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Professional BoundariesAn occupational therapist’s guide to the importance of appropriate professional boundaries

PO Box 9644, Wellington 6141, New Zealand

P +64 4 918 4740 | [email protected] | www.otboard.org.nz

Occupational Therapy Board of New Zealand Professional Boundaries 2016

Professional Boundaries


3Occupational Therapy Board of New Zealand

PO Box 9644, Wellington 6141 | www.otbnz.org.nz

Contents Introduction 4

Theimportanceofmaintainingboundaries

inprofessionalrelationships 5

Acontinuumofprofessionalbehaviour 6

Pre-existingrelationships 7

WorkingwithMäoriconsumers 7

Caringforclosefriendsorfamily/whänau/hapü/iwi 8

Socialmediaandelectronicformsofcommunication 8

Workinginsmall,ruralorremotecommunities 9

Concludingprofessionalrelationships 9

Preventingboundarytransgressions 10

SignsofoverinvolvementinOccupationalTherapy–

Healthconsumerrelationship 11

Sexualrelationshipswithcurrenthealthconsumers 12

Sexualrelationshipswithcurrenthealthconsumer’s

partnersorfamilymembers 12

Relationshipswithformerhealthconsumers

andtheirfamilies 13

Gifts 14

Bequests,loansorfinancialtransactions 14

Financialtransactions 15

Actingasarepresentativeorpowerofattorney 15

Whattodoifyoubecomeawareofacolleague’s

boundarytransgression 16

References 17

Glossary 18



4

Introduction

ThisguidelinehasbeendevelopedbytheOccupational

TherapyBoardofNewZealand(“theBoard”)to

provideadvicetooccupationaltherapists(and

thepublic)onoccupationaltherapistsmaintaining

appropriateprofessionalrelationshipswithhealth

consumers*.Occupationaltherapistsmustbe

awareoftheirprofessionalresponsibilitytomaintain

appropriatepersonal,sexualandfinancialboundaries

inrelationshipswithcurrentandformerhealth

consumersandtheirfamilies.

TheroleoftheBoardistoprotectthehealthand

safetyofthepublicbysettingstandardsofclinical

competence,ethicalconductandculturalcompetence

foroccupationaltherapists1.TheCode of Ethics for

Occupational Therapists(OccupationalTherapyBoard

ofNZ,2015)setsstandardsofprofessionalbehaviour

thatoccupationaltherapistsareexpectedtouphold.It

isexpectedthatoccupationaltherapistsmaintainthese

standardsofconductwithintheirprofessionalpractice

and,tosomeextent,withintheirpersonallives.The

Code of Ethics for Occupational Therapists,together

withthecompetenciesforoccupationaltherapists,

scopeofpracticeandotherBoardguidelines,provide

aframeworkforsafeandresponsiblepractice

thatprotectspublicsafety.Thisguidelinecontains

standardsofbehaviourfromtheCode of Ethics for

Occupational Therapistsandmoredetailedadviceon

professionalboundaryissuesandhowtheyshould

bemanaged.Itisnotpossibletoprovideguidance

foreverysituationandoccupationaltherapistsmust

developandusetheirownprofessionalandethical

judgmentandseektheadviceofcolleaguesand/or

theirprofessionalorganisationwhenissuesarisein

relationshipswithhealthconsumers.

Differentculturesmayhavedifferentexpectations,

andunderstandingofrelationshipsandboundaries.

Culturallysafecareinvolvesbalancingpower

relationshipsinthepracticeofoccupationaltherapy

sothateveryhealthconsumerreceiveseffective

treatmentandcaretomeettheirneedsthatis

culturallycompetentandculturallyresponsive.

AotearoaNewZealandisasmallcountryand

thisguidelinehasbeendevelopedrecognising

thatoccupationaltherapistsaremembersoftheir

communitiesandmayhaveexistingrelationships

withsomehealthconsumers.TheBoardisaware

thatforMäoriandothers,establishingconnections

andrelationshipsoftrust,areanimportantelement

ofprovidingculturallysafecare.Theprinciplesof

theTiritiOWaitangi/TreatyofWaitangi,partnership,

protectionandparticipation,areintegraltoproviding

appropriateoccupationaltherapyservicesforMäori.

Thisguidelineprovidesadviceonprofessional

boundarieswhenworkingwithMäorihealth

consumers.

ThisGuidelineandtheCode of Ethics for Occupational

TherapistscontaintheBoard’sadviceonprofessional

boundaries.

*Thetermhealthconsumerisusedthroughout

theseguidelines.HowevertheBoardrecognises

thatoccupationaltherapistsworkinothersectors

otherthanhealth.TheBoardexpectsthese

guidelinestoapplyinallsectors.

1FunctionsofauthoritiesSection118(i)oftheHealthPractitionersCompetenceAssuranceAct



5

The importance of maintaining boundaries in professional relationships

Code of Ethics for Occupational Therapists Section 1.2

Occupational therapists shall ensure that people

receiving their services feel safe, accepted and

are not threatened by actions or attitudes of the

therapist.

