Confidentiality

**canoehead, BSN, RN** · Mar 20, 2001

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.

MollyJ · Mar 22, 2001

Canoehead, you have hit on something that we as nurses don't talk about enough. The last hospital I worked at developed an ED with a very open nursing station, a patient room that was actually behind the station and a window onto the nursing break room. All of this occurred in spite of our protests (even the ED docs). The stated theory behind these is that it created openness and accessibility. In actuality it deprived us of a place to go to process difficult situations, deal with our own emotions and implied that we didn't even have the right to a private and uninterrupted break. (If you knew the administrator, you would not mistake the message.)

Any you are right! It endangered patient confidentiality because their were so few places that you could retreat to to do charting or have a confidential but necessary private conversation with another staff member. The door for the patient room behind the nurses station actually sat a couple feet away from the doc's dictation desk. For those of you that work the ED, you know that SOME clientele enjoy the entertainment value of being an ED patient or being in the ED with patient designate of the evening and this was a prize room for them. Not much would move these folks out of the doorway so that they could survey almost the entire ED and listen in on happenings in the nursing station.

This post does not negate the true problems of patient confidentiality, but to administrators: You gotta help us out with this. This same hospital had "nurse servers" where the patient charts were kept in the hallway and many of the effects canoehead talks about happened. Nurse and doctor discussing case in the hallway. POOR hospital design can promote breaches in confidentiality.

kjmta57 · Mar 23, 2001

I work in a max prison so confidentiality is a real political issue right now especially since alot of inmates we deal with do alot of gassings(throw urine,feces,blood on staff)Basically I tell the staff that you treat all of them as if they were positive and use universal precautions at all times.But the inmates have the same rights as a patients in the hospital in that the staff has no right to their medical history. But what is scary is over 52% of inmates randamaly tested have shown positive for hepititis c.

HotSpam · May 2, 2001

kday - 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."

I know I used to get that a lot too. I still do occasionally with hospice care. I have to say though I am glad you say you deal with it politely.

Often people do not know how seriously the industry takes confidentiality. It disgusts me when I hear a nurse being short, curt, and matter-of-fact when someone calls for an update. They also don't know just how busy nurses are.

I still call various hospitals regularly for info on patients I am going to see for hospice and ask for faxed info. Often the nurse on the floor will spill it right there on the phone without a second thought. tsk-tsk

HotSpam

**canoehead, BSN, RN** · May 2, 2001

I also spend some time in the ER and especially during busy shifts families loiter in the hallway, listening to talk at the desk, and peeking into treatment rooms. Generally the ones that are this obnoxious are also the type to challenge us with "but that's my mother/son/friend!" It is most common when the waiting area is full, and waiting time is long.

I especially hate the clients that demand to know why they have to wait so long. We can't very well tell them that bed 1 is having a heart attack, bed 2 needs three people to hold them down for a treatment, waiting for labs on beds 3 and 4, and the empty room they see is waiting on the ambulances bringing in an MVA. They just see one area with the curtain closed and empty bed and a nurse sitting waiting at the desk to triage or the ambulance. :mad:

pamclpn · May 22, 2001

Originally posted by mindil:
Hello,
I am a first year student in nursing at university and have an assignment to write an essay in which I have to discuss one or more issues of communication in nursing. I have chosen to write my essay on confidentiality as an issue in nursing. I would love any ideas, suggestions, stories etc that anyone would like to share with me, either on the board or to my private email address that would give me an insight as to how you see confidentiality as an issue in nursing?
Thanks

I have a for instance. On payday most of us at our LTC go to the local grocrey store to cash our checks. While standing in line waiting to cash my check a CNA at my facility called over to me "hey pam did you know that the state was in today." I replied "no." She proceded to tells the whole store about a med error that one of the supervisors had made that the state had picked up. She used the supervisiors name and the residents name in the conversation. The line was long and she wasn't whispering either. I then told her she shouldn't be talking about residents in front of other people. Another CNA disgusted by her behavior went and told the DON and all that aide got was a verbal warning if it was I who had did that (not that i would) I would have been terminated. It's in our policy that any breach of confidentiality will be met with termination.

Nottanurse1 · May 22, 2001

I totally agree with Jenny P on nurses reading patient's charts that they shouldn't. It is none of their business what so and so is in for if they are not their nurse! My husband's ex wife looked up one of my family member's med records then went home and told my step kids about how "crazy" this patient was (due to pain med withdrawls). When family first checked into hospital, we were assured that ex would have no access to records since family was on a different floor! Not so! Since then family member refuses to stay overnight at this hospital and has needed to several times. Our family gave her the benefit of the doubt once but will never trust this hospital or her again. If we had been smart we would have insisted she be fired but as most of you know, she will do herself in soon enough!

lpnandloveit1 · May 26, 2001

confidentiality is one of our hardest and most important duties. I work in home care and confidentiality extends from just the patient to the family, family life etc. one agency I worked for would not even let us give family the address. they asked if we needed to get dropped off the have the driver drop us off at the end of the block. Of course for the night nurse this causes a safty issue and I managed to get a signed letter from the family allowing me to give my husband the address.

nurs4kids · May 26, 2001

Originally posted by Jenny P:
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.

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?

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 · May 26, 2001

Originally posted by nurs4kids:
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?

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 · May 26, 2001

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.)

MQ Edna · May 29, 2001

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