Patient Confidentiality and Privacy - Case Study Example

Patient Confidentiality and number: of Affiliation: Introduction Nowadays, health care organizations and practitioners are expected to give patient privacy utmost priority. Patients are entitled to have their information safeguarded and always confidential (U.S. Department of Health and Human services, 2012). As a result, patient privacy concern has enforced privacy laws enacting, which safeguard patients medical as well as the confidentiality of records. Moreover, patients are entitled to understand exactly what information is confidential and safeguarded. Patient entrust their health care provider to protect their information. This stipulation is entailed in The Health Insurance Portability and Accountability Act (HIPAA) 1998 that deals with the privacy and protection of medical records of patients (Nursing World Organization, 1998). In this paper discussions pertaining to practitioners as one of the major parties affected by this issue and analysis of the situation as it raises issues from patient records will be pursued. Theories applicable alongside legal and ethical sides of patient confidentiality as well as why privacy is important will also be focused on. This will also incorporate discussion of practitioners’ responsibilities and how to address patient problems. Eventually, the essay will conclude on potential resolutions to privacy problems to eliminate or minimise future issues. In John’s situation, he was exposed to an ethical dilemma where he should or should not freely disclose information concerning a resident, in ARG nursing home, to family friends hailing from his hometown. Before John reveals any information to anyone he must recall that the nursing career has nursing standards guidelines and codes of conduct. Every bit of them states that it is section of a nurse’s scope of nursing practice to abide and pursue these guidelines in relation to safeguarding the patient’s confidentiality and privacy of patient’s health care data (Finkelstein, 2007). John hails from a small urban centre where everyone is familiar with each other. As a result of it, John’s family friends had to be asked concerning the health condition of a close friend, out of profound concern. Regardless of the fact that John hails from a small urban centre, it was wrong of John’s colleagues to assume there wasn’t any trouble in giving away information relating to a patient. In fact, according to the practice standard, nurses need to make sure that the entire personal health information remains confidential and private always (Tingle and Bark, 2011). Therefore, it is evident that ARG nursing home was not following appropriate nursing standard guidelines in relation to patient confidentiality and privacy. The Nursing Homes Act (1990) states that nursing homes carry the responsibility of guaranteeing security and confidentiality of personal records of residents. In this light, every nursing home or any given medical facility is expected to put in place policies and procedures in relation to patient privacy and confidentiality of resident. Nurses must sign some kind of agreement form which confers them the right to fully act in conformity in protecting the health information of the entire residents. Nonetheless, at any time in revealing any kind of personal information, it is a requirement under the Personal Health Information Act (PHIPA) to get consent from the resident concerned or from any able person (a substitute decision-maker) authorized by the resident in writing or by word of mouth to stand for them while they are under nursing care (U.S. Department of Health and Human services, 2012). Making such a commitment, on the part of the nurse, is equal to taking an oath of professional practice that embodies confidentiality. Therefore, maintaining patient’s information confidentiality is a demonstration of respect of that individual and, in a number ways, is necessary to the relationship of nurse-patient. Generally, nursing standards must apply to all nurses in spite of their position, job description, or practice area. Moreover, one’s capability to maintain confidentiality in life of someone is also demonstration of autonomy. Autonomy refers to self-determination, having the right to make decisions independently regarding one’s own life and welfare (McLean, 2010). In this case, if John disclosed any information to his home urban centre’s family friends he would be regarded as not being autonomous given that respect for autonomy implies granting persons the right to confidentiality and privacy. It is necessary and important to be autonomous and to have nurses understand that confidentiality is necessary in the profession of nursing. It assists residents/patients feel comfortable and capable to have confidence in health care professionals to entrust them with their private information so as to receive the right, competent and safe care needed. Ultimately, patients look for safety of their care and health information. Therefore, it would be nice if the nurse make that safety net that patients need. Moreover, it is patient’s right to expect that such information will be kept confidential unless there is a peril to self or others, or if not the law requires its disclosure. In case of legal proceedings in court, the law may require revelation of patient information. Nonetheless, in this