“We deal here with grey”: a grounded theory of professional boundary development in a forensic inpatient service.

Background: The question of how to maintain appropriate professional boundaries with clients in mental health settings can be complex, particularly for forensic inpatient nurses and healthcare workers. The literature in this area to date has mainly focused on boundary violations with little research on how staff members develop and maintain boundaries in forensic inpatient units, despite safe working relationships being beneficial for staff experience and client recovery.
Method: Interviews with eleven psychiatric nurses and healthcare workers from forensic inpatient wards were analysed using a grounded theory methodology.

Results: A cyclical model of boundary development was developed in which staff initially acclimatize to the forensic environment using their existing experiences and personal values before entering a calibration phase, where they constantly assess and address professional boundary issues in the course of their daily responsibilities. Staff members use this experience alongside reflection, social learning and clinical supervision to undergo individual learning and team development. In the fourth phase, staff members use this learning to recalibrate their views on boundaries, themselves and how they work with clients. This recalibration impacts on staff members’ further management of daily boundaries providing more material for learning, which leads to further recalibration.

Conclusions: This study echoes previous literature suggesting the importance of supervision and reflective spaces in professional boundary understanding. The model is comparable to existing learning theory and highlights the importance of social and experiential learning. There are implications for forensic psychiatric nurses in terms of training, team building, supervision and provision of reflective spaces.