Boundary Violations Standard

Standard

The physiotherapist acts with integrity and establishes and maintains appropriate professional boundaries (including social, physical, or psychological boundaries) with patients, colleagues, supervisees, and others.

Expected outcome

Patients can expect to be treated with dignity and respect, and that the physiotherapist will maintain boundaries appropriate to the therapeutic relationship in all interactions.

Colleagues, supervisees, and others can expect to be treated with respect and that the physiotherapist will maintain professional boundaries in all interactions.

Performance expectations

Related to Therapeutic Relationships with Patients

The physiotherapist:

• Demonstrates awareness of and sensitivity to the impact of power, trust, respect, and physical closeness on relationships with patients.
• Treats patients with respect, acknowledging their individuality and personhood throughout the professional interaction.
• Avoiding all situations, comments and/or actions that could reasonably be perceived as:
  • Unprofessional,
  • In violation of human rights, or
  • Discriminatory.
• Recognizes that each patient’s boundaries will be unique to their own experiences, including their culture, age, values, or experiences of trauma, and establishes additional boundaries as needed to ensure the patient’s comfort and safety, including:
  • Being mindful of any known or possible conditions, sensitivities, vulnerabilities, or patient experiences that could affect the way care is provided,
  • Being attentive to verbal and nonverbal cues from the patient, and
  • Offering or permitting supports where appropriate, such as a support person or emotional support animal.
• Does not enter into or continue therapeutic relationships with individuals with whom professional boundaries, judgment and objectivity cannot be established and maintained. 
• Establishes and maintains a professional physical environment that supports the maintenance of therapeutic boundaries during patient assessment, treatment, and education in both formal and informal practice environments. Including but not limited to:
  • Proactively providing options for draping or other barriers when treating sensitive areas of the body and advising the patient before placement or adjustment.
  • Providing privacy while the patient is undressing or dressing.
• Obtains informed consent before and during treatment, including by:
  • Clearly communicating planned procedures and each step in the examination or treatment in a manner that respects professional and patient boundaries, while supporting the patient’s active involvement in their care,
  • Confirming consent personally, without assuming that it has been obtained by another provider, and
  • Identifying and addressing potential barriers to consent, such as cognitive impairment, hearing loss, or language differences.
• Does not attempt to promote or persuade patients to a personal view related to politics, religion, or spirituality in the context of a therapeutic relationship.
• Does not use their professional role as a means of intentionally pursuing personal relationships beyond the therapeutic relationship with patients or caregivers (e.g., parent of a minor receiving physiotherapy services, patient’s spouse) and former patients.
• Identifies and addresses boundary violations, whether initiated by the physiotherapist or the patient, by:
  • Addressing the concerns with the patient,
  • Taking steps to resolve issues while maintaining professionalism,
  • Documenting the actions taken to address the breach in the patient’s record.
• Ends the therapeutic relationship by properly discontinuing treatment or transferring care as required in instances where:
  • The physiotherapist is unable to maintain their objectivity,
  • Attempts to maintain or re-establish professional boundaries have been unsuccessful.
  • A positive, respectful therapeutic relationship cannot be established or maintained.

Related to Relationships with Others in the Workplace

The physiotherapist:

• Demonstrates awareness of and sensitivity to the impact of power, trust, respect, and physical proximity in relationships with colleagues, supervisees, and others in a workplace environment.
• Conducts oneself professionally in the work environment, treating colleagues, supervisees, and others with respect avoiding all situations, comments and/or actions that could reasonably be perceived as:
  • Unprofessional,
  • In violation of human rights, or
  • Discriminatory.
• Establishes and maintains professional workplace boundaries with colleagues, supervisees, and others in support of a safe and patient-centered environment.
• Does not commence an intimate or sexual relationship with a supervisee for the duration of the professional relationship.