The essay will define confidentiality its importance to nurses as a profession and the Nursing and Midwifery Code of Professional Conduct. It will further look at possible dilemmas that could arise in course of practice between the nurse colleagues and the clients. Examples will be based on my clinical placement 1 at Blackfriars Work Centre.
Confidentiality is keeping secret, the shared information depending on the situation arising. Dimond (2002) define confidentiality as one of the values of good practise that is concerned with protecting the private information obtained about the patient and client during the period of professional practice.
Importantly all nurses including midwives have legal and professional responsibilities to respect the rights of patients and clients and treat them equally. NMC (2002) states that as a registered nurse, midwife or health visitor, you must protect confidential information. Clause 10 UKCC (1992) further states that health professionals should avoid from divulging such information without the client’s consent or a nominated person advocating on his behalf unless the disclosure is required by court order, in the public health interest and in the best interest of the patient.
In addition, confidentiality as part of the social, ethical and moral basis of working in care setting is further explained in the NMC (2002) clause 5.1-5.4. 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 Hogston and Simpson (1999).
Arnold and Boggs (1999) argued that if client feel confident to communicate their information to the nurse, made aware that their information is secure with assurance that it will be passed on with their consent and use on a 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 health, but it might be found later on to be a 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
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 Fletcher et al (1995).
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 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 absolute, but it can be seen as a key ethical issue and good guideline to practice. All nursing codes of ethics have a clause regarding confidentiality Rumbold (1999).
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 who has epilepsy and 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 concluded that the after taste of the medicine prevent her from taken it as required.
Due to my concern, I confirmed her awareness of the implication of missing the RDA of the medicine. On clarification of this, 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. Chilver (2002).
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 the client asked questions and answers were given to his satisfaction, but clarification was made that he would not be able to take anything out of the file but could have the extracts. At the end, the client read and signed of having access the file. This is an example of a legal aspect of confidentiality, regarding patient’s note. Client can be denied an access to information on their files; so as to protect sources of information, the rights and confidentiality of others or if it might hinder the achievement of good care plan. Access can also be denied if the information held can have bad effects on the client. The Data Protection Act (1998) Clients have unqualified right of access to information in manually held health records since 1st November 1990 Access to Health Records Act (1990).
In my placement, telephone investigation, record keeping, and periodical assessment of clients are all potential nursing procedure where patients’ confidential information can either be maintained or breached. But being aware of importance of good interpersonal skills and effective communication as essential to nursing skills, I ensure that client information are not discussed on the phone, information conveyed to others during practice are made clear and appropriate to the situation. Any concerns are refer to my practice mentor for clarification. Although the placement is for short period, but my communication skills has improved with time as I am given the opportunity to work and plan activities with clients thereby shaping myself for future practice. According to Arnold and Boggs (1999) effective communication is basis of therapeutic relationship and must reflect the trust, respect, empathy and confidentiality.
Blackfriars Work Centre Annual Report states that confidentiality been a concept of advocacy require nurses to be aware of their own feelings, acting with compassion, respect, confidence and competence so as to help the clients find meaning to their living or dying. I was involved in implementing confidential matters when my mentor sought Mr K’s consent prior to review meeting with client. This is to give me the opportunity to experience how reviews are done and incorporated to client’s assessment. At this meeting client’s information are discussed within the multidisciplinary team and the outcome is use to review the co-ordinated care plan and make adjustment to client’s need as necessary. Carson and Montgomery (!989). Clients explicit consent is necessary to establish trust relationship, but overall the client decision is final as to who is allowed in the meeting. But my placement has a policy that forbid note taking during the assessment meeting. Documentation has to be done after the client might have left the meeting. Clients are given the opportunity to read, amend and sign all their review reports. This may indicate respect to the client, promote good relationship and enhance a flow of communication. This reflects the settlement’s adhere to Data Protection Act (1998) apart from been known that many of the clients have by tradition been disadvantaged and to encourage their representation is vital.www.blackfriars.co.uk (online) 2003
After a brief introduction on my first day at placement, a copy of Equal Opportunity Policy was given to me for guidance, with ‘confidentiality’ aspect clearly highlighted as on need to know basis. Client’s permission is mandatory prior to using of client information by the staff and student for article journals, public format and assignments. In my assignment, name and address are altered to protect the client’s identity. It is interesting to note that placement system have restrictions on the categories of information that I may accessed. But this is less surprising, a trainee is responsible for her practice but my mentor is accountable for my action. Burnard and Chapman (1991).
Certainly the knowledge and compliance with the legislative requirements and the settlement’s privacy policies about the collection, use, and access to information are the best defence in any situation which I will always abide with in the entire time of my practice. Although confidentiality is a complex issue which is easily overlooked, but the key point for nurses is to know the boundary to maintain confidentiality. Nurses must not to take client’s right for granted; our interest should be towards the general public, the clients and our colleagues and must strife to improve on the good image of nursing organisation at all time. In dilemma, clients’ interest should be the priority. Careful consideration is also necessary prior to divulging confidential information so that the client’s right to confidentiality does not conflict with the public interest or to the practice guidelines.