Professional Boundaries
It is reasonable for a patient to expect their SLP or audiologist to maintain professional boundaries because they help define the difference between therapeutic and personal relationships and avoid potential misunderstanding of words and actions.
Professional boundaries recognize the power imbalance and responsibilities of a regulated member and are mandated in ACSLPA’s Standards of Practice.
Examples of professional boundaries include:
- obtaining informed consent before service provision;
- communicating about touch necessary for service provision;
- respecting the clients decline for physical touching;
- declining to meet clients socially (outside of your scheduled appointments);
- declining friend/follower/connection requests on personal social media profiles;
- communicating professionally over the phone or in writing; and
- avoiding sexually suggestive comments/actions, racist or discriminatory comments/actions, or the expression of opinions/remarks that could violate the professional boundaries.
Managing Professional Boundaries
A regulated member recognizes when professional boundaries may be compromised by feelings, conduct, behaviour, or remarks of a sexual nature, regardless of who initiates.
To demonstrate this standard, the regulated member must manage professional boundaries by:
- taking steps to ensure the professional relationship and professional boundaries are maintained, or
- where professional boundaries cannot be maintained, terminating the professional relationship and taking steps to transfer care of the patient to another regulated health professional.
The regulated member must document any decisions made and steps taken.
Touch and Proximity Guidelines
Never make any assumptions about the patient’s acceptance or tolerance for being touched or in close contact.
Always explain to the patient:
- how they will be touched during service provision;
- why they need to be touched to accomplish the assessment/treatment; and
- obtain patient consent before beginning the assessment/treatment and document the consent.
Be self-aware of the intent and nature of all touch and discuss any reactions the patient is having to touch with the patient and/or their guardian. It is important to allow and encourage the patient to express concerns and feelings regarding touching during service provision.
Always:
- ask the patient or caregiver to move hair, head or neck covering(s), or get their consent to do so, as needed;
- demonstrate respect for the patient;
- maintain the patient’s dignity (e.g. draping);
- respect the patient’s personal space;
- respect their right to withdraw their consent at anytime;
- use gloves as required for infection control and to reduce intimacy;
- avoid unnecessary physical contact; and
- use physical barriers (e.g. pillows) to prevent contact with other body parts.
Cultural norms about touch and proximity vary from culture to culture, and knowledge about them is valuable; however, touch in professional settings should not be guided by broad generalizations. Consulting the individual about touch should be done in the present, as something may have changed for that individual since the last visit (e.g. trauma event, boundary development).
Some examples of physical contact commonly used by SLPs and audiologists, which could be misinterpreted include:
- tactile facial prompts provided as part of phonological therapy;
- abdominal and/or chest touch during breathing exercises;
- close physical proximity and facial/head contact as part of an audiologic assessment or hearing aid fitting; and
- contact with the neck and face during feeding and swallowing interventions.