Which of the following demonstrates a boundary violation in a nurse–client mental health setting?

• A. Honouring a request by the client to keep a secret from the healthcare team.
• B. Asking the client about his sexual history.
• C. Sharing coffee and cookies with the client during a therapeutic session.
• D. Nodding and smiling at the client.

Answer: (A)

Maintaining professional boundaries and ensuring safe, collaborative care is the focus here. When a nurse agrees to keep a client’s secret from the rest of the health-care team, that crosses a professional boundary. It hides information that the team needs to assess risk, plan treatment, and respond to safety concerns. It also creates secrecy, undermines accountability, and can erode trust in the therapeutic relationship. Confidentiality has limits, and information necessary for safety and care should be shared with the team; nurses don’t promise to conceal such information.

The other options don’t inherently violate boundaries: asking about sexual history is a normal part of assessment; sharing coffee and cookies can be a harmless, brief boundary crossing if it doesn’t blur roles; and nodding and smiling are standard supportive communication.