Abstract:
Therapeutic relationships are central to mental health nursing. The
nurse's role in maintaining professional yet therapeutic boundaries within
this relationship can be challenging. When therapeutic boundaries are
breeched within the nurse adolescent relationship the adolescent's
safety within this relationship is compromised. There is currently limited
literature on how nurses are managing professional boundaries in
relationships with adolescents in this setting. The adolescent's nature is
to push boundaries; therefore the nurse needs to be acutely aware of
this boundary pushing in everyday practice settings. For the safety of
the adolescent and the nurse it is vital the nurse understands her role in
managing the professional boundary.
This thesis explores, through the use of narrative inquiry, four adolescent
mental health nurses' experiences of assessing, understanding and
maintaining therapeutic boundaries with adolescents in a mental health
setting in New Zealand. The unique and specific implications for
adolescent mental health nursing are discussed.
Three key themes emerged from the analysis and findings: the
importance of the nurse clarifying his/her role; the learning that occurs
throughout the practice journey; and the role of the nurse in keeping the
adolescent and the nurse safe.
These findings highlight the importance of clinical supervision and open
communication with senior nurses and mentors, which assist the nurse in
monitoring practice. When nurses do not have sufficient knowledge of
the fundamental principles of adolescent mental health nursing; such as
knowledge and skills in both adolescent development and
psychodynamic nursing, they are at risk of boundary crossings.
Recommendations from this research include more emphasis on
psychodynamic nursing principles in nursing education and nursing
practice. There is a need for specialised education for nurses in child and adolescent mental health nursing. Nursing entry to practice
programmes for new graduate nurses working in mental health, could
assist in providing this. There is a call for further research into
therapeutic relationships and professional boundaries in this complex
nursing specialty.
