[nurs4kids]

Originally posted by Jenny P:
<STRONG>Another breech of confidentiality is when one nurse reads a patients' chart when the patient isn't assigned to them. This is one of those things that most of us don't even realise or consider when we speak of confidentiality. If it isn't your patient, why are you in the chart? And it can be a big problem, especially when you have computerized charting without enough limits on who has access to the chart.</STRONG>

This one confuses me, Jenny. We work a 20 unit med surg with 4-5 RN's. Pretty much we work as a team. We listen to report on all 20pts. When a patient codes, we all respond and need to be utd on pt. How on earth is it breech of confidentiality for me to know what's going on with another patient on the unit? What if the nurse is off the unit and the patient has a need? If this is the case, then what about nursing students? Technically the patient isn't their responsibility, right?

<scratches head> i just don't see this one.

I do agree with notta, that it should absolutely not be used in the manner she described. I actually had a friend from HS who went in for a cholecystectomy and found out he was HIV+ at this time. A scrub TECH in the OR who knew him passed this info throughout the community. I encouraged him to call administration and/or a lawyer. He didn't, but 13yrs later he jokes that the money from a lawsuit sure would have helped cover his massive drug bills. He's a lot nicer than I would have been!!

[ May 26, 2001: Message edited by: nurs4kids ]

[Doc]

Originally posted by nurs4kids:
<STRONG>
This one confuses me, Jenny. We work a 20 unit med surg with 4-5 RN's. Pretty much we work as a team. We listen to report on all 20pts. When a patient codes, we all respond and need to be utd on pt. How on earth is it breech of confidentiality for me to know what's going on with another patient on the unit? What if the nurse is off the unit and the patient has a need? If this is the case, then what about nursing students? Technically the patient isn't their responsibility, right?

</STRONG>

I've got to agree with nurs4kids here. That information is already given in a lot of places to all staff during handover. It is necessary to know what the patients' problems and general history are, whether you can resuscitate them or not and whether they are NBM, etc so that if the nurse looking after a diabetic patient is not in the room and you see the lunch lady handing him the wrong meal, you can stop a potentially dangerous situation. Quite often a nurse or nurses aide does the obs for the whole floor or half a floor. If the obs are out of normal range she needs to know the pt's history so she knows if she needs to report the obs or not. Or during meal breaks when another nurse has to cover for you, they are then responsible for the pt and need to know their history. The nurse in charge also needs to be in the know about every patient on the floor. And there is the code situation, as nurs4kids pointed out.

Nottanurse's story about the nurse who looked at the notes of her ex-husband's new partner who was a pt, to find 'ammunition' on her, shows where the line is drawn. We need to know a certain amount of history to do the job and to be able to take on a code, prevent disasters, to responsibly be in charge of the floor, and to cover for someone on a meal break. But that doesn't mean we should pry into the depths of someone's history (especially sexual or psych history, but all medical information could be just as sensitive) for no plausible reason. And to disclose it to your family or friends or in front of others using the pt's name (or room/bed number) is a definite no-no.

The example that fergus mentioned about taking a sexual history in front of the mother is also an example of a breach of confidentiality. It is always good policy to assume someone is uncomfortable talking about their sex life in front of someone they know. This also applies to other things besides sexual history - drug/alcohol history is one of the many that springs to mind. The problem is that when you tell the mother that you would like her to leave because you are taking a history, she may say "oh that's ok, she tells me everything". Then when you insist you create a conflict where (no matter how it turns out) the mother feels you have insulted her as a parent and you will loose her respect. The way I say it is: "Can you leave the room now, Mrs Brown, I need to do an assessment." Calling it an assessment mystifies it to some degree, helping you to protect the pt's confidentiality and achieve privacy by better effecting the removal of the parent from the room in a dignified way.

As for the original query by the nursing student, I suggest she also differentiate between privacy and confidentiality.

Confidentiality generally involves words or information. It is protecting a pt's history, diagnosis, prognosis and other findings from reaching any parties that don't need to know or whom you don't have the pt's consent to disclose the info to. It is acceptable to disclose the info to other members of the team who will be looking after the pt. There are legal guidelines to confidentiality. For instance, confidentiality allows you to disclose the information if it is subpenaed. If the pt tells you they are going to harm themselves or others, you have a legal obligation to report that, which comes before keeping the patient's trust.

