patient confidentiality

**canoehead, BSN, RN** · Nov 3, 2003

I think that we are kept well up to date, and are actually an information source for other hospital workers. I've usually had more issues with family wanting to know more than I can tell them, or if the doc speaks to the family they sometimes want us not to tell the patient. Then we are stuck sidestepping the patient's questions when they really have a right to know.

BarbPick · Nov 3, 2003

Since April 14, 2003, Hippa became federal law. You are missing the boat confusing nurses becoming infected with God knows what and patient confidentuality.

We practice universial Precautions. Where are you in your nursing education that you are not aware of such things?

I suggest you read this link: http://www.nclnet.org/healthprivacy/

luckylucy · Nov 4, 2003

I don't think that you fully understand my meaning. If a patient has a respiratory problem, you don't know if it is SARS or TB. I have several RN friends that has been working in the ER for 20 years or more, they all talk about things like this. They have also told me that they have seen doctors and nurse get in trouble for disclosing too much about a patients medical history. I hope I am making more sence. I know that everyone is supposed to use precautions, but sometimes you don't have time or the hospital has buget cuts.

**canoehead, BSN, RN** · Nov 4, 2003

Our charts are marked if the patient has an illness that would be a danger to staff on the next admit. MRSA and c.diff patients are isolated every time they come in the hospital. Plus, handwashing alone will take care of 80-90% of the bugs we come in contact with.

When you are talking about disclosing too much information, I still don't get it. The patient has a right to as much information as they can get about their illness. When talking to family we ask the patient's permission first, and then try to have the conversation with the patient there so they know exactly what was said. If the patient doesn't consent to sharing information then the family doesn't get anything from us.

luckylucy · Nov 4, 2003

I see. If the doctor knows that a patient has something, is he allowed to disclose that information before the nurses start careing for the patient? I ma under the undrstanding that the doctor can't. A friend of mine explained that there has been several situations that she has been put in, example: She put a patient on a reperator and the doctor did not tell her they suspected SARS. When the tests came back possitive for SARS that was when the docs finally put it into the charts. There was no issoation until the tests results came back. Therefore, everyone that was in the room has been exposed. She further explained that the docs are not supposed to tell the nurses of thier suspisions. Due to the patients right to confidentiality.

stevierae · Nov 5, 2003

Originally posted by BarbPick
Since April 14, 2003, Hippa became federal law. You are missing the boat confusing nurses becoming infected with God knows what and patient confidentuality.
We practice universial Precautions. Where are you in your nursing education that you are not aware of such things?

I suggest you read this link: http://www.nclnet.org/healthprivacy/

Barbara, you took the words right out of my mouth--I was about to respond to LuckyLucy's post by saying "2 words--UNIVERSAL PRECAUTIONS!!!--"

Then I saw that you had beat me to it. :chuckle

Patient confidentiality is an entirely different issue. Do read up on HIPAA, as suggested, LuckyLucy--it is that important.

stevierae · Nov 5, 2003

Originally posted by luckylucy
I see. If the doctor knows that a patient has something, is he allowed to disclose that information before the nurses start careing for the patient? I ma under the undrstanding that the doctor can't. A friend of mine explained that there has been several situations that she has been put in, example: She put a patient on a reperator and the doctor did not tell her they suspected SARS. When the tests came back possitive for SARS that was when the docs finally put it into the charts. There was no issoation until the tests results came back. Therefore, everyone that was in the room has been exposed. She further explained that the docs are not supposed to tell the nurses of thier suspisions. Due to the patients right to confidentiality.

Nurse are not stupid, and doctors and nurses work as a team. Reading the chart, careful nursing assessment, and good communication among all team members ensure that one would know a patient's diagnosis, even if it was NOT revealed outright--

(i.e., I remember back in the very early '80s when "AIDS" written on a chart was taboo, mostly because the disease process was poorly understood--indeed, HIV had not even yet been identified as the cause--but the diagnosis was obvious to one and all simply by other descriptive wording that was used in lieu of writing "AIDS"--and it was done not to keep nurses in the dark, but because there was a stigma attached to it at that time simply because it was not yet understood, and PATIENTS did not necessarily want their diagnosis known to those who did not have a need to know--we have moved on from those dark ages as we have become educated about the disease and adopted universal precautions--we no longer have to calm hysterical housekeepers who think that breathing the air in the room of a patient that they had certain preconceived notions about was going to infect them with a fatal disease--)

I cannot think of a situation today in which a diagnosis would NOT be revealed--the patient is in the hospital in the first place for treatment--and a treatment plan cannot be arrived at, and implemented, without a diagnosis and subsequent collaboration.

