Exploring boundary violations between staff and clients in healthcare and forensic settings

Britton, Emma (2016) Exploring boundary violations between staff and clients in healthcare and forensic settings. DForenPsy thesis, University of Nottingham.

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Thesis Aim: Boundary violations are committed when a professional crosses the emotional, physical, spiritual or sexual limits of another, thus disrupting the relationship between staff and clients. This thesis explores this issue in the context of healthcare and forensic settings. It identifies boundary violation risk and protective factors for staff working with forensic healthcare patients. The thesis also investigates reasons why staff under-report and may not whistleblow their concerns in these areas.

Methods: A mixed method approach was used to explore multiple elements of this topic. A systematic review was used to identify risk factors associated with staff committing boundary violations in healthcare and forensic settings. This was then expanded, through a regression, to specifically look at risk and protective factors in the forensic healthcare settings. A thematic analysis was carried out to explore staff’s perceptions of whistleblowing and boundary violating behaviours. A case study and several psychometrics (including the Exploitation Index) were also used to investigate this topic in more depth and assess the impact that boundary violating can have on the patients involved.

Findings: The setting and environment were shown, through the systematic review, to be key when exploring this topic, as they not only impact on the definition of boundary violating along with what factors protect or put staff at risk of boundary violating. The regression identified risk factors, including staff feeling they had no one to turn to and working alone with patients. There were also factors which protected staff from committing boundary violations, such as having good social support and receiving training about boundaries. The thematic analysis found that people did not raise concerns of colleagues’ boundary violating due to concerns about anonymity, feeling that nothing would be done, and feeling that personally intervening (not management) would be a more effective method.

Conclusions: It is of great importance to explore this topic and develop a greater understanding of boundary violations, as the impact of and harm caused by this behaviour are wide ranging. This thesis can aid the identification of professionals at risk, and create strategies to prevent or manage this destructive behaviour. These findings can also help create a more open and honest arena for concerns about boundaries to be raised and managed.

Item Type: Thesis (University of Nottingham only) (DForenPsy)
Supervisors: Duff, S.C.
Whitfield, K.C.
Keywords: Professional-patient relations, Medical personnel and patient, Boundary violation risk
Subjects: W Medicine and related subjects (NLM Classification) > W Health professions
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 33231
Depositing User: Britton, Emma
Date Deposited: 19 Jul 2016 06:40
Last Modified: 14 Sep 2016 01:23
URI: http://eprints.nottingham.ac.uk/id/eprint/33231

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