quality of care, low work engagement and intention to retire early. • Emotional outcomes: Such as the development of mood disturbance, depressive and anxiety symptoms, decreased life satisfaction and an eroded sense of compassion. • Health-related outcomes: Transient health problems such as recurrent infection or chronic health problems including cardiovascular disease, musculoskeletal pain, sleep difficulties, increased biological aging and possible early mortality. The healthcare professional therefore faces a catch-22 type situation, i.e.: maintaining appropriate boundaries with patients can be a taxing process, which contributes to the need to replenish physical, emotional, or cognitive energy resources, and if these resources are not meaningfully replenished, the healthcare By Kevin Jooste Industrial/Organisational Psychologist Director – KJ Jooste and Associates Incorporated, Centurion: Gauteng kevin@psyqconsulting.co.za BOUNDARIES AND SELF-PRESERVATION FOR HEALTHCARE PROFESSIONALS MHM | 2024 | Volume 11 | Issue 2 | Crisis Intervention Skills for Doctors MHM Issue 2 | 2024 | MENTAL HEALTH MATTERS | 31 MHM