Nurse-patient relationship boundaries and power: A critical discursive analysis

Introduction: Mental health nursing is dependent on nurses' ability to engage in therapeutic relationships with patients. The ability to manage professional boundaries is equally important, but less explored. This study aims to address the following research questions: How do nurses define their professional, personal, and private roles? What are nurses' experiences with professional boundaries? What are the implications of nurses' understanding of these boundaries?Background: Nurse-patient relationships are characterized by asymmetrical power dynamics, which places the responsibility of delineating professional boundaries on the nurse. While ethical codes offer guidance, nurses must identify appropriate boundaries in a dynamic process that relies on the clinical context.Research design: This study used critical discursive psychological analysis to examine data from participant observations, individual interviews, and focus group discussions.Participants and research context: We included 16 nurses working in mental health care in this study, comprising 12 in specialist mental health care and 4 in community mental health care.Ethical considerations: The study was registered with Norwegian Social Science Data Services.Results: Nurses defined professionalism as being an educated caregiver who prioritizes patients' needs. Professionalism involves personal engagement, while some personal matters remain private. However, nurses experienced challenges in maintaining professional boundaries, facing dilemmas due to the subjective nature of boundaries and patients' unpredictable responses.Conclusions: While nurses prioritize patients' needs and best interests, this study demonstrated that personal engagement is considered part of professionalism. However, nurses encounter complex dilemmas in setting professional boundaries. Additionally, these boundaries can either emphasize or de-emphasize the power differential in nurse-patient relationships.