Caregiving and Nursing Care: Where are the Boundaries?

Sorting out and identifying “boundaries” in the healthcare profession presents nursing care challenges and varies according to each caregiver’s situation.

So what do I mean by boundaries? An invisible boundary line is drawn in any caregiving situation between the professional caregiver (nurse, doctor, social worker, etc.) and the family caregiver (spouse, child, relative, friend). When a family caregiver becomes too involved in professional nursing care or vice versa, animosity and conflict result, often ending in poor patient care. For example, if a family member starts outguessing and providing nurses with directions for patient care, the boundary is violated. If a professional is overwhelmed with emotion, the lines may be blurred. And when a professional finds himself/herself in the role of family caregiver, then roles can get blurred and twisted even more.

I recently met a young man, a doctor whose mother was in the hospital with a severe case of pneumonia. He admitted that every time he visited his mother, he took over the medical charts and questioned every aide, nurse, and doctor on the unit floor. Even more frustrating to him, he noted that he knew that he should just play the role of “son” but really couldn’t help himself. This story is not unusual!

Conversely, as frustration and anxiety grows, family caregivers can offer too much advice, demanding attention. Over the last few years, I admit to being one of those caregivers and have met several of them as well. In all situations, being aware of roles and feelings of the other party can help resolve these issues. To stay aware of roles and the feelings of others, the first principle is to always ask, “What is best for the patient?” Let me provide a few examples.

In the case of the young doctor, he commented, “All my mom wants is for me to be her little boy.” How telling! When he said those words, he looked at me for confirmation and I gave it. “Yes, your mother is right. That is your role- to be there as a loving son. Being her son will ensure she feels more comfortable with your healing touch.”

He further commented, “I know it upsets my mom when I come into her room and immediately demand the chart.” This example clearly demonstrates that what is best for the patient is to play the appropriate role. However, I could tell that this doctor really needed to see the numbers on the chart, so I suggested that he ask for them outside his mother’s room, and that he make every effort to not second guess his medical colleagues. “Trust yet verify” as Ronald Reagan once said. How questions are asked will determine how well the medical and family caregivers provide nursing care.

As a family caregiver, being aware of your caregiving style can go a long way to acknowledging appropriate boundaries and to increasing your effectiveness in your loved one’s care. Let’s examine three possible styles:  whirlwind, research, and compliant. As a ‘whirlwind’ caregiver, you tend to dash in every day with an agenda that you insist must be addressed.  Emotion is high and stress is a likely outcome. Take some deep breaths, enter the patient’s room calmly, and ask questions in a clear, logical way.  Writing down your questions ahead of time will help you to be calm and patient.

If you are a ‘research’ caregiver, you’re filled with numbers, but you know what they say- you can find a number to support almost any idea or theory. So be cautious in offering up all the information you read on the internet!  Both the ‘whirlwind’ and ‘research’ caregivers can put professional/medical caregivers on the defensive. Instead, your goal is that doctors and nurses look forward to seeing you and your loved one. The best possible outcome will then be achieved for the patient.

The ‘compliant’ caregiver has the opposite problem, often not pushing the boundaries enough. The compliant caregiver is often overheard saying, “Whatever you think is the right thing to do, just do it” to the professionals. Clearly, this caregiver needs to be more collaborative by asking questions and doing research. As someone once said, “Moderation in all things”.

Thoughtful caregivers will always consider their behaviors through the lens of what is best for the patient and will be aware of boundaries between themselves and others involved in the healing process. I hope National Caregiving Month will be an enriching one for all of you.