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D’Agostino is a travel nurse who had cared for Costello for six weeks at a rehabilitation hospital following the bombing.

However, we should bear in mind that this is a perspective based more on Western norms, and may be rarer in Asian cultures like Singapore and Malaysia.

The most important question that must be asked is whether it is ethical.

Patient A referred to the visitor as his girlfriend.

AT BEST, NURSES AND PATIENTS develop a special bond based on trust, compassion, and mutual respect.

Depending on the nurse's and patient's gender, culture, age, and ethnicity, certain behaviors may be perceived differently than intended; for example, as having a meaning that's more personal than professional.

One of the survivors of the Boston Marathon bombing in 2013, James Costello, married his nurse, Krista D’Agostino, in Aug 2014.

According to Baca, professional boundaries support key elements of the nurse practitioner-patient relationship: trust, compassion, mutual respect, and empathy; these elements are needed in the nurse-patient relationship as well.3 Boundaries also serve to keep lines of communication open and let patients and nurses interact in a professional atmosphere.

Unfortunately, setting boundaries isn't straightforward. The Code of Ethics for Nurses states, "When acting within one's role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships."4 The familiarity and trust that develop between a nurse and a patient, combined with the seductive pull of helping, the complexity of the patient's treatment needs, the dependence of vulnerable patients (such as pediatric patients), and a general lack of understanding of boundary theory, can threaten the integrity of the relationship and lead to boundary violations.5 Male and female nurses alike can be influenced by emotions during patient encounters, leading them to perceive that interactions may have a deeper meaning.

Boundaries may be blurred when either party initiates conversation or physical contact outside of professional boundaries.

An example of an inappropriate conversation would be the nurse asking the patient where he or she normally hangs out on the weekends.

Professional boundaries may be viewed in light of a continuum of professional behavior model that views the therapeutic relationship between nurse and patient as the ideal in the center and under-involvement and over involvement as the usually undesirable positions to either side.

A NURSE has admitted starting a sexual relationship with a vulnerable former mental health patient.

Boundaries may be tested by anything from whether or not to accept a gift from a patient, which may be acceptable in certain situations, to dating and sexually intimate relationships with patients [which] are always prohibited” (ANA, 2015).

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