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Nursing Ethics: What is Confidentiality?

Career News July 29, 2013

Students learn that nurses must follow strict guidelines for moral and ethical treatment of patients. There is a great deal of concern about confidentiality today as well. Understanding what is confidentiality and what is not will help students comply with ethical and legal standards once they are on the job.

Confidentiality Defined

The simplest definition of confidentiality is maintaining privacy. Nurses are bound by their professional code of ethics and federal regulation to refrain from discussing or sharing personal information related to their patients without permission.

According to Nursing World, “Confidentiality applies to protected patient information, including basic identifiers of the patient’s past, present, or future physical or mental health conditions, including the provision of health services and payment for those services.”

Maintaining Quality Continuity of Care

Some information sharing is necessary for patients to receive treatment. In order to make this allowed sharing more efficient and protect both patients and medical providers, patients must sign a copy of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) before they receive treatment.

The HIPPA explains which information will be shared regarding patient records and with whom. The list below shows examples of entities and individuals that routinely share information to provide treatment, testing and financial services.

•Physicians
•Nurses
•Laboratories
•Administrators
•Insurance Companies
•Occupational and Vocational Therapists

What is Confidentiality Breaching?

Breaching confidentiality occurs when nurses share information about patients with people that do not have a “need to know” status covered under the patient’s written authorization. Unless otherwise instructed to do so, nurses cannot discuss patient care or diagnosis with family, friends, co-workers, other nurses, insurance providers or financial aid organizations. Even casual conversation that might reveal private information is precluded.

In addition, sharing is not just talking to unauthorized people, but includes every form of media and conversation.

This includes paper, vocal and digital channels:

•Verbal conversation
•Written conversation
•Fax
•Email
•Text
•Voice mail messages
•ASL

Confidentiality Conflicts

Trained nurses are often compassionate and caring, good listeners and great communicators. The traits often drive men and women to pursue an education and career in nursing. These same characteristics can be disadvantages because the nurturing aspects naturally compel some nurses to discuss patient recovery and treatment with concerned family and friends. Nurses want to “help” maintain a safe, secure environment, which can lead to conflicts.

During the practice of nursing, professionals have to make many judgment calls every day, asking themselves “what is confidentiality” and “does it apply in this case.” These conflicts arise in hospitals, private practice offices and treatment facilities across the nation.

One area where conflicts arise involves observing actions or overhearing conversations. When a nurse has information that indicates a patient is behaving irresponsibly, and others may be harmed, confidential guidelines help shape decisions. Determining who needs to know is often the most challenging judgment call. Some situations seem benign, while others are serious.

Examples of Conflict

•A nurse becomes aware that an HIV patient is having unprotected sexual encounters.
•A nurse observes a patient/co-worker taking prescribed narcotics for pain while treating patients.
•A nurse hears a doctor discussing patient treatment with an unauthorized family member, later the family member asks the nurse for more details.
•A hospitalized patient is taken to have surgery and a friend stops by to ask why the patient is not in his or her room.
•A friend is a patient and a mutual friend asks about the patient’s health or recent doctor visit.

Kathy Quan, RN, BSN, PHN wrote an interesting article called “Confidentiality and Your Nursing Job” for Nursing Together. In her article, she reminds prospective students and nurses to carefully consider patient privacy and she challenges nurses to thoroughly answer the question, “What is confidentiality?” before pursuing a career in nursing. Considering a breach could result in job loss, legal actions and physical, emotional or financial damages, which is excellent advice for nursing students to heed.

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