Creating Healthy Boundaries Part 1

Definition   

Personal  boundaries  are guidelines, rules or limits that a person creates to identify for themselves what are reasonable, safe and permissible ways for other people to behave towards him or her and how they will respond when someone steps past those limits.

Why Set Boundaries?

•Setting boundaries protects ourselves and others.

•With established personal boundaries we respect the boundaries of others, staff and patients.

•We are responsible TO others and FOR ourselves

•Boundaries define us:    

o What IS you and what is NOT you.

o Where you END and someone else BEGINS.

o What you OWN and have RESPONSIBILITY for.

In sports boundaries maintain limits, fairness and safety.  Going out of bounds can get you in trouble, disqualified or even end your play.  In hospice, boundaries are lines which separate professional behavior from any behavior which (well-intentioned or not) could reduce the benefit of care to patients and families.

The entire hospice team is held accountable for establishing and maintaining healthy boundaries.

What Motivates Hospice Volunteers?

Healthy

    •  Desire to help or serve others.    

  • Interest in learning.

• Desire to “give back”.

                      • Search for meaning.

              • Respect for human dignity.

Outcome:  Well balanced       

               caregiving   

Unhealthy

• Need for admiration, appreciation, gratification.

• Need to be needed.

• Desire for power, control in the “helper” role.

• Re-live past experience.

• Therapy from personal loss.

• Already know it all – “been there, done that”.

Outcome:  Imbalanced

             caretaking  

  Comparing Relationships

Personal Relationships    

May be forever

Personal choices                    

Spontaneous      

No preparation           

Mutually centered           

Do I like this person?           

                      

Volunteer Relationships

      Time limited

      Structured within role

      Organization commitment

      Requires preparation

      Patient centered

      Can I support this person?   

Hospice Patients are a Vulnerable Population

• This is a time of intense need.

• They are seeking help, direction and services.

• There are many unknowns.

• Many have no idea what to expect.

• They are susceptible to changing emotions.

• Anticipatory Grief.

Volunteers Represent Hospice

As a result volunteers:

• Have intimate access to patients and families' personal time and space.

• Encounter their need to develop sincere connections.

• Bring your own spirituality, beliefs and lifestyle.

• Must remember hospice brings a team approach vs. an individual role.

1. Avoid thinking you can solve patient/family problems. We cannot “fix” their problems or change their family dynamics.

2. Be aware of crossing the line between professional and personal involvement.

3. Be aware of patient/family dependency on you.

4. Do not give advice or instructions. 

5. Good boundaries enable you to actively and confidently engage with the patient/family.

Know Your Role

Patients often get very close to you very quickly.  If you start moving from the outer circle to the inner circle it is not fair to the patient or to their family.

Look at the next Post to find PART 2!

Creating Healthy Boundaries Part 2

I Know I’m Exceeding My Boundaries When…

• I become stressed over the situation.

• I can’t get the patient out of my mind.

• I feel like I want to control the situation.

• I begin talking to others outside of hospice about my patient and/or family.

• I feel like the patient or caregiver can’t make it without my assistance.

     • I begin changing personal   

        obligations to benefit

        patient/family needs.

    

 • I begin sharing personal problems/concerns with the patient/family.

AND

When volunteering with a patient/family becomes all consuming!

Other Boundary

Violations

• Inappropriate displays of emotions or

  physical contact.

• Pressure to maintain personal

  relationship after professional one ends.

• Desire to change ones beliefs to fit the patient/family.

• Doing personal favors outside of the plan of care.

• Giving or soliciting of funds.

• Disclosure of information regarding other members of the hospice team.

• Receiving expensive or inappropriate gifts.

To Maintain Your Boundaries

Ask Yourself…

• Do I know my role and limits?

• Whose needs am I meeting?

• Am I giving clear messages?

• Do I know when to say “no”?

• Do I know when to say “yes”?

• What would other members of my hospice team say?

 

For Maintaining 

Professional Boundaries

• Ensure your care is focused solely on 

the patient and families’ health and 

well being.

• Ensuring that you are there only 

as a volunteer (not a friend, 

neighbor, relative, etc.)

• Maintaining a proper appointment and visit system.

• Getting help for yourself when you are in a crisis.

• Consulting with your Volunteer Coordinator about 

difficult situations.

• Refraining from over familiarity. 

What if I am Feeling
Overwhelmed?

• Be upfront and honest about your feelings.

• Never take on a task that you don’t feel you can 

commit to.

• Let us know if you feel uncomfortable.

• Ask for staff support

When To Let Go After The Death Of Your Patient

Bereavement services begin immediately after the death of our patients.  Phone calls, letters, support groups and home visits are offered to the patient’s caregiver or survivor.  It IS appropriate however for the volunteer to:

o Make a phone call to the family after the death.

o Make a home visit after the death.

o Attend the funeral OR watch over the house while the family attends the funeral and/or graveside services. 

    It should be understood at that point bereavement services will take over.

When you help, you see life as weak.

When you fix, you see life as broken.

When you serve, you see life as whole.

Fixing and helping may be work of the ego,

but serving is the work of the soul.

Rachel Naomi Remen

Medi Hospice Volunteers: Please refer to your "Creating Healthy Boundaries" Questions and Answer Sheet to complete your Mandatory Education requirement.