The subject I intend to reflect upon is confidentiality within a professional healthcare setting. Confidentiality formed a part of our professional issues lectures and it piqued my interest due to how differently it is interpreted within healthcare as opposed to education, which is my background. In an educational setting I was taught repeatedly that I could never ensure confidentiality between myself and a child. Comparing that to what I have now learnt in healthcare, this seemed to me almost the opposite way of working as I was used to and so I wish to reflect upon this.
I intend to look at why confidentiality is so important within healthcare and how it relates to the Nursing and Midwifery Council’s (NMC) Code. I will look at the strategies in place to protect the privacy of healthcare users, including the areas where confidentiality is even more important. I will also be looking at the various occasions that arise in which a confidentiality can be breached and who should be informed in these cases and finally I hope to look at a case study where confidentiality was breached and use that information to help guide me to make better choices in the future.
Jasper (2011) tells us that reflection is the ability to see ourselves both physically and metaphorically. She also states that reflection can be looking again at something or in a different way. Somerville and Keeling tell us that reflection is the study of our thoughts, actions and focusing on our interaction and environments with the intention of fully seeing ourselves (Nursing Times, 2004).
The Term Paper on Reflection practice
Reflection practice is an approach that allows practitioners to understand how they use their knowledge in realistic situations and how they mix action and learning in a more successful manner (Henderson, 2002). Kondrat (2004) claims that the aim of critical reflection is to be conscious of the influence of the subject self in relations to prejudices so that such prejudices may be reduced or ...
Bulman & Schutz (2008) talk of reflection as being a tool to review experience, so that it may be “described, analysed [and] evaluated” then used to influence future practice.
Sully & Dallas (2010) state that reflection is essential in the nurse’s development into sound and responsive professionals and they cite Benner (2001) who stated that nursing cannot expand or fully develop without the practice of reflection. According to Johns and Freshwater (2005), reflection is a skill that is used on a regular basis and in all sorts of situations, such as important events in our lives.
There are various reflective cycles available to help with the reflective practice and Johns’ cycle discusses the relationship between practitioners and supervisors and makes reflection a joint exercise, looking at the actions and consequences, the feelings behind it, the personal ethics involved and the knowledge gained (Johns, 1995).
Alternatively, Gibbs’ cycle takes a slightly different approach and is cyclic in nature, it takes a similar reflective outline but moves on to conclusions and then action plans to guide future practice (Oxford Brookes University, 2011).
There are other cycles available including Driscoll’s “What? So What? Now What? ” reflective model which can help in more general reflective situations (University of Nottingham, 2012).
However, I will write this essay using a reflective style instead of referring to reflective cycles. I intend to use this exercise to inform and prepare me for my future career and to explore a subject that has had some bearing on my life and will be increasingly more important as I continue down this career path. Confidentiality is an important aspect of healthcare including the entire spectrum of healthcare workers and settings.
It is enshrined in the World Medical Association’s Declaration of Geneva (WMA, 2012) and the Hippocratic Oath (National Library of Medicine, 2012) as being a central part to our role as healthcare professionals since before healthcare became so structured. The reasons for keeping a confidence in the healthcare setting are summarised by Lockwood in that the information belongs to the patient who is giving it to the doctor and therefore the doctor has a responsibility to not misuse such information (2005).
The Essay on Utilization of Reflective Practice among Healthcare Professionals
Reflective practice is frequently utilised throughout nursing care. It allows the healthcare professional to explore their past and present experiences, their concepts of current practice and enables the ability of identifying means to enhance ongoing development (Levett-Jones & Bourgeois 2007, p. 117). Mann, Gordon & Macleod (2007, p. 595) highlights that current healthcare professionals ...
Lockwood also talks of the trust between a doctor and patient which would certainly break down should confidentiality be breached.
Thompson, Melia & Boyd (2000) tell me that the information a patient gives about themselves not only gives the healthcare professional power to help them but also gives them power over them. In this case, it is vital that healthcare professionals use information that is given to them wisely and with the utmost care. Seeing information about a healthcare user in such terms makes me realise that some information is not necessarily in the public domain and therefore I have a privilege and responsibility to not only care for the patient but also for the knowledge about them that I am privy to.
I realise that, although I have a duty to retain confidentiality, I may be placed in a position where the confidence has to also include other healthcare professionals and I need to involve the patient in such a situation (ibid).
It is also just as important to keep a confidentiality because of data protection legislation which enforces the rights of the individual to have their personal information prot ected (Legislation. gov. uk, 1998).
So legally, healthcare professionals have a duty to protect the healthcare user’s personal information, at least to the legal minimum, or face proceedings.
On top of this though, there is a further responsibility placed on the healthcare professional to respect the right of the user to their private life and beliefs. This is outlined by the NMC’s Code (2012) which reiterates the Data Protection Act, 1998 and further clarifies the lengths that healthcare professionals should go to ensure the healthcare user’s confidentiality and privacy is protected. In my previous experience in education, guidelines to teacher-pupil relations involved not just teachers but all professionals in contact with pupils.
