What would not be acceptable in terms of your relationships with service users?

All formal working relationships need rapport and trust to function well. This is particularly relevant to the relationship between a client and their care worker.

It is certainly important that the care worker makes sure clients feel at ease with approaching and relating to them – but it is equally important that the lines don’t become blurred.

The relationship between an individual and their care worker should never come at the expense of maintaining clear professional boundaries. Successful and ethical working relationships are based on a clear understanding of what the workers’ role is – and just as importantly – what their role isn’t.

What is a professional boundary?

Professional boundaries are limits which protect the space between a worker’s professional power and their client’s vulnerability. Problems for care workers that can arise if these boundaries aren’t maintained are:

• Becoming overly involved or attached to a client
• Showing exceptional behaviour towards a client
• Being emotionally entangled or showing fluid work/home boundaries
• Disclosure of personal information of the client by the worker, including excessive self- disclosure
• Considering the client to be a ‘friend’ or allowing the client to have that view

Professional boundaries are complex and often contentious subject because they relate to our personal values. They are experientially, culturally and historically influenced – and they change over time. Although we may talk about what’s ‘right’ and ‘wrong’ and that we should use ‘common sense’, it’s not always clear cut. For example, a care worker might feel it’s rude not to accept a gift, even though it is the policy of Mable that gifts should not be accepted.

Appropriate relationships with vulnerable clients are those which recognise that we provide personal services and as such we have enormous power over their lives.

In all our relationships we set limits. One of the key issues for workers is to be able to recognise when we may be crossing the invisible line which separates a client from a worker and which defines our relationship as professional and therefore workable.

Providing care to clients with disabilities (physical, intellectual, mental health, or neurological) raises many challenges for care workers. The role of the care worker can mean that you are in many intimate situations with clients and their friends and families. You may have access to private or confidential information. You may also encounter situations where you are confronted with needs, requests or demands for services or support that are not your role as care worker.

The information provided in this article is aimed to provide practical information on some of the key ethical and boundary issues in providing support in the community.

Qualities of a Good Support Worker

The qualities of a good worker are many and varied. Everyone brings different strengths to their role, different values, beliefs and practical knowledge and skills. But there are some key skills areas that make workers more effective, for example:

• Ability to listen and understand
• Good communication skills
• Interest in helping people
• Willingness to collaborate and consult with others
• Ability to accept and respect the choices of other people
• Respect for different needs, values, beliefs, culture
• Commitment to increasing independence and capability in others
• Ability to share knowledge and skills but not to take over
• Having a positive attitude
• Being aware of realistic goals and limitations – making sure you understand each person and their strengths, needs, goals and support needs
• Consistency and ability to follow through
• Professional – human, friendly, but not needy or dependant

Why do we Need Ethical Standards?

Ethics are the beliefs that we hold about what constitutes the right conduct in a particular situation or job. We need to have a sound ethical framework to provide good quality care and to protect the rights of individuals who are aged or with a disability, especially those who may be more vulnerable.

Some people will have limited ability to evaluate the quality of care provided to them by workers, to communicate their concerns or complaints. Individuals themselves may also lack awareness that their behaviour and expectations places demands on workers to do things that are not appropriate or in their role.

Ethical guidelines are important in providing a safe and clear working environment for workers in assisting them to provide effective and goal-directed services and support.

Simply, they tell everyone what is expected of them in the performance of their work. They also ensure that individuals providing services have adequate training, skills, knowledge or expertise to provide the services that they are offering in the community.

Privacy

All clients have a right to privacy in their personal information, and workers should not seek information that is not relevant or necessary to the performance of their duties. Care workers also have a right to privacy, and these boundaries will often need to be set with clients and families who may seek personal information about you, or want to have a relationship with a worker.

Confidentiality

Confidentiality means that any information obtained or received by workers must be kept absolutely confidential, except with the written or verbal consent of the individual with a disability or their legal guardian. Workers must not discuss or disclose confidential information with anyone without this permission. It is expected that workers will sometimes need to discuss matters with co-workers, peers or supervisors but this should always be in an appropriate and respectful way.