Professionalrelationshipsaretherapeuticrelationships

thatfocusonmeetingthehealthorcareneedsof

thehealthconsumer.Occupationaltherapistsmust

beawarethatinalltheirrelationshipswithhealth

consumerstheyhavegreaterpowerbecauseof

theirauthorityandinfluenceasahealthprofessional,

theirspecialisedknowledge,accesstoprivileged

informationaboutthehealthconsumerandtheirrole

insupportinghealthconsumersandthosecloseto

themwhenreceivingcare.Thehealthconsumerdoes

nothaveaccesstothesamedegreeofinformation

abouttheoccupationaltherapistwhichincreasesthe

powerimbalance.Theoccupationaltherapistmay

alsohaveaprofessionalrelationshipwiththehealth

consumer’sfamilyandothersclosetothatperson

thatmayincreasethehealthconsumer’svulnerability.

Thepowerimbalanceisincreasedwhenthehealth

consumerhaslimitedknowledge,ismadevulnerable

bytheirhealthcircumstancesorispartofavulnerable

ormarginalisedgroup.Someparticularlyvulnerable

consumersarechildren,frailolderpeople,andthose

withamentalillnessordisability.Healthconsumers

mustbeabletotrustoccupationaltherapiststo

protectthemfromharmandtopromotetheir

interests.Occupationaltherapistsmusttakecareto

ensurethattheirownpersonal,sexualorfinancial

needsarenotinfluencinginteractionsbetween

themselvesandthehealthconsumer.Theymust

alsorecognisethathealthconsumersmayreadmore

intoatherapeuticrelationshipwiththeoccupational

therapistandseektohavepersonalorsexualneeds

met.Itistheoccupationaltherapistsresponsibilityif

thisoccurstomaintaintheappropriateprofessional

boundaryoftherelationship.

Theoccupationaltherapisthastheresponsibilityof

knowingwhatconstitutesappropriateprofessional

practiceandtomaintainhisorherprofessional

andpersonalboundaries.Thehealthconsumeris

inanunfamiliarsituationandmaybeunawareof

theboundariesofaprofessionalrelationship.

Itistheresponsibilityoftheprofessionaltoassist

healthconsumerstounderstandtheappropriate

professionalrelationship.Thereisaprofessional

onusonoccupationaltherapiststomaintaina

relationshipbasedoncareplansandgoalsthat

aretherapeuticinintentandoutcome.



6

A continuum of professional behaviour

Thediagrambelowrepresentsthecontinuumof

professionalbehaviour,providesapictureofthe

therapeuticversusnon-therapeuticbehaviourin

arelationshipbetweentheoccupationaltherapist

andthehealthconsumer.

The‘zoneofhelpfulness’describesthecentreof

acontinuumofprofessionalbehaviour.Thiszone

iswherethemajorityofinteractionsbetweenan

occupationaltherapistandahealthconsumer

shouldoccurforeffectivenessandsafety.

‘Overinvolvement’ofanoccupationaltherapist

withapersonintheircareistotherightsideofthe

continuum;thisincludesinappropriaterelationships

withthehealthconsumerortheirfamilymembers.

‘Underinvolvement’liestotheleftofthecontinuum;

thisincludesdistancing,disinterest,coldness,

andneglect.Thesebehaviourscanbeseenalso

asboundaryissuesbuttheyarenotdiscussedhere

indetailasthefocusofthisdocumentisonthe

over-involvementendofthecontinuum.

Everyoccupationaltherapyclientrelationshipcan

beplottedonthiscontinuum.

• Maintainprofessionalboundariesintheuse

ofsocialmedia.Keepyourpersonaland

professionallivesseparateasfaraspossible.

Avoidonlinerelationshipswithcurrentor

formerhealthconsumers.Donotusesocial

mediaorelectroniccommunicationtobuildor

pursuerelationshipswithhealthconsumers.

• Textmessagingmaybeanappropriateform

ofprofessionalcommunication,e.g.reminding

healthconsumersaboutappointments.

Occupationaltherapistsmustbeaware

ofprofessionalboundariesandensure

communicationviatextisnotmisinterpreted

bythehealthconsumerorusedtobuildor

pursuepersonalrelationships.Refertoour

ProfessionalBoundariesGuidelinesformore

information.

• Allmessagesshouldbedocumented.

Disinterested Neglectful

Therapeutic Relationship

Boundary Violations

Under Involvement

Zone of Helpfulness

Over Involvement

(NursesCouncilofNewZealand2012)



7

Pre-existing relationships

Whenanoccupationaltherapisthasapre-existing

relationshipwithahealthconsumer,suchasbeing

aneighbour,acquaintanceorbusinessassociate,

theoccupationaltherapistneedstobeawareofthe

potentialforboundaryconfusion(bytheoccupational

therapistorhealthconsumer)andpossibleharm.