Privacy is broader than this. If you disclose information under legal obligation you have broken privacy, but not confidentiality. Privacy also includes more than information or words. For instance, drawing the curtain around the pt when exposing their body or when they are in a teary mood, or preventing people from walking into the pt's room unless the pt wants to see them - the pt has a right to be left alone which comes under privacy.

[fiestynurse]

You may want to check out JCAHO's standards on this issue. Confidentiality and privacy is a BIG deal when they do their surveys. For instance, they do not like to see a patient's name visible to the general public anywhere in the building. This means no names on doors, no bed boards in view, no papers or charts with the patient's name on them laying around where people can see them, no computer screens in view with patient info on it, etc. Many organizations have hired Shredding companies to assistance them in the disposal of confidential materials. In addition, they require that all employees sign a confidentiality statement on a yearly basis. It is also important to include this in the new employee orientation. Confidentiality is about protecting a patient's privacy and much of it is common sense. (ie:closing doors, pulling curtains, keeping your mouth shut, etc.)

I just have to add my own story here. Before I entered nursing school I worked as a monitor tech in ICU in a small, community hospital. The kind where everyone knows everyone. One of the nurses I worked with had a grown son, late 20's I think. When people she knew where in the unit, she would tell her son. He would come in and eat lunch with her and she would tell them what was going on. Once, he even went to the door of a pt's room and stood there for a while, looking in!!!

If I had known then what I know now about confidentiality, I would have been in our supervisor's office so fast she wouldn't have known what hit her. My bad.

The stories I could tell about the horrible things this particular nurse has done!

Laura

[bigjay]

Here's a good one about poor judgement on confidentiality.

My wife is a public health nurse who sees new mothers and babies and also deals with pregnancy issues. She got a case, 16 year old girl, 17 weeks pregnant, family upset and would like to discuss options. She makes an appointment and goes to the address she's given. Turns out to be the wrong address. She phones back, leaves a message for the girl to call her back. Calls back again, gets the girl's brother who tells her that his sister will be back in an hour or so. My wife asks for the address. It's our next door neighbours (we're new to the area, don't know everybody's last names yet).

Needless to say, my wife moves the case to another public health nurse. The girl left her (my wife) a message that she had had an abortion. My wife passed this on to the nurse seeing her. Today she found out that this nurse left a message on the family's answering machine telling them she had got the message about the abortion and layed out the symptoms and difficulties that could follow. Their office got a very angry and justified call from the girl's father as his two other boys who didn't know about the situation had heard the message. Ouch!

Anyway, just goes to show that some nurses just don't think enough about confidentiality.

Cheers,

J-P

[lpnandloveit1]

just a question who was concerned about confidentiality when your wife told the story. she shouln't have

[bigjay]

Ouch, good point....

[Sue D]

It's a very difficult issue. I work on a reconstructive/plastic surgery unit and we recently had a patient admitted for a bilateral breast augmentation. She insisted that her husband should not be told about the nature of her operation and had, in fact, told him that she was in hospital for investigation of possible breast cancer.All the staff found it very hard to uphold this lie as the husband was extremely distressed at the prospect of his wife having cancer.
We had no choice but to withold information from a genuinely concerned relative.
What could we do? despite all arguments the patient insisted that we did not tell her husband and we had to uphold that right.

[fiestynurse]

Some other areas to watch out for concerning breaks in confidentiality are messages left on answering machines and faxing information about patients to doctors, insurance companies, etc. When faxing make sure that you use a cover letter stating that this is confidential and dial the phone number very carefully. I sometimes ask patients if it is o.k. that I leave a message on their machine regarding their test or whatever.

[nbicurn]

I work in a newborn ICU. We have parents step out during bedside report between the nurses to help maintain confidentiality. Unfortunatly, the physician rounds are done at the bedside, and then the neonatologists dictate into their portable dictation machine at the bedside, with parents and many other visitors in the room. This is a BIG problem in our unit and we are attempting to deal with it. The neo's say that it's ok, because they have to dictate and the other parents will hear the stuff any way, but I don't know. Two biggies that were "mentioned" during rounds (in front of other parents) were, "This mom is a prostitute" and "this is the baby the mom attempted to abort and failed."