Confidentiality Dilemmas.....

[WannaBeNrse]

Hi,

I am working on an assignment for my ethics class (regarding confidentiality dilemmas), and I am really stuck on a couple of them. I've discussed them with classmates, too, but we cannot really come to a solution.

Here are the two situations:

1.) You're a home health nurse and your patient has active TB. As you leave, her neighbor approaches you and says "I hear she has TB....I spent all summer with her, can you tell me if I need to get tested?" What do you say?

I am pretty sure I'd have to maintain my patients privacy, right? But at the same time, I would want the neighbor to get tested, so what is a good response? The one I came up with so far, is "I'm sorry, I cannot tell you whether or not Mrs.------- has TB. But if you are concerned, why don't you have the test done, it's quick and easy, and many people get tested routinely, since you never know where you might come in contact with TB". Is this okay....?

2.) Your (adult) patient in the ER has bruises that are inconsistent with a fall. She says "Nobody laid a hand on me. Just fix me up and mind your own business". What do you say to her?

On this one, we are really torn. My friends think the suspected abuse has to be reported. I think as long as the patient is not a vulnerable adult, I have to take her by her word, otherwise I would suggest that she's lying, and that to me is an intrusion of privacy....also, if battered women have to fear that there is a report made when they go to the ER with their injuries, wouldn't that cause them to avoid seeking medical treatment? and that can't really be our goal, right? My response to her would be "If that is what you say has happened, I have to believe you. However, here are some phone numbers (to crisis centers). If there's anything you would like to talk about, feel free to call". What do you think?

Thanks!!

[RochesterRN-BSN, BSN, RN]

The first sounds good to me the second...well keep in mind you can always call a social worker and discuss this with her and ask if she minds seeing this patient. Giving a card with the number for ABW is always good. Bringing it to the attention of the doc as there may need tobe further questioning as sometimes these people end up with enough to mandate a psych eval....chances are she may have other psych symptoms....depression, anxiety, even Borderline PD.....or be abusing ETOH or drugs and need to be offered tx.

There could be more there so getting a psych or SW person to talk to the patient is a good idea. If this is an older adult sometimes you can call adult protective.