Confidentiality can be defined quite simply as a set of rules or a promise that limits access or places restrictions on certain types of information, but in this assessment, we are trying to draw the connection between confidentiality and the links it as to my specific field of nursing as also the substantial impact it as on my role.
Being more precise than broaden in defining what confidentiality means in my field of work, patient confidentiality is when the right of an individual patient to have personal, identifiable medical information kept private; such information should be available only to the physician of record and other health care and insurance personnel as necessary.
It safeguards personal and/or medical information given to a health care provider making sure that it will not be disclosed to others unless the patient has given informed consent. This is becoming extremely difficult to ensure in an age of electronic medical records and third-party insurance payers, which is why I have chosen to choses to theme especially, to express my own concerns.
The main focus of this assignment is to amplify our knowledge and understanding of the profession, ethical and legal issues that are associated with providing good care to patients in a health and care setting. This assignment is aimed to look at the issue of confidentiality, which is a highly imperative topic to use when I practice. I thought it was essential to write about confidentiality as it is something that everyone is entitled to, but don’t necessarily get which goes against some of the acts and legislations that will later be talked about further into the assignment.
I defiantly want to single out this topic in relation to older adults.
Through my training, which I admit I have done a few times myself; we forget that some adults do not have the ability to apply confidentiality to themselves. For example, a patient has asked for their moist bed sheets to be changed due to an accident that they had and repeating that information to others without taking the patients thoughts or feelings into consideration may have an substantial effect. Easy mistake, however confidentiality needs to be upheld to the highest and applied at all times. The Nursing and Midwifery Council (NMC, 2009), The Code: Standards of conduct (2008) enthuses, guides nurses, and midwifes to allow people to have the right knowledge about who they share information with and how we would go about it to provide the right care. It also enforces that we must disclose information if necessary, if we are to think the patient might be at risk or a risk to someone else, which entwines with the Data protection Act (1998) which will later be discussed. Guides such as these can defiantly influence the level of care in a positive way and the way we work with confidentiality.
According to the NMC, The Code its states that as professionals/ student nurses we are liable for our own actions and omissions in our health and care setting, alongside being able to justify the reasons for making these decisions. This is also supported by Griffith and Tengnah (2010) which acknowledges the same grounds. In terms of confidentiality and accountability, I will be using the defined subject of record keeping as I think it is a key factor towards good practice.“ Accountability is integral to professional practice. As nurses, we do make many decisions and it is important that we take responsibility to maintain that care. We are duty bound by the policies and procedures that administrate our health and care profession. It is important that I know my limitations and know that once this relationship is established we have a duty of care to ensure that we provide what is expected.
If this is breached, we can cause injury to our patients and as a student nurse my mentor and myself are accountable for my actions as they oversee the care that I give towards the patient at hand. “The law imposes a duty of care on practitioners, whether they are HCAs, APs, students, registered nurses, doctors or others, when it is ‘reasonably foreseeable’ that they might cause harm to patients through their actions or their failure to act (Cox, 2010).” The patients look up to us and are dependent on our expertise and knowledge by placing their health and wellbeing in our hands (Department of Health 2003). It is essential that we don’t abuse and neglect this trust as it will can cause additional problems to both the nurse and the patients. For example, the patients may avoid getting further treatments or being seen by a health service because of the negative experience that they have had previously before.
Ethics is a philosophy that identifies between right and the wrong acts or decision that is in relation to an individual. How we all interpret, ethics will be different to the next as it is rather an individual principal he/she may lives by. Ethics is universal and is used in every profession; however it is built on our own morals and values. The NMC does not state specifically about ethics, however through the acts, our governing body has provided laws and legislations, implying that ethics should be included throughout nursing. It’s a certain code that should be followed but due to people’s morals and values it’s sometimes dismissed and not up taken to its highest importance.
There are certain elements of confidentiality that are not fully covered by the law are things such as gossiping about what a friend had discussed with you. Ethically it’s argued that what that individual done was wrong but because the law does not cover it, it may not be seen as something serious. However discussing professional issues, information that has been discussed with you by a patient in your professional role is against the code of conduct which is covered by the NMC. We have to safeguard our patients. Disclosing patients information is also against the law, and if found guilty the nurse is most likely to be suspended following investigation and if the severity of the claim is over-whelming then he/she will be fired.
Law’s such as HIPAA (1996) guidelines (Health Insurance Portability and Accountability Act) protects the privacy of the patient’s personal information allowing identifiable information private. The guideline like the one all the other laws regulate that states that those who do not comply can either be suspended whilst investigations are carried out or be relieved of their duty completely. In twining both law and ethics, we have a duty to disclose any information that we might have about their health, progress or risks etc. They have the right to know and we cannot take that right away from them because we think different, by discussing these disclosures the ethical principle or B Beneficence found by Beauchamp and Childress (2008) suggests that we should allow them to access this information to benefit them and empower our patients.
Beauchamp and Childress (2008) suggests’ that there are four principles that can possibly structure a guide when looking at ethical decision making. These four consists of Autonomy, Non-maleficence, Beneficence and also Justice which they consider to be at the centre of the health and social profession.
