It is presently unclear whether a distinct “rural ethics” of navigating professional boundaries exists, and if so, what theoretical approaches may assist practitioners to manage overlapping relationships. To be effective clinicians while concurrently partaking in community life, practitioners must develop and maintain safe, ethical, and sustainable therapeutic relationships in rural and remote healthcare. A narrative review was conducted identifying a significant body of qualitative and theoretical literature which explores the pervasiveness of dual relationships for practitioners working in rural and remote (...) healthcare. Rather than viewing dual relationships as ethically unacceptable, much contemporary work focusses on the lived experiences of healthcare workers and explores what approaches may be available that both protect the therapeutic relationship while recognizing the unique nature of rural and remote healthcare practice. We conclude that practitioners must have a means of operating within a contextually informed ethics of professional boundaries. Drawing on pre-existing work, one schema is proposed that could form the basis for further engagement through interactive teaching sessions, professional development, mentoring, or guidelines. (shrink)

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, (...) there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). (shrink)

Professional boundaries are an important aspect of social work theory and praxis – yet it is an underexplored topic within the research literature. Research often explores specific types of professional boundary issue rather than exploring social workers’ boundary stories or boundary narratives. In contrast, this qualitative study explored UK social workers’ broader understanding and experience of professional boundaries. This paper will examine one of the research themes – Humour as a boundary breaker. By using humour, social workers were able to (...) break down the boundaries that often impede effective practice. Participants also used humour to build connections with service users, colleagues and other professionals. Nonetheless, there were various aspects of this practice that raised serious issues related to power, prejudice and discrimination. This theme is important to explore because of how relevant it was for participants’ practice and because humour is also an underexplored topic within the social work literature. (shrink)

Mental health nurses are frequently confronted by intense emotions within the therapeutic relationship. In this philosophical hermeneutic inquiry, five mental health nurses were interviewed to extend our understandings of how nurses are impacted by the interplay with the often emotion-laden narratives of their patients. Findings exposed the nurses journeyed between fluctuating needs to separate and protect their private from their work life. In order for this fluctuation to occur, they developed a sense of the world as requiring a sanctuary. This (...) ontological place of home is the extent to which they felt safe and sheltered in order for this process of awareness of self as person and self as nurse to unfold. This research brings to the forefront the ways in which mental health nursing practice, education, and research are reciprocally moved by the practical day-to-day activities of being in therapeutic relationships. (shrink)