Working with clients in inpatient services

The question of how to maintain appropriate professional boundaries with clients can be complex and further difficulties can arise for forensic inpatient nursing and healthcare workers.

The literature in this area focuses mainly on boundary violations and there is little research on how staff members develop and maintain boundaries on forensic wards, despite this being beneficial for staff experience and client recovery. Interviews with eleven psychiatric nurses and healthcare workers were analysed using a grounded theory methodology, which led to the formation of a cyclical model of boundary development. Staff initially acclimatize to the forensic environment using their existing experiences and personal values and then enter a phase of calibration, where they constantly assess and address professional boundary issues in the course of their daily responsibilities. Staff members use this experience alongside reflection, social learning and supervision to undergo individual learning that parallels team development. In a fourth phase, staff members use this learning to recalibrate their views on boundaries, themselves and how they work with clients. This recalibration impacts on staff members’ further management of daily boundaries, which provides more material for learning, which leads to further recalibration.

This study emphasises the consideration staff have for boundaries and echoes previous literature suggesting the importance of supervision and reflective spaces. The model is comparable to existing learning theory and highlights the importance of social and experiential learning. There are implications for training, team building, supervision and reflective spaces. Further research could explore cultural aspects of boundary development.