It proposes that there are three types of rules for guiding actions when using it. Some of the imperative and substantive rules consist of truth telling, confidentiality which is our main focus in this assignment, privacy and fidelity. Authority rules are the ones that favour who are capable and ought to perform those actions. Finally, it states that Procedural rules establish procedures to be followed.
Non-maleficence obliges that no harm should be caused and forced onto patients whether it was intentionally inflicted or by accident. Non-maleficence can easily be linked with confidentiality as having poor confidentiality can be regarded as clinical carelessness and negligence which can cause harm to the patients. Having inappropriate undisclosed information breaches the duty of care. The NMC (2010) states that safeguarding is a part of our daily nursing practices in whatever setting we happened to be in. In addition to that, as a nurse whether we are qualified or not it’s part of our role to be too able to identify when something is unsuitable and manage situations effectively. This can be because a person that is in my care is at risk, whether they have been mistreated or neglect and also if there has been poor practice. This can link closely with The Mental Capacity Act (2005), making sure that we are taking note of autonomy if they not able to have the right mental capacity.
However, through my training I have come across myself breaching confidentially. This was not an intentional act but after the shift, I still managed to have the handover sheet for that day still slipped into my side pocket without realising when I got home. This breaches confidentiality as that information should not have been taken outside the ward, and if someone else found it, it could put that patient at risk. In addition to that I am encouraging patients information to be disclosed to people they font know. Upon noticing this, I realised straight away of the consequences and made sure that I disclosed of the information properly.
On the other hand, Beneficence refers to actions that are implemented that can possibly contribute and help the well-being of others. It holds two principles which is that positive beneficence necessitates the provision of benefits and also utility requires that the benefits and drawbacks are balanced. The main thing that we should give to every patient is respect and autonomy which allows them to have a freedom of choice. We, as professionals should not discharge that even if it came to a situation where we disagreed. A good example of this is during my practice I’ve seen that to some abortion might be seen as wrong ethically, however, the law accepts it making it legal to do. We cannot tamper with that, and if a riot was formed against it, it would be seen as an act against the law and would be taken seriously as they are disturbing the peace. It’s hard to judge sometimes what is wrong from right but we have to stick to the rules that are placed before us.
Patients have a right to expect that information about them will be held in confidence by their doctors/nurses. You must treat information about patients as confidential, including after a patient has died. This duty of confidence is derived from common law the decisions of the Courts and statues which are passed in parliament. The common law of confidentiality applies to anyone who discloses information in a way that constitutes a breach of confidence. Common law are hardly written in statutes but as been established by court decisions over time which to me indicate that a breach of confidence will be unlawful if the data is not in the public domain. It is in some way sensitive or significant the data was obtained in circumstances when an obligation to keep it in confidence might be expected (a good example is nurse -patient relationship).
Use of the data is unauthorised but that a breach may be lawful if justified by being in the public interest, if a data use is not a breach of confidence then it will normally also not constitute and infringement of the right to respect for private life under the Human Rights Act 1998. Even if a data use is not a breach of confidence, you will still need to be sure you comply with the conditions of the Data Protection Act 1998 (DPA). Similarly, compliance with the DPA does not necessarily guarantee that there can be no breach of confidence. Now in relation to statues on confidentiality you must disclose information to satisfy a specific statutory requirement, such as notification of a known or suspected case of certain infectious diseases. Various regulatory bodies have statutory powers to access patients’ records as part of their duties to investigate complaints, accidents or health professionals’ fitness to practise. You should satisfy yourself that any disclosure sought is required by law or can be justified in the public interest. Many regulatory bodies have codes of practice governing how they will access and use personal information.
Most if profession if not all abide by the data protection act (1998) it governs the processing of information that identifies living individuals. Processing includes holding, obtaining, recording, using and disclosing of information and the Act applies to all forms of media, including paper and electronic. Poor record keeping is inexcusable and unprofessional by any reasonable and sensible person. A health professional record is the only this that is a legal nonverbal form of communication which is conformation of the care that has been given to that patient. Which links back to accountability, by using record keeping effectively their professional accountability won’t be judged and questioned. The courts embrace that if there is no identification or it has been recorded, it simply has not been taken place (Owen, 2005)
Other legislations for example The Human Fertilisation and Embryology Act (1990), The Mental Capacity Act (2005) and The Computer Misuse Act (1990), all have their individual importance but the one that relates more to my field in nursing is disclosure. Relating back to my time in practice I myself have seen the data protection act broken several times. I came across a nurse who was giving out unwanted information to a member of public, even though it was a family member of the gentleman it was not accepted as he did not agreed to this. The Nursing Midwifery Council defined disclosure as the giving of information. One aspect of privacy is supposed to be that individuals have the right to control access to their own personal health information. Disclosure is only lawful and ethical if the individual has given consent to the information being passed on such consent must be freely and fully given. Consent to disclosure of confidential information maybe explicitly implied required by law or capable of justification due to the public interest.