circumstance John would only be capable to reveal certain information as permitted by the Personal Health Information Protection Act of 2004. In general, John is confronted with a tricky ethical dilemma. Therefore, in the situation the reader does not make out what John lastly decides to do, considering the difficulties of the circumstance. A number of factors surfaces that may account for John’s last decision of action (e.g. His colleagues not being concerned and the fact that ARG nursing home was friendly to residents and the fact that no complains had ever emanated from the residents about this kind of circumstance previously). This is one of the sticky circumstances and John could act upon four possible alternatives. The first alternative is that he would inform the family friends, who are asking concerning the health condition of the resident, that any information relating to the resident should be kept private and confidential always. The next alternative, depending on the health condition/status of the resident, would involve John to send on the family friends to the person they are concerned about (resident) or the resident’s preferred substitute decision-maker for more answers. Therefore, if the resident having no mental issue gives consent that can be in writing or verbal, this allows the nurses to reveal personal health information to people outside the health care group (McLean, 2010). This is equally applicable to those residents having dementia. Nevertheless, the substitute decision-maker would assume the responsibility of giving consent in writing or verbally. Therefore, John’s third alternative should be to reveal the personal health information of the resident to only those indicated or specified in the verbal or written consent. Finally, the final alternative would be to reveal any information requested by the family friends of the resident, keeping in mind that releasing such personal information is regarded ‘okay’. According to the current legislation, John is under no peril, of contravening patient confidentiality or doing a professional misconduct, if he follows any of the initial three options discussed above. Nevertheless, if he decides to act upon the last alternative, he would be contravening patient privacy and confidentiality (McHale and Tingle, 2000). Thus, if not indicated via a special consent or exception the only information permissible to be disclosed includes the verification that resident is presently living in the nursing home as well as their general health standing. The current legislation relies on laws which are enforced since there is need to guarantee security, privacy and confidentiality of personal information of patients is maintained at all times. Given the four alternatives shown here, only the first three alternatives have fallen within the guiding principles which consist both of the CNO and CNA (Nursing World Organization, 1998). Nevertheless, the third alternative best demonstrates that a practice of nursing standard is being illustrated. According to CNO, the professional Standards demonstrate what professional expectations of nurses are in every field of their nursing practice (Henderson, Martin, and Charlesworth, 2012). According to the scenario in question, John brings to the fore professional values such as knowledge, accountability, and leadership. John illustrates accountability by advocating for his customers, the healthcare system and the nursing profession while guaranteeing that his practice remains right to the standards of colleges and provincial legislations (Dimond, 2005). He is knowledgeable because John illustrates awareness of the CNA and CNO nursing guidelines. Ultimately, he shows leadership by working together with his colleagues in inquiring in their thought about the circumstance. Moreover, all folks deserve treatment with compassion and respect. Moreover, in my thought, I believe John must just reveal the health information of residents to only those voiced or specified in the consent since it is safer on the resident’s behalf. Furthermore, by only revealing health information as defined through the consent of client, it is guaranteed that privacy is kept while simultaneously consoling those who are concerned. Owing to the situations, this alternative best reflects the standards and codes of nursing practice. This is due to the fact that John is only attempting to resolve the circumstance by going directly to colleagues for a working together on what to do and also again he is attempting to keep confidentiality. Nevertheless, with consent, any health information he subsequently reveals does not breach any privacy laws since it is done according to the guidelines as stipulated by the patient or substitute decision maker. This situation is very challenging because from the outset it puts someone in an uncomfortable position. John was placed in an awkward position where he had to decide amid professionalism and his social relationship he had created with the people hailing with him in the same home urban surroundings. Again, John was in a small urban centre that had a very lively social life, attending several community parties and events, he practically knew everyone. John’s urban centre was friendly and everyone maintained very close ties with another one. Nonetheless, now if John made a decision to share any information concerning another person it might