Theoccupationaltherapistmustclarifyandif

necessarycommunicatethisnewprofessional

relationshipwiththepersoninordertoprovide

appropriatecare,andalsodeclareittotheother

membersoftheteamanddocumentitinthehealth

consumer’srecord.Thehealthconsumershould

beofferedthechoicetobeassignedtoanother

occupationaltherapist,ifpossible.Occupational

therapistsneedtoensurethatthepre-existing

relationshipdoesnotunderminetheirprofessional

judgmentandobjectivitywhenthepersonisintheir

careandtheymayneedtotakestepstohandoverthe

caretoanotheroccupationaltherapistifpracticable.

Ifpossibletheyshouldnotbetheprimaryoronly

healthpractitionerinvolvedinthisperson’scare.

Itiscriticalthatoccupationaltherapistsdistinguish

between‘beingfriendly’and‘beingfriends’.

Toachievethis,clearboundarieshavetobe

establishedidentifyingwhentheyareactingin

apersonalroleandwhentheyareactingina

professionalrole.Byestablishingtheseboundaries

occupationaltherapistsprotecttheconfidentiality

ofthehealthconsumerandprotecttheirown

personalintegrity.

Working with Mäori consumersEffectiveandculturallyresponsivepracticewithMäori

islikelytobebasedonanunderstandingoftikanga

(Mäoriprinciplesandvalues).Whanaungatanga

involvesestablishingarelationshipoftrustbymaking

connections.Thismayincludetheoccupational

therapistsharinginformationaboutwhänau(family),

whakapapa(ancestors)ortheirownpersonallife

toestablishtrustandrelationship.Itmayalsoinclude

establishingrelationshipswiththehealthconsumer’s

whänauandincludingthemindecisionsaboutcare.

Manaakiinvolvessharinghospitalityorkai(food)

toshowrespectandestablishrelationships.

Itisimportantthatoccupationaltherapistspartake

inritualsaroundfood

Establishing boundaries

protect the confidentiality

of the health consumer

and their own personal

integrity.



8

Caring for close friends, family/whänau, hapü or iwi

Insituationswhereanoccupationaltherapisthas

toprovidecaretoclosefriendsorfamilymembers

itisrarelypossiblefortheoccupationaltherapistto

maintainsufficientobjectivityaboutthepersonto

enableatrulyprofessionalrelationshiptodevelop.

Inthesesituations,wherepossible,another

occupationaltherapistshouldbeassigned

responsibilityforthatperson’scare.However,

attimes,anoccupationaltherapistmayhaveto

careforafriendorfamilymemberinanemergency,

orwheretheyliveinsmallcommunitieswherethere

islimitedaccesstooccupationaltherapiststowhom

theycanhandovercare.Whenanoccupational

therapisthasnooptionotherthantocareforaclose

friendorfamilymember,careshouldbehanded

overtoanotherappropriatecareproviderwhenit

becomespracticable.Ifcarehasbeenassignedto

theoccupationaltherapistwhoisafamilymember

thisshouldbedocumentedinthetherapyplan.

Itisalsoimportantforoccupationaltherapiststobe

clearabouttheirrolewhenaclosefriendorfamily

memberisreceivingcare.Theyhavearoleasan

informedsupportpersonorfamilymemberbutare

nottheretomakedecisionsaboutthecare.

SomeMäorioccupationaltherapistshaveastrong

senseofaccountabilityinworkingwithandcaringfor

whänau/hapü/iwi.Mäorioccupationaltherapistsneed

tobeclearabouttheirroleasaprofessionalandtheir

roleasarelative.Theymustrecognisewhenthey

mayneedtopassoncaretoanotheri.e.whenthey

feeluneasyandarelosingclarity,theirprofessional

judgmentmaybecompromisedortheyexperience

strongemotionsasacloserelative.

Social media and electronic forms of communication

Maintainprofessionalboundariesintheuseofsocial

media.Keepyourpersonalandprofessionallife

separateasfaraspossible.Avoidonlinerelationships

withcurrentorformerhealthconsumers.Donotuse

socialmediaorelectroniccommunicationtobuildor

pursuerelationshipswithhealthconsumers.

Textmessagingcanbeanappropriateformof

professionalcommunicatione.g.remindinghealth

consumersaboutappointments.Occupational

therapistsmustbeawareofprofessionalboundaries

andensurethatcommunicationviatextisnot

misinterpretedbythehealthconsumerorusedto

buildorpursuepersonalrelationships.

FormoreinformationpleaseseetheBoardsguidance

onsocialmedia.



9

Working in small, rural or remote communities

Thereisanaturaloverlapandinterdependenceof

peoplelivinginsmall,ruralorremotecommunities.

