This essay will choose and explore clause 5 from the Code of Professional Conduct (NMC 2002).
CODE OF CONDUCT
AIM:
This essay will choose and explore clause 5 from the Code of Professional Conduct (NMC 2002). Examples and relevance of the clause to nursing practice and discipline will be based on placement 1 clinical experience. The links between academic and practice will also be structurally discussed; using relevant literature to elaborate points. References will be listed at the end.
Introduction:
Any learned profession is founded on the principle that its members may be relied upon to conduct their work in a manner that will reflect credit on themselves and honour to their profession. Although this principle is universally understood, its importance is, more usually, recognised in cases of professional misconduct. It is therefore necessary that every learned profession should define, and enforce among its members, strict rules of professional conduct. To this end code of professional conduct, as approved by nursing and midwifery council (2002a) is issued to all qualified members of nurse midwife or health visitor. (NMC 2002a clause 1 section 1.1)
Importantly, the protection of clients' rights in care situations is an area of considerable importance within care work; all nurses owe clients a duty of care and are under a legal obligation to ensure that they observe the requirements of the legislation protecting the rights and interests of their clients. Moreover, users of care services have become more aware of their rights over the years and their expectations of care services are now much higher than previously. Clients' right and interests are now protected through care related law such as the data protection act 1984, government charters such as patients' charter, code of practice such as NMC 2002. Hence, the codes as a guiding light developed as evidence based to professionally practice is useful to deal with failure, shape and influence the role of nurses, and learning from the past mistakes which is vital to the success of any code of conduct. (nursing management vol9/ No4/ July 2002)
Nurses are accountable to themselves, although the code can conflict with their own position (Dimond 2002), to nursing professions so as to uphold standard, to the public (protected by criminal law) for an allegation occurrence, and to the employer by contract of employment.
The significance of Code of Conduct should be realised by health staff so as to acknowledge/ be aware that they are accountable for their practice, both to themselves and the public. (Nursing Standard February 19/vol 17/no 23/2003). This is necessary due to the fact that the nursing profession is now more demanding than ever. Today, users of care services have become more aware of their rights over the years and their expectations of care services are now much higher than preciously.
Oxford Dictionary (1998) define 'accountability' as being able to answer for the standard of care, undertaking and negligence to the allocated professional body whose right is to question/challenge, in obedience to and as stated by Code of Professional Conduct.
Ken worthy et al (1993) through more light on accountability. As one of the key factor supporting professional obligation in clinical care. Nurses might be called during legal matter to give details of her care to patient due to negligence causing damage to a patient. This might require written statement from the nurse that will be looked into; ...
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Oxford Dictionary (1998) define 'accountability' as being able to answer for the standard of care, undertaking and negligence to the allocated professional body whose right is to question/challenge, in obedience to and as stated by Code of Professional Conduct.
Ken worthy et al (1993) through more light on accountability. As one of the key factor supporting professional obligation in clinical care. Nurses might be called during legal matter to give details of her care to patient due to negligence causing damage to a patient. This might require written statement from the nurse that will be looked into; proving the question intelligent/knowledge/professional standard of the nurse. Therefore it's not enough for nurses to be accountable just for the sake of Code of Conduct. It is good as well to be able narrate/recall the motive behind the action, based on good skill/competence, understand the ground for the actions taken and moreover the danger, and the consequence of the actions. That is one of the main reasons of good documentation.
The NMC Code of Professional Conduct (2002) is clear that each nurse is accountable for their own practice and that in practice professional accountability should recognise limitations of competence.
Clause 5 NMC (2002a), 'As a registered nurse, midwife or health visitor, you must protect confidential information'. The nurse-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 clients social situation and health status.
The meaning of confidentiality in care
Within care relationships, the principle of confidentiality plays a vital role in establishing and maintaining the trust that effective relationships depend upon. Confidentiality refers to the protection of personal and private details about clients;' situations or conditions. In care settings, the term confidentiality is used to refer to the rights of service users to have access to their private information restricted to people who have an accepted need to know about the content.(Dimond 1995)
Clients generally consent to this information being made available to a restricted group of care professionals on need-to-know basis. They also expect that care workers will respect the limits they place on the disclosure of the 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. (nursing standard, july 7, vol 13, no 42, 1999).
