# Situation: A nurse in a psychiatric day-hospital program holds weekly one-to-one sessions with a 29-year-old woman who has borderline personality disorder. In their first meeting they agreed on 10 sessions. During a team supervision meeting, four nurses describe their contact with their clients. Which nurse's action is a boundary violation rather than a boundary crossing?

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> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse in a psychiatric day-hospital program holds weekly one-to-one sessions with a 29-year-old woman who has borderline personality disorder. In their first meeting they agreed on 10 sessions.

During a team supervision meeting, four nurses describe their contact with their clients. Which nurse's action is a boundary violation rather than a boundary crossing?

## 보기

1. Mentioned her own exam stress to a student client, then refocused on his goals
2. Extended one session by 10 minutes for a client who had just learned of a death
3. Placed a hand on the shoulder of a client who cried at a family meeting
4. Accepted a client's friend request on her personal social media account **✔ 정답**

**정답: 4**

## 해설

A boundary crossing is brief and purposeful and returns to the professional role; a boundary violation creates a dual or personal relationship that meets the nurse's needs and can harm the client. A personal social media connection moves the relationship outside the professional role.

## 심화 해설

Core concept: boundary crossing vs. boundary violation

In psychiatric nursing, the therapeutic relationship is the treatment itself. It is built on trust, safety, and a clear professional role. When a nurse steps outside that role, the action is classified as either a boundary crossing or a boundary violation, and the difference matters for both client safety and nursing accountability.

A boundary crossing is a brief, deliberate departure from the usual professional frame that is intended to serve the client’s clinical needs and then returns to the professional role. It is usually discussable, time-limited, and does not create an ongoing personal relationship. In contrast, a boundary violation moves the relationship into a dual or personal domain. It tends to meet the nurse’s own needs rather than the client’s, erodes the therapeutic structure, and can cause harm. The key distinction is not whether the nurse did something outside the usual rules, but whether the action served the client’s care and returned to the professional role, or instead created a personal, ongoing connection outside that role.

In this question, the client has borderline personality disorder, a condition in which unstable interpersonal boundaries, fears of abandonment, and intense attachment are core features. That clinical context makes boundary management especially important. The nurse and client agreed on 10 sessions, which itself is a boundary that structures the work.

| Option | Action | Classification | Rationale |
| --- | --- | --- | --- |
| 1 | Mentioned own exam stress, then refocused on client goals | Boundary crossing | Brief self-disclosure used to build rapport; the nurse returned the focus to the client’s goals, so the professional role was restored. |
| 2 | Extended one session by 10 minutes after a death | Boundary crossing | Time-limited, purposeful accommodation to an acute crisis; the nurse remained in the therapeutic role and the extra time was for the client’s need. |
| 3 | Placed a hand on the shoulder of a crying client | Boundary crossing | Brief, culturally sensitive therapeutic touch in response to distress; it does not create a personal relationship and is generally considered within the professional role when used judiciously. |
| 4 | Accepted a client’s friend request on personal social media | Boundary violation | Creates a personal, ongoing connection outside the therapeutic frame; it serves the nurse’s social role and exposes the client to the nurse’s private life. |

Watch out! The word “crossing” sounds negative, but in nursing ethics a boundary crossing can be clinically appropriate when it is brief, purposeful, and followed by a return to the professional role. The real danger signal is a dual relationship — when the nurse becomes both care provider and personal contact.

Key point! Accepting a social media friend request is a boundary violation because it permanently moves the relationship outside the professional role and into the nurse’s personal life. The client gains access to the nurse’s private posts, photos, and social network, and the nurse gains a personal, non-therapeutic connection with the client. This is not a brief, purposeful intervention; it is an ongoing structural change in the relationship.

The literature supports this distinction. Peternelj-Taylor and Yonge describe boundary maintenance as part of the nurse’s fiduciary responsibility, emphasizing that nurses must be able to identify crossings and violations through self-awareness and supervision [1]. Valente specifically names social media befriending as a boundary violation that may erode trust, harm patients, and trigger professional discipline [2]. Unhjem and Hem add that the nurse–patient relationship is characterized by asymmetrical power, which places the responsibility for delineating professional, personal, and private roles entirely on the nurse [3]. Because the client cannot be expected to protect the boundary, the nurse must recognize that a personal social media connection is never a neutral act — it is a structural shift from professional to personal relating.

For a client with borderline personality disorder, this shift is particularly risky. The personal connection can intensify idealization, dependency, or fears of abandonment, and it blurs the very relational frame that the 10-session agreement was designed to hold. The nurse’s own needs — for friendship, validation, or relief from professional distance — may be met, but the client’s treatment is compromised.References (research sources)

- [1]Exploring boundaries in the nurse-client relationship: professional roles and responsibilities.Research articlePeternelj-Taylor CA, Yonge O (2003) · DOI: 10.1111/j.1744-6163.2003.tb00677.x

- [2]Managing Professional and Nurse-Patient Relationship Boundaries in Mental Health.Research articleValente SM (2017) · DOI: 10.3928/02793695-20170119-09

- [3]Nurse-patient relationship boundaries and power: A critical discursive analysis.Research articleUnhjem JV, Hem MH (2025) · DOI: 10.1177/09697330251314093

## 임상 시나리오

Boundary Management in Psychiatric NursingCrossing vs. Violation in the Therapeutic Relationship
A boundary crossing is a brief, purposeful departure from the professional frame that serves the client's clinical needs and returns to the professional role. Examples include limited self-disclosure that is refocused on the client, extending a session briefly during a crisis, or offering a comforting touch when clinically appropriate.

A boundary violation creates a dual relationship or personal connection outside the professional role. Accepting a client's friend request on a personal social media account is a violation because it moves the relationship into a personal, ongoing domain that meets the nurse's needs and can harm the client.

The distinction is not whether an action breaks a rule, but whether it served the client's care and returned to the professional role, or instead created a personal, ongoing connection. In clients with borderline personality disorder, unstable interpersonal boundaries make this distinction especially critical. Agreeing on a fixed number of sessions, such as 10 sessions, is itself a boundary that structures the work.

CautionPersonal social media contact with clients is never appropriate in a professional relationship. If a client sends a friend request, decline it privately and discuss the boundary in session if clinically indicated. Document the event and consider supervision or team consultation.

## 핵심 개념

- **Boundary crossing** — A brief, purposeful departure from the usual professional frame that serves the client's clinical needs and returns to the professional role.
- **Boundary violation** — An action that moves the relationship into a personal or dual domain, often meeting the nurse's own needs and potentially harming the client.
- **Dual relationship** — A situation in which the nurse has both a professional and a personal or social relationship with the client.
- **Therapeutic relationship** — The professional, trust-based connection between nurse and client that is itself a core treatment modality in psychiatric nursing.
- **Borderline personality disorder** — A mental health condition characterized by unstable interpersonal boundaries, fears of abandonment, and intense attachment patterns.

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