Whensomeonefromthecommunityrequires

professionalcarefromtheoccupationaltherapist,

theoccupationaltherapistneedstokeepthemselves

safebyclarifyingtheshiftfromapersonaltoa

professionalrelationshipinanopenandtransparent

way.Theoccupationaltherapisthastoensurethe

person’scareneedsarefirstandforemostand

theymustmanageprivacyissuesappropriately.

Forexampletheoccupationaltherapistmightbe

approachedforinformationaboutthehealthconsumer

inalocalstorebyaconcernedneighbourandmust

maintainthehealthconsumer’sprivacy.

Ifpossiblethehealthconsumershouldbegiven

achoiceofcareriftheyknowtheoccupational

therapistfromapriorrelationship.Whenoff

dutytheoccupationaltherapistshouldreferthe

healthconsumertotheappropriateondutyhealth

practitioner.

Smallcommunitiesarenotlimitedtoruralandremote

communities:theyalsoincludesmallordiscrete

communitieswithinlargeurbancentres

(e.g.religious,gayormilitarycommunities).

Concluding professional relationships

Knowinghowandwhentoconcludeprofessional

relationshipsisasimportantasknowinghowto

beginthem.Theconclusionofarelationshipoccurs

whenahealthconsumerandtheirfamilyareableto

managetheirownhealthneeds.Orifneedsarestill

evident,areferralhasbeenmadetoanotherhealth

provider.Ortheclienthasmadeaninformeddecision

nottoparticipateinongoingservices.Anoccupational

therapistmaydecreasetheirinvolvementwithahealth

consumerormayactivelyencourageothersupportif

thehealthconsumerisbecomingundulydependent

ontheoccupationaltherapist.

Terminationritualsmaybeappropriateinsome

circumstanceswheretherehasbeenaclose

involvement.Thiscouldhappenindifferentways

dependingonthecultureofthehealthconsumer

e.g.attendanceataTangihangaorfuneralmay

beanappropriatewayofshowingrespectforthe

healthconsumerandtheirfamily/whänau.

Itisimportanttodocumentwhencareistransferredto

anotheroccupationaltherapistincludingadescription

onhowandwhytheprofessionalrelationshipwas

concluded.

Communities include small

and discrete communities

within large urban centres

(e.g. religious, homosexual

or military communities.)



10

Preventing Boundary Transgressions

Thissectionfocusesonboundaryissuesthatarise

whenanoccupationaltherapistbecomesover

involvedwithahealthconsumerorfamily/family

member.Theoccupationaltherapistmaybelieve

he/sheishelpingthehealthconsumer(orfamily

member)bydevelopingafriendshiporclose

relationship.Howevertheseboundarycrossings

havethepotentialtoharmthehealthconsumerby

changingthefocusfromthetherapeuticneedsof

thehealthconsumertomeetingtheoccupational

therapists’ownneedse.g.tobe“special”orhelpful

orneeded,ortobeclosetosomeoneortohave

otherpersonal,financialorsexualneedsmet.

Theyhavethepotentialtoharmthehealthconsumer

byincreasingtheirvulnerabilityordependencein

therelationshipwiththeoccupationaltherapistand

couldbedetrimentaltotheirhealthoutcomesby

compromisingtheoccupationaltherapist’sobjectivity

andprofessionaljudgment.

Theharmfulconsequencesmaynotberecognised

orexperienceduntilmuchlater.

Occupationaltherapistscanreducetheriskof

boundarytransgressionsby:

• Maintainingtheappropriateboundariesof

theoccupationaltherapist–healthconsumer

relationship,andhelpinghealthconsumers

understandwhentheirrequestsarebeyond

thelimitsoftheprofessionalrelationship.

• Developingandfollowingacomprehensive

careplanwiththehealthconsumer.

• Involvingothermembersofthehealthcare

teaminmeetingthehealthconsumer’sneeds.

• Ensuringthatanyapproachoractivitythatcouldbe

perceivedasaboundarytransgressionisincluded

inthecareplandevelopedbythehealthcareteam.

• Recognisingthattheremaybeanincreasedneed

forvigilanceinmaintainingprofessionalismand

boundariesincertainpracticesettingse.g.rural

andremotelocations.Forexample,whencare

isprovidedinaperson’shome,occupational

therapistsmaybecomeinvolvedinthefamily’s

privatelifeandneedtorecognisewhenhisor

herbehaviouriscrossingtheboundariesofthe

professionalrelationship.

• Usingsupervisiontodiscusspotentialboundary

issues.

• Consultingwithcolleaguesand/orthemanager

inanysituationwhereitisunclearwhether

behaviourmaycrossaboundaryoftheprofessional

relationship,especiallycircumstancesthatinclude

selfdisclosureorgivingagifttooracceptingagift

fromahealthconsumer.

• Documentingindividualisedinformationinthe

healthconsumer’srecordregardinginstances

whereitwasnecessarytoconsultwithamanager

orcolleagueaboutanuncertainsituation.

