1.5 Boundaries

Boundaries are limits we set as individuals that define our levels of comfort when interacting with others. Personal boundaries include limits in physical, sexual, intellectual, emotional, sexual, and financial areas of our lives. Boundaries promote psychological safety in relationships at work, home, and with partners by protecting one’s well-being and limiting the stress response. For example, if you come away from a meeting or conversation with someone feeling depleted, anxious, or tense, consider if your boundaries were crossed. A lack of healthy personal boundaries can lead to emotional and physical fatigue.^[1]

Five major types of personal boundaries include the following^[2]:

• Physical: Physical boundaries refer to one’s personal space, privacy, and body. For example, some people are comfortable with public displays of affection (hugs, kisses, and hand-holding), while others prefer not to be touched in public.
• Sexual: Sexual boundaries refer to one’s comfort level with intimacy and attention of a sexual nature. This can include sexual comments and touch, not just sexual acts.
• Intellectual: Intellectual boundaries refer to one’s thoughts and beliefs. Intellectual boundaries are not respected when someone dismisses another person’s ideas and opinions.
• Emotional: Emotional boundaries refer to a person’s feelings. For example, an individual might not feel comfortable sharing feelings with another person and prefer to share information gradually over time.
• Financial: Financial boundaries refer to how one prefers to spend or save money.

When caring for clients with mental health disorders, it is common to notice problems with setting appropriate boundaries. For example, a client experiencing bipolar disorder may exhibit a lack of financial and sexual boundaries. When they are experiencing a manic episode, they may spend thousands of dollars on a credit card over a weekend or have sexual relations with someone they just met. Another example of boundary issues is an individual with a depressive disorder who is treated poorly by their partner but does not leave or assert boundaries because they don’t feel that they deserve to be treated any better.

Nurses must establish professional boundaries with all clients while also maintaining a respectful and caring relationship. Due to their professional role, nurses have authority and access to sensitive information that can make clients feel vulnerable. A Nurses Guide to Professional Boundaries by the National Council of State Boards of Nursing (NCSBN) states that it is the nurse’s responsibility to use clinical judgment to determine and maintain professional boundaries. Nurses should limit self-disclosure of personal information and avoid situations where they have a personal or business relationship with a client. The difference between a caring nurse-client relationship and an over-involved relationship can be difficult to discern, especially in small communities or in community health nursing where roles may overlap. In these circumstances, it is important for the nurse to openly acknowledge their dual relationship and emphasize when they are performing in a professional capacity. Signs of inappropriate boundaries include the following^[3]:

• Self-disclosing intimate or personal issues with a client
• Engaging in behaviors that could be interpreted as flirting
• Keeping secrets with a client
• Believing you are the only one who truly understands or can help the client
• Spending more time than is necessary with a particular client
• Speaking poorly about colleagues or your employment setting with the client and/or their family
• Showing favoritism to a particular client
• Meeting a client in settings outside of work
• Contacting a client and/or their family members using social media

Establishing professional boundaries with clients diagnosed with mental health disorders is essential due to the vulnerability of the client population, as well as the behavioral manifestations of some disorders. For safety purposes, nurses and nursing students should keep their last name, home address, personal telephone number, and social media handles private.