Boundary Erosion in Oncology Nursing: Psychosocial Consequences and Coping Strategies-A Qualitative Study.

OBJECTIVES

This study explored oncology nurses' perceptions and experiences of professional boundaries in cancer care, including boundary violations, psychosocial consequences, and coping strategies.

METHODS

A qualitative design using conventional content analysis was conducted. Five online focus group interviews were held between July and October 2025 with 25 oncology nurses working in inpatient oncology units and outpatient chemotherapy services in Türkiye. Participants were recruited via snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed independently by two researchers. Reporting followed the COREQ guideline.

RESULTS

Five main themes and fourteen subthemes emerged. Nurses described boundaries through metaphors representing rigid, professional, and permeable boundaries, indicating boundaries are dynamic and context-dependent. Boundary erosion was influenced by long-term nurse-patient relationships, emotional closeness, cultural expectations, role ambiguity, limited experience, and insufficient institutional/legal clarity. Nurses reported violations related to privacy and physical space as well as professional role violations, including task overload and increased informational demands when physician communication was inadequate. Consequences included secondary traumatic stress (intrusive memories, sleep problems, fear of illness) and burnout (irritability, emotional distancing, reduced motivation). Coping strategies involved therapeutic communication and assertive limit-setting, self-care and cognitive reframing, and organizational supports such as protocols, education, and adequate staffing.

CONCLUSION

Professional boundaries in oncology nursing are vulnerable to erosion, increasing psychosocial burden and challenging sustainable therapeutic care.

IMPLICATIONS FOR NURSING PRACTICE: Training should strengthen boundary management and difficult conversations, supported by routine supervision/debriefing, clear roles, and workload and staffing arrangements that protect breaks.