From this I would understand that when an article states doctor-patient relations it would include all healthcare professionals’ not just doctors. I agree with Cornock in that a patient gives information to healthcare professionals in the hope that it can be used to assist in treatment (2009).
If this confidentiality is breached, the patient may not feel comfortable to reveal all information for fear of it becoming more generally known. I personally believe that this can lead to less effective healthcare treatment and even a fear of receiving any treatment at all in cases of injury or disease that may be more of a societal taboo.
The Essay on Patient Confidentiality
... and confidential. As healthcare professionals, we must know that if confidentiality is breached, patients may be reluctant to disclose full information to any healthcare professional or even ... is not considered a breach of confidentiality if you share secret information with other health professionals involved in the patient’s care. In the article, an ...
The NMC Code (2008) states that healthcare professionals must “respect the patient’s right to confidentiality” and to discuss with the patient when any of their personal information will be passed to another member of the team; this is a much more formal and professional approach to dealing with information than I have experienced in the past and the onus is on me to ensure that I make the healthcare user fully aware of the ways in which their information will be utilised.
This involves an aspect of communication in gaining a user’s trust and giving them the environment in which they feel they can be listened to and that their opinion will be valued. By doing this I am building a trust and confidence relationship with the patient. Once I have gained the trust of the patient and now have this information which can be used to better their quality of life, I need to be aware of the strategies in place to protect this information from the public domain. The NMC Code sets out guidelines for the nurse to ensure that information is protected.
It requires the nurse to not discuss any information about the patient outside of the clinical setting, to not discuss patient’s cases in public places where it can be overheard and to not leave records unattended where they could be read by unauthorised people (ibid).
These also encompass the use of internet social networking sites among others; I think that a “public place” also includes an area of the internet which can be read by people not connected with the healthcare setting. These three principles will help to ensure that any information the nurse gathers will not inadvertently travel to sources outside of the care of the patient.
The Caldecott Report was a report carried out by the Department of Health about the use of patient information in the NHS with regards to confidentiality, especially in light of the increasing use of information technology. The report identified strategies that should be in place in healthcare settings to protect information (DoH, 1997).
The Essay on Importance of patient confidentiality
... in place for confidential health information collected, maintained, used, or transmitted in electronic form. Patient confidentiality can be avoided if healthcare providers remain professional at ... a breach of confidentiality. This means patient records can be disclosed to a third party, without patient consent or court order, of private information that ...
These included using the NHS number as an identifier instead of the patient’s name, using the least amount of identifiable information, educating healthcare professionals on the responsibility of holding such information, etc.
A lot of the recommendations in the report are about ensuring the patient’s identification is kept separate from the details about their healthcare or keeping identifiable information to a minimum in case of inadvertent transfer. The protection of the patient’s privacy is paramount and the report sets out to help healthcare professionals ensure they maintain this privacy. Healthcare professionals have a duty to record data relevant to the patient for various reasons such as justifying decisions made, helping keep continuity of care consistent, to document delivery of care, etc.
These records however need to be handled with exceptional care to ensure that they are not a source of leaking information. For this reason the NMC have strict guidelines as to how the records should be made and kept. The records need to be legible and signed and dated and held in accordance with the NMC guidelines and individual Trust’s instructions (NMC, 2009).
There are areas though that confidentiality is considered a lot more important due to the nature of the health problems.
My mother worked in sexual health for years and she emphasised the necessity of complete confidentiality in that area due to the “unseen” aspect of the health problems. It fascinated me as to how serious the implications of breaching a confidentiality could be in these situations, especially with public perceptions of certain sexually transmitted infections. A study done by Richard Ma on sexual health clinic users found that confidentiality within the sexual health clinics was the single most important quality to the user (Ma, 2007).
He claims that this is a consistent finding in previous studies done on sexual health and goes to support the idea that sexual health is an area that requires more attention to confidentiality between users and practitioners. The Department of Health have issued documents with regards to confidentiality and have specifically singled out sexually transmitted infections as needing to be treated with even more care with regards to the identity of the patient (DoH, 2006).
The Essay on Confidentiality Of Individually Identifiable Health Information
Criterion A: Describing the issue The misuse of private health care information can cause discrimination against others in society. Nowadays we trust and depend upon the medical professionals to secure our private records. The computer revolution has made the process of transmitting information convenient, thus allowing our family secrets to travel from our family doctor to hospitals to insurance ...
There are cases however, when confidentiality needs to be breached, even in the case of sexual health.
From my own experience and background in education and youth work, I understand the need to divulge information especially with regards to child abuse. It is the primary reason that confidentiality was not assured with the young people I worked with. From the NMC’s Code, I learn that it is similar within nursing practice. There is a clause under the confidentiality section which instructs nurses and midwives to disclose information when someone may be at the risk of harm, as long as it is in agreement with the law of the land (2008, op cit).
