Associate Professor of Psychology at Mount Allison University, Sackville, NB
Crossing boundaries: Issues for hospice palliative care volunteers

“Here’s my cell phone number, call me any time.”

“I’m not supposed to accept gifts, but I guess it can’t hurt.”

“I can stay a little longer if you like.”

If you are someone who volunteers in hospice palliative care, have you ever found yourself saying these kinds of things? If you are a volunteer manager, have you heard your volunteers share comments like this? If so, you're not alone. It’s sometimes easy for volunteers to lose sight of the fine line between being a friend to a patient or the patient's family and being a member of the formal caregiving team.

Boundaries can be a source of concern for hospice palliative care volunteers. It’s not always clear when to say “yes” and when to say “no” to a patient’s or family’s request. Of course, if you are the patient’s friend, it's OK to do any of the things mentioned above; if you’re the patient’s volunteer, however, it's best to think twice before doing these things. Better still, check your program’s policies or talk to your coordinator or manager before doing things such as accepting gifts or giving out personal information, such as phone numbers.

What was done

Boundary issues were the topic of a recent study by Claxton-Oldfield, Gibbon, and Schmidt-Chamberlain published in the American Journal of Hospice & Palliative Medicine (1). Seventy-nine hospice palliative care volunteers from two community-based hospice programs responded to a 27-item Boundary Issues Questionnaire. Each item on the questionnaire was an action that a volunteer might undertake, for example, “Accept a gift from a patient or family”, or “Agree to sign a patient’s will as a witness”. For each item, volunteers were asked to indicate two things:

  • 1) whether they considered it to be a boundary issue (something not to do) and;
  • 2) whether they had ever done it.

What was found

The researchers divided the actions into three categories, based on how many volunteers indicated that a particular action was something not to do:

  • 70% or more - definite boundary issue
  • 40 - 69% - potential boundary issue
  • less than 40% - questionable boundary issue.

Some of the actions considered definite boundary issues:

  • accepting money from, or lending money to, a patient or family
  • accepting a patient’s power of attorney or signing a patient’s will
  • lending personal belongings to a patient/family
  • attempting a deathbed conversion
  • providing medical care to a patient
  • gossiping about other members of the formal caregiving team.

Some of the actions considered potential boundary issues:

  • accepting a gift from, or buying a gift for, a patient or family member
  • attending a patient’s medical appointments
  • breaking down emotionally in front of a patient or family member.

Some of the actions considered questionable boundary issues:

  • giving out personal phone numbers
  • accepting an invitation from a patient or family to attend a family activity or party
  • continuing to visit with a family following the patient’s death
  • providing clothes, toys or meals to a patient or family.

Of the 27 items (actions) on the questionnaire, only three were done by more than half of the volunteers:

  • giving out personal phone numbers
  • staying with a patient or family for longer than the agreed time
  • sharing private information about their personal experiences with the death of a loved one.

There were also three actions never done by any of the volunteers:

  • accepting money from a patient or family
  • accepting a patient’s power of attorney
  • attempting a deathbed conversion.

Small percentages of volunteers indicated that they had, for example, done the following actions:

  • talking about a patient or family with others in the community
  • providing medical care to a patient
  • attending a patient’s medical appointment
  • doing jobs around the patient’s home that the patient or family was unable to do accepting a gift from a patient.

Implications

Among the implications of these findings for hospice palliative care volunteer programs is the need for clear policies and procedures about what volunteers can and cannot do.

If you are a volunteer, it is important to understand the policies and procedures of the volunteer program before being matched with patients and families. If you are a program manager, it is important to make these rules, and the reasons for them, explicit during volunteer training, along with the consequences for breaking them (e.g., volunteer dismissal), They may need to reinforced in annual refresher sessions.

Without such policies and procedures, programs may be putting themselves at risk legally.

For a copy of the Boundary Issues Questionnaire, please contact Dr. Stephen Claxton-Oldfield.



Reference

 1. Claxton-Oldfield, S., Gibbon, L., & Schmidt-Chamberlain, K. (2011). When to say “Yes” and when to say “No”: Boundary issues for hospice palliative care volunteers. American Journal of Hospice & Palliative Medicine, 28 (6), 429-434. doi: 10.1177/1049909110397926