Patient Confidentiality and the Nurse Term Paper

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Professional Nursing

THE RIGHT THING TO DO

Two nurses are good friends to an in-patient. One of the nurses got so concerned with this patient that she accessed the patient's medical records and confided her findings to the other friend. Neither of them was assigned to the patient-friend and, thus, had no authority to access her chart. Nor are they blood-related to the patient. The first nurse faces the dilemma of reporting the violation of patient confidentiality or keeping quiet about it but sharing the violation with her. The guilty nurse promised never to repeat the act. The first nurse feels concerned with her as this is her sole source of living in support of herself and her two children. She is a single mother. The first nurse must decide correctly and fairly.

Three provisions of the American Nurses Association Code of Ethics apply to this case (ANA, 2001). Provision 3.2 on confidentiality is bound up with the patient's fundamental right to privacy. It is a nurse's duty to keep all patient information confidential. The patient's well-being and trust will be compromised when this rule if violated. It explicitly prohibits access to patient data or its inappropriate or un-authorized revelation to another person who has no right to the information (ANA).

Provision 3.5 of the Code on Acting on Questionable Practice mandates the nurse to be alert and take appropriate action on actions or practices by a healthcare team member, which compromises the rights or best interests of the patient (ANA, 2001). Her action should be based on this Code, professional standards, pertinent laws of the land, and the hospital or facility's policies and procedures. Her attention should be called about the violation and its potential detrimental effect on the welfare of the patient and the integrity of the profession. When such a threat exists, the appropriate next-higher authority should be informed. Appropriate procedures should then be implemented in dealing with the violation (ANA).

And Provision 3.6 of the Code on Addressing Impaired Practice (ANA, 2001) underscores the nurse's duty to protect the patient and extend assistance or support to a colleague whose practice may be impaired in some way. The troubled colleague may consult the appropriate supervisor or the nurse may help her to resources she needs in order to restore her to optimal functioning level (ANA).

The Principles and Legal Implications

Nursing Ethical Practices

One of these is confidentiality, which states that patient information entrusted to a health professional on-duty should not be revealed to, or accessed by, others who are not authorized or entitled to the information (Nursing Help, 2011). At the outset, this specific principle seems to apply to the case. The other nursing ethical practices are autonomy, informed consent, veracity, beneficence and non-maleficence, justice, paternalism, fidelity, respect for others and utility (Nursing Help).

Legal Principles

Nurses and other health professionals should show utmost importance to the principles of confidentiality and other public interests (Fullbrook, 2007). Common law embodies and mandates them. But in this digital age, confidentiality of patient information is difficult to keep and assure. Regulatory groups, like the Nursing and Midwifery Council, have devised new rules and guidelines to adjust to new trends in communication. These have been embedded in their respective codes of professional conduct. Some sectors have, however, suggested that rules and regulations on confidentiality may need to either expand or made more lenient as to securing, keeping, using and transmitting information (British Medical Association, 2005 as qtd in Fullbrook).

Interstate Practices and Regulations

Nurses are licensed in the state where they practice (Silva & Ludwick, 2014). Some of them have two or more licenses and apply for reciprocity in another state. States are changing their laws to adapt to trends. Countries, such as the United Kingdom and Australia, have regulatory licensing bodies for practitioners from other countries. Ethical issues have come up in the course of interstate practice. One of these is privacy or confidentiality. The others are non-maleficence, beneficence, autonomy, and justice (Silva & Ludwick).

The ethical principle on confidentiality prohibits the sharing of patient information with anyone without the authority or for un-intended purposes (Silva & Ludwick, 2014). A patient's confiding personal information with a nurse or another health professional equates to a duty on the professional's part to keep it and protect it from spreading. Interstate practice makes the observance of this principle difficult for both the patient and the nurse. More and more individuals have the need and right to patient information.

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Telenursing brings and receives such information with much ease and thus poses as an ethical problem (Silva & Ludwick).

Some patients, especially high-risk ones, are reluctant to share information with healthcare providers (Silva & Ludwick, 2014). These high-risk patients are those stricken with HIV or AIDS, genetic or mental disorders. They thus limit the information they share and this compromises their recovery and health. They are compelled to take recourse to the "don't ask, don't tell" mechanism. Certain agencies have taken steps in addressing breaches to this ethical principle by devising strategies and clear policies and procedures. Periodic audits are in place to insure strict observance of these policies and procedures (Silva & Ludwick).

Resolution

This can be in three steps. In Step 1, the nurse speaks in confidence with the erring nurse-friend again to remind her that she violated this ethical principle of confidentiality. The offending nurse certainly knows it and the first nurse very likely also reminded her about the violation, which led the offending nurse to promise that she would not repeat the act. The nurse emphasizes that she too will be involved if the situation progresses and neither of them wants to lose their job.

In Step 2, the nurse need not report the offending nurse for what she did. Technically, there was no offense. Provision 3.5 clearly states that accessing patient information without authority or entitlement must put the patient's health and well-being in jeopardy in order to constitute a breach. On the contrary, she accessed the information out of compassion and concern, not out of mere curiosity or any malicious intent. After all, she is a friend of the patient too and both of them would want their friend to get better.

In Step 3, the nurse should help the second nurse deal with her compassion in the right way. Both of them can visit their patient-friend. Either of them can also work out to be officially assigned to this friend so that the access to her information will be official and authorized.

The very act of accessing confidential patient information by a nurse who has no authority to do so may have some impact on their professionalism and personal conscience. But both of them can look at the act in another way. The second nurse accessed the chart not as a nurse but as a friend, although that access was possible only because she is a nurse. Nonetheless, Provision 3.5 clearly states that the access must be a threat to the well-being of the patient in order to be considered a violation. Both nurses can invoke this provision in their defense in case someone else gets to know about it. And very likely, this will remain a secret between them. But they should learn from this experience and make sure it is never repeated. When the patient-friend recovers, that secret will remain a secret forever.

Evaluation and Impact

Nurses and other members of the health team should always remember that they have the privilege of access to confidential information on patients only because of their profession. They should be more conscious of their personal feelings and motivations, such as compassion or retaliation towards any person in the healthcare setting. While these professionals are one another's watchdog, they are also mandated by the Code of Ethics to be one another's supporters and sources of morale and inspiration.

The only drawback the two nurses may have is the feeling of conspiracy for the access. This was the basis for the apprehension of the first nurse over the act of the second nurse. The first nurse thought of reporting the second nurse for it because she, thought that mere access constitute a breach. By thoroughly reading Provision 3.5, she will be better informed.

Friends will be friends. The two nurses who naturally want the pstient to get better can inquire about her condition when they visit her as a friend. They need not satisfy their desire for information from official documents.

BIBLIOGRAPHY

ANA (2014) Privacy and confidentiality. Nursing World: American Nurses Association.

Retrieved on December 7, 2014 from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/PrivacyandConfidentiality.html

- Code of ethics for nurses. Retrieved on December 7, 2014 from http://www.nursingworld.org/codeofethics

Fullbrook, S. (2007). Legal principles of confidentiality and other public interests: Part

1. Vol. 16 # 14, British Journal of Nursing. Retrieved on December 7, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/17851349

Nursing Help (2011). Nursing ethical principles. Retrieved on December 7, 2014 from http://www.nursing-help.com/2011/07/nursing-ethical-principles.html

Silva, M.C. And Ludwick, R. (2014). Ethics:.....

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