As a registered nurse, midwife or health visitor, you must protect confidential information, Clause 5 NMC guidelines 2002 (see appendix .1). The nurse- patient / client relationship is special. Nurses are in a relative powerful position in relation to service users because of their specialist skills, clinical knowledge and the privileged access that they have to information about client’s social situation and health status.
Patients / clients also expect that health care professionals will respect the limits they place on the disclosure of confidential information outside of the care team, and for any reason that is not related to their care. Nurses should not break confidentiality in situation where clients have a right to privacy and their comments and behaviour do not cause harm to others and break the law (Beauchamp & Childress, 2001).
As a student nurse who is likely to be a temporary visitor to a care setting, whilst on placement or collecting information for an assignment. Observing or overhear things about patients / clients, and indeed members of staff, should remain confidential. Confidentiality is a key care value and is an important part of the nurse value base (Kenworthy et al, 2003).
The importance of confidentiality
Confidentiality is given a high value by healthcare; it is one of the foundation stones on which they build their relationships with patients / clients. For care workers to do their jobs well they need a range of information about their patient / client, this can range from facts about someone’s physical well-being and financial situation to more personal details about their feelings and relationships. People who use care services are often vulnerable and anxious about the situations in which they find themselves. Giving this information can be embarrassing and worrying. Despite this, patients / clients must be able to establish appropriate relationships and be able to communicate effectively with health and social care workers, patients / clients need to feel they can talk openly to their health and social care practitioners. This means trusting them to maintain the confidentiality of any information obtained. If patients / clients do not have confidence in the care practitioners’ ability to keep their personal information confidential, they will never be able to trust them sufficiently to establish an effective therapeutic relationship (Mallett & Dougherty, 2003).
Whilst the need to establish a trusting caring relationships is an important reason for preserving confidentiality, there are also other practical reasons for ensuring that confidential information about patients / clients is not revealed inappropriately. The security of patients / clients possessions, information concerning their finances and homes and their personal safety are also confidentiality issues. Disclosure of even simple details to the wrong person, such as the fact that a patient / client is in hospital, lives alone or has a particular condition, can expose the person to possible exploitation, theft, burglary and discrimination.
Confidentiality is a value that is a part of the ethical code of practice of most professions. Nurses, lawyers, doctors, and accountants all have code of ethics that impose a duty of confidentiality on practitioners. Confidentiality is an important value that should be a constant consideration for health care professionals and social care workers in their interactions with their colleagues and with patients / clients, their friends and relatives (Beauchamp & Childless, 2001).
What should remain confidential?
Service users generally give care workers four different types of information:
- Identification information.
- Medical information.
- Social information.
- Psychological information.
Identification information includes your name, address and marital status.
Medical information includes details of your medical condition, extent of your condition, treatment and past history.
Social information includes details of your housing, job, family situation and sexual preferences.
Psychological information includes details of stress levels, emotions, sexual problems and mental state (Downie & Calman, 1994).
Identification information is less likely to be as sensitive and confidential as your medical, social or psychological information. However, there are always exceptions. For example, people who are admitted to psychiatric hospitals often don’t want this fact confirmed to other members of their family or to close friends because they fear the social stigma that is attached to it. Women who have experienced domestic violence and who live in refuges will not want their addresses revealed to other people, even care workers, unless they have a clear need to know, and any information that is exchanged will be kept confidential. As a nurse, you should let service users decide what information about themselves they will allow you to reveal to others. Health and social care workers store, share and present information about service users in a number of different ways but should always do so in a manner that maximises patient / client confidentiality (Beauchamp & Childress, 1994).
Generally, confidential information about patients / clients should be:
- Kept secure and private, and locked in special filing cabinets.
- Only shared within the strict boundaries of the care team.
- Only used for the purpose for which it is given.
- Never deliberately disclosed so as to break confidentiality, other than in exceptional circumstances. Care practitioners must always be able to justify their decisions to break confidentiality (Dimond, 2002).
