Aprendizaje informal del huayno

Four participants were able to define the term boundaries, specifically in relation to the ward environment and with relationships on the ward:

I think they’re limits that you have to put upon people, especially with regards to the ward environment. It’s limits to what they can do, what they can have, to the type of relationship that you can have with, whether it’s with a service user and, you know, like myself, or a HCA or whatever, or whether it’s service user to service user (Laura).

In addition, whilst considering needing limits within relationships with service user, this one participant acknowledged that boundaries were also applicable to staff:

It’s important to have a good working relationship but I think there’s a fine line that you could step over (Ben).

The Personalised Nature of Boundaries

As outlined in the journal paper, several participants spoke about the personalised nature of boundaries, which these quotes explain:

Everyone’s different. We treat everybody as individuals, everybody’s different. They’ve all got different illnesses, different needs, different ages, different gender (Carol).

124 …people come from different areas, different boundaries, boundaries are different’ (Andy).

All participants spoke about boundaries developing through experiences in childhood, as illustrated here:

‘Well it’s your upbringing isn’t it? I think it’s about how you’ve been brought up. Certain people have certain values and beliefs that they would not, you know, and that’s been taught to them. You don’t do this or you can do that… I think it’s about your beliefs and what’s been instilled into you as a child and how you’ve been brought up, within broader life.’ (Ben)

As boundaries were perceived to develop through early experiences, they were seen to be underpinned by values. Participants acknowledged that it was impossible not to be influenced by these values when working on the wards:

‘Well I suppose from myself, I think everybody sort of grows up and learns their own personal boundaries. And you can’t help but that to influence how you communicate with other people and your own value systems…So the boundaries have always been there and I think that impacts on the way that you practice... (Trisha).

Therefore, given the different life experiences that people have, which influences the different values that participants have, it is unsurprising that the participants here recognised that people are likely to perceive boundaries differently

125 and implement them differently. This may go some way to explaining why participants found it so difficult to define the term boundaries.

Three nurses also applied ideas about the importance of upbringing to service users, and how this could impact on service users’ perceptions of boundaries. They also connected this idea to particular presentations or diagnostic labels attached to service users, particularly ‘personality disorder’ and ‘bipolar’, e.g:

‘Especially with personality disorders, you’ll find they’ve had really bad upbringings, generally they don’t have a cohesive sort of support system around them. They quite often won’t have had these boundaries instilled as children, so they don’t know what boundaries are, they don’t know what’s socially acceptable. So quite often you’ll get them coming into hospital and behaving in ways that are thought to be socially unacceptable (Laura).

One participant also recognised that as service users are likely to have their own unique experiences, service users may have their own ideas about boundaries and may have different boundaries to those perceived to be important to staff.

‘So we’re not always, again we’re working to our boundaries, we’re allowing them to get on with what they want to do on the ward, without interfering with them. I mean they have their own boundaries from us as well I suppose, as us from them (Dawn).

Professional Training and Experience

Although participants perceived that childhood experiences influenced their ideas about boundaries, it was recognised that such ideas could change over time.

126 Specifically, participants considered training to be important for a professional conceptualisation of boundaries:

‘So you definitely, your life skills will teach you about boundaries, but also here, doing your training through University or all that kind of thing. That’s what teaches you the other boundaries that are used, yes’ (Isla).

In addition to training, post qualification work experience on the wards was also considered to continually shape ideas about boundaries:

‘…I certainly think boundaries were the main learning curve when I qualified and became a nurse and sort of respected that a lot more… So I think in terms of valuing it more and perhaps the understanding was there, able to value it and to understand the concept in that manner and to why it’s there, is certainly from sort of working within this role (Mark).

More generally, professional codes of conduct and practice were seen as important in shaping boundaries:

I think, I’ve realised that my own code of conduct and, you know, my sort of NMC registration is very important to me. So I sort of, I do sort of preserve that and try to protect that as much as I can (Mark).

Organisational policies and procedures influenced how participants perceived boundaries, and how they implemented them in practice. One participant spoke

127 specifically about how policies and procedures are developed in response to incidents and feedback on services:

‘A lot of these things have come from lessons learnt from things that have gone wrong. So again, that’s another factor with the boundaries, of things that have happened, lessons learnt from things that have not gone so well by not having boundaries in place. It would be through incident reporting, patient feedback, how they feel about things and what they’d like to see improved or better, carers’ involvement. So yes, a lot of it is through, and sort of national guidelines that are put in place by NICE and things like that, they’re expectations of how we do it forms around that, so it’s all about governance.’ (Sarah)

As well as conceptualisations of boundaries changing depending on different work experiences, the participants perceived that the setting in which they worked in could also change or influence their ideas about boundaries, as this participant outlines:

…if I went to work at a different hospital, their boundaries would be totally different than I’ve got. (Ben)

Participants also acknowledged that they could both influence and be influenced by colleagues, for example one participant referred to ‘absorbing good practice’ (Mark). Indeed, participants spoke about being influenced by others, as well as influencing others. Management decisions about boundaries were often seen as

128 being set, but there was some scope for feeding back information to managers to inform such decisions:

I mean the times and doors have been set by managers, things like that are just passed down to us and then we adhere to them. I mean and at times there is also, they ask for feedback from us, so we’d get some input as well. But usually it’s the managers who decide most of those things (Dawn).

Therefore, although participants acknowledged that early experiences were key in developing their ideas about boundaries, these ideas could change due to the experiences of being trained as a nurse, as well as having post qualification work experience in different settings. Their professional code of conduct also seemed to be important when working day to day on the ward.

Social Expectations

Participants acknowledged that there was a social aspect that influenced ideas about boundaries, that for instance society influences what is acceptable or appropriate, and that boundaries are needed by society in order for it to function. Specifically, participants spoke about working to the routine set out by the institution, and one participant recognised that this routine was influenced by society’s expectations:

‘Well society’s expectations is that we all get up in the morning and we go to bed at night and not the other way around. So, you know, that is something from society…But

129 we do get patients that stay in bed all day and then get up at night, and then want to stay up all night because they’ve slept all day.’ (Margaret).