Small town nurse KIM CARTER is well aware of the Rapid Response Rural Grapevine (RRRG) and even more so after her recent wedding. She reflects on when to share and not to share with patients, and on finding the balance between building a therapeutic relationship and maintaining Code of Conduct professional boundaries.
Over the New Year I got married.. finally! Having such a major life-changing event has made me really think about how much personal detail we share (or others share on our behalf) with patients – particularly because our wedding came fairly soon after I attended a Nursing Council Code of Conduct education session.
I live and work in a small rural community and am well aware of the Rapid Response Rural Grapevine (RRRG). In this instance, the RRRG kicked into gear the moment we contacted the local bakery to place a catering order and patients were congratulating us before we had the dents on our fingers from the rings!
When personal information is out there, what should be my response when questioned by people who are both neighbours and patients?
Within my work I have always been reticent to divulge much in the way of personal details. As we all do, I carry the professional burden of holding to therapeutic and personal distance standards, but it is very challenging at times to remain removed from patients by withholding every scrap of personal information. People can find it both rude and disrespectful when you provide a vague answer or fail to respond in a manner that reflects to them a level of genuine human-to-human interaction.
Where to draw the line?
In my experience, when a patient asks a personal question, they do this to establish a connection, to get a sense of who I am and what I stand for.
In rural general practice, where the line sits can shift and move, reflecting the reality of living and working in small communities and the reliance we have on each other both within and without clinical relationships. People in my community see me and my partner (as they have done for many years) at the supermarket, getting petrol, at the bank, at barbecues and social events.
They gain knowledge about me as I live my life, not through work-related interactions, but they may ask or refer to something personal when they see me at work. However, in my experience rural people are very respectful of me as a person and as a health professional. They seldom take advantage of my knowledge and skills outside of the workplace, and demonstrate appreciation that their rural community still retains its local clinicians and services through showing high levels of protection and concern for my wellbeing and quality of life.
I have experienced moments in my work where there would have been no therapeutic relationship established at all without sharing some personal details. Some patients are searching for a clinician who 'gets them' and understands their needs because of some degree of shared experience or point of reference. Acknowledging this can be the pivotal moment at which trust is established and nursing work begins. After all, we are a partnership-based profession!
However, I have also seen the effect of colleagues sharing personal information that was more about their needs than the patients and this is what we must avoid with regard to our Code of Conduct and our professional standards. As clinicians, we always hold the balance of power in relationships with patients. We know lots about them and, usually, they know little to nothing about us. In rural communities that balance is somewhat redressed just through the exercise of living under each other’s noses, and for me this actually feels more comfortable because it seems like we all start at a more even place by default.
The RRRG will always remain alive and fully operational as long as people share their lives with others who work and live alongside them, so I will just need to continue to assess in every situation where the line needs to be placed. However, I still need to find ways to respond to patients with dignity and respect while still protecting the therapeutic relationship. More importantly, I also need to ensure I don’t lose what nurses have always shared with patients: trust, humanity, and a real place in their lives, as they have a real place in mine.
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