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  1. John Cotter Privacy and Confidentiality

  This discussion post will review confidentiality and privacy in our role as Nurses. We will define privacy and confidentiality and discuss the case study in our course book (Ethics & Issues in Contemporary Nursing)Privacy is the right of an individual to decide what happens to their personal information; confidentiality is an ethical obligation to protect that privacy, (Burkhardt & Nathaniel 2014).The case study requires the nurse to evaluate if the patient’s right to privacy is superseded by the nurse’s obligation to report abuse of a minor. Privacy and confidentiality are the primary ethical principles that need consideration in this case study. However, other ethical principles such as respect for autonomy, advocacy, beneficence, nonmaleficence, veracity and fidelity need also to be considered in part or full.Both choices -the choice to maintain or the choice to not maintain confidentiality- have potential negative outcomes. If the nurse chooses to respect the patient’s privacy, the patient is at risk of further physical abuse. If the nurse choses not to maintain the patient’s confidentiality, the patient’s father could face criminal consequences and the patient will lose trust in medical professionals. The nurse is required to advocate for the patient, but again, does that mean respecting the patient’s right to privacy or protecting the patient from further abuse? Beneficence, the principal of doing good for the patient, along with nonmaeleficence, the principal of preventing the patient from harm, are ethical obligations to be considered also. In addition to ethical principles, the nurse must also balance the federal law on patient privacy -HIPAA- with state law on mandatory reporting on abuse of minors (psa-org). In Pennsylvania, the state requires mandated reporters to report abuse when they become aware of actual or potential abuse of a minor (ACLUPA, 2019). The Child Protective Services Law. identifies a nurse as a mandated provider in Pennsylvania. The patient in this case study is still a minor. If the patient were 14, the actions of the nurse would not differ; the patient in both situations is a minor. There is the concept of “emancipated minor” in Pennsylvania. This is where a person under the age of 18 is treated as an adult. But the patient in this case would not be considered an emancipated minor based on current law in Pennsylvania.The options for the nurse in this case study are twofold. The nurse reports the abuse as mandated by state law or the nurse does report the abuse and maintains the confidentiality of the patient. The consequence of reporting the abuse are that the patient loses trust in health care providers, is separated from her family but is now safe from physical and sexual abuse. The consequence of not reporting the abuse is the patient risks further physical and sexual abuse and the nurse and her employer can be criminally and/or civilly prosecuted for non-reportingIn my professional experience, I have not faced ethical choices as difficult as those in this case study. Primarily, I would be maintaining the privacy of patients when providing wound care. As would be standard in any facility, I would draw the curtains and explain to the patient what the wound care would be. I would sometimes get inquiries from other patients about why a roommate had gone to the hospital; I would offer a generic answer without specifics. One situation I observed was that of an elderly gentleman with multiple chronic conditions. The patient was regularly being sent to the hospital from the nursing home for treatment. One day, while the patient was being transported to the hospital, he said “Why are you doing this to me?”. The patient was in the early stages of dementia, but I felt he was capable of still making or giving input on his healthcare. I mentioned what I observed to the unit manager. The unit manager told me that the patient’s son was his power of attorney and wanted his father to be full code and everything possible done for him. There had been multiple discussions with the son and his several siblings about the option of palliative or hospice care. But the family did not want palliative or hospice care for their father..In this case study, the autonomy of the patient does not outweigh the nurse’s responsibility to report the abusive situation. The evidence shows that the abuse is ongoing and is likely to happen again. The nurse has an obligation under state law and under the ICN Code of Ethics for Nurses (2006) to protect the patient from harm (Burkhardt & Nathaniel, 2014). Nurses need to understand their ethical and legal obligations of confidentiality under Federal and State laws and those of their employer. The choice is difficult, adolescents have been shown to be less likely to seek healthcare if they believe their confidentiality is not respected (Pasternak, Hawkins & Schumann, 2019). However, the choice in this case, is to report the abuse of the patient.ReferencesBurkhardt, M. A., & Nathaniel, A. K. (2014). Ethics & issues in contemporary nursing. Fourth edition. Australia: Cengage LearningPasternak, R. H., Hawkins, K. B., & Schuman, A. J. (2019). Adolescent privacy and the EHR: Adolescents are more likely to see a healthcare provider if they are certain their private information will be kept confidential. Here’s how to create a secure environment for these patients within your electronic health record (EHR) system. Contemporary Pediatrics, 36(4), 50–53. Retrieved fromhttps://search-ebscohost-com.proxy.library.ohio.edu/login.aspx?direct=true&db=rzh&AN=135791607&site=ehost-live&scope=sitehttps://www.pa-fsa.org/Mandated-Reporters/Understa...Confidentiality in Adolescent Health Care Nursing for Women's Health, Volume 21, Issue 6, 509 – 510 https://doi.org/10.1016/S1751-4851(17)30329-X

