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I’ve read some recent information from CNO about patient sexual abuse. How many sexual abuse cases has CNO received?
While most nurses do not harm their patients, CNO does respond to several cases of patient sexual abuse by nurses each year.
Between 2000 and 2017, CNO received 280 complaints and reports related to sexual abuse. The number of complaints and reports CNO receives has been increasing since 2015. In 2018, there were 49 sexual abuse matters reported to CNO. We suspect this is an underestimate of actual incidences of patient sexual abuse. Research shows that patients do not report sexual abuse by health professionals for many reasons, including fear of not being believed, fear of repercussions and stigmatization associated with sexual abuse. The Sexual Abuse Task Force Report (2016) estimated that 200,000 Ontario patients experienced sexual abuse at the hands of health care professionals, including nurses, over a six-year period.
CNO exists to ensure Ontarians receive safe nursing care. We believe that even one case of sexual abuse is one too many.
I like to hug my patients. Is hugging appropriate?
Hugging can be acceptable in some contexts, and if it is in the patient’s therapeutic interests. For example, it may be appropriate to offer a hug when a patient receives distressing news. In all situations, always ask for permission: for example, “Can I give you a hug?”
It is important to remember that in the nurse-patient relationship, nurses hold a position of power. Given this, maintaining professional boundaries is the nurse’s responsibility. This includes physical boundaries.
I’ve read information from CNO that a nurses’ well-being can impact quality patient care. How so?
Nurses care best for patients when they take care of themselves. Research shows that physical and emotional fatigue reduces cognitive functioning including decision-making, memory and attention. Professionals are also less likely to violate the boundaries of others, to make ethical errors, or to misuse power when they are emotionally and physically well.
Research also shows nurses’ well-being not only benefits patients; it gives nurses increased job and life satisfaction, and better physical health. It’s important to step back and identify times when stressors in your personal and professional lives need attention. CNO developed a fact sheet with ideas for nurses reflection, and suggestions from our research about to respond to stress.
I am starting to develop feelings for one of my patients. I know I’m not allowed to have a relationship with a patient. How do I deal with these feelings?
While therapeutic relationships can bring about feelings of closeness, intimacy or attraction, it is the nurse’s responsibility to maintain professional boundaries and not pursue these feelings.
In the nurse-patient relationship, nurses hold a position of power by virtue of having: professional knowledge and skills patients rely on for their well-being, such as performing physical assessments and accessing patient’s personal health information. Because of this power, any sexual or romantic relationship a nurse has with a patient is abuse and professional misconduct. It does not matter if the patient agrees to the sexual acts.
To manage a situation like this, you can:
- Be clear with yourself about your feelings, and any limitations or risks they may create. Self-reflection is important: recognizing these feelings lets you take proactive steps to ensure you don’t cross a boundary
- Speak with a colleague or a manager
- Consider if another nurse ought to provide care for the patient
Remember, the law says that someone is considered a patient for one year after the nurse-patient relationship ends. This means you cannot have a relationship at any time while caring for the patient, or for a full year after care has ended.
Are there different profiles of nurses who sexually abuse patients?
The data tells us most nurses do not harm their patients. Yet there are two profiles of nurses who sexually abuse patients. Some nurses are predators, intentionally harming patients. Other nurses begin a sexual relationship with a patient, which by law, is sexual abuse. Both cause physical and emotional harm.
Some nursing interventions are very intimate. Sometimes patients may perceive a nursing intervention as sexual in nature. How can nurses address this misperception with patients?
Nurses can use therapeutic communication to address this misperception with patients. Nurses have an accountability to provide clear and timely information and talk to patients in ways they can understand. Here are some guiding questions for nurses to consider when performing a nursing intervention:
- Have I obtained informed consent?
- How do I best communicate to the patient about what they should expect before, during and after the intervention?
- Is my communication clear and timely?
- Does my patient understand the intervention?
- If I were the patient experiencing this intervention, how would I expect to be treated?
Is consent always needed before using therapeutic touch?
Yes, consent is always needed before using therapeutic touch. Nurses have ethical and legal obligations to obtain consent for all nursing interventions. By doing so, nurses demonstrate patient-centred care. Asking for consent actively includes the patient as a partner in their care and shows sensitivity and respect for their choices.
If the patient confides in you that they have been abused by another staff member, who should you report this to?
Nurses have an obligation to report suspected patient sexual abuse by a health care professional to the relevant regulatory college, if the staff member is a regulated health care professional. If the staff member is an unregulated health professional, nurses should comply with their employer’s reporting policies. Nurses are encouraged to review both their employer policies and relevant legislative requirements as it relates to their reporting obligations.