Often, family members or others will ask you to breach this confidence. You can usually find a way of avoiding this but sometimes you will have to state clearly tat you cannot break any confidences made by the client.
Some people working in a caring capacity have to sign contracts committing them to respecting confidential information. There can be legal penalties for breaking these contracts. If a lawyer, policeman, judge or employer says you must breach a confidence you will need to take advice from someone in a senior position in your organisation.
Boundaries of Confidentiality
It is sometimes useful, when deciding on who should be given confidential information, to separate people into the following groups:
- Those who must know
- Those who should know
- Those who could know
- Those who shouldn’t know
A typical team on a medical or surgical ward would include doctors, nurses, social workers, physiotherapists, dieticians, pharmacists and others. Related to this team are secretaries, receptionists, porters and ward cleaners. These individuals are vital to the working of the team but do not always need to know everything about their client.
Confidentiality of Information
It is possible to identify a series of levels of information, which might be used to decide on weather or not the information could be shared. There are four levels or information:
- Identification: name, address, sex, martial status and primary disease.
- Medical information: disease, extent of disease, treatment investigation, past medical history and drug information.
- Social information: housing, work, family and social relationships.
- Psychological relationships: anxiety, stress, sexual problems and emotional state.
At present this information is stored, presented and shared in a variety of ways:
- Documents, reports, case sheets, nursing Kardex ect.
- Tutorials, or formal doctor-doctor, nurse-nurse contact
- Ward meetings, formal or informal, where problems are shared and discussed
- Ward rounds, with discussion between the staff
- Letters giving information are exchanged between the staff
- Investigation forms are completed and sent throughout the hospital, and into the wider community.
- Computers and records: the use of computers and databases has provided a new element in the maintenance of confidentiality, and the problem of ensuring access to records by patients.
Data Protection Act
Many organisations, both public and private, hold files of information on the people they deal with. People who have never met or spoken to you may take important decisions about you on the basis of your file, often. All they know about you is what the file says.
If the information is incomplete, inaccurate or unfair, your rights may be at risk- or you could be denied a benefit or a service that you need. The best safe guard is a right to see the file for yourself. Several laws allow people to see certain files held on them, and some information can also be obtained under the non-statutory ‘open government’ code of practice.
Data Protection Act 1984
This Act gave patients the right of access to their own medical records held on computer.
Access to Health Records Act 1990
This Act gave a similar right of access to information recorded after November 1991 on non-computerised medical records. The cut off date is likely to disappear under new legislation. There are some exceptions to rights of access, the most important being:
- Doctors may refuse the patient access too all or part of the records if it is their medical opinion that access may ‘cause serious physical or mental harm to the patient’.
- Access may be denied if this would disclose information about a third party without his or her consent. Third parties do not include doctors or others whose errors might be disclosed by a scrutiny of the records.
Access to Medical Reports Act 1989
This Act gives people the right to see medical records prepared by the doctor for employment or insurance purposes.
Maintaining client confidentiality in St John’s Hospice
All nursing and other staff have to comply with the ‘UKCC Guidelines for professional practice’, which explain issues of confidentiality, and the ‘Code of Professional Conduct UKCC’. Patients are fully involved in all written Care Plans etc and nothing is written down secretly or without their knowledge, but will be stored privately so strangers cannot access it. It is very much a policy of trust, openness and honesty. The Data Protection Act 1984 and Access to personal files Act 1987 and Access to Health records Act 1990 are all followed recording and storage of client information.
St John’s confidentiality and communication can cause implications. The hospice confidentiality must be handled with care. The patient has a right to believe that any information they give will be used only for the purpose for which it was given and will not be released to others without the consent of the patient. A confidentiality form needs to be signed by the patient and nurse. Documents of patients are kept in a locked room and in 10 years after the patient has died the documents are then shredded and burnt. Codes and locks are kept on computers and cupboards, which are changed frequently to stop people knowing the codes easily.
