The Maintenance And Preservation Of Health Essay

For certain people, the responsibilities of the nurses may seem apparent, as all they need to do is following the orders from the doctor. Even for an experienced nurses, they still need to concede from the doctors in matters that they are restricted and not qualified in. This is called professional boundaries. According to CRNNS (2002), professional boundaries are the defining lines which distinguished the therapeutic behavior of a nurse from any behavior which, could lessen the benefit of nursing care to individuals and communities.

But in reality, the job of the nurses sometimes being pushed to the limit based on the patient’s condition. This may lead to some instant decision making with or without the conceding from the doctors. This case however may be seen as the boundary violation. The boundary violation can be defined as a disruption of the barrier between a professional and the client. The Maintenance And Preservation Of Health Essay. In our context, it is an act or interaction which damages the relationship between the patient and the professional (either nurses of doctor). The action of crossing the professional boundaries may be regarded as against the law.

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The boundaries in the nurses practice can be divided into a few categories. According to Allen (2001), there are five keys of nursing boundaries that had been identified which consist of boundary among nurse – nurse itself, nurse – supported worker, nurses – doctor, nurses – patient and nurse – research undertaken. In my workplace, the most common boundaries that can be identified is between nurses – doctors and nurses – patient.

I am a staff nurse that is assigned in an oncology ward in one of the hospitals in east Malaysia. As the nurses that specialize in cancer disease, we are trained in a specific aspect of cancer care, such as palliative care and administration of chemotherapy. Some nurses on the other hand, will choose to become an expert in cancer control. This will need a further education in cancer control at a higher level such as degree and masters.

At my workplace, the process of administering of chemotherapy to a cancer patient is a common thing. As a staff nurse, our responsibility during the process is to assist the doctor and make sure that all precautionary steps are taken. It is a doctor’s responsibility to provide the prescription of the drugs and administer the chemotherapy, as a regular staff nurse are not being trained to do such things.

The most common procedure in the chemotherapy process is to specify the amount of drugs to be administered to the patients. The prescription has usually been provided by the doctors beforehand. But during the chemotherapy process, a problem may occur in which the prescription had to be changed immediately based on the patient’s condition. Some of the nurses who have adept knowledge in the chemotherapy will decide on her/his own the dose of the drug without consulting with the doctors beforehand. It is noted that the decisions have to be made by doctors but the fact that this will save time and work as the decisions has to be made instantly.

During some of the chemotherapy, the process is done without the attendance of the doctor. Thus the process will be conducted by the nurses and lab technicians. The Maintenance And Preservation Of Health Essay. All the details from the safety precaution, to the briefing of the after effect of the treatments are being handled by the nurses. The doctors are frequently given the orders verbally as they are busy handling other cancer patients.

The act of crossing the boundary may be caused by some external and internal factor such as shortage of doctors, massive amount of patient to be taken care, lack of capability by junior doctors, and the working environment and culture. All of these factors become the reasons for the nurses to create a boundary violation, sometimes against their free will.

In my workplace, there are only 3 doctors working in a shift. They had to be responsible to nearly 50 patients diagnosed with cancer. It is impossible for the doctor to cope with all this workload and naturally some of the workload will shift to the nurses. Most of the time, the nurses had to make a decision that is supposedly decided by the doctors due to the restricted workforce.

Many nurses stated that boundary violation happens due to the lack of experiences by the junior doctor. The nurses claimed that it takes twice the time to seek for junior doctor’s conceding compared to the senior doctors. Nurses feel that by seeking permission from a junior doctor will delay the chemotherapy process and wasting the patients’ time. As for junior doctor, without letting them handle the process themselves, it will deter their learning process thus preventing them to gain knowledge and experience. As being stressed by Lancaster, McQueeney, and Van Amburgh (2011), “as we attempt to educate ever-evolving generations of students, we must learn to adapt and tailor our teaching approaches to meet the students’ needs”. The environment of clinical experience was seen as special and to maintaining medical staffing level was proving difficult. When the case of an emergency, it is hard for junior doctors to conduct the situation without enough practice and experience (Tye and Ross, 2000).

Sometimes, the excessive authority that is possessed by the doctors promote the nurses to cross the professional boundaries. In the hospitals in Malaysia, the doctors are regarded as the person who is at the top hierarchy in the status of the occupational health worker. Basically, the nurses have to follow all the orders from the doctor. There are times where the doctors are forcing the nurse to obey to their orders even though the nurses are not in the same page with them regarding the decisions. Some of the more experienced nurse will defy the orders after taken into consideration the condition of the patients. The Maintenance And Preservation Of Health Essay.

