This essay will discuss the legal, ethical and professional concept of patient/client confidentiality and will identify any im
This essay will discuss the legal, ethical and professional concept of patient/client confidentiality and will identify any implications this may have for practice with relation to a recent clinical experience.
With regards to a recent clinical placement the author has chosen to discuss a recent placement within the community with references to client care.
The author feels strongly that the responsibilities on caring is to maintain the general trust of patient/clients, not only through care but also through observing certain codes of practice and adhere to legislation laid down by the government in order to preserve clients rights. These are there for a guide to follow in order to uphold the general principles regarding staff and clients.
Within the nursing profession The Nursing and Midwifery council (NMC 2002) are guided by the codes of professional conduct, these are the shared values of all UK health regulatory bodies.
Confidentiality is paramount to all nursing codes, in all cases the focal word is trust.
As a registered Nurse. Midwife or Health visitor they are accountable for their practice and in the exercise for professional accountability must "protect all Confidential information concerning patient and clients obtained in the course of practice, and make disclosure only when consent, where required by a court or where you can justify disclosure in the wider public interest" (Hendrick 2000).
As a student nurse and not registered, there is an agreement in place that student nurses will adhere to these codes .
During a placement within the community the author was working closely with the district nurses, clients were visited within their own homes and nursing homes, on one particular occasion the author visited a nursing home with the District nurse to treat a lady who I will refer to as Mrs Green this is pseudonym in order to comply with the NMC 2002 guidelines with relation to confidentiality.
The author and the nurse were met in the entrance of the nursing home by the care manager who stated that Mrs Green wasn't feeling to well, she was 76 years old and was at the home on respite care after falling at home, she had a wound to her leg, the manager explained that Mrs Greens daughter had been to see her the day before and there had been a conversation about her selling her home, although the care manger was not sure, She believed that this had upset Mrs Green and asked us to find out if this was the case.
The district nurse told the manager that she was not able to pry into Mrs Greens private affairs but would speak to her.
We went to her room, Mrs Green was sat in her chair staring out of the window, the district nurse spoke to her and asked her how she was, Mrs Green stated that she was fine, the author began to change her dressing while the District nurse talked to her about life in general, Mrs Green then said, " I'm going to die here aren't I ?", the district nurse asked her what was ...
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The district nurse told the manager that she was not able to pry into Mrs Greens private affairs but would speak to her.
We went to her room, Mrs Green was sat in her chair staring out of the window, the district nurse spoke to her and asked her how she was, Mrs Green stated that she was fine, the author began to change her dressing while the District nurse talked to her about life in general, Mrs Green then said, " I'm going to die here aren't I ?", the district nurse asked her what was wrong and if anything had happened, Mrs Green began to cry saying that her daughter was moving away and that she was worried that she wasn't able to return home as there was no-one there to look after her, after a long discussion and lots of reassurance the district nurse explained that there was help out in the community and with the right help and support she may be able to return home and to be positive about the future, this immediately lifted her mood and there appeared to an instant client-nurse relationship, Mrs Green listened to what the nurse had told her and in return trusted the nurse not to discuss anything that had been said in the room to anyone else.
On leaving the manager approached us again and asked if Mrs Green was any better and wanted to know if she had told us what was bothering her, The District Nurse explained that a private and confidential conversation had taken place with Mrs Green and she was feeling a lot better and to contact us again if she had any concerns. The Care manager did not appear very happy with the answer, but didn't ask anymore questions.
If the Nurse had discussed the conversation with the care manger she would be breaching the professional codes of conduct also Mrs Green would have felt betrayed by the District Nurse which could have had a very negative effect on the her and could lead to compensation and disciplinary action for the District Nurse, whereby if the client is contented with the actions of the District Nurse this would give her a positive out look and aid to her recovery.
Mrs Green expected the nurses to keep the information that she gave which showed that she was happy and confident with the nurse but there are occasions where the issues of being ethically bound by confidentiality for professionals within health and social care can present them with ethical conflicts. For example Mrs Green could have been extremely depressed and there may have been an issue that she could have been a suicide risk, whereby the nurses would have had to inform other agencies and even the care manager. Informed consent for example, means that confidentiality is not absolute. In cases dilemma or conflict, universal moral principles are implemented to help caring professionals deal with the problems presented. Ethical codes and the law are liable to changes and it is the duty of professionals to update themselves on these changes. Nevertheless, the morals still remain the same regardless of these changes.