Duty of Care

Care workers have a duty of care to anyone who might reasonably be affected by their activities, requiring them to act in a way that does not expose others to an unreasonable risk of harm – physical, psychological or financial. As a worker you are required to protect an individual from risks of injury or harm that you can foresee or anticipate. This means you are required to act with a knowledge of the individual (particularly about their disability and their living situation), and of your own abilities, knowledge and limitations. You should not give assistance or advice outside your role or expertise (e.g. financial advice, family counselling or relationship advice).

Friendships

The role of a care worker is to build, support and strengthen the existing social, family and community network of a person with a disability or who is aged. The role of a friend is different from the role of worker and constitutes a conflict of interest in doing your job.

Care workers may find this difficult as clients are often isolated, lonely and in need of friends, but it is the role of a care worker to build friendships, not to be the friendship.

Similarly, relationships with client family members are also not appropriate and risks blurring the boundaries of your professional relationship.

Be careful not to include clients in your social or family life and activities.

An inappropriate relationship with a client or family member has risks for workers including:

• Increasing/or unreasonable demands and expectations from the client or family
• High worker stress and burnout
• Inability to provide professional and objective support
• Difficulty setting limits and dealing with behaviour
• Distress when relationships break down
• Grief and loss for clients when workers leave

Gifts

Occasionally clients and family members may offer gifts to workers as a “thank-you” for work done, for example, chocolates, flowers, cards etc. We may not want to refuse a small token gift and cause offence. However acceptance of gifts should always be considered with caution, particularly gifts of money or expensive items. You can always respond “Your thanks is enough – this is my job.”

Be aware of Mable’s policy on acceptance of gifts – you are not allowed to accept them under our terms and conditions for clients who hire you through the platform.

In health and social care settings, effective work relationships are based on professionalism and principles of care, which require health and social care workers to respect and promote the rights of everyone they work with.

Relationship centred working is a personalised, partnership approach of forming and maintaining important relationships, as well as recognising the importance of these relationships in delivering effective and safe care and support. This includes team members, colleagues, other professionals, the individuals who need care and support and everyone who is important to them. Their families, friends and advocates, for example, are further supported by relationship centred working.

The relationship centred approach recognises the importance of the interpersonal and intrapersonal relationships that exists between the individual and others around them. The relationship forms the context within which care and support takes place.

Mewn lleoliadau iechyd a gofal cymdeithasol, mae cydberthnasau gwaith effeithiol yn seiliedig ar broffesiynoldeb ac egwyddorion gofal, sy'n ei gwneud yn ofynnol i weithwyr iechyd a gofal cymdeithasol barchu a hyrwyddo hawliau pawb y maent yn gweithio gyda nhw.

Mae gwaith sy'n canolbwyntio ar perthnasoedd-ganolog yn ddull wedi'i deilwra i ffurfio a chynnal cydberthnasau pwysig yn ogystal â chydnabod pwysigrwydd y cydberthnasau hyn wrth ddarparu gofal a chymorth effeithiol a diogel. Mae hyn yn cynnwys aelodau o'r tîm, cydweithwyr, gweithwyr proffesiynol eraill, yr unigolyn y mae angen gofal a chymorth arnynt a phawb sy'n bwysig iddynt. Er enghraifft, caiff eu teuluoedd, eu ffrindiau a'u heiriolwyr gymorth pellach gan waith sy'n canolbwyntio ar gydberthnasau.

Mae'r dull gweithredu perthnasoedd-ganolog yn cydnabod pwysigrwydd y cydberthnasau rhyngbersonol a phersonol sy'n bodoli rhwng yr unigolyn ac eraill o'i gwmpas. Y gydberthynas sy'n ffurfio'r cyd-destun ar gyfer darparu gofal a chymorth.