A Review of the Effectiveness of my Interactions and How they can be Improved
In my group interaction I felt that my interactions were very effective and this was proved as I got my points across very well and I could see people nodding in agreement and contributing to my point after I had finished showing that they understood my meaning. My eye contact was maintained fairly well throughout the group work. But I found it hard to keep really good eye contact throughout, as there were a lot of people in the group. My tone of was suited to what was being said in that part of the conversation. My posture was relaxed and could have been more formal as the meeting was also formal. Proximity within the group was fairly close as everyone sat next to each other in a horseshoe shape. I gave good encouragement to all opinions that were voiced throughout the meeting. I used good reflections and rose up previous issues discussed to help with newly arisen problems. My pace and clarity of voice in conversation was clear and well heard for the group. Turn taking was done very well in the group and everyone waited until one another had finished talking before they started. The barriers were that it was hard to see the two people sitting next to me due to the shape we were sitting in but I tried to prevent making barriers as much as possible. My ways of communicating in the group interaction proved very effective. To improve my interaction within the group I think I need to work on my eye contact as it did waver as I found it hard to focus on people as there were so many and also because I felt uncomfortable and unnatural if I looked at them to long, but if practiced the right way maintaining better eye contact will improve my interaction. Also to improve my interaction skills, I need to concentrate on how my body position is presented. At times my position was lax and made me looked uninterested in what was being said in the conversation.
In the one to one interaction most of the time looked in clients eyes.
My expression changed to suit contrasting emotions and I tried to make my head move with the clients, I did this a lot when explaining things. My tone of voice changed and softened when I was telling the client something, which may upset her. My hands were mainly well placed, usually in my lap and open palm up. My posture was faced towards client and open, not aggressive. I only touched the client once on the leg, I didn’t feel comfortable to do any more and it was not necessary, but I feel that small amount of touch was enough to soothe the client a little. When I used reflective communication it was to help and encourage the client to talk more I also used prompts to do this, e.g. when client asked me about their holiday and her options, but I did not use a lot of prompts as I was being more informative than looking for a conversation. I only used questioning to find out what happened in the accident. I was very calm and responded quickly to all the clients’ problems. There were few barriers. The only barrier really was sitting side on and not face-to-face. My actions in the one to one interaction proved very effective. If I was to improve on aspects within the interaction I think it would be how I first approached the client as I approached her rushed but then made too much effort to be comforting at that time which she did not need straight away because she wanted news on her injured fiancé not sympathy. Once I had informed her on her fiancés condition our interaction became less formal and that was when I comforted her more beneficially. Also I can improve my patience. I’m naturally not patient and this showed when I was doing my role-play interaction. Again my posture could be improved as I kept loosing the correct position for my body. I don’t think the client noticed on that occasion but on another it could set off a wrong impression.
Factors that Influenced my Interactions and How I Avoided Them
Inhibiting Factors
The right kind of environment can make a conversation easier. Successful interaction is less likely to take place in a location, which is noisy, unattractive or too hot or cold. If the environment is bleak and impersonal a client may feel intimidated. The environments in which my interactions take place are, for the group piece, a formal conference room designed for meetings. The room is designed for meetings and so there for would not intimidate the other people involved in the group piece. Using a conference room I avoided the chance of anyone feeling uncomfortable in the surrounding environment, as it was a formal gathering so required a formal room. For the one to one interaction the environment was in a hospital waiting room. The room is quiet and there is no one else in the room, making interaction easy but still people were able to come in to the room. I avoided people overhearing my conversation by talking in a low voice and by sitting face on and in close proximity to the patient’s fiancé. This also made the interaction more personal.
Common distractions include: other activity taking place in the same room; attempting to carry on two conversations at once; thinking about something else rather than giving full attention to the other. In my one to one interaction the distraction was people coming in and out. I ha to make sure that they were allowed in the room and also seeing that they are ok. I avoided going too these people however by noting who they were in my mind and then making a mental note of what state they were in.
When working in a health and care unit your attitudes may be influenced by previous encounter with other clients. In my group interaction I had already met the client and was biased to her going to get her own cigarettes etc as I thought she would still be able to walk. This was made clear as I kept on bring up that the client should join in activities and walks with others. I taught my self to avoid this throughout the interaction was to constantly think accurately about what I was going to say before I did.
Sitting directly opposite another (especially either side of a table) can imply competitions ad may cause a client to feel intimidated. Sitting side by side implies cooperation: students working together on a project, for example, will often sit like this. The position often favoured by health workers when meeting clients is to sit at an angle to the other person.
For my group interaction we sat in a horseshoe shape. This was the best way for us to see one another but it did cause a problem if I wanted to talk to the people next to me, as I could not see them properly. I avoided this problem by trying to move my body with the conversation and moving to an angle when I was speaking to the people by my side. In my one to one interaction I was at an angle to the client but could not talk to the client properly and so to avoid further miss communication I moved to face the client.
Enhancing Factors
When it seemed like it was appropriate I used touch to help with the situation. This helped increase my interaction and enabled the client to trust me more.
I used this only in my one to on interaction. I used silence to let the client reflect on what I had just told her. This also let me sympathise with her and was shown through my body language.
