Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”
- Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response
- Response posts: Minimum 100 words excluding references
John Cotter Privacy and Confidentiality
This discussion post will review confidentiality and privacy in our role as Nurses. We will define privacy and confidentiality and discuss the case study in our course book (Ethics & Issues in Contemporary Nursing)Privacy is the right of an individual to decide what happens to their personal information; confidentiality is an ethical obligation to protect that privacy, (Burkhardt & Nathaniel 2014).The case study requires the nurse to evaluate if the patient’s right to privacy is superseded by the nurse’s obligation to report abuse of a minor. Privacy and confidentiality are the primary ethical principles that need consideration in this case study. However, other ethical principles such as respect for autonomy, advocacy, beneficence, nonmaleficence, veracity and fidelity need also to be considered in part or full.Both choices -the choice to maintain or the choice to not maintain confidentiality- have potential negative outcomes. If the nurse chooses to respect the patient’s privacy, the patient is at risk of further physical abuse. If the nurse choses not to maintain the patient’s confidentiality, the patient’s father could face criminal consequences and the patient will lose trust in medical professionals. The nurse is required to advocate for the patient, but again, does that mean respecting the patient’s right to privacy or protecting the patient from further abuse? Beneficence, the principal of doing good for the patient, along with nonmaeleficence, the principal of preventing the patient from harm, are ethical obligations to be considered also. In addition to ethical principles, the nurse must also balance the federal law on patient privacy -HIPAA- with state law on mandatory reporting on abuse of minors (psa-org). In Pennsylvania, the state requires mandated reporters to report abuse when they become aware of actual or potential abuse of a minor (ACLUPA, 2019). The Child Protective Services Law. identifies a nurse as a mandated provider in Pennsylvania. The patient in this case study is still a minor. If the patient were 14, the actions of the nurse would not differ; the patient in both situations is a minor. There is the concept of “emancipated minor” in Pennsylvania. This is where a person under the age of 18 is treated as an adult. But the patient in this case would not be considered an emancipated minor based on current law in Pennsylvania.The options for the nurse in this case study are twofold. The nurse reports the abuse as mandated by state law or the nurse does report the abuse and maintains the confidentiality of the patient. The consequence of reporting the abuse are that the patient loses trust in health care providers, is separated from her family but is now safe from physical and sexual abuse. The consequence of not reporting the abuse is the patient risks further physical and sexual abuse and the nurse and her employer can be criminally and/or civilly prosecuted for non-reportingIn my professional experience, I have not faced ethical choices as difficult as those in this case study. Primarily, I would be maintaining the privacy of patients when providing wound care. As would be standard in any facility, I would draw the curtains and explain to the patient what the wound care would be. I would sometimes get inquiries from other patients about why a roommate had gone to the hospital; I would offer a generic answer without specifics. One situation I observed was that of an elderly gentleman with multiple chronic conditions. The patient was regularly being sent to the hospital from the nursing home for treatment. One day, while the patient was being transported to the hospital, he said “Why are you doing this to me?”. The patient was in the early stages of dementia, but I felt he was capable of still making or giving input on his healthcare. I mentioned what I observed to the unit manager. The unit manager told me that the patient’s son was his power of attorney and wanted his father to be full code and everything possible done for him. There had been multiple discussions with the son and his several siblings about the option of palliative or hospice care. But the family did not want palliative or hospice care for their father..In this case study, the autonomy of the patient does not outweigh the nurse’s responsibility to report the abusive situation. The evidence shows that the abuse is ongoing and is likely to happen again. The nurse has an obligation under state law and under the ICN Code of Ethics for Nurses (2006) to protect the patient from harm (Burkhardt & Nathaniel, 2014). Nurses need to understand their ethical and legal obligations of confidentiality under Federal and State laws and those of their employer. The choice is difficult, adolescents have been shown to be less likely to seek healthcare if they believe their confidentiality is not respected (Pasternak, Hawkins & Schumann, 2019). However, the choice in this case, is to report the abuse of the patient.ReferencesBurkhardt, M. A., & Nathaniel, A. K. (2014).
Ethics & issues in contemporary nursing. Fourth edition. Australia: Cengage LearningPasternak, R. H., Hawkins, K. B., & Schuman, A. J. (2019). Adolescent privacy and the EHR: Adolescents are more likely to see a healthcare provider if they are certain their private information will be kept confidential. Here’s how to create a secure environment for these patients within your electronic health record (EHR) system.
36(4), 50–53. Retrieved from
https://www.pa-fsa.org/Mandated-Reporters/Understa…Confidentiality in Adolescent Health Care
Nursing for Women’s Health, Volume 21, Issue 6, 509 – 510
- 2 Vanessa Davis
M3 A5 DB: Privacy and Confidentiality of the Patient