Care workers write down a lot of confidential information in patient / clients notes. Many disclosures relating to matters of patient confidentiality are unintentionally done. The care worker should never discuss a patients / clients personal or confidential information where they may be overheard, patients / clients medical notes should never be left where they can be seen by other patients / clients, unauthorised health care staff or members of the general public. For example GP keeps all medical notes in a file at his surgery. Increasingly patient / client notes are produced and stored on computer. The confidentiality of patients / clients notes should be protected by locking all files and reports in secure cabinets, by limiting access to them, by ensuring access to computer records are protected by the use of passwords and by avoiding conversation about service users in front of non-team members, confidential information can be kept secure (The data protection act 1998), (Appendix 2).
Disclosing Confidential Information
There are times when care practitioners have to reveal what they have been told, or have seen, to a more senior person at work or to an external organisation. Patients / clients’ request that you keep what they tell you a secret can be overridden if:
- What they reveal involves them breaking the law or planning to do so.
- They tell you that they intend to harm himself or herself or another person.
- They reveal information that can be used to protect another person from harm.
Care workers should never promise a client that what they say would be absolutely confidential. They should explain that, depending on what they are told or observe, there are times when they may have to share information with their colleagues and other authorities. In all care settings the standard of confidentiality that care practitioners are able to provide should be communicated to patient / client at the first point of contact and may be reinforced by leaflets and posters ( Dimond, 2002).
It is good practise for care workers to discuss the issue of confidentiality with patients / clients at an early point in their contract, ideally before the health care professional commences a medical and personal patient assessment to gather relevant information. Patients / clients should be given an opportunity to indicate how much of their personal information they are happy to have disclosed and to say with whom, outside of the care team, the staff can share information with. Care workers must always respect the confidentiality limits and preferences that the patient / client impose and gain their permission before discussing any personal matters with their family or friends. It may be necessary at times for a care practitioner to gently but firmly refuse to discuss a patient / client medical issues and circumstances with other patients / clients or even with his or her relatives. This in itself can inspire confidence that the health and social care worker can be trusted with confidential information (Mallett & Dougherty, 2003).
Confidentiality should work in favour of patient / client. Their private information must be protected and should not be revealed to people whom they feel do not need to know. There are certain circumstances in which care practitioners are told something in confidence but feel they should reveal what has been confided in them. There are occasions when patient / client can request confidentiality and put care practitioners in an untenable position. They may disclose information that indicates that they intend to do something that may put themselves or others at risk. In these circumstances it is important for the health care professional to let the patient / client know that they have a responsibility to disclose the information to other members of staff who are involved with their care. This might now sound confusing, and contrary about protecting confidentiality and respecting patient / clients rights. However, confidentiality dilemmas sometimes raise a difficult and ethically controversial issue. Key confidentiality questions for all health care professionals to think through include: how much to share, what you should do if someone confides information to you that you feel should be shared and when it is acceptable to break confidentiality.
Thinking through these questions, it is important to remember that interactions and relationships between patient / client and health care professionals and social care staff are based on trust. There is a general assumption that information revealed by patients / clients will remain confidential. At the same time it is necessary for health care professionals to share certain pieces of information so that effective care can be given (Mallett & Dougherty, 2003).
Patient / client confidentiality can be violated when information is received that suggests that a patient / client or another person may be in danger or might commit an illegal act. Under these circumstances, it is the obligation of the health care professional to break patient confidentiality; this break of patient / client confidentiality usually involves a danger to a third party (Beauchamp & Childress, 2001). As an example, if a patient / client confides in the health care professional that once they are discharged from hospital they are going to cause harm to someone, if then the health care professional believes that the threat is real and will be carried out, the health care professional is then faced with an ethical dilemma. His duty should be to protect patient / client confidentiality, or should the third party be protected from the potential threat of harm. If the health care professional legitimately believes there are valid reasons for the third party to be protected from the threat of harm, the ethical obligations of the health care professional must outweigh their need to protect patient / client confidentiality (Beauchamp & Childress, 2001).
Patient / client confidentiality may also be shared when a serious infectious disease is involved. Under the Public Health Act 1984, it is compulsory for a registered medical professional to notify the appropriate authorities of the following diseases:
- Cholera
- Plague
- Smallpox
- Typhus
- Relapsing fever
Under the guidelines of the act, patient / client details must be sent to the appropriate officer of that district, stating the following:
- The name, sex, age and address of the patient / client.
