In collaboration with the approved course preceptor, students will identify a specific evidence-based topic for the capstone project change proposal. Students should consider the clinical environment in which they are currently employed or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a leadership or quality improvement initiative, or an unmet educational need specific to a patient population or community. The student may also choose to work with an interprofessional collaborative team.

Students should select a topic that aligns to their area of interest as well as the clinical practice setting in which practice hours are completed.

Write a 500-750 word description of your proposed capstone project topic. Include the following:

1. The problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project that will be the focus of the change proposal.
2. The setting or context in which the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project can be observed.
3. A description (providing a high level of detail) regarding the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
4. Effect of the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
5. Significance of the topic and its implications for nursing practice.
6. A proposed solution to the identified project topic with an explanation of how it will affect nursing practice.

You are required to cite to a minimum of eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Plan your time accordingly to complete this assignment.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Reply to my peers

Begin reviewing and replying to peer postings/responses early in the week to enhance peer discussion. See the rubric for participation points. Participate in the discussion by asking a question, providing a statement of clarification, providing viewpoints with a rationale, challenging aspects of the discussion, or indicating relationships between two or more lines of reasoning in the discussion. Always use constructive language, even in criticism, to work toward the 

goal of of positive progress.

As in all assignments, cite your sources in your work and provide references for the citations in APA format. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below

Include references with peer responses

Based on the development of therapeutic nurse-patient relationships:

• Explain the continuum of boundaries of the nurse-patient relationship.
• Describe the negative results of boundary crossing in the nurse-patient relationship.

Peer #1

The nursing professional boundaries are defined as “the space between the nurses’ power and the client’s vulnerability” (Black, 2017). These levels can be seen in a level of continuum in where behaviors range from under involvement, helpfulness to over-involvement. Samples of these behaviors include distancing, neglect, secrecy, role reversal, to money, and gifts (Black, 2017). In the nurse-patient relationship, it is not the responsibility of the patient to maintain boundaries by is the nurse’s responsibility.  It is a must that these boundaries lines never be blurred because it may result in harm to the patient (Black, 2017).  When these boundaries are crossed, it is considered a volitation of the nurse code of ethics, and is a reportable offense and may result in termination, and be reported to the board of nursing (Black, 2017). Also, as a practicing nurse, it is crucial to understand their professional boundaries. Seven principles that  should be maintained in the nurse-patient relationship are:

1. The nurse is responsible for maintaining the boundary
2. Work in the zone of helpfulness
3. Examine any boundaries crossings
4. Certain variables can affect these boundaries such as the care setting
5. Any action that oversteps established boundaries to meet nurses needs
6. Avoid dual relationships
7. Post-termination relationships (Black, 2017)

Nurses must develop trust, establish clear communication, and well-defined boundaries to prevent any confusion in the nurse-patient relationship.

Black, B. (2017). Professional Nursing Concepts &Challenges 8th edition. St. Louis, Missouri: Elsevier.

Peer #2

From the very first encounter with our patients, we are communicating and setting professional boundaries. The focus of a nurse-patient relationship includes clear definitions of the professional role, confidentiality of information, and goals for patient care and treatment (Valente, 2017).  In order for a nurse to set healthy boundaries with their patients, they need to be self-aware. Self-awareness is defined as being able to recognize one’s own emotions, prejudices, beliefs, values, and how they are seen by others (Black, 2017). By being self-aware, you can begin to see when the line starts to get crossed from a professional relationship, to that of a social relationship, and this recognition is key. If one was to find that the lines are starting to get blurred, it is wise for the nurse to step back and self-reflect and to ask themselves, “Where is this emotion coming from?” or “Why am I feeling this way?” This allows the nurse to adjust her practice and re-focus on the patient and reach their goals for their treatment. It is the nurse’s responsibility to ensure that a healthy rapport is made with their patients, setting healthy boundaries, and evaluating the therapeutic relationship so that the patients’ needs are met and not the nurses (Christensen, 2018). When keeping professional communication with patients, such as body language, feedback, and listening, it is less likely that the professional boundaries will be crossed.  

Negative results of crossing the professional nurse-patient boundaries can have a negative impact, not only on the care of your patient, but the nurse as well. Having worked in the correctional setting as a nurse, I have seen this happen on several occasions. An example is of a nurse getting “love letters” from an inmate. This nurse was flattered and would brag about it to her co-workers. When I confronted this nurse on why she accepted the note from the inmate and did not give it directly to the corrections officer, she had thought that she had done nothing wrong. I immediately walked her to the corrections officer on the unit and informed him of the incident. After an investigation, it appeared this activity had been going on for a period of time. The nurse’s actions of crossing her professional boundaries placed her at risk, as well as her co-workers. She was not following policies and protocols set in place to keep staff safe in that environment, and was ultimately fired. The patient can also suffer negative effects if the professional boundaries are not kept. For example, the nurse may be feeding into the patient’s co-dependency issues and therefore not creating a therapeutic environment for the patient, causing more harm than good.   

References 

Black, B. (2017) Professional Nursing Concepts & Challenges 8th edition. St. Louis, Missouri. elsevier 

Christensen, D. (2018). The Case of the Blurred Boundaries. ONS Voice, 33(5), 30. 

Valente, S. M. (2017). Managing professional and nurse-patient relationship boundaries in mental health. Journal of Psychosocial Nursing & Mental Health Services, 55(1), 45-51.