Infection control is another resource to contact if a nurse is somehow feeling that she has been "left out" of critical communication--but, again, we are part of the team--I have never seen that happen. We need the info to make our OWN nursing diagnoses and to implement our OWN care plans. There would be no purpose served by a doctor leaving us "out of the loop."

indie · Nov 6, 2003

In a similar vein to the last posting; in the 1970s when TB was suspected, but we did not want to label the door to the room we had notices stating "all visitors report to nursing station" and "AFB" (acid fast bacteria) in small letters. Even then there were ways of protecting nurses, visitors, and the patient's privacy.

Even then, before Universal precautions, health care staff were immunized, masks were available and there was great attention paid to handwashing. If 'budget cuts' reduce the availability of protection (as you imply), a professional nurse is required by the Nurse Practice Act (in most states I believe) to report this as this compromises not just the nurses' health, but the patients'.

It seems as if you may have 'friends' who are trying to sensationalize their work as 'nurses' and dramatize the risks. The profession is not risk free, but professional nurses try to maintain professional perspective for everyone's benefit.

As a team, we work on the diagnosis keeping many of the 'worst case scenarios' in our minds. If a respiratory nurse puts a patient on a vent in the middle of the SARS outbreak and has not kept that possibility in mind, I question his/her skills.

I'm not a resp. RN, but what is the protocol for a new, undiagnosed patient going onto a vent? Does it include wearing a mask? To relate to my own specialty (peds) we have protocols for undiagnosed rashes, fevers, or meningitis etc which protect the patient's privacy and the staff and other patients.

As with other posters, I refer you to HIPAA guidelines. I also suggest that you clarify your paper's objectives to yourself before you begin to collect material or write. If you take your first statement 'patient confid. and how it affects the nursing staff' then HIPAA covers it all.

The 'effect' is no loose talk, no notes with patient ID on them, reporting only to those who need to know, shredding of IDd docs etc. A little more time on paperwork, but I challenge that there is any effect on disease risk which is where you seemed to be heading.

We all sound a bit brusque in our responses; I think we all mean to keep you on the right track. Hope this helps.

luckylucy · Nov 6, 2003

I really do appreciate all of the help you all have done. I guess that I am not as "smart" as I thought on this subject. I am going to write my paper, but with HIPPA as my back up. I will write about the amount of paper work that it has caused and so on. I think it will be a good paper. Thank you once again for all of your input, God Bless everyone... LL.. :imbar

stevierae · Nov 6, 2003

Originally posted by indie
We all sound a bit brusque in our responses; I think we all mean to keep you on the right track. Hope this helps.

Yes, Lucy; I in no way meant to come off as brusque, and hope that you did not take my response that way.

Just trying to be helpful and making sure you understand the differences in the issues. I wish there had been a BB like this around when I was a student nurse. We have all been there, and know how overwhelming it can be to have to write a paper and not know where to start--especially when the waters have been muddied by anecdotes and "the gospel according to our nursing instructors" to the point where you one is unsure what is evidence based practice and what is not.

stevierae · Nov 6, 2003

Originally posted by indie
The 'effect' is no loose talk, no notes with patient ID on them, reporting only to those who need to know, shredding of IDd docs etc. A little more time on paperwork, but I challenge that there is any effect on disease risk which is where you seemed to be heading.

This is a really good and important point, indie!!! Lucy, you will see more signs in elevators that say "Respect patient confidentiality. Do not discuss patient care in public areas."

Nurses will be more careful about discussing their patients with other nurses while having lunch in the hospital cafeteria. Who know who that is sitting across from you, hearing every word? Who knows what that person would do with that info which should have never left the unit?

I used to teach IV nursing in various facilities, and was always alarmed when I picked up a piece of scratch paper, or saw documents that had been copied onto the reverse side of another patient's discarded records, as a way of recycling.

I commend their efforts to recycle, but there could have been info on the reverse side of those documents that a patient might have preferred remain on a "need to know" basis.

Hopefully, HIPAA compliance has put a stop to this practice.