The NMC states, ‘The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it was given and will not be disclosed without permission’. According to the NMC it identifies that confidentiality is a fundamental part of professional practice that protects human rights which is identified in article 8 (right to respect for private and family life). Therefore, it meant not respecting the clients wishes and also defeating the act. I have also seen on a few occasions members of staff not logging out of the system, with patients information there on the screen for anyone to look at. This information is secure for a reasons and not logging out can be an easy mistake on a busy ward. Nevertheless, it is essential to keep that information to those who are permitted to see it. However, there are times where information can be disclosed under the law. Such as the Police and Criminal Evidence Act (1984) which permits healthcare professionals to pass on data and information to the police if they believe that someone may be of been harmed or more fatal, death, may occur if the police are not informed.
This links closely with safeguarding and also accountability. Due to the professional duty we have we have to report these kinds of things if observed. Disclosure to third parties is when information is shared with other people that are not directly linked with the individuals care. Nurses have to ensure that those of the third party are informed properly. . People in the care of a nurse or midwife have a right to object to the use and disclosure of confidential information in this case. However, it’s essential that they need to be made aware of this and completely understand its implications and backfires. Information that can possibly identify individual’s information that is in the care of a nurse must not be used or disclosed. Conclusion
In conclusion, from undertaking this assignment I am now able to apply the knowledge that I have gained from this important topic into practice. It has allowed me to see how simple and easily confidentiality can be broken when not focussing on what’s important which is the patient. Their needs need to go first whether it’s their health, their safety or their care. I am in a privileged position where I am respected and trusted by others it’s imperative that it is not abused under any circumstance. It’s essential that I implement these acts and legislations when caring for my clients so I can give them the best quality of care possible.
I was able to develop an awareness of my own and others professionals role and boundaries in safeguarding individuals that may be vulnerable. The three elements that were discussed, accountability, law and ethics are the heart of nursing. Directing our attention on these elements can help to support to create boundaries and moralities in the health and care setting, making it a more safer and reliable with accountable staff. As a nurse I would need to be competent to deal with professional issues, ethical and legal issues that I may come across during my training.
I have produced a SWOT analysis table to devise my learning from this assignment.
Able to use information to the best of its ability and apply it to certain situations such as when to know how to safeguard a patient, disclose information etc.
Trying to uncover problems and knowing how to report it as its part of my duty of care.
Be able to demonstrate that I am making sure that the patients that I am caring for are my first concern and priority.
Being able to be focussed at all times to notice when I might break confidentiality, for example taking a handover sheet home by accident and not disposing of it properly.
Not be able to be confident at periods to engage with other members to tell them if I have seen confidentiality being broken as I might think it might lead myself to be in trouble
Having the confidence to tell someone that is senior that what they are doing is wrong (such as a mentor or colleague), it might shape my learning in practice differently
It allows me to strengthen my knowledge about the Acts, Laws and Legislations and apply them.
Allows me to research and read about other laws, acts and legalisations that I can implement into my practice
Able me to witness different types of situations through the experiences where confidentiality might have been broken
Working in a team will allow me to take on and digest different peoples personality and behaviours, which I can apply to my everyday life and also most importantly my work in how they keep confidentiality
In me being able to analysis certain situation and give my best evaluation on certain problems I think it will help me judge on good and bad situations and how to deal with them
To understand that people around me can lead me to break confidentiality, so making sure that I notice these things because I can be involved without knowing
Adrian O’Dowd. (2013). HCAs and patient confidentiality. Available: http://www.nursingtimes.net/whats-new-in-nursing/unison/hcas-and-patient-confidentiality/5000408.article. Last accessed 24th May 2013. Anne Mehnke. (2010). Managing a breach in patient confidentiality. Available: http://journals.lww.com/nursingcriticalcare/Fulltext/2010/07000/Managing_a_breach_in_patient_confidentiality.12.aspx. Last accessed 22rd May 20013. British Association for Counselling & Psychotherapy. (2013). Respecting privacy and confidentiality. Available: http://www.bacp.co.uk/ethical_framework/ETHICAL%20FRAMEWORK%20(BSL%20VERSION)/Respectingprivacyandconfidentiality%20.php. Last accessed 24th May 2013. College of Registered Nurses of British Columbia. (2010). Privacy and Confidentiality.Available: https://www.crnbc.ca/Standards/Lists/StandardResources/400ConfidentialityPracStd.pdf. Last accessed 22rd May 20013. D, Marijke . (2013). HIPAA Privacy Rule & Patient Confidentiality.Available: http://nursinglink.monster.com/education/articles/2370-hipaa-privacy-rule-patient-confidentiality. Last accessed 24th May 2013. E Notes. (2013). Patient Confidentiality. Available: http://www.enotes.com/patient-confidentiality-reference/patient-confidentiality-172269. Last accessed 24th May 2013. General Medical Counsil. (2009). Confidentiality. Available: http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp. Last accessed 22rd May 20013. Health and human development. (2013). Theoretical Approaches To Health Care Ethics. Available: http://www.personal.psu.edu/dxm12/n458/index.htm. Last accessed 22rd May 20013. Legislation.gov. (2013). Computer Misuse Act 1990. Available: http://www.legislation.gov.uk/ukpga/1990/18/contents. Last accessed 20th May