Furthermore, the mentality of the nurses these days have been changed. The nurses refuse to follow orders without considering the rationale and the consequences of the said matter. This is because if anything bad happen to the patients, the nurse will most likely to take the fall for it. The doctor should take into consideration of all the delegation of tasks that they had given to nurses to prevent any mistakes from occurring. As the leader, doctors should show their integrity in handling any decision making and consider any other alternatives suggested by their subordinate. Ang and Long (2003) had mentioned that “Someone once said, ‘Leaders are people who develop leaders and not followers.’

Some impact will occur due to the violation of the professional boundaries. First of all, the acts can affect the patients greatly. Since chemotherapy are always being conducted by a doctor, some patients will become uneasy when the responsibility of administering the drugs have been shifted to the nurses and lab technician. The patients most likely feeling neglected by the doctors and thought that there is no hope for them as the doctor are not trying hard in their treatments. According to Australian Medical Council (2009), patients have unconditional believe in the doctors. They believe that the doctors are competent and will not take advantage of them as well as display qualities such as integrity, honesty, determination, empathy and compassion.

Crossing the boundaries may also lead to some problem relating to the relationship between the nurse and doctors. Most doctors will feel threatened by the fact that the nurse are defying their orders by making their own decisions. As for the nurses, they feel that their actions is the right at the moment as it is the best for the patient. This will bring some misunderstanding and will lead to problems in the working environment as the nurse and doctors are required to work as a team. The Maintenance And Preservation Of Health Essay. In order to avoid a boundary violation, both nurses and doctor have to work and communicate well with each other. As mentioned by Slev and Pop (2012), effectiveness in new roles and environments can be achieved by communicating with other people, therefore social learning skills are of great importance, and learning occurs when engaged in work projects.

Furthermore, for an experienced nurse, they feel that they had the necessary competency and are convinced that conducting the chemotherapy without the attendance of a doctor will actually do some justice on the patients. As the patient did not have to waste any time to adapt to the busy schedule and wait for the doctor’s arrival. Cited from NHS (2007), the patients who are admitted to the hospital believed that they are entering a safe place which they confident to receive the best possible are there. Even when their disease worsens, they confident that they are in the best place for immediate and effective treatment.

There are some worries that the nurses who violate the professional boundaries will forget about their actual role and responsibility in the nursing profession. The nurses have to bear in mind that their action is made only based on the patient’s condition and the environment. The nurse should be given an opportunity to make their own decisions rather than consult with the doctor on the matter that they are experienced in. As cited from Mackay (2007), the more you can involve an employee in decisions that affect his or her job, the more motivated that employee will become in working towards establishing goals, the highest level of participation is letting the employee actually make the decision.

It is important for the administration to find a ways to avoid boundary violation, one of the methods is to improve the the nurses educational system. The nurses need to be upgraded by allowing them to take on the degree or even a higher program to put them on par with the doctors and thus being allowed to make more important decision regarding their work. Mackay (2007) once said that the more you can involve an employee in decisions that affect his or her job, the more motivated that employee will become in working towards established goals, the highest level of participation is letting the employee actually make the decision.The administration should also provide sufficient training and facilities to motivate the nurses to pursue higher level as much as they can for their career development. The Maintenance And Preservation Of Health Essay.

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Besides that, every healthcare worker should be given a training regarding the professional boundaries. This is to make sure that all the worker are exposed to the legal demands and adhere to professional boundaries. The acts of violating the professional boundaries could be avoided if the worker is remained their integrity and act professional during working.

In conclusions, there are many advantages and disadvantages that can be draw related to crossing the professional boundaries. It was not about the right or wrong of the doing but the fact that it was the responsibility of all to maintain the quality of the healthcare profession. This is crucial for the future development of the healthcare practitioner. In order to maintain a good practice, good communication and relationship will help both nurses and doctors to work in a comfortable environment and able to enjoy the pleasure of working together .

A praise should be given to all the nurses who are able to fully devote themselves into taking care and give the best treatment to the patients. As stressed by Lam, Yim and Ng (2008), the person who has been praised for effort will remain persistent in the face of subsequent setbacks because they have learned to attribute their learning outcomes to the effort. The Maintenance And Preservation Of Health Essay.