January 6, 2017
Nancy, a nurse in a memory care unit, loved her client Mrs. A. Over the course of caring for Mrs. A for nearly five years, Nancy came to look upon the woman like a second grandmother. When Mrs. A’s dementia progressed to the point where she no longer recognized Nancy, the nurse felt devastated. She described the situation as “almost like losing my mom.”
As Nancy discovered, clinicians can benefit from maintaining a certain professional distance (also called ‘clinical distance’ or ‘clinical detachment’) when working with clients. Empathy is an admirable quality in a senior care professional, but becoming too emotionally involved with a client can become a professional and personal stumbling block. What if you became so emotionally attached to a client with diabetes that you constantly “gave in” to their requests for ice cream because you couldn’t bear to say no? In this case, a lack of clinical detachment might compromise the client’s health.
Or, what happens when a beloved client dies? If you haven’t maintained an appropriate clinical distance, you could be emotionally devastated.
The following tips will help you maintain professional distance without compromising empathy.
1. Set boundaries from the beginning
The start of a client relationship marks the perfect time to set professional boundaries for yourself and the client. You can demonstrate empathy to the client by providing compassionate care, and you can reinforce emotional boundaries within yourself by letting go of client concerns when you walk out the door at the end of your shift. Try to remind yourself you are not obligated to think about the client outside of your professional relationship. By setting these boundaries at the beginning of a client relationship, you can position yourself to practice a healthy clinical detachment over the life of your association.
2. Use rituals to maintain emotional distance during long-term care relationships
Whether you work as a gerontology physician, a hospice nurse or an in-home caregiver, you can expect to develop deep relationships with the clients you care for over weeks, months or years of their life. To avoid becoming overly affected by these relationships, try using rules and rituals to shift your attention away from client concerns when you are not on duty. Some suggestions:
- After a shift, take a hot shower or bath to wash away the work day and refocus on yourself and your family.
- Pause before you enter your house after work and say aloud, “I enjoyed caring for you today, [name or names of clients], and now that you are safely in someone else’s care, I am shifting my attention to my family.”
- Meditate after a shift to clear your mind.
- Name your clients in prayer as you drive home after work, then let God take over until you return for your next shift.
- Do not discuss a client’s issues outside the work environment. It may be tempting to vent to your spouse about the way a client’s daughter spoke to her that day, but this may violate professional boundaries and may also compromise the client’s legal confidentiality.
- Avoid giving gifts that are too personal in nature. Depending on your employer’s rules, it may be all right to give a gift of lavender-scented bath products if a client has said she loves the smell of lavender, but giving an engraved picture frame with both of your names on it could indicate you are too emotionally attached to the client.
- Avoid getting involved in the client’s personal life. If you find yourself inserting yourself into a client’s relationships with family members, for example, you may have lost your professional distance and need to reevaluate the situation.
3. When a client nears the end of life, begin a gentle detachment process within yourself
Maintaining professional distance is a mental process that involves examining your own feelings and determining how emotionally attached you want or need to be to a client. If a client begins to decline or goes into hospice care, take a moment to reevaluate your feelings toward the client. If you feel you have become too attached, now is the time to mentally pull back a bit.
This does not mean radically changing the way you interact with the client, nor does it mean suddenly adopting a sterile, clinical manner. Indeed, you should maintain your empathetic, compassionate demeanor at this time. But emotionally you can begin to detach from the client in order to avoid being hurt when they ultimately pass away. You can do this by shifting your focus from the individual to the health conditions that need attention. For example, instead of empathetically attaching yourself to the client’s dying process, focus clinically on the client care needs you can attend to, such as hygiene. This detachment can be a necessary part of the process involved in maintaining professional distance.
One of the great joys of being a senior care professional lies in the emotional bonds you can forge with those in your care. At times, professional caregivers become like surrogate family members to their clients. This can be a wonderful experience for everyone involved, but you should take care to maintain some professional distance so that you can provide high-quality care and avoid being hurt emotionally.
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