The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge, comfort, experience, and ethical decision-making: a longitudinal randomized controlled trial

Abstract

Purpose: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client–practitioner boundary dilemmas.

Methods: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman’s two-way analysis of variance was used to examine the trajectories over time.

Results: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ² = 10.673, p = 0.014) and comfort (χ² = 9.727, p = 0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ² = 3.609, p = 0.307) or control group (χ² = 7.800, p = 0.050). Ethical decision-making improved in the control group (χ² = 13.188, p = 0.004) following training, however remained unchanged in the experimental group.

Conclusions: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated.

Implications for Rehabilitation

• Ethical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting.

• In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making.

• Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting.

• Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.

Keywords:

• Professional boundaries
• practitioner–client relationships
• ethics
• ethical dilemmas
• interprofessional training

Acknowledgements

The authors wish to acknowledge the contributions of Greg Ungerer, Julianne Malt, Ellen Eugarde, and Professor Tim Geraghty.

Disclosure statement

The authors report no declarations of interest.