• Consideringtheculturalvaluesofthehealth

consumerinthecontextofmaintainingboundaries,

andseekingadvicefromculturaladvisors.

• Raisingconcernswithacolleagueifthe

occupationaltherapisthasreasontobelievethat

theymaybegettingclosetocrossingtheboundary

orthattheyhavecrossedaboundary.Sometimesa

newlyregisteredoccupationaltherapistmaynotbe

awarethathis/heractionshavecrossedaboundary.

• Discussingthenatureofatherapeuticrelationship

withahealthconsumeriftheybelievethatthehealth

consumeriscommunicatingorbehavinginaway

thatindicatestheywantmorethanaprofessional

relationshipwiththeoccupationaltherapy.



11

• Consultingwithcolleaguesorthemanagerwhere

anothercolleagueappearstohavetransgressed

boundariesorahealthconsumerisbehavingin

aninappropriatemannertowardsanoccupational

therapist.

• Reducingprofessionalisolationbymaintaining

regularcontactwithoccupationaltherapistpeers,

reflectingonprofessionalrelationshipswithpeers

andparticipatinginformalprofessionalsupervision.

Signs of over involvement in an occupational therapist – health consumer relationship

Questions for reflection

Is the occupational therapist doing something

the health consumer needs to learn to do

themselves? Whose needs are being met –

the health consumer’s or the occupational

therapists?

Will performing this activity cause confusion

regarding the occupational therapist’s role?

Is the behaviour such that the occupational

therapist will feel comfortable with their

colleagues knowing they had engaged in this

activity or behaved in this way with a health

consumer?

Somewarningsignsthattheboundariesofa

professionalrelationshipmaybebeingcrossedand

thataninappropriatepersonalorsexualrelationship

isdevelopingare:

• Theoccupationaltherapistrevealsfeelingsand

aspectsofhis/herpersonallifetothehealth

consumerbeyondthatnecessaryforcare.

• Theoccupationaltherapistbecomesemotionally

closetoahealthconsumerorregardsthehealth

consumerassomeonespecial.

• Theoccupationaltherapistattemptstoseethe

healthconsumer(orthehealthconsumerattempts

toseetheoccupationaltherapist)outsidethe

clinicalsettingoroutsidenormalworkinghours

oraftertheprofessionalrelationshiphasceased.

• Theoccupationaltherapistfrequentlythinksofthe

healthconsumerwhenawayfromwork.

• Theoccupationaltherapistreceivesgiftsor

continuescontactwithaformerhealthconsumer

afterthecareepisodeortherapeuticrelationship

hasconcluded.

• Theoccupationaltherapistprovidesthehealth

consumerwithpersonalcontactinformation.

• Ahealthconsumerisonlywillingtospeakwith

aparticularoccupationaltherapistandrefuses

tospeaktootheroccupationaltherapists.

• Theoccupationaltherapistdeniesthatahealth

consumerwasinhisorhercareinthepast.



12

• Theoccupationaltherapistaccessesthehealth

consumer’shealthrecordwithoutanyclinical

justification.

• Theoccupationaltherapistgivesoracceptssocial

invitations.

• Textingorusingformsofsocialmediato

communicateinawaythatisnotclinicallyfocused.

• Theoccupationaltherapisttouchesthehealth

consumermorethanisappropriate.

• Theoccupationaltherapistincludessexualcontext

ininteractionswiththehealthconsumerorin

relationtotheirpartners,familyandfriends.

• Theoccupationaltherapistchangeshisorherdress

styleforworkwhenworkingwithaparticularhealth

consumer.

• Theoccupationaltherapistparticipatesinflirtatious

communication,sexualinnuendooroffensive

languagewithahealthconsumer.

• Theoccupationaltherapistisunableorreluctantto

concludeaprofessionalrelationshipandpursuesa

personalrelationshipwiththehealthconsumer.

• Theoccupationaltherapistfostersdependencyin

thehealthconsumeranddoesnotencourageself-

management.

Sexual relationships with current health consumers

Code of Ethics 1.2.3

Occupational therapists may not enter into

or continue with any personal or professional

relationship with clients or their carers that will,

or have the potential to, exploit or harm the

client and/or others.

Sexualrelationshipswithcurrenthealthconsumers

areinappropriate.Theyareunacceptablebecause

theycancausesignificantandenduringharmtohealth

consumers,damagethehealthconsumer’strust

intheoccupationaltherapistandthepublictrustin

occupationaltherapists,impairprofessionaljudgment

andinfluencedecisionsaboutcareand

treatmenttothedetrimentofthehealthconsumer’s

wellbeing.Howeverconsensualtherelationship

appearstobe,thereisapowerimbalancethatwill

alwaysmeanthatthereisthepotentialforabuseof

theoccupationaltherapistsprofessionalpositionand

harmtothehealthconsumer.