As a student nurse who is likely to be a temporary visitor to a care setting. Perhaps whilst on work placement or collecting information for an assignment. Observing or overhear things about service users, and indeed members of staff, should remain confidential. Confidentiality is a key care value and is an important part of the nurse value base.
Why is confidentiality important?
People who use care services are often vulnerable and anxious about the situations in which they find themselves. Despite this, service users must be able to establish appropriate relationships and communicate effectively with health and social care workers. Confidentiality is given a high value by healthcare because it is one of the foundation stones on which they build their relationships with service users. If service users do not have confidence in care practitioners' ability to keep their personal information confidential, they will never be able to trust them sufficiently to establish effective relationships.
Whilst the need to establish trusting care relationships is an important reason for preserving confidentiality, there are also other practical reasons for ensuring that information about service users isn't revealed inappropriately. The security of service user's possessions, for example 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 service user is in hospital, lives alone or has a particular condition, can expose the person to possible exploitation, theft, burglary and discrimination.
Ethics and confidentiality
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 and social care workers in their interactions with their colleagues and with service users, their friends and relatives.(british journal of nursing, 2000,vol 9, no 8)
What should remain confidential?
Service users generally give care workers four different types of information:
Identification information, including name, address and marital status. Medical information, including details of disease, extent of disease, treatment and past history. Social information, including details of housing, job, family situation, sexual preferences. Psychological information, including details of stress levels, emotions, sexual problems and mental state.
Identification information is less likely to be sensitive and confidential than 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 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. 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 their confidentiality.
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. 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 themselves or another person.
* They reveal information that can be used to protect another person from harm.
If an offence that could have been prevented by your revealing the confidence is committed, you could be brought to court to face charges. Care workers should never promise a client that what they say will 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 practioners are able to provide should be communicated to service users at the first point of contact and may be reinforced by leaflets and posters.
Generally, information about service users 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 practioners must always be able to justify their decisions to break confidentiality.
Managing confidentiality
It is good practise for care workers to discuss the issue of confidentiality with service users at an early point in their contract. Service users 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. Care workers must always respect the confidentiality limits and preferences that service users 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 service user's confidence and circumstances with other service users 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.
Care workers write down a lot of confidential information in service users' notes. For example GP keeps all medical notes in a file at his surgery. Increasingly service users' notes are produced and stored on computer. The confidentiality of service users' notes should be protected by locking all files and reports in secure cabinets, by limiting access to them, by ensuring access to computer records is protected by the use of passwords and by avoiding conversation about service users in front of non-team members.
The Data Protection Act 1984
Confidentiality dilemmas
Confidentiality should work in favour of service users. Their private information must be protected and should not be revealed to people whom they feel don't need to know. But there are circumstances in which care practitioners are told something in confidence but feel they ought to reveal it. There are occasions when service users can request confidentiality and put care practitioners in an untenable position. They may disclose information that indicates that they intend to do something that they may put themselves or others at risk. In these circumstances it is important for care workers to let service users know that they have a responsibility to disclose the information to other members of staff involved with their care. This might now sound confusing, and contrary about protecting confidentiality and respecting service user's rights. However, confidentiality dilemmas sometimes raise difficult and controversial issues. Key confidentiality questions for all care workers to think through include: how much to share, what you ought to do if someone confides information to you that you feel ought to be shared and when it is acceptable to break confidentiality.
Thinking through these questions, it is important to remember that interactions and relationships between service users and health and social care staff are based on trust. There is a general assumption that information revealed by service users will remain confidential. At the same time it is necessary for care workers to share certain pieces of information so that effective care can be given. Confidentiality can be violated when information is receive that suggests that a service user or another person may be in danger or might commit an illegal act. The key confidential dilemma that health and social care workers face is how to share confidential information without losing service users trust.