During my one to one interaction I was very relaxed and let this show so that the client would not get even more stressed out. My relaxed manner reflected back on to the client so that by the end of our interaction she was a bit more calmed than how she was at the start.
In both interactions my voiced was clam and relaxed but also remained professional. This helped enhance my performance by letting people see I could cope but still stay refined.
Notes on St John’s Hospice
St Johns Hospice has 17 beds and is a palliative care home of Sue Ryder Care. It is independent of the health service and financial support of the community. People go in for a break for either themselves or the family. The hospice deals with pain, sickness ect. The hospice is for people at the terminal stage of their illness and go in for respite, symptom control and terminal care. Palliative care aims to promote both physically and psycho- social well being as a vital and integral part of clinical practice. They do not hasten or try to prolong life. They provide support for friends and family and animals of the patient. The hospices principles are; emphasis on whole patient effective symptom control, communication and sharing information, providing service 24/7, care for the whole family and support for staff.
Aims of communication within the hospice are to reduce uncertainty, enhance relationships, and give advice, to work with patient to identify their specific needs and health goals within a holistic framework.
People involved with the patient; volunteers, kitchen staff, management, specialist staff, community liaison, relatives, friends, social worker, bereavement team, maintenance team, nurses, physio, office staff, doctor, chaplain, domestics and receptionists. Also they include transport, district nurses, g.p, pharmacy, funding, Macmillan nurses, social services and the Gladys Ibbett House.
Their confidentiality and communication can cause implications. The hospice confidentiality must be handled with care. The patient has a right to believe that any information they give will be used only for the purpose for which it was given and will not be released to others without the consent of the patient. A confidentiality form needs to be signed by the patient and nurse. Documents of patients are kept in a locked room and in 10 years after the patient has died the documents are then shredded and burnt. Codes and locks are kept on computers and cupboards, which are changed frequently to stop people knowing the codes easily.
Bibliography
Jefferson & Barrett – AVCE Health and Social Care
Health and Social Care
2003 – December
Unit 2
Samantha Buckley
ASSESMENT EVIDENCE
An analysis of the implications of inappropriate communication on the health and well- being of clients, drawing on your notes on your chosen care setting
Effective communication is achieved not only through an awareness of the kind of behaviour that characterises successful interaction but also through knowing what not to do. If we understand the factors that commonly inhibit successful communication between individuals we are more likely to avoid them. Things that cause inappropriate communication would include, the environment, distractions, preconceived ideas, jumping to conclusions, interrupting, changing the subject and manipulation. These factors can cause implications of inappropriate communication towards clients in a care based setting. In St Johns Hospice inappropriate communication can lead to clients mistrust in a nurse and can result in a client becoming withdrawn from the hospice and regretting their time at the hospice. The client’s quality of life will deteriorate and they could come depressed. If a client becomes depressed they may start to loose their appetite, stop looking after themselves e.g. in their appearance, start thinking negative thoughts of their illness and may cause their condition to deteriorate quicker as they do not look after themselves as well as they did before. This can have a bad effect on the hospice as it may upset other clients and the hospice’s reputation could be affected by people considering going there and hearing about unfortunate clients affected by inappropriate communication. Inappropriate communication could also lead to information being wrongly to or interpreted. In St John’s Hospice it is vital for information to be correctly processed at all times. If information is wrongly passed on or processed it could mean that a patient may perhaps receive the incorrect care or could cause a patient unnecessary embarrassment. Inappropriate communication within the hospice can also lead to information being passed on incorrectly to the relatives of the client and can give them false hopes or avoidable sorrow. With lack of effective communication it can cause mental discomfort for the client, a ‘wall of silence’ can be formed between the client and the nurses if nurses do not tell the client the truth. The client can also feel let down if they are lied to and may feel their treatment is not working properly. Inappropriate communication can also lead the client to be uncertain of what to expect and feel inadequate in their new surroundings if they have just moved into a hospice. Inappropriate communication can also make the client feel like they are being intruded if a nurse is too nosey or interfering with a loss of privacy. The clients need intimate care. At St Johns Hospice communication starts as soon as the possibility of hospice care is mentioned to the patient. They are often fearful and have the wrong impression of what the hospice is like and that they go there to die. If one of St Johns representative used inappropriate communication this may upset the patient even more before they even go to the hospice. St Johns try to put the patients mind at rest by using effective, skilled and delicate communication.
A critical evaluation of your use of skills and provide a realistic action plan for improving your group and one to one communication skills