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It's all relative

Case study about providing nursing care to a family member

As she hangs up the phone, Ling realizes she has a decision to make. Her sister, Naomi, is being discharged after an unexpected hospitalization and will need nursing care at home for several weeks.

Professional boundaries when caring for a family member 

As a registered nurse, Ling is used to fielding requests for minor care and advice from family members and friends. This situation however, will be more difficult to navigate. She knows her family will want her to be involved in Naomi’s care, and if she’s honest with herself, she’d like to be.

But would it be the best approach for everyone involved? How will Ling keep separate her roles as nurse and sister?

What do the Standards say?

Ling knows when a nurse must care for a family member or friend because there are no other options, overall responsibility for care is transferred to another health care provider when possible. She also knows that if a nurse wants to care for a family member or friend, caution is required.

Boundaries in the Nurse-Client Relationship outlines requirements for nurses related to boundaries and professional relationships.

If Ling chooses to provide some nursing care to her sister, she understands she’ll be entering into a professional relationship with Naomi and acting in a dual role. She knows she'll need to be objective enough to have an effective professional relationship with her sister.

What should Ling consider?

Ling knows that this situation requires thoughtful consideration, caution and discussion with her sister, family and the care team. She'll need to be able to separate her personal feelings, values, beliefs and family relationships from her professional and ethical obligations.

She’ll want to:

  • Reflect on why she wants to care for her sister and whether she can maintain her objectivity and professionalism.
  • Explore all available options with her sister, family and care team.
  • Decide if she is competent to provide the necessary nursing care in this setting.
  • Consider whether her sister is fully informed and consents without feeling pressured or coerced.
  • Consider how she will make it clear to everyone involved (her sister, her family, other health care team members and herself) when she is acting as a sister and when she is a nurse.
  • Think about how she will meet all professional and ethical standards (especially Privacy and Confidentiality, Consent, Documentation, Conflict of Interest, and Duty to Provide Care).
  • Consider how she will communicate with her sister’s health care team and practise within the established plan of care.

 What does Ling decide?

Ling decides against providing any nursing care

Ling decides she’d rather be a sister than a nurse—she knows she can help Naomi with her recovery but doesn’t want the responsibilities or implications that come with providing nursing care. She realizes her relationship with her sister is too familiar to allow her to separate her personal feelings from her professional obligations.

She’s also concerned that her sister and family may have unrealistic expectations about what she can or should do. She lets Naomi know that she’ll be there to support her, but not as her nurse.

Ling decides she wants to provide some nursing care

After careful consideration and discussion with her sister, family and the care team, Ling decides she will provide some nursing care to help out over the weekends. It’s a time-limited commitment and she has a support system that will allow her to keep the situation professional and as agreed upon.

Ling is competent to provide the necessary nursing care in a home care setting and is clear about her role within the plan of care developed by the home care nurses. She believes family relationships and expectations will not interfere with her meeting her sister’s care needs but has a plan if issues arise.

Questions and reflection

Have you been asked to provide nursing care to a family member or close friend? How did you make a decision?

Email us practice@crnbc.ca if you have thoughts or ideas for future case studies.

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