- The date, if know of the onset of the disease which the patient / client may be suffering.
The Prevention of Terrorism Act 1989, also requires anyone with information about an act of terrorism or terrorist activity to inform the police. These are legitimate reason for disclosure of confidential information.
Conclusion
In this essay the meaning of confidentiality was discussed and the importance it plays within health care today. The subject of confidentiality is an important one, it is seen as an essential component of the health care professional – patient / client relationship, without this fundamental trust and honesty which must exist between each other, it is doubtful that comprehensive care would be able to be delivered successfully.
It is the duty of all health care professionals to uphold patient / client confidentiality. It is fundamental to the caring profession as a whole, in terms of maintaining patient / client trust and the therapeutic relationship that can develop. One of the key confidential dilemmas that health care professionals and social care workers face is how to share confidential information without losing service users trust.
What should remain confidential and disclosing confidential information was also examined, it is sometimes difficult to define what is confidential and what is not, it is obvious that how much and when to disclose confidential information is left to the discretion of the individual health care professional the majority of the time, as to whether particular information would be classed as confidential or not. As discussed in an earlier section there are times when confidentiality can be legitimately broken.
Given the vastness of this particular subject matter, only the basics have but, briefly been covered, and highlighted only some of the main points relating to confidentiality and how it relates to the health care profession and the people that work within our healthcare system.
APPENDIX 1
Clause 5 (NMC 2002a)
5.1 You must treat information about patients and clients as confidential and use it only for the purpose for which it was given. As it is impractical to obtain consent every time you need to share information with others, you should ensure that patients and clients understand that some information may be made available to other members of the team involved in the delivery of care. You must guard against breaches of confidentiality by protecting information from improper disclosure at all times.
5.2 You should seek patients’ and clients’ wishes regarding the sharing of information with their family and others. When a patient or client is considered incapable of giving permission, you should consult relevant colleagues.
5.3 If you are required to disclose information outside the team that will have personal consequences for patients or clients, you must obtain their consent. If the patient or client withholds consent, or if consent cannot be obtained for whatever reason, disclosures may be made only where:
- They can be justified in the public interest (usually where disclosure is essential to protect the patient or client or someone else from the risk of significant harm)
- They are required by law or by order of a court
5.4 Where there is an issue of child protection, you must act at all times in accordance with national and local policies.
APPENDIX 2.
Data Protection Act 1984 - eight principles
- The information to be contained in personal data shall be obtained,
and personal data shall be processed, fairly and lawfully.
- Personal data shall be held only for one or more specified and
lawful purposes.
- Personal data held for any purpose or purposes shall not be used or
disclosed in any manner incompatible with that purpose or those
purposes.
- Personal data held for any purpose or purposes shall be adequate,
relevant and not excessive in relation to that purpose or those
purposes.
- Personal data shall be accurate and, where necessary, kept up to date.
- Personal data held for any purpose or purposes shall not be kept for
longer than is necessary for the purpose or those purposes.
An individual shall be entitled:
(A) at reasonable intervals and without undue time or expense
(i) to be informed by any data user whether he holds personal data
of which that individual is the subject; and
(ii) to access any such data held by a data user; and
(B) where it is appropriate, to have such data corrected or erased.
Appropriate security measures shall be taken against unauthorised
access to, or alteration, disclosure or destruction of, personal
data and against accidental loss or destruction of personal data.
Reference List
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Beauchamp, T & Childress, J (2001) Principles of Biomedical Ethics, USA: Oxford University Press.
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Dimond, B (2002) Legal Aspects of Nursing ,London: Longman.
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Downie, R & Calman, K (1994) Healthy Respect: Ethics in health care, Great Britain: Oxford University Press.
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Kenworthy, N, Snowley, G, Gilling, C (2003) Common Foundation Studies in Nursing, London: Churchill Livingstone.
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Mallett, J & Dougherty, L (2000) Manual of Clinical Nursing Procedures, Denmark: Blackwell Publishing.
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Rumbold, G (1999) Ethics in Nursing Practice, London: Bailliere Tindall.