Sexual relationships with health consumer’s partners or family members

Itisareasonableexpectationthattheprofessional

relationshipwillnotbeexploitedinanywaybythe

occupationaltherapisttohavehis/herownneeds

met.Onoccasionoccupationaltherapistsmayfind

themselvessexuallyattractedtoahealthconsumer’s

familymemberorcarer.Itistheoccupational

therapist’sresponsibilitytoensurethathe/shenever

actsonthesefeelingsandrecognisestheharmthat

anysuchactionwouldcause.



13

Relationships with former health consumers and their families

Sexualrelationshipswithformerhealthconsumers

maybeinappropriatehoweverlongagothe

professionalrelationshipceased.Thereisnoarbitrary

timelimitthatmakesitsafeforanoccupational

therapisttohaveanintimateorsexualrelationship

withahealthconsumerwhowasformerlyintheir

professionalcare.Thereasonforthisisthatthe

sexualrelationshipmaybeinfluencedbytheprevious

therapeuticrelationshipwheretherewasaclear

imbalanceofpower.Thereisalsopotentialforthe

healthconsumertobeharmedbythisrelationship.

Inconsideringwhetherarelationshipcouldbe

appropriatetheoccupationaltherapistmustconsider:

• howlongtheprofessionalrelationshiplasted

(thelongertherelationshiplasts,theless

appropriateapersonalrelationshipbecomes).

Assistingahealthconsumerwithatemporary

probleme.g.abrokenlimbisdifferentfrom

providinglong-termcareforachroniccondition;

• thenatureofthatrelationshipintermsof

whethertherewasasignificantpowerimbalance

andwhethertheoccupationaltherapistcouldbe

perceivedasusingtheirpreviousinfluenceto

beginarelationship;

• thevulnerabilityofthehealthconsumeratthetime

oftheprofessionalrelationshipandwhetherthey

arestillvulnerable(includingthehealthconsumer’s

psychological,physicalandcharactertraits);

• whethertheymaybeexploitingtheknowledge

theyholdaboutthehealthconsumerbecauseof

thepreviousprofessionalrelationship;and

• whethertheymaybecaringforthehealth

consumerorhisorherfamilymembersin

thefuture.

Wheretherelationshipwasapsychotherapeuticone

orinvolvedemotionalsupport,wheretheoccupational

therapistwasprivytopersonalinformationthat

couldcompromisethehealthconsumerifusedout

ofaprofessionalsetting,orifthehealthconsumer

waspreviouslyamentalhealthconsumerorhasan

intellectualdisability,itmayneverbeappropriatefor

asexualorintimaterelationshiptodevelop.

Thesameconsiderationsapplytorelationships

withthefamilymembersofformerhealthconsumers.

Therecouldbepotentialtoharmthehealthconsumer

orotherfamilymembers.Insituationsthatareunclear

theoccupationaltherapistshouldseekadvicefrom

theirprofessionalorganisation.



14

Gifts

Code of Ethics for Occupational Therapists Section 3.3, and 3.3.5

Occupational therapists shall not bring the

profession or other health practitioners into

disrepute.

Occupational therapists shall if offered tokens

such as favours, gifts or hospitality from clients,

their families or commercial organisations,

always respond in a manner commensurate

with contextual guidelines.

• Generallyspeakingoccupationaltherapistshould

politelydeclineanythingotherthan“token”gifts

fromhealthconsumerse.g.chocolatesorflowers.

Itismoreacceptableforagifttobegiventoa

groupasanyprovisionofgoodcareisbythe

wholeteamratherthananindividualoccupational

therapist.

• Smallconsumablegiftsforsharing,suchas

chocolatesmaybeacceptable.Largeritemsor

itemsofvalueareunacceptable.

• Healthconsumersshouldneverformthe

impressionthattheircareisdependentupon

giftsordonationsofanykind.

• Cashgiftsshouldneverbeaccepted.Health

consumer’swhowishtogivecashmaybe

permittedbytheorganisation’spolicytodonate

fundstoacharityortoaddtoafundtopurchase

itemstobenefitotherhealthconsumerorthe

staffasagroup.

• Theremaybesituationswhenrefusingagiftmay

bedifficult,impoliteorappeartobeculturally

insensitive.Thegivingofgiftsmaybean

expectationundercertaincircumstancesorwithin

somecultures.

• Mostorganisationshaveclearpoliciesconcerning

thereceiptofgifts.Anygiftmustbeopenly

declaredtoensuretransparency.Occupational

therapistsmaycontacttheirprofessional

organisationforadviceifnopolicyexists.

• Occupationaltherapistsshouldnotgivegiftsto

healthconsumersasthehealthconsumermayfeel

obligatedtogivesomethinginreturn,orinterpret

thegiftasanindicatorofapersonalrelationship.

Bequests, loans or financial transactions

Aswithagift,thebestoptionistorefuseabequest

withapoliteexplanationorrequestthatitbe

reassignedtoanappropriatecharitableorganisation

orthefamilyanddiscloseittomanagersorsenior

personnel.

