Nurses have the opportunity to defend and protect patient rights, to promote compassionate care, and to enhance the dignity and the autonomy of their patients or clients (Keatings, & Smith, 2010). As nurses we are often required to choose from among a number of good or “least wrong” alternatives and to also assess and defend the choices made or actions taken (Keatings, & Smith, 2010). Furthermore, nurses are faced with ethical issues everyday in the healthcare setting and dealing with these challenges are or may be difficult, so how does a nurse decide on what is the right thing to do? It is important to know that when dealing with ethical issues it entails skills in the process of critical thinking, value clarification, ethical decision making, self-awareness, and empowerment (Burkhardt, & Nathaniel, 1998). According to the ANA Code of Ethics (2001) and the CNA Code of Ethics (1997) states that nurses are to maintain the confidentiality of patient information (Burkhardt, & Nathaniel, 1998). Confidentiality is the ethical principle that requires nondisclosure of private or secret information with which one is entrusted with (Burkhardt, & Nathaniel, 1998). On the other hand, privacy is the right of individuals to keep information about them from being disclosed (). So, it should be left with the patients to decide on who, when, and where to share their health information. Confidentiality is how we, as nurses, treat private information once it has been disclosed to others or ourselves (). So, this disclosure of information usually results from a relationship of trust (), and nurses are entrusted with this private information.
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Personal health information is considered any type of information that identifies a patient and their overall health condition/status or medical history (CNO, 2008a). It is important to keep the patient’s health information confidential and private because it provides protection for the patient from any type of harm (Mulligan & Branunack-Mayer, 2004), also it contributes to public protection. With these guidelines, it helps reminder nurses of their accountabilities and what the public expects f rom the nurses (CNO, 2008a).
In Marion’s situation, she was experiencing an ethical dilemma of whether or not she should freely disclose information regarding a resident in the nursing home to family friends from her hometown. Before Marion discloses any information to anyone, she must remember that the nursing profession have guidelines of nursing standards and codes of conduct all of which states that it is part of a nurse’s scope of nursing practice to abide and follow these guidelines in regards to protecting the patient’s privacy and confidentiality of their health care information. Marion is from a small town, where everyone knows each other and because of that it resulted in Marion’s family friends to asked about a close friend’s health condition out of deep concern. Despite the fact that Marion is from a small town, it was wrong of Marion’s colleagues to say there wasn’t any problem in giving away patient information. In fact, in the Practice Standard: Ethics (2008b), nurses need to ensure that all personal health information remains private and confidential at all times. So, it is evident that the nursing home that Marion works at was not following proper guidelines of the nursing standards in regards to patient privacy and confidentiality.
It is stated in the Nursing Homes Act (1990), that nursing homes have the responsibility of ensuring confidentiality and security of residents’ personal records. It is important for nursing homes or any other medical facilities to have policies and procedures in regards to patient privacy and resident’s confidentiality. Nurses should sign some sort of agreement form which entitles them to fully act in accordance in safeguarding all residents’ health information (PHIPA, 2004). However, at any time in disclosing any sort of personal health information, the Personal Health Information Protection Act (PHIPA) requires to obtain consent from the resident or from any capable person (also known as a substitute decision-maker) who the resident has authorized in writing or verbally to represent them during the time of their nursing care (Cavoukian, 2005). In the past, as nurses graduated an oath (Nightingale Pledge) was recited which discussed confidentiality, “I will do all in my power to elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in my practice of my profession” (Burkhardt, & Nathaniel, 1998). Thus, maintaining confidentially of the patient’s information is an expression of respect of that person and, in many ways, is essential to the nurse-patient relationship (Burkhardt, & Nathaniel, 1998). All in all, nursing standards should apply to all nurses regardless of their role, job description, or area of practice (CNO, 2008a), and one’s ability to maintain privacy in someone’s life is also expression of autonomy (Burkhardt, & Nathaniel, 1998). Autonomy means self-determination, the right to make independent decisions concerning one’s own life and well-being (Yeo, & Moorhouse, 1996). In this case, if Marion revealed any information to her hometown family friends she would be considered not being autonomous because respect for autonomy means granting individuals the right to privacy and confidentiality (Keatings, & Smith, 2010). Being autonomous is important and having nurses know that confidentiality is essential in the nursing profession, it helps patients/residents feel comfortable and able to trust health care professionals with their private information in order to receive the right, safe and competent care needed (Keatings, & Smith, 2010). In the end, patients want to feel safe with their care and also their health information, so it would be good if the nurse build that safety blanket that patients need. They also have the right to expect that such information will remain confidential unless there is a risk to self or others, or unless disclosure is require by law (Keatings, & Smith, 2010). During any circumstance such as a court case, the law may require disclosure of patient information; however in this situation Marion would only able to disclose certain information as allowed by the Personal Health Information Protection Act (2004).
