Ethical question

[Bluecap]

If a patient is admited to hospital and indicates to the RN that they are HIV positive - but it is not recorded in the patient's charts and the patient asks the RN not to disclose this information to anyone (because of previous discriminatory practices against her) - what is the position of the RN from an ethical and legal position?

[spydercadet]

a pt's medical history must be complete and the hiv positive status can be pivotal in the decisions about the treatment plans her physician's will make. in the u.s. we have laws that prevent the transfer of health information to unnecessary personnel and visitors. patients can determine whether friends or family members can know about their illnesses; but to admit a patient into the healthcare system and not note this diagnosis can be very detrimental to her. i guess i'd try to explain to the patient that you'd do everything in your power to make sure the diagnosis goes no further than those who need to know. try to explain how important it is for the medical and nursing staff to know so they can look for any signs or symptoms that indicates a change in his/her hiv status. also, you may want to find out about who has discriminated against her; in america that would be illegal. how about social services? can they help her with managing and maintaining good relationships with her physicians while making sure her medical information remains hers?

[Sabby_NC]

I agree with Spydercadet. I am sitting here wondering if she has really had any proper counseling? I am so sorry she has been on the end of discriminatory actions against her.

No matter how she became infected with HIV she still deserves the proper treatment and respect.

I pray Bluecap that you are able to make a difference in her life and outlook while this person deals with HIV in a healthier way.

[TDub, MSN, EdD]

It seems like it would only matter to the pt in the case of changes r/t her disease. It wouldn't matter to the staff because they are treating everyone with universal precautions (or should), so they won't be exposed. In the case of a needle stick or other exposure, the patient is tested anyway, whether she discloses her HIV status or not.

So all in all, the only person who needs to know is the person taking care of her that shift, the number of which is kept to a minimum with continuity of care and then her primary physician.

IN THE REAL WORLD......

I have no idea. The above should be all that's needed but you know gossip's going to get around, someone's going to pitch a fit because they weren't told, the pt never has the same nurse or doc twice and something's going to fall through the cracks.

Our hospital's response has been to have the HIV status in the records, but it's not accessible by just anyone. The person looking it up has to attest they need to know it, and their presence in the records is noted. It doesn't stop people from knowing, but it does provide a way to track people and hand out punishment for violating pt confidentiality.

Just recently some people were fired and some also disciplined for peeking at George Clooney's records when he broke his arm. And that wasn't even HIV status, just looking up his childhood history of mumps or something. There are many rumors flying around; the number of people varies between a dozen and 40, some accounts have them just peeking, some have them selling his info on the net, giving out phone numbers, people were fired, suspended, fined, scolded, but all stories agree that doctors and nurses are involved. It wasn't only ancillary personnel.

Evidently he asked "while I believe in a patient's right to privacy, I would hope that this could be settled without suspending medical workers." That's a lot more forgiving than I would be.

[al7139, ASN, RN]

Hi,

I have had several patients who were HIV positive or had AIDS. In some cases they found out while in the hospital, and some had an existing history. Some were drug users (or in recovery), some weren't. In my hospital, if someone discloses they are HIV/AIDS positive, we have to pass it on to the people who are caring for that patient (MD's, nurses, aides). No, they are not treated any differently than a pt not infected, but for our staffs safety, they need to know so they can be aware of how to care for that person safely. BUT, that information is confidential, and I reassure patients all the time that it will NEVER be disclosed without their consent to family or friends, but that the staff need to know their status. I recently had a pt who was elderly, and had contracted HIV through her husband who received a tainted blood transfusion many years ago. Her daughter did not know she was HIV positive, and this pt did not ever want her to know. We made sure that when we gave report to oncoming personnel to alert them not to discuss this when her daughter was present. She was discharged, and although her daughter was at the bedside for most of her stay, she never knew her mother's "secret." Our pts charts are kept where only staff can access them, and we question anyone that we don't recognize asking for access to the records, even if they are wearing hospital ID. The privacy laws are there for a reason. We, as nurses need to know sensitive information, but noone else does, no matter who they are.

Amy

[TDub, MSN, EdD]

I see what you mean and before, I would have preferred to know whether or not someone is HIV positive, but our hospital's position is that the caretakers really don't need to know. If they were exposed, then the questions was moot, but up until then...

This is how they explained it: You are going to treat everyone with UBP, i.e. as if everyone was HIV+, so it doesn't matter. You aren't going to do anything different. I liked it that way. There wasn't any danger of blabbing, because you didn't know plus you didn't feel weird around anyone and didn't have to try to school your behavior around anyone, either. You never had to worry about making a mistake, remembering to use gloves with Mr. Jones because you ALWAYS used gloves with everyone, never thought back and went, "uh oh, shoot, was I wearing gloves when I picked up that chux pad?" etc. It was automatic.

I don't think we need to know. That goes for all things covered by UBP--Hep B and C, babeosis, viruses, syphilis, brucellosis, ebola and so on. Stuff we don't usually get: TB, measles, anthrax, stuff we don't use universal precautions for, we do need to be told so we can protect ourselves.