Professional Boundaries in Nurse-Patient Relationships: Perspectives of Undergraduate Nursing Students in Brunei Darussalam

Abstract

Background: Professional boundaries in nurse-patient relationships are central to ethical practice, yet often difficult to define and maintain in day?to?day care. Undergraduate nursing students, who are still developing their professional identity, may be particularly vulnerable to boundary confusion. This study explored nursing students’ perceptions of the challenges and opportunities involved in navigating nurse-patient relationship boundaries.

Methods: A descriptive qualitative study using conventional content analysis was conducted. Forty?two essays written by undergraduate nursing students enrolled in a nursing ethics course at a university in Brunei Darussalam were analysed. The essays responded to four structured questions about professional limits in care delivery, challenges and benefits of setting work boundaries, and the role of the Code of Ethics in boundary maintenance. Meaning units were identified, condensed, coded, and grouped into categories and themes. Credibility was enhanced through double coding of a subset of essays, peer debriefing with experienced qualitative researchers, and maintenance of an audit trail and reflexive notes.

Results: Three overarching themes were identified: (1) Having professional relationships, describing students’ views of professionalism, trust, and power in the nurse–patient relationship; (2) Setting limits, highlighting students’ uncertainty about where and how to draw boundaries in situations such as self?disclosure, gift?giving, and caring for relatives; and (3) Taking responsibility, capturing students’ emphasis on self?reflection, seeking guidance, and clarifying expectations with patients.

Conclusion: The findings suggest that these nursing students conceptualise professional boundaries primarily through the lens of professionalism and personal responsibility, while dealing with ambiguity in clinical situations. Educational strategies that openly address boundary dilemmas, such as gifts, social media use, and emotional attachment, using case?based discussion, guided reflection, and clear institutional policies, may strengthen ethical sensitivity and support students in developing safe, compassionate, and professionally accountable nurse-patient relationships.