Maintaining Healthy Boundaries

Families dealing with serious childhood illnesses often develop close bonds with members of their care teams. And very often members of the care team develop relationships with their patients.

Caring for these children and families involves tending to daily needs for extended periods of time. These bonds can be helpful in several ways. Good relationships between families and care team members can:

• Promote honest communication
• Encourage trust and partnership in decision making
• Offer emotional support

But healthy boundaries are important to protect both families and providers.

Why boundaries are important

Families and care team members often develop connected relationships. For care team members to do their jobs well, they need to show compassion, empathy, and respect.

Getting to know patients and families is a natural part of the process. At the same time, boundaries are important. Children and their families must rely on the care team to make critical decisions about treatment and care. These decisions can be complicated.

Maintaining professional boundaries makes sure:

• The same level of care is provided to all patients
• Care decisions are made objectively and in the best interest of patients
• Patients and families do not have unrealistic expectations of care team members
• Patients and families are protected from inappropriate influence or relationship
• Care team members are respected as professionals

Setting boundaries

Different care team members may have different views on their own professional boundaries. Some might be more formal with their patients. Others may have a more open personal style. The same goes for patients and families.

Care team members may provide support and connect with families by:

• Giving a hug or providing comfort through physical touch
• Sharing brief personal details or stories to show empathy, offer encouragement, or lighten the mood
• Getting to know the patient’s siblings and friends
• Interacting at home visits
• Asking personal details to motivate the patient and develop trust
• Providing small gifts such as suckers, stickers, or balloons

Sometimes children may need extra attention during treatment to keep their spirits up. This is especially true for patients who have extended hospital stays away from friends, school, and other sources of comfort.

It is always the care team member’s responsibility to maintain boundaries. It is not your responsibility. Certain inappropriate behaviors from team members are clear:

• Romantic or sexual relationships
• Financial manipulation
• Asking for help or venting about personal problems
• Pressure to support certain political, lifestyle, or religious views
• Encouraging friendship outside the medical setting

Other boundaries may not be as clear. Some families may feel uncomfortable if care team members share too much personal information or ask personal questions. Patients and family members should set their own boundaries and express when they are not comfortable with a situation. If a care team member may have crossed the line into inappropriate behavior, families can alert another member of the care team or seek help from a patient advocate.

Set your own boundaries and express when they are not comfortable with a situation. If a care team member may have crossed the line into inappropriate behavior, alert another member of the care team or seek help from a patient advocate.

Patient privacy on social media

Technology and social media have created new avenues for care teams to communicate with patients and families. However, the ease of sites such as Facebook, X, YouTube, and CaringBridge come with risks. Potential risks include:

• Unintentionally disclosing personal or health information. This may happen if a care team member replied to a family’s Facebook post by commenting how exciting it is that their son is so close to completing chemotherapy treatment.
• Unintentionally obtaining personal or health information. Reading a family blog may include information that was not given to the care team.

Care team members are generally advised not to “friend” patients or patient families on social media. They are also advised not to initiate an invitation to become connected on social media.

This helps providers maintain the boundaries and protect patient privacy. Families should not feel hurt if their invitations are not accepted or if care team members seem more distant in certain settings. When the boundaries are unclear, honest communication is important to make sure everyone is comfortable.

Ways families can encourage healthy boundaries

• Don’t feel pressure to share everything. Relationships naturally deepen as you get to know someone. Just because a person is on the medical team doesn’t mean they need to know personal details unrelated to patient care. It is also natural to be closer to certain care team members compared to others.
• Communicate honestly. Health providers should respect patient and family boundaries. Part of respect and empathy is following the other person’s lead in familiarity and communication. However, if something makes you uncomfortable, tell the person directly. If you don’t feel comfortable speaking with the person, let another team member or hospital representative know.
• Clarify expectations and ask questions. There will be things that come up that are not clear. It can help to have an honest discussion to ensure mutual respect of boundaries. For example, ask for clarification by saying, “I’m not sure what is appropriate. Would it be ok if ___?” or “You don’t have to tell me if it makes you uncomfortable, but I was wondering if ___.”
• Teach children how to set boundaries in age-appropriate ways. Patients can learn to advocate for themselves. As much as possible, give children control over boundaries in their relationships. This can include setting limits on sharing personal information or physical touch and respecting personal space.

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