make him look very arrogant and rude. In turn, it could compel him to sharing the information ultimately to feel welcomed by the people in his urban centre. Furthermore, another issue that could come up in terms of John’s circumstance is losing that relationship of patient-client because of trust issues. Setting up and maintaining trust of patients in caregivers is crucial to obtaining a full history, an appropriate health record, and conducting an effective treatment plan (Simpson, 2007). Nurses have to recall that trust of patients is sacred, and any contravention of confidentiality, no matter how minute it might look to the nurse, amounts to breach of this trust. Several ethical theories applicable to John’s situation can be used to explain it. To begin with, deontology theory states that persons should follow duties and obligations when analyzing an ethical dilemma (Rainbow, 2011). As has been mentioned above, John as a health caregiver, who follows this theory has to observe the standards of nursing practice in making the right decision. Confidentiality and privacy are fundamental rights in the today’s society. Protecting those rights alongside respecting a person’s personal health information, is care provider’s ethical and legal responsibility. Nurses are important in guaranteeing creation of an environment to protect rights of patients to confidentiality in organizations. Protecting patients’ health information permits the client or resident to have confidence in the nurse and demonstrates that the nurse respects their confidentiality and privacy. If trust lacked in the client-nurse relationship, the resident or client may withhold or give false information that may be useful for their care (Mehnke, and MSN, 2010). In the field of social and health care, there are several learning ethical theories that apply to it. Therefore, John can select appropriate ones to this situation. Deontology theory says that individuals should follow their duties and obligations when analyzing an ethical dilemma (Rainbow, 2011). As a result, a caregiver in health care that applies this theory will set a practice standard that will cause them keep the right to abide by the law. John would have to recall that he has a duty and obligation to safeguard the privacy and confidentiality of the patient or resident information. To do this John will refer both to the law as stipulated by the HIPAA which deals with the protection and confidentiality of medical records of the patient. At the outset, it is the sole responsibility of a health care worker to access personal health records of clients for the right reason. In that connection health workers are directed to the confidentiality clause. It stipulates that it is very important for the health care professional to maintain their client’s medical history safe and accessible only to those that require reviewing the records (Mehnke and MSN, 2010). As a result, all healthcare workers have to sign what is referred to as a duty of confidentiality that abides them to the privacy of specific information not just health information of clients. That being the case contravening confidentiality involves revealing medical information of clients whether it’s in writing or verbal with someone outside the health group caring for that person without client’s content. Therefore, John’s standard of practice can only match the confidentiality legal and ethical guidelines to enable him abide by the law. This means that John will strive not to break or compromise with the situation to the extent of breaking the law whatsoever. In the same context, John can apply the utilitarianism ethical theory to his situation. It refers to the ability to know what the aftermaths of one’s action can bring about (Rainbow, 2011). John can use this theory to track past identical or closely related situation and the result and learn from it. In other words, he can learn from the mistakes or successes of colleagues in past situation and come up with a better way of dealing with the current dilemma. This means, that both ethical and legal implications of the situation will have to be factored in the decision he makes. The only situation in which a practitioner in health care may breach the confidentiality principle is where there are contra public interests (Badzek, Mitchell, Marra, and Bower, 1998). Seldom, cases may emerge in which disclosure in the interest of the public may be justified. For instance, a circumstance in which non-disclosure of proper information would expose the patient/client, or someone else, to a peril of death or serious damage. However, patients in particular and public in general are entitled to expect medical records to be confidential and safe, and it is not for any person to take it upon herself or himself to contravene that confidence whether persuaded by a journalist or otherwise. John has to consider this legal implication because it is hard to justify public interest in his case. A number of the difficulties linked to the exceptions of the confidentiality duty come under the extensive public interest heading and there is petite guidance from the courts. This, thus, raises ethical dilemmas as to whom a health care worker should safe guard (Seaquist, 2012). Should the confidentiality of the patient be safe guarded or does the public interest in disclosing the information overrule the right of the patient to confidentiality? The health care practitioners associations will protect as well as defend a practitioner who contravenes the rule against revelation if the public interest permits it. It is for every particular practitioner to decide individually if the specific situations justify revelation in the public interest. Non-notification of the relevant individual(s) or body in situations that warrant revelation can sometimes amount to a contravention of duty towards that individual or body. Circumstances that warrant revelation of information raise difficult ethical, professional, and legal question. This difficulty arises mainly because of the fact that most of the law applicable to the public interest is determines via case law (Sankar, Mora, and Jones, 2003). Every practitioner still has to employ his professional judgement in deciding whether disclosure is warranted and he is professionally and personally accountable for his decision. The difficulty in this situation augments because the Data protection Act 1998 made access to and revelation of personal information tighter, exerting more pressure on the determinations of the individual practitioner. Practitioners should make sure that they employ the presence of the Caldicott Guardian documented by their organizations to advice on matters concerning confidentiality and to help in safe guarding the patient’s interest. If essential, the safe guard of the Public interest Act of 1998 could be consulted if concerns on confidentiality require to be made at a higher-ranking level within the organization. In enabling individuals to bring forth actions against public entities who have failed to uphold an individual’s right to respect family and private life, as stipulated in Article 8, The Human Rights Act of 1988, is probable to result into more litigation where patients allege that there has not been respect of confidentiality. Apart from the civil requirement to keep confidentiality a professional requirement exist for keeping the confidentiality of the patient. Failure to follow the requirement amounts to a contravention of good medical practice and would lead to sanctions. Conclusion It is important for health care worker to maintain patient confidentiality and privacy at all times. It is the patient’s right to have personal health information safeguarded and confidential always. The patient’s right extends to knowing what part of the information is private and safeguarded. Through this the patient gets to feel safe and honestly given better care by the practitioners, and this enhances the reputation of the medical facility. Therefore, health care workers should build this trust by maintaining patient confidentiality because ethical, professional, and legal issues are on the rise, resulting from contravention of confidentiality. The only way to avoid legalities on patient confidentiality is to follow related company policy and procedure. Confidentiality issues are captured under a standard of practice concerning professional and ethical health care (The College of Physicians and Surgeons of Ontario, 2010). Patient privacy is safeguarding medical information of a patient and the patient possesses the right to maintain information from being disclosed. Moreover, patients have the right to be familiar with who can review their information and just for insurance and require knowing the bases. Therefore, caution should be taken because patient privacy affects the entire patient body and can result into profit or loss to an organization, if a contravention happens. References Badzek, L., Mitchell, K., Marra, S., & Bower, M. (1998). Administrative Ethics and Confidentiality/Privacy Issues. Online Journal of Issues in Nursing ,3(3) 2-10. Data Protection Act 1998 Dimond, B. (2005). Legal Aspects of Nursing. London: Longman Press. Finkelstein, P. (2007). Confidentiality, friends, family members and nurses. Minn Nurs Accent , 3. Henderson, E. S., Martin, V., & Charlesworth, J. (2012). Managing in health and social care. New York: Routledge. McHale, J., & Tingle, J. (2000). Law and Nursing . London: Butterworth-Heinman. Mclean, S. (2010). Autonomy, Consent and the Law. London: Routledge-Cavendish. Mehnke, A., & MSN, R. N. (2010). Managing a breach in patient confidentiality. New York: Routledge. Nursing World Organization. (1998, December 13). The Health Insurance Portability and Accountability Act. Retrieved March 21, 2014, from Nursing World Organization: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJI N/TableofContents/Vol31998/No3Dec1998/PrivacyIssues.aspx Public Interest Disclosure Act 1998 Rainbow, C. (2011). Description of Ethical Theories and Principles. New York: Routledge. Sankar, P., Mora, S., & Jones, N. (2003). Patient Perspectives of Medical Confidentiality. New York: John Wiley & Sons. Seaquist, G. (2012). Business law for managers. San Diego, CA: Bridge Point Education, Inc. Simpson, P. B. (2007). Legal questions: patient confidentiality. Nursing ,33(8) 77-79. The College of Physicians and Surgeons of Ontario. (2010). Confidentiality of Personal Health Information. New York: John Wiley & Sons. The Human Rights Act 1988 Tingle, J., & Bark, P. (2011). Patient Safety, Law Policy & Practice. Abingdon: Tayler & Francis. U.S. Department of Health and Human Services. (2012). Patient Confidentiality. Washington, DC: U.S. Department of Health and Human Services. Read More