  
  
• 2 Vanessa Davis
  M3 A5 DB: Privacy and Confidentiality of the Patient
  Nurses are privy to personal information about their patients. Entrusting nurses with sensitive and private information creates a need for great responsibility on the part of the nurse to be judicious about when and with whom to share this patient information. The ANA Code of Ethics for Nurses and the CNA Code of Ethics for Registered Nurses both direct that nurses maintain confidentiality of patient information (Russell & Wade, 2009). Additionally, there are federal laws that mandate nurses maintain confidentiality. However, there are other laws that mandate reporting of information in certain situations, particularly for the promotion of public health, or to protect vulnerable populations (Russell & Wade, 2009). Nurses must use discretion and good judgment to balance multiple conflicting ethical and legal obligations.The terms “privacy” and “confidentiality” are interrelated. Privacy pertains to one’s right to control when and how personal information is shared with others. Confidentiality is to protect another’s privacy by not revealing that person’s personal information (Russell & Wade, 2009). Privacy is related to the principal of autonomy, because it pertains to a person making a decision about sharing their own personal information, allowing the person to maintain dignity and a sense of control. Confidentiality is related to the principal of respect, because the nurse is respecting the patient’s right to privacy. In the case study on page 77, To Tell or Not to Tell in Ethics and Issues of Contemporary Nursing (Russell & Wade, 2009), the nurse faces a complicated ethical dilemma, involving the principles of privacy, confidentiality, autonomy, and respect. A 17 year old patient reveals physical abuse by her father and stepfather, and asks for the nurse to keep the information confidential. Privacy is not absolute, and it is particularly important to protect vulnerable groups. The nurse has a greater obligation to protect the patient from abuse than to maintain confidentiality, and has an absolute duty to report child abuse (Russell & Wade, 2009). If the patient were 14 it would be likewise an obligation to report. The nurse has the option to make a report, or remain silent. It is difficult to know the outcomes of each action, but if the nurse were to report, there would likely be an investigation into the situation by the Department of Child and Family Services. Perhaps resources and therapies would be provided, or perhaps Lora would be removed from the home based on the results of the investigation. If the nurse were to remain silent, Lora would likely continue to live with her father and suffer physical abuse.The nurse is also putting herself at risk by remaining silent. In 2009 a nurse was arrested and charged for not reporting suspected child abuse. After an investigation, the nurse’s license was suspended by the Board of Nursing (Burkhardt & Nathaniel). Failing to report suspicion of child abuse is unprofessional conduct, and can result in legal action against the nurse. In this case, Lora’s autonomy does not outweigh the nurse’s responsibility to report the abusive situation, because as a minor Lora is in a protected group. While it may sometimes be difficult to balance conflicting ethical and legal obligations, it is imperative that nurses utilise good judgment and decision making when it comes to the issues of privacy and confidentiality. It is very important to earn the trust of patients by keeping information confidential, and nurses must utilise judgment to share patient information only when professionally needed. Nurses must also have the ability to make difficult decisions and when necessary divulge sensitive information in order to fulfil their obligation to protect innocent people. While it is sometimes difficult to navigate, staying informed about the laws, ethics, and principles of privacy and confidentiality will help nurses make these decisions in a way that upholds professional values.

  Burkhardt, M.A. & Nathaniel, A.K. (2014). Ethics & Issues in Contemporary Nursing 4th ed. Stamford, CT: Cengage Learning

  Russell, K.A. & Wade, R.A. (2009). When the Court Interprets Legislative Intent: Mandatory Reporting of Child Abuse. Journal of Nursing Regulation, 6 (1), 39-42