Although this instruction can be applied more broadly than I previously used it, as it would include all adults, not just young people. Even broader than the scenario of child abuse however, is the issue of illness affecting judgement and therefore putting people at risk, such as the case of politician Mo Mowlam. Castledine talks about how Mowlam’s brain tumour affected her judgement and personality and how the doctor’s hand were tied as Mowlam refused to divulge that she had such a life threatening and personality changing illness when she entered into the Good Friday peace talks with Northern Ireland (Castledine, 2010).
The issue Castledine raises is that thousands of lives could have been at risk if the Good Friday peace talks were not successful and it would not have been sensible to allow someone to be involved who could potentially harm those talks. In this case, the doctor did not divulge but I wonder, as a healthcare professional, how easy it would be to interpret the NMC rules and how thin the line between breaking the code, and therefore the law, and supporting it would be. From reading up on the subject, the boundaries do not seem to be clear and Betty Lynch confirms this in her guidelines to breaching confidentiality (Lynch, 2006).
She states that it is not always easy to know when to breach confidentiality and so she directs the reader to five questions that would aid in whether breaching the confidentiality would also be breaking the law. These questions include whether to gain consent, the reasons behind disclosing, what is to be disclosed, who will be receiving the information and are they duty bound to keep it confidential, and finally whether disclosing the confidential information is a proportionate response to protect the patient or others.
The Essay on Hipaa Compliance Patient Information
HIPAA Compliance If you are in the healthcare industry, you have probably heard some rumblings about the Health Insurance Portability and Accountability Act of 1996, coolly referred to as HIPAA. The word is your medical practice will have to be HIPAA compliant by April 2003, but you " re not exactly sure what this act mandates or how to accomplish it. In very basic terms, HIPAA has two primary ...
Lynch is dealing mainly with the sharing of information between agencies, but the guidelines can be used in dealing with situations as a healthcare professional to ensure that when confidentiality is breached, it is being breached legally and in line with the NMC Code. In some situations however, the consent of the patient cannot be given. Such cases are usually to do with a consideration of public safety and taking into account the broader ramifications of the information and whether it concerns more than just the patient (2012, op cit).
There are also laws dictating what has to be disclosed and it is usually with regards to the Road Traffic Act, terrorism and public health issues. As a healthcare professional, I have no choice whether I disclose a confidentiality related to such issues but there are some cases where it is not so clear. Take the controversy caused by Margaret Haywood, the nurse who tried to report failing standards through the proper channels and in the end resorted to filming the practices of fellow healthcare professionals in a care home.
The NMC struck her off the register for breaching patient confidentiality (Nursing Times, 2009) because they claimed that she had failed to get the consent of the patients that she was filming. However, there was support for Haywood’s actions as it highlighted the substandard care of the elderly. Higginson (2009) writes that exposing the mistreatment of the elderly is more important than being confidential. It is support like this and others that has helped to reinstate Haywood into nursing.
However it does concern me that should I be working in a place where patients were being harmed or neglected I would be unable to help because of the fear of breaching confidentiality and the backlash against me. Confidentiality is a delicate subject and seems incredibly difficult to manoeuvre around to ensure that, as a healthcare professional, I do not unnecessarily breach a confidence and yet, I also divulge the correct information to the correct people. However, I can fully understand the need of the laws and NMC to insist upon almost absolute confidence.
Reading about the case of “Janet”, the nurse who divulged information about a patient A in an unsatisfactory manner to the family and made unfounded remarks to A’s friends about her condition, I realise how damaging and hurtful breaching a confidence is and could have contributed to the rapid decline of the patient’s health (British Journal of Nursing, 2005).
This just emphasises once again, how much power I hold over a healthcare user and how much responsibility comes with that.
Moving from an education background into a healthcare future is revealing some similarities and a lot of differences as to how things are done. The issue of confidentiality piqued my interest as it seemed so different in the two settings and yet, I had expected it to be a lot more similar. I think that I laboured under the false assumption that confidentiality was only assured between doctor and patient and in sensitive subjects such as sexual health. I did not expect that confidentiality would be so important for the nurse or healthcare assistant in dealing with simple and routine procedures.
I have discovered that confidentiality is of the utmost importance throughout healthcare and is given the strictest guidelines in various healthcare codes of conduct. I have learnt that there are stringent practices to ensure that confidentiality is not breached and that data is completely protected. Looking into the various laws and acts regarding protection of privacy reaffirms its value and importance with healthcare users as well as healthcare authorities.
I have never worked in a healthcare setting and so learning the strategies that protect patient confidentiality is an important learning curve for me. I need to ensure that I hold the NMC guidelines foremost in my mind as I work with healthcare users and make certain that I adhere to the rules set out by the hospitals or care homes I am working in. When I first started working in education I had to make a point of familiarising myself with procedures and rules within my place of work and I need to take this forward and continue the same practice in the placements and work places I will find myself in.
This means talking to the supervisor or manager with regards to their policies on confidentiality and following those rules alongside the NMC’s Code rules. I also must ensure that I learn to judge when confidentialities must be breached and remember to include the patient as much as possible with the decisions I make regarding this. I intend to look further into this subject and make it one of my highest priorities to get this part of my studies and future work as a nurse right so as to keep faith with healthcare users and provide them with the best healthcare experience I possibly can.
