In the nursing profession, keeping patient confidentiality is of the upmost concern. It is an important feature of the nurse -patient relationship and must be maintain as basis of providing care. Confidentiality is described as respecting other people’s secret and keeping security information gathered from individuals in the privileged circumstances of a professional relationship. (Lee and Godbold , 2012). The privacy act offer nurses some flexibility in using professional opinion regarding disclosure of information; however safe guards must be utilized (McGowan 2012). In the following paragraph, implications of breach of confidentiality and application of ethical principles and theories in decision-making in an ethical dilemma with reference to article by Nathanson , (2000)entitled “ Betraying Trust or Providing Good Care? When is it Okay to Break Confidentiality?” will be addressed.
Confidentiality is fundamental in the healthcare system. When Confidentiality is breeched, it may deter patients from seeking treatment for fear of disclosure of one’s personal information (Beech 2007). Confidentiality can result in legal and professional problems, distrust, disrespect, and feelings of betrayal and or poor compliance with treatment. The question then arises, when is it okay to breech confidentiality between a patient and the healthcare provider? Confidentiality may be breeched when harm is foreseen for the patient and the society at large. Mark Gowan (2012) suggests that “Nurses should be aware of some regulations regarding confidentiality as well as situations and when to use; and disclosure of Protected Health Information are permitted. (****). When faced with an ethical dilemma, all possible options should be explored in order to protect the patient’s right of confidentiality and autonomy.
While maintaining confidentiality of patient, it is imperative to note that issues might arise that will necessitate the breach of confidentiality as seen in the case of Nurse Hathaway and the teenagers. Nurse Hardaway was involved in an ethical dilemma when two teenagers with serious diagnosis and demanding confidentiality approach her for care. The nurse was confronted with breaking or maintaining confidentiality and let harm come to the patient (Nathanson , 2000). Of either choices, the nurse may be liable for breach of patient confidentiality or neglect when poor decision is made, because the nurse is professionally and personally responsible for their actions. When faced with ethical dilemmas, applications of ethical principles and theories become necessary in making good decisions. It is vital that nurses are familiar with the principles, theories, standard of practice and code of professional ethics.
The decision made by Nurse Hathaway to disclose the diagnosis to the teenager’s parents was viewed as the right decision given the circumstances. Failure of the nurse to disclose the diagnosis to the teenager’s parent would consequently jeopardize the health of the teenager. The ethical theory utilized in the scenario reflects Utilitarian and Deontology approach. A utilitarian approach requires identifying and choosing an alternative that would likely produce the most good for all involved (least harm).
The positive outcome of breaching confidentiality outweighs the suffering and poor health status foreseen for the teenager. Nurse Hathaway also utilized the theory of Deontology, which focuses on doing ones duty as long as it is universally applied irrespective of the circumstances. Critical thinking and good decision making skill is vital In advocating for the patient; as it is the duty of the nurse to protect, promote, restore, and maintain the health of the individual and the community.
The decision to disclose the teenager’s health information to the school authority was considered unethical. The poor judgment and action by the nurse resulted in humiliation and possible suicidal attempt by the teenager (Nathanson 2000). Ethically, this decision proved not to be in the best interest of the patient and defies the principles of nonmaleficence and beneficence. Both principles entail the duty to do good l and cause no harm. Confidentiality was breached because the situation did not require reporting to the school authorities.
An alternative way of dealing with such ethical dilemmas would be for the school nurse to conduct health fairs on safe sex education and health practices among teenagers in the school and community. School nurses and authorities should also be notified of the prevalence of sexually transmitted diseases without identifying any particular student. In worst case scenario, the nurse should also consult with the facility or institutional ethical committee for directive.
The ethics committee plays several key roles when it comes to making ethical decision because they are able to identifying whether or not an action is justifiable. One of the roles is to assist in revising and developing policies pertaining to clinical ethics ( DCD ETHICS committee). Collaboratively, the ethics committee together with their diverse experiences, educational back grounds, perspective and unique values would produce a well balanced discussion of alternatives (GCU). The ethics committee might also utilize a combination of the ethical principles and theories in making decision.
Uustal’s model also assist in identify the following steps to be taken: identifying the problem, stating your values and ethical position related to the problem, considering factors related to the situation, generating alternatives related to the dilemma, categorizing the alternative, developing a plan of action, implementing the plan and evaluating the plan of action taken. The sole aim of the ethics committee is to advocate, protect and promote the right of the patient while making decisions that will benefit all. As in the previous scenario, the ethical committee if consulted would provide necessary guidance in the dissemination of the patient’s information, thereby eliminating the implication of breach of confidentiality.
Confidentiality helps to foster a good nurse-patient relationship. However there are times when confidentiality conflicts with ones duty and values. The law of confidentiality is complex, and demands a balance between patient’s right and the nurse’s duties. When faced with an ethical dilemma there’s a need for proper integration of the ethical principles and theories in order to arrive at a descion that promotes and respects the patients autonomy. Nurses should be acquainted with their code of professional conduct and responsibilities frequently. Nurses should employ the use of the ethics committee found in most facilities as needed.
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