Overall, Marion is faced with a difficult ethical dilemma. So in the scenario, the reader is unaware of what Marion ends deciding in doing based on the complications of the situation. Many factors come into play that may contribute in Marion’s final decision of action such as the lack of concern from her colleagues and the fact that at this nursing home was resident friendly and the fact that the residents had never complained about this type of situation in the past. This is quite the sticky situation and Marion could act upon four of the options listed. The first option is that she would tell the family friends who are inquiring about the resident’s health condition that any information regarding the resident must be kept confidential and private at all times. Now depending on the resident’s health condition/status then the second option would involve Marion to redirect the family friends to the resident or the substitute decision-maker for further answers. So, if the resident who is mentally alert gives consent, which can be either written or verbal, this gives permission to the nurses to be allowed to disclose personal health information to those outside the health care team (CNO, 2004). This also applies to the residents who have dementia, but of course the substitute decision-maker would have to give written or verbal consent. So, Marion’s third option should be to disclose the resident’s personal health information to only those specified or indicated in the written or verbal consent. Lastly, the last option would be to release any information asked by the resident’s family friends, keeping in mind that giving away such personal information is considered ‘okay’. Based on the current legislation, Marion is under no risk of violating patient confidentiality or performing a professional misconduct if she follows any of the first three alternatives mentioned above but if she makes the decision to act upon the forth option, she would be breaching patient confidentiality and privacy. So, unless specified through a special exception or consent, the only information that is allowed to be unveiled includes the confirmation that resident is currently living in the facility and their general health status (Cavoukian, 2004).
Our legislation is based on laws that are enforced because of the need to ensure the security, confidentiality and privacy of patient’s personal health information is maintained always. Given the four options listed above, only the first three have fallen under the guiding principles that consist both of the CNA and CNO, however the third choice best illustrates that a nursing standard of practice being demonstrated. In the CNO Compendium, the Professional Standards (2008c) illustrates what nurses’ professional expectations are in every area of their nursing practice. Based on the scenario, Marion presents professional values such as accountability, knowledge, and leadership. Marion demonstrates accountability by advocating for her clients, the nursing profession and the healthcare system while ensuring that her practice remains true to the College’s standards and provincial legislations (CNO, 2008c). She is knowledgeable because Marion demonstrates awareness of the CNO and CNA nursing guidelines. Finally, she shows leadership by collaborating with her colleagues in asking in their opinion about the situation. In addition, all persons deserve to be treated with respect and compassion. Furthermore, in my opinion, I believe Marion should just disclose the resident’s health information to only those indicated or voiced in the consent because it is safer on behalf of the resident. Also, by only disclosing health information as defined by the client’s consent, it is ensured that privacy is maintained while at the same time comforting those who are concerned (PHIPA, 2004). Due to the circumstances, this option best reflects the codes and standards of nursing practice because Marion is only trying to resolve the situation by going directly to co-workers for a collaboration on what to do (CNO, 2008c), and also again she is trying to maintain confidentiality. With consent, however, any health information she consequently gives out does not break any privacy laws because it is based on the guidelines as outlined by the client or substitute decision-maker (Cavoukian, 2005).
One of the most challenging things about this situation is the fact of being put such an awkward position to begin with. Marion was placed in uncomfortable position where she had to decide between professionalism and the social relationships she created with the people from her small town. Again, Marion was a small town who had a very active social life, attending many community events and parties, she practically knew everyone. Marion’s hometown was friendly and everyone had very close tied to one another. However, now if Marion decided to not share any information about another individual might make her seem very stuck-up and impolite, in turn, it could force her to sharing the information eventually to feel liked by the people of her town. Also, another issue that could arise in terms of Marion’s situation is losing that patient-client relationship due to trust issues. Establishing and maintaining patients’ trust in their caregivers is critical to obtaining a complete history, an accurate health record, and carrying out an effective treatment plan (). It’s important for nurses to remember that a patient’s trust is sacred, and any breach of confidentiality, no matter how small it might seem to the nurse, is a violation of this trust (Burkhardt, & Nathaniel, 1998).
Privacy and confidentiality are basic rights in our society (). Safeguarding those rights, with respect to an individual’s personal health information, is our ethical and legal obligation as health care providers (). Nurses are important in ensuring that organizations create an environment to safeguard patients’ rights to confidentiality (). As stated in the ANA Code of Ethics, “The nurse advocates for an environment that provides for sufficient physical privacy, including auditory privacy for discussions of a personal nature and policies and practices that protect the confidentiality of information” (ANA, 2001). Protecting their health information allows the client or resident to trust the nurse and shows that the nurse respects their privacy. If there was no trust in the nurse-client relationship, the client or resident may withhold or provide false information that may be important to their care (CNA, 2003).