Thissituationisparticularlydifficultforseveral

reasons.Theremaybefamilyconsiderationsinthat

thefamilymaynotbesupportiveofthebequest.

Thefamilyandtheoccupationaltherapistmay

notevenknowaboutthebequestuntilthehealth

consumerhasdied.Familymembersorcolleagues

mayperceivethattheoccupationaltherapisthas

exertedundueinfluenceonavulnerablehealth

consumerintheircare.



15

Financial transactions

Healthconsumersmaydeveloparelationship

oftrustwithoccupationaltherapistsandseek

toinvolvetheminfinancialtransactionsorask

themtorepresentthem.

Financialtransactionsbetweenanoccupational

therapistandahealthconsumer(otherthanina

contractforprovisionofservices)maycompromise

theprofessionalrelationshipbyresultinginmonetary,

personalorothermaterialbenefit,gainorprofittothe

occupationaltherapist.Occupationaltherapistshave

accesstopersonalandconfidentialinformationabout

healthconsumersundertheircarethatmayenable

themtotakeadvantageofsituationsthatcouldresult

inpersonal,monetaryorotherbenefitsforthemselves

orothers.Anoccupationaltherapistcouldalso

influenceorappeartocoerceahealthconsumerto

makedecisionsresultinginbenefittotheoccupational

therapistorpersonallosstothathealthconsumerand

itisunacceptableforoccupationaltherapiststotake

suchactions.

Occupationaltherapistsmaybelegitimatelyrequired

bytheiremployertopurchaseitemsonahealth

consumer’sbehalforassistthemwithotherfinancial

mattersunderspecificconditions.Alltransactions

mustoccurwithinacceptableorganisationalpolicy,

bedocumentedinthehealthconsumer’srecordand

anotherappropriateperson/signatoryshouldalways

beinvolvedwhenmoneyorpropertyisinvolved.

Acting as a representative or power of attorney

Asageneralruleoccupationaltherapistsshould

notactforhealthconsumersintheircarethrough

representationagreementsoracceptpowerof

attorneytoamakelegaland/orfinancialdecisions.

Familymembersorcolleaguesmayperceivethat

theoccupationaltherapisthasexertedundue

influenceonavulnerablehealthconsumerintheir

care.Theremayoccasionallybeanexceptiontothis

principlewhenthehealthconsumerisalsoarelative

orclosefriendandnoalternativearrangementcan

bemade.Theoccupationaltherapistneedstodiscuss

thesituationwithboththeirmanagerorsenior

occupationaltherapistandotherfamilymembers

andcarefullyandclearlydocumentthediscussion.



16

What to do when you become aware of colleagues’ boundary transgressions

Thehealthconsumer’swelfaremustbethefirst

concern.Someboundarytransgressionsmaybe

unintended,anoccupationaltherapistmaybe

unawarethattheyhavecrossedaboundary.

Undersuchcircumstances,itmaybeeasierforan

occupationaltherapisttoaddressacolleagueabout

aboundarytransgressionandeasierforindividual

occupationaltherapiststobeapproachedbya

colleague.Theissuesthatanoccupationaltherapist

couldaddresswiththecolleagueinclude:

• whatwasobserved?

• howthatbehaviourwasreceived

• theimpactonthehealthconsumer;and

• theemployer’sprofessionalpracticestandards.

Ifunabletospeaktothecolleaguedirectlyorifthe

colleaguedoesnotrecognisetheproblemthenext

stepisfortheoccupationaltherapisttospeakto

hisorherimmediatesupervisor.Theoccupational

therapistshouldputtheconcernsinwritingand

includethedate,time,witnessesandsometypeof

identificationofthepersonconcerned.Ifthesituation

isnotresolvedatthislevel,oriftheissueisaserious

boundarytransgression,furtheractionmayberequired

suchasreportingthemattertotheappropriate

regulatoryauthority.

Occupationaltherapistsobservingtheinappropriate

conductofcolleagues,whetherinpractice,

management,educationorresearch,haveboth

aresponsibilityandanobligationtoreportsuch

conducttoanappropriateauthorityandtotakeother

actionasnecessarytosafeguardhealthconsumers.

Failuretotakestepstopreventharmtoahealth

consumermayleadtodisciplinaryactionbeing

takenagainstthatoccupationaltherapist.

Iftheoccupationaltherapisthasobservedacolleague

whohasdisplayedsexualisedbehaviourtoahealth

consumer,thefirstpriorityisthesafetyofthehealth

consumerandtheoccupationaltherapistmust

taketheappropriatestepswithoutdelay,including

informingtheemployerand/orregulatorybody,or

eventhepoliceiftheoccupationaltherapisthasreason

tobelievethatacriminaloffencehasbeencommitted.

