Codes of Conduct
The essay will define confidentiality its importance to nursing profession and professional code of conduct. It will further look at possible dilemmas that could arise in interaction between the nurse colleagues and their relatives. How to ensure confidentiality and legislation governing access to confidential information.
Confidentiality is keeping secret, the shared information depending on the situation arising. Dimond (2002) define confidentiality as one of the values of good care practise that is concerned with protecting private information about the patient and clients obtained during the period of professional practise
Importantly all nurses including midwives have legal and professional responsibilities to respect the rights of patients and clients and to treat them equally. The NMC (2202) state that as a registered nurse, midwife or health visitor, you must protect confidential information.
In addition, the social, ethical and moral basis of working in care setting is further explained in the NMC (2002) clause 5.1 - 5.4.that
In clinical setting, preserving confidentiality is view as the key to establish trust, promote good relationship and interaction. In the absence of this, nurses might not be able to offer the client the required quality care as expected
Again if client feel confident to communicate their information to the nurse, aware that their information is secure with the assurance that it will be passed on with their consent and on need to know basis. This will give them willingness to disclose sensitive and relevant information more freely. Although, the information might have nothing to do with their present ill health, but might later be found to be the contributory factor to the client’s condition. Incorporating this information into the care plan might help contribute towards the best holistic care within the multidisciplinary team
In looking at the pros of keeping information obtained in course of professional practice secret. It is worth remembering that disclosure of client information to wrong party might be detrimental to the client. For example divulging information about mentally ill client to another person not directly involved in his care might expose them to discrimination and labelling. In this case, the client might not open up and refuse to give full details about himself, unless the client-nurse trust has been built and it has been stressed that the disclosure is in the interest of the client
In the course of duty such as during hand over, record keeping and relative discussion during visiting hours. Nurses will come across and hear many things about the client. The nurse has a duty of care and responsibility to keep the information secret in situation where the clients have right to privacy and his action do not cause anybody harm or break the law.
Duty of care is an obligation of nurses to the client, the employer and the society in general. Patient generally expects that nurses will respect their rights and interests despite the nurse’s privileged access to information about their health status. Similarly it is only the patient who has power to access and control how their information should be shared with nominated person. But there may be occasions when other agencies will require client information to be revealed. It is important to let the client be aware at first contact about how information will be shared. For example, disclosure of client information can in some cases be made within care team to make decisions about the client and their care. But the nurse must gain the client’s explicit consent. It must be stressed that the consent policy must be follow to avoid legal actions be taken for breach of confidentiality.
However exceptions to such permission from the client as described by Dimond (1992): a court order might request for a report, when there is statutory duty to disclose such as in suspicion of child abuse of any kind. This type of disclosure is necessary to protect the children at risk The Children Act (1989).
Furthermore information from client about their intention to harm others or endanger themselves require disclosure. Clause 5.3 Code of Professional Conduct NMC (2002) supports the practising and registered nurses and argues that confidentiality can be overridden if it is in the public interest.
Despite the fact that confidentiality is not an absolute guarantee, it can be seen as a key ethical issue and guideline to good practice. All nursing codes of ethics have a clause regarding confidentiality
Ethical issues often arise to question the principle of confidentiality and create conflicts. The examples will be from my placement experience where I worked with clients experiencing mental health illness. I will look into the client’s right to confidentiality. The first case is about a patient of mental health condition, has epilepsy and is on daily medication to manage her condition. She attends the IT session at the work centre and being in change of her has been talking to me in confidence about problems with studying. She further said that due to taste of the medicine she occasionally doesn’t bother to take it.
Due to my concern, I asked him if she is aware of the implication of not having proper amount of medicine. Being very clear about the consequences, I further reinforce this and explain that other clients could be upset if she had a fit in the workshop. But having stated clearly that she is not going to talk about the side effects to her doctor and said she is better off to have relapse, rather than the nasty taste of the medication.
The client believes that I would not reveal her information, although I have no opportunity to inform her of my intention not to comply with her confidence; as she phoned in from lunch break of not coming back till the next day. Despite her right to privacy and decision for herself; I am still under the responsibility to act always in a manner to promote and safeguard the interests and well being of patients especially if client’s decision might be harmful to her and others. While I tried to relate my feelings to hers and try to be empathetic; I decided to tell the centre manager on her behalf. This might be difficult as I have to balance conflicting demands to respect client’s wishes and rights. Since breaking the trust could affect the client-nurse relationship. At the same time protecting safety and interest of others who may be affected by the decisions. I believe that the best course of action after considering the pros and cons is to put the client life as priority rather than her right to confidentiality.
Another case is about client’s right to information held about them. The client has learning disability and had been in care since age 3 when his mother died. Now age 19, he plans to go leave the work centre to go College but wants to see his records so that he can have a clear picture of his past. His social worker has talked to him about this and supports him through the process and is certain that he understands that he might be unsettled by some of the things in his file. The client was invited 25 days after his letter was received. The client was already informed that he would not see everything in his file because material by third party can be withheld where that person has not given their consent. In addition, we have decided as a care team involving in her care plan that some of the material would seriously damage his mental health.
At appointment day, the client asked questions as he wished and was given satisfactory answer, but explanation was given that he would not be able to take anything out of the file but could have extracts from any of the records. At the end, the client signed of having access to the file. In this case, there may be expectations when clients will be denied an access to all information on their files; so as to protect sources of information, the rights and confidentiality of others or hinder the achievement of good care plan. The Date Protection Act (1998). But clients access is denied to manual health records held before 1st November 1991. Access to Health Records Act (1990)