Within Nursing, moral issues are referred to as the moral philosophical codes of ethics, which are similarly, additional and complementary to the traditional medical codes of
ethics and ultimately can be expected to reinforce them.
Nurses and caring professionals are involved in caring for and assisting the well-being of individuals with needs ranging from social, physical and psychological issues. Likewise, these individuals are from different ethnic, cultural and religious backgrounds, which according to Human and Smith (1995), are each in different ways, moral concerns, embedded in the mores of society, and so are laden with social values.
Hence its intentions are embedded in the Socratic tradition which emphasizes that "the unexamined life is no life for a human being "( Gilling et al 1996). Thus moral ethics
explains or present thoughtful arguments of justifications to ethical dilemmas.
Theses moral principles according to Jones et al (2000) are :
Beneficence - achieving the greatest good
Non-Maleficence - causing the least harm
Justice - what is fairest ?
Respect Autonomy - maximizing opportunity for all to implement their choices
Law - What is legal ?
Additionally the health care profeeional needs to be aware of legislation that is in place to protect an individuals right to their personal information being kept safe and confidential.
The Data protection Act 1998 which aims to ensure the confidentiality of information stored and sets out specific rules on personal information which is held, it contains eight data protection principles, theses state than data must be
Processed fairly and lawfully
Obtained and used only for specified and lawful purposes
Adequate, relevant and not excessive
Accurate, and where necessary, kept up to date
Processed in accordance with the individuals rights
Kept secure
Transferred only to Countries that offer adequate data Protection
There are exceptions where confidential information can be disclosed these exception are laid out in the Data Protection act guidelines.
As most personal information is now stored on computer The Computer Misuse Act, 1990 was brought in initially for hackers but is now his act is concerned with unauthorised access to computer systems and any subsequent crimes or changes to data or programs. It has three levels or sections of offence one of which is-
a) he/she causes a computer to perform any function with intent to secure access to any program or data held in any computer
In conclusion it must be seen that these Acts have been put into place to protect patients/clients and health care professionals, these Acts which have been discussed within this essay is just a small part, there are many other Acts that can assist the health care professional to provide a quality service to patients/clients and to avoid breaking the Law and the Profession codes of conduct for example the Mental Health Act 1983, the Children's Act 1989 the NHS and community Act 1990 all of which provide valuable information which is essential knowledge when caring for theses particular groups.
It is health care professional who needs to be aware of the implications that their actions may have on the client, themselves and the trust they are employed by, be it legal or moral, As with Mrs Green she trusted the actions of the District Nurse as she felt they could help her present situation. If the client feels betrayed by the health care professional it can have a very negative effect on the client and could lead to compensation for the patient/client and disciplinary action for the health care professional, whereby if the client is contented with the actions of the health care professional this will give them a positive out look.
The incident with Mrs Green made the author aware of just how easy it is to disclose information, a conversation which the author may have believed would have been in the best interest of the client could have broken the codes of professional conduct, the author is also now aware of how much legislation is in place to protect an individual and the importance of keeping up to date with it, such as Freedom of information Act 2000 which came into place on 1st January 2005 whereby the general public will be able to view the working practices and minimum standards which are already in place this means that the the NHS and staff will be will be publicly open to scrutiny.
References
Computer Misuse Act, 1990 (Public General Acts - Elizabeth II) Stationary office
Data Protection Act,1998 (Public General Acts - Elizabeth II) Stationary office
Freedom of Information Act (Public General Acts - Elizabeth II) Stationary office
Gilling,C. Kenworthy,N. Snowly, G. (1996) Common Foundation Studies in Nursing 2nd Edition. London. Churchill Livingstone
Hendrick,J. (2000) Law and Ethics in nursing and healthcare. Cheltenham, Stanley Thornes Ltd.
Hugman, R. and Smith, D.: Ethical Issues in Social Work, 1995, Routledge, London
Jones, C. et al: Questions of Ethics in Counseling and Therapy, 2000, Open University Press, Buckingham
Nursing and Midwifery council (2002) Codes of professional conduct
Bibliography
Gillon, R.: Philosophical Medical Ethics,1992, Antony Rowe Ltd., London
Tschudin, V.: Ethics; Nurses and Patients. 1993, Sctari Press, England
www.hmso.gov.uk/acts/acts2000/20000036.htm