Occupationaltherapistsmaybemadeawareofa

colleague’sactionsbythehealthconsumer,either

thepersondirectlyaffectedbytheconductor

anotherhealthconsumer.Theoccupationaltherapist

shouldbeconsciousofhowdifficultitmayhave

beenforthehealthconsumertocomeforwardwith

thisinformation.Thebestcourseofactioninthese

circumstancesistoanswerthehealthconsumer’s

questions,provideinformationtoassistthehealth

consumerindecidingifabreachofprofessional

boundarieshastakenplace,andinformthehealth

consumeroftheavenuesformakingacomplaintif

heorshewishestodoso.

Ifthehealthconsumerdoesnotwishthematterto

bepursued,andtheoccupationaltherapistbelieves

thatthereisarisktopublicsafety,theoccupational

therapistmustactwithoutdelaysothatanyconcerns

areinvestigatedandthehealthconsumerprotected.

Ifindoubttheoccupationaltherapistshouldseek

advicefromacolleague,managerortheappropriate

professionalorregulatorybody.

Decisionsonseriousprofessionalboundary

transgressionscanbeaccessedontheHealth

PractitionersDisciplinaryTribunalwebsiteat

www.hpdt.org.nz.



17

For more information please contact OTBNZ at [email protected]

References

�Ministry�of�Health�(2003).�Health Practitioners Competence Assurance Act.

�Occupational�Therapy�Board�(2015).�Code of Ethics for Occupational Therapists.

�Occupational�Therapy�Board�(2015).�Competencies for Registration and Continuing Practice.


Glossary

ColleaguesIncludesotheroccupationaltherapists,students,other

healthcareworkersandotherslawfullyinvolvedinthe

careofthehealthconsumer.

CommunityReferstoNewZealandsocietyasawholeregardless

ofgeographiclocationandanyspecificgroupthe

individualreceivingoccupationaltherapydefinesas

communityincludingthoseidentifyingasculturally

connectedthroughethnicity,sharedhistory,religion,

genderandage.

Cultural�SafetyTheeffectiveoccupationaltherapypracticefor

apersonorfamilyfromanotherculture,andis

determinedbythatpersonorfamily.Cultureincludes,

butisnotrestrictedto,ageorgeneration;gender;

sexualorientation;occupationandsocioeconomic

status;ethnicoriginormigrantexperience;religious

orspiritualbelief;anddisability.Theoccupational

therapistdeliveringtheservicewillhaveundertaken

aprocessofreflectionontheirownculturalidentity

andwillrecognisetheimpactthattheirpersonal

culturehasontheirprofessionalpractice.

Unsafeculturalpracticecomprisesanyactionwhich

diminishes,demeansordisempowersthecultural

identityandwellbeingofanindividual.

HapüAkinshipgroup,clan,subtribe–sectionofalarge

kinshipgroup.

Health�ConsumerAnindividualwhoreceivesanoccupationaltherapist

careorservices.Thistermrepresentspatient,client,

resident,ordisabilityconsumer.

IwiAnextendedkinshipgroup,tribe,nation,people,

nationality,race–oftenreferstoalargegroupof

peopledescendedfromacommonancestor.

Kawa�WhakaruruhauCulturalsafetywithintheMäoricontext.Isaninherent

componentofMäorihealthandoccupationaltherapy

especiallyinitscontributiontotheachievementof

positivehealthoutcomes.

ManaakiTosupport,takecareof,givehospitalityto,protect,

andlookoutfor.

PowerThecapacitytopossessknowledge,toactandto

influenceeventsbasedonone’sabilities,wellbeing,

education,authority,placeorotherpersonalattributes

andprivileges.

PrincipleAnacceptedorprofessedruleofconducttoguide

one’sthinkingandactions.

Professional�RelationshipProfessionalrelationshipsexistonlyforthepurposeof

meetingtheneedsofthehealthconsumer.

Theprofessionalrelationshipbetweenanoccupational

therapistandahealthconsumerisbasedona

recognitionthattheperson(ortheiralternatedecision-

makers)areinthebestpositiontomakedecisions

abouttheirownliveswhentheyareactiveand

informedparticipantsinthedecision-makingprocess.



19

ResponsibilityAchargeordutythatarisesfromone’sroleorstatus

inaprofessionororganisation.

Therapeutic�RelationshipArelationshipestablishedandmaintainedwitha

personrequiringorreceivingoccupationaltherapy

bytheoccupationaltherapistthroughtheuseof

professionalknowledge,skillsandattitudesinorderto

provideoccupationaltherapyexpectedtocontributeto

theperson’shealthoutcomes.

TikangaMäoriprinciplesandvalues.

Tiriti�O�WaitangiIsthefoundingdocumentofAotearoaNewZealand

signedin1840bytheMäoripeopleandtheBritish

Crown.

WhakapapaAncestors

WhänauExtendedfamily

WhanaungatangaEstablishingrelationships,makingconnections.

PO Box 9644, Wellington 6141, New Zealand

P +64 4 918 4740 [email protected] | www.otboard.org.nz

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