Of Beautiful Boundaries and Bonds

We nurses learn about professional boundaries during nursing school and in practice.  Professional boundaries refers to the ways in which we are to therapeutically relate to our patients and our colleagues while separating personal from professional life.  The boundaries delineate what personal information is appropriate to share and what should be kept private.  They also define what types of relationships are appropriate between nurse and patient and nurse and colleague — for example, expressing romantic affection is off-limits.  Unspoken boundary rules promote the idea that nurses (and doctors) are stoic, steady, and emotionally “strong.”  They are expected to be calm in the face of crisis, and the expression of negative emotion (e.g. anger, sadness, fear, grief) in professional settings is often frowned upon.

Clear professional boundaries do serve us well — most of the time.  But what happens when maintaining boundaries inadvertently leads to feelings of shame or unworthiness, or when they prevent us from authentically sharing our stories and who we are with each other?  What happens when boundaries cut off our avenues to connectedness, deep caring, and collegiality?  What results occur when there is no forum for emotional expression, naming of our grief, distress, and sadness?  We can begin to feel demoralized and emotionally exhausted.

Boundaries need to be healthy ones that have some permeability and that still allow relational bonding to occur.  Bonding occurs when we experience a place of safety and support.  Bonding is what happens when we listen well and make space for each other to be heard.  The bond between a nurse and patient (and between nurses and their colleagues!) can form well when there is attunement to the patient’s needs on the part of the nurse, as well as an ability of the nurse to differentiate self from the patient’s self, not personally taking on the needs of the patient, but creating a space for them to be held and handled with care by the nurse.

Self-differentiation is a psychological concept that may at first glance seem paradoxical to forming safe bonds with others, but it provides another framework for defining healthy boundaries.  Self-differentiation means being able to clearly name and own your personal thoughts and feelings and to distinguish them from others’ thoughts and feelings.  We can also think of self-differentiation as a process of not losing connection to self while still being able to stay deeply connected to others, including people whose views may differ from our own.  Self-differentiation enables the nurse to deeply care for self at the same time as caring for people who have so many needs that it would be impossible for the nurse to meet them all.  It enables the nurse to maintain a permeable boundary that is open to deep caring and bonding.

Nurses and healthcare professionals need to take the time to attend to permeable boundaries, healthy bonds, and self-differentiation.  Attention to these concepts provides the space for healing and wholeness to occur, for the nurse and the patient.  I’m grateful to be able to say that at EMU, I experience permeable boundaries, healthy bonds, and self-differentiation in my interactions with colleagues and nursing students on a daily basis.  May each of you continue to find your way toward such beautiful boundaries and bonds, too.

Dr. Laura Yoder, Program Director and Associate Professor