Confidentiality

I think confidentiality is a HUGE issue in nursing. I deal with it every day in the sense of having to defend my patients' rights to confidentiality from various friends/family members calling on the phone wanting an "update" on the patient's condition. It just amazes me that people have the audacity to think we give out such information. The one that cracks me up is when you refuse to give out information to them, and they reply back, "but I'm her mother/sister/best friend/supervisor!" LIKE I CARE. I can't check I.D. over the PHONE!! I politely tell them I cannot give out patient info over the phone, and offer to transfer them to the patient's room where they can ask the patient directly for an "update." Some are happy with that answer, some get irate and slam the phone down. Then of course, there's the issue of the patient admitted under an alias whose next door neighbor (oh, yes...you read that right...NEXT DOOR NEIGHBOR...not even FAMILY)calls to find out if the patient has been admitted, and when we say no, they get irate and scream and yell and say, "I KNOW SHE'S THERE!!" Well, obviously she checked in under an alias to protect herself from jerks like YOU is what I so desperately want to say. It's amazing how the general public thinks they should be privy to the patient's medical information, no matter who they are. Obviously, they've never been patients themselves. I'll step off my soapbox now.

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It is one of the most important things in nursing. How are we ever going to be seen as professionals when we go home and gossip about our patients.

I think the worst breach of confidentiality is when nurses disclose to parents information they don't NEED to know. One of my friends was in the hospital ER with what turned out to be appendicitis but they thought it could have been an ectopic pregnancy, so this nurse starts asking her about her sex life in front of her motehr. My friend was 17 at the time. I think that type of behavior is unacceptable.

Originally posted by fergus51:

It is one of the most important things in nursing. How are we ever going to be seen as professionals when we go home and gossip about our patients.

I think the worst breach of confidentiality is when nurses disclose to parents information they don't NEED to know. One of my friends was in the hospital ER with what turned out to be appendicitis but they thought it could have been an ectopic pregnancy, so this nurse starts asking her about her sex life in front of her motehr. My friend was 17 at the time. I think that type of behavior is unacceptable.

OH MAN!! That nurse should have been SHOT!! How inappropriate! I deal with grown WOMEN who still don't want their mothers to know they have genital herpes, had an abortion, etc.. IT'S NOBODY ELSE'S BUSINESS. I've even had patients who gave a baby up for adoption that no one knew about, even their own husband. I just don't understand how some nurses can be so insensitive. I'm sooooooo protective of my patient's confidentiality and privacy, that I just can't fathom anyone behaving any ohter way. The patient's health history and current medical condition is for the pt. and their direct care providers to know, PERIOD. Why do people have such a hard time grasping this concept? Obviously they've only been the one at the bedside, never in the BED. Fergus, I hope you let your friend know that all nurses are not insensitive jerks like the one she encountered in the e.d..

Another issue I have seen happen is a nurse explaining *why* a patient was on isolation, not just what the visitor needed to wear to go into the isolation room. I immediately counselled that nurse that it was a confidentiality breach but I know that probably wasn't the first time or first nurse to do that. If asked, our usual answer is that either we are protecting the patient from infection that may accidentally be brought in or there is an infection we don't want to accidentally spread or for them to take home to their family. When we explain how to put on the gowns, gloves and sometimes mask and that they can touch their family member after those are on, they are usually satisfied. If they have more questions, we tell them to ask the patient (adult floor obviously) who can decide to give them more details.

Another thing to watch for is going into one room and telling the nurse another of her patients needs something specific. Or calling down a hall to the nurse saying something like "Mrs. Example in 201 needs pain meds." These are little breaks of confidentiality that are missed in orientations where they warn you not to talk about patients in halls, lunchrooms, elevators, etc.

Thank you. I have been working for the past 10 years in a clerical capacity on hospital wards and have seen and heard so many instances of what you have described. I am now doing my nursing degree and I appreciate all of your input.

Sheree

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,-._|\Sheree

/ Oz *\ Gold Coast

\_,--. / Australia

v

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kday,

my friend knows very well all nurses aren't like that. Her mother is the best nurse I have ever met and one of the main reasons I went into nursing.

The ed nurse also dragged her across the room puking rather than getting her a bucket. It was a really bad experience for her.

Originally posted by fergus51:

I think the worst breach of confidentiality is when nurses disclose to parents information they don't NEED to know. One of my friends was in the hospital ER with what turned out to be appendicitis but they thought it could have been an ectopic pregnancy, so this nurse starts asking her about her sex life in front of her motehr. My friend was 17 at the time. I think that type of behavior is unacceptable. [/b]

There is no doubt about the nurse's need to know the information however I always felt that you should respect the client's privacy and get the history or at least ask the question in a setting where you wouldn't force the kid to lie to you SO generally I would walk these client's to the bathroom for the CCUA and do my focussed history there. It wasn't ideal (less than ideal privacy generally), but it avoided horrid situations like the above. Sometimes I would experiment with asking mother to leave the room so that I could finish the history if the kid was too sick to walk to the BR but it usually didn't make things go well for the teen when you left. (Mother hissing, "What did that nurse want to know?") Teens teeter on the cliff between childhood and adulthood and some times no one copes well with it.

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.

I am interested in this topic also since I will be starting school in August. Is there a web site or publication that clearly defines patient confidentality with examples, case studies?

Originally posted by Bonnie Blue:

I am interested in this topic also since I will be starting school in August. Is there a web site or publication that clearly defines patient confidentality with examples, case studies?

I don't know of any specific publications, with the exception of nursing ethics textbooks. Don't worry...the subject will be WELL covered in school. Which of your fellow colleagues choose to take the confidentiality lectures to heart and which choose not to, however, is a whole other issue. Good luck in school!

Molly, I think your solution is the best I have heard. And when I said "don't need to know" I meant the parents don't need to know. I think respecting teens confidentiality is the hardest.

It is difficult to follow guidelines on confidentiality when the med carts, and supplies are placed in the hall within earshot of patients and visitors. And once the policy is broken once it becomes more the norm to make necessary work communications in the hall.

Just a comment.