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Professional Boundaries and Therapeutic Relationships within UW Health (7.55)

Professional Boundaries and Therapeutic Relationships within UW Health (7.55) - Policies, Clinical, UWHC Clinical, UWHC-wide, Patient Support

7.55

As of April 1, 2017, this administrative policy applies to the operations and staff of legacy UWHC. Effective July 1,
2015, the legacy operations and staff of UWHC and UWMF were integrated into the University of Wisconsin
Hospitals and Clinics Authority (UWHCA). All administrative policies are being transitioned to apply UWHCA-wide,
but until future revision to this policy #7.55, it applies only to the operations and staff of legacy UWHC.


7.55 Professional Boundaries and Therapeutic Relationships within UW Health
Category:

UWHC Administrative Policy
Policy Number:

7.55
Effective Date:

April 1, 2017
Version:

Revision
Section:

Patient Support (Hospital Administrative)

I. PURPOSE

To provide a framework within which to address professional boundaries and therapeutic relationships between
employees, patients, and families anywhere within UW Hospital and Clinics (UWHC), including University Hospital,
the American Family Children's Hospital (AFCH), and The America Center (TAC), in either the inpatient or
outpatient setting.

II. POLICY

Employees who work at UWHC are to maintain therapeutic relationships with patients and families within
appropriate professional boundaries. A therapeutic relationship is defined as a "clear, caring, well-defined, positive
boundaried relationship between the health care provider and patient/family as they work together toward a goal
to promote health" (McKlindon and Barnsteiner, 1999).

III. PROCEDURE
A. Professionalism
1. Interaction with patients and their families should be limited to the staff member's scope of
authorized work duties compensated by the hospital, unless authorization is obtained from the
staff member's supervisor or manager. Team leaders cannot provide any of the authorizations
specified in this policy.
2. Staff members will not establish personal relationships with current patients or families or with
patients/families when ongoing care at UWHC can be anticipated.
3. In the case of a staff member having an established personal relationship with a patient or
patient's family member(s), the staff member must disclose the relationship to their manager if
the person is being treated in the unit in which the staff member works. The staff member will
not provide professional care for that patient, unless the supervisor or manager determines that
expertise, staffing or other considerations warrant an exception.
B. Therapeutic Relationships
1. In order for staff to maintain a therapeutic relationship with a patient/family, staff should
recognize behaviors which cross the boundary between therapeutic and non-therapeutic
relationships. Staff should direct any questions about boundaries to their manager or refer to the
information listed in Section VII below. In communicating with patients, staff should be mindful of
the purpose for the communication to ensure it does not extend beyond caring and professional.
Communication with patients must be professional and within appropriate boundaries.
2. Examples of non-therapeutic relationships:
a. Staff members sharing personal information with patients and their families such as
phone numbers, addresses, text messages, and email addresses.
b. Coming in to the hospital or clinic during "off hours" without supervisor approval for the
purpose of interacting directly with a parent or family.
c. Spending personal time with patients and/or family outside of hospital facilities or other
assigned work areas.
d. Staff members making negative statements about the care the patient is receiving or
has not received in the presence of the patient or family. This can include discussion of
personnel or staffing issues and disagreements between team members.
e. Offering to or providing personal services, such as child care or transportation to
patients or family members on personal time.
C. Social Media
1. Internet usage for health care providers and patients continues to increase. Staff needs to be
very aware of maintaining appropriate therapeutic relationships when using any form of social
media. Examples of inappropriate behavior include:

a. Staff initiating an invitation to a patient or member of his/her family to become social
networking “friends” or follower of a blog.
b. Staff reviewing a patient or family member’s social media site for information relating to
the patient’s health or treatment.
c. Making posts or discussing patients, including any patient protected health information.
d. Participating in any unauthorized online conversation with patients or regarding patients,
even if it is the patient who is initiating the conversation.
2. All UW Health guidelines for social media must be observed. Refer to UWHC Administrative policy
1.47 UW Health Social Media.
D. Gift Giving/Receiving
1. Employees will not provide items of monetary value to patients or their families such as money
for medications, transportation, etc; toys; clothes; or other items which can be construed as
gifts.
2. When an employee believes that a patient or family member may require added resources, such
as clothing, supplies, toys, etc. the employee will refer the patient/family to appropriate
resources within UWHC (Social Work Services, Child Life, Patient Relations) or consult with a
supervisor or manager concerning appropriate responses.
3. Individual staff may not accept gifts of any monetary value from patients or families except
where refusal would be non-therapeutic or culturally insensitive.
a. When patients or their family express a desire to give gifts, they should be referred
to supervisors or managers to discuss options.
b. For situations including circumstances surrounding end of life events the family may
wish to make a contribution to the unit, department or hospital.
c. In the event a gift has been received the decision will be made between the supervisor
and individual staff member as to whether the family needs a thank you letter from UW
Health along with direction for any future gifting.
IV. OTHER

UW Health is not a legal entity. UW Health is comprised of three separate entities: University of Wisconsin Hospital
and Clinics, University of Wisconsin Medical Foundation and University of Wisconsin School of Medicine and Public
Health. When each entity has approved the policy, that entity is responsible for enforcement of this policy for its
own employees.

V. REFERENCES

American Medical Association. (1995-2011). AMA Policy: Professionalism in the use of social media.
American Nurses Association. (September, 2011). Principles for social networking and the nurse. Silver Spring,
MD.
Association of Pediatric Hematology/Oncology Nurses. APHON Position Paper on Social Media in the Workplace.
Blog Guidelines for Clinicians and Other Staff Sponsoring UW Health and U-Connect Blogs, (February, 2011).
National Council of State Boards of Nursing. (August, 2011). White Paper: A nurse’s guide to the use of social
media. Chicago, IL.
"Therapeutic Relationships" McKlindon, Donna and Barnsteiner, Jane, MCN Vol 24, No. 5, Sept/Oct 1999.
UWHC Administrative Policy 1.29 Use of Internet Technology via Hospital Resources

VI. COORDINATION

Sr. Management Sponsor: SVP Patient Care Services and Chief Nursing Officer
Author: Director, Coordinated Care; Director Patient Relations

Approval Committee: UW Health Clinical Policy Committee

SIGNED BY

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee