The Nursing Standards - Essay Example

Confidentiality Breaches Contents Contents 2 Confidentiality Breaches 3 Introduction 3 Discussion 3 Conclusion 7 References 8 Confidentiality Breaches Introduction The nursing standards apply to all nurses regardless of their roles, area of practice, job description, in private or public hospitals. The standards inform them of their accountabilities and what the public expects of them. Among the major standards of nursing are the ethical and legal responsibilities to maintain the privacy and confidentiality of clients’ health information obtained while providing care. The clients have a right to confidentiality and privacy and the nurse-client relationship should not deny them that right (American Nurses Association, 2010). There is a general principle to all health professionals, including nurses. They are under a duty to maintain confidentiality of all information that comes to their knowledge in the course of their relationship with the patients. The principle prevents the disclosure of any information to any organisation or individual who are not involved in the provision of health care to a patient. This duty of confidence does not end even when the patient leaves the care of the professional or when he maybe dies, but the professional should never breach the confidentiality. Exceptions to the confidentiality duty include when the public interest justifies disclosure, where disclosure of the information is permitted or required by operation of certain laws or where the patient consents the disclosure. If a patient is a minor or a mentally incompetent person, the parent or legal guardian’s consent is the deciding factor. The duty of confidence always arises by statute, in equity or under the common law (Buppert, 2008). Discussion Confidentiality is both a legal and an ethical issue. An ethical rule is the identification of values and actually doing what ought to be done. A legal issue is expression of values in social rules and following them to perform an activity. Confidentiality always seems like a straight forward principle, but translating it into practice could be problematic. Many professionals suffer the consequences of breaching it (Munson, 2003). A good example of this is the case of a private hospital’s employee who was having coffee with friends in the hospital’s café and boasted of knowing a well-known celebrity under the hospital’s care. The celebrity was an inpatient following the birth of her baby. Unknown to her that the friends and family of the celebrity were in the same cafe, she went ahead and claimed that she had the power to easily obtain more information about the celebrity’s situation. The friends and family members reported this ordeal to the hospital’s executive staff as a complaint expecting harsh punishment to the nurse. The nurse was, however, not dismissed but was provided with a warning letter. The nurse in the case scenario has first of all broken all the four requirements of a good confidential service. These include protection, which requires a nurse or a health professional to look after patients’ information and ensure that it does not get to third parties. There is also informing, which requires that a patient be aware of how information obtained from him is used, and providing choice which requires him or her to be allowed to decide whether the information should be disclosed or not. The last requirement is improving, which necessitates a nurse to look for better ways of protecting, informing or providing better choices on a patient’s information. The nurse should not disclose facts about any patient’s admission details or any information that might lead to the identification of a patient. The fact that she claims she could get more details shows clearly that she could disclose particulars of the celebrity’s treatment or information in her medical records. This is a great breach of privacy by both the nurse and the hospital (Dennis, 2000). Under the Personal Health Information Protection Act, a personal nurse should be a custodian of the patient and is responsible for maintaining confidentiality of the personal health details of the patient. Providing her friends with the patient’s details, whether they are doctors, nurses or civilians, without the client’s expressed consent is a breach of the Act. Under the same Act, a nurse is only allowed to pass certain information based on a client’s consent, who should clarify exactly what information he or she is willing to disclose. In case it is an official request may be from the client’s boss, there should also be a written expressed consent, including the client’s specific request. The fact that the nurse was heard by the relatives and friends of the celebrity, who most probably had the information, does not make it right since she was telling it to her friends. There are several case scenarios in which relatives are given information about a patient. When it comes to disclosing information about a patient to relatives and friends, a patient should get the information and then pass it to the family as he/she sees fit. When the patient is conscious and has an ability to make decisions, it would be ideal for a health professional to ask permission from him/her to communicate with the relatives. If unconscious, then the health care giver has the power to decide what information to give and get from close relatives, without this constituting a breach (Guido, 2010). Among the ethical issues involved in an inpatient, is the right to accurate information, right to make decisions, the right to confidentiality and to continued care. There are also rights to courtesy, dignity, respect, timely attention to her needs and responsiveness. The nurse has breached most of these ethics in that by disclosing the patient’s details, she has denied the celebrity her dignity, respect and confidentiality. Punitive actions should, therefore, be taken. The above outlined rights, which are in both the Australian and American Medical Associations, act as guidelines for the medical professionals as well as for nurse-patient realtionships (Dennis, 2000). If no legislation requires the medical professional to disclose the information, then there is a breach of confidence. The patient under law may be able to sue for a breach of confidence if the information has the necessary quality of confidence about it. Moreover, the information must have been given to the doctor by the patient in circumstances indicating that it should be treated in confidence. According to the Australian law, the person claiming has to show that the unauthorised information will or did cause economic detriment. It is, however, unclear whether this economic or any other detriment is required under medical cases (Buppert, 2008). There is always a notion, however, that depicts that on consulting or entering any hospital, public or private, the duty of confidence is a part of the contract. If a patient believes that the rights of his or her services have been breached, he or she can request internal reviews in accordance to with the Health Records and Information Privacy Act 2002 and the NSW Privacy and personal Information Protection Act 1998. If not satisfied with the internal review outcome, the patient has the right to lodge an application with the Administrative Decisions Tribunal for the health centre to be reviewed further. The investigations are taken by the Privacy Commissioner (Buppert, 2008). The management risk strategies that could be employed in a hospital to avoid breaches of confidentiality include setting and communicating professional boundaries and limits in the hospital. There should also be an emphasis on the importance of confidentiality to both colleagues and patients. The system should also develop skills of analysing boundary crossing. Nurses should also understand that they need to balance patients’ safety and treatment with respect to privacy. Safety should always be chosen above all. They should also know that they have no right to access any information about a client, unless it is useful in the treatment. Colleagues should also hold each other accountable when it comes to respecting patients’ privacy. In addition to being mentors to other professionals in privacy issues, one should also learn to stand up to pressure from friends and neighbours asking about patients’ information (Guido, 2010). Communication strategies should also be included in the avoidance of confidentiality breaching. Apart from having rules in the individual communications around the facility, the administration should also utilize encryption systems in its computers to secure patient privacy. They should also place controls on data storage and access to the information systems. Portable devices and storage media devices use should be regulated while old storage equipment and out-dated records should be well and carefully disposed (Guido, 2010). Conclusion Though patient confidentiality is kind of tacit, it is essential that nurses and healthcare givers enhance it both legally and ethically. Patients have a right to have their details kept private and safe from third parties, and any breach of this right warrants them to take legal action against the healthcare provider responsible (Munson, 2003). In the case scenario, which the principle of justice seems to have been abandoned by giving the nurse only a warning letter, the internal review seems to have seen nothing wrong with the information shared. They should have, however, punished the nurse more sternly for crossing the confidentiality boundaries and for claiming the possibility of getting more information. The hospital’s management should ensure that all records and documents containing patients’ information are safely stored away from unauthorized personnel. References American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring, MD: American Nurses Association. Buppert, C. (2008). Nurse practitioners business practice and legal guide. Sudbury, Mass: Jones and Bartlett. Dennis, J. C. (2000). Privacy and confidentiality of health information. San Francisco, Calif: Jossey-Bass. Guido, G. W. (2010). Legal & ethical issues in nursing. Boston: Pearson. Munson, R. (2003). Intervention and reflection: Basic issues in medical ethics. Australia: Thomson/Wadsworth. Read More