¶ … Professional Nursing
THE RIGHT THING TO DO
Two nurses are good friends to an in-patient. One of the nurses got so concerned with this patient that she accessed the patient's medical records and confided her findings to the other friend. Neither of them was assigned to the patient-friend and, thus, had no authority to access her chart. Nor are they blood-related to the patient. The first nurse faces the dilemma of reporting the violation of patient confidentiality or keeping quiet about it but sharing the violation with her. The guilty nurse promised never to repeat the act. The first nurse feels concerned with her as this is her sole source of living in support of herself and her two children. She is a single mother. The first nurse must decide correctly and fairly.
Three provisions of the American Nurses Association Code of Ethics apply to this case (ANA, 2001). Provision 3.2 on confidentiality is bound up with the patient's fundamental right to privacy. It is a nurse's duty to keep all patient information confidential. The patient's well-being and trust will be compromised when this rule if violated. It explicitly prohibits access to patient data or its inappropriate or un-authorized revelation to another person who has no right to the information (ANA).
Provision 3.5 of the Code on Acting on Questionable Practice mandates the nurse to be alert and take appropriate action on actions or practices by a healthcare team member, which compromises the rights or best interests of the patient (ANA, 2001). Her action should be based on this Code, professional standards, pertinent laws of the land, and the hospital or facility's policies and procedures. Her attention should be called about the violation and its potential detrimental effect on the welfare of the patient and the integrity of the profession. When such a threat exists, the appropriate next-higher authority should be informed. Appropriate procedures should then be implemented in dealing with the violation (ANA).
And Provision 3.6 of the Code on Addressing Impaired Practice (ANA, 2001) underscores the nurse's duty to protect the patient and extend assistance or support to a colleague whose practice may be impaired in some way. The troubled colleague may consult the appropriate supervisor or the nurse may help her to resources she needs in order to restore her to optimal functioning level (ANA).
The Principles and Legal Implications
Nursing Ethical Practices
One of these is confidentiality, which states that patient information entrusted to a health professional on-duty should not be revealed to, or accessed by, others who are not authorized or entitled to the information (Nursing Help, 2011). At the outset, this specific principle seems to apply to the case. The other nursing ethical practices are autonomy, informed consent, veracity, beneficence and non-maleficence, justice, paternalism, fidelity, respect for others and utility (Nursing Help).
Legal Principles
Nurses and other health professionals should show utmost importance to the principles of confidentiality and other public interests (Fullbrook, 2007). Common law embodies and mandates them. But in this digital age, confidentiality of patient information is difficult to keep and assure. Regulatory groups, like the Nursing and Midwifery Council, have devised new rules and guidelines to adjust to new trends in communication. These have been embedded in their respective codes of professional conduct. Some sectors have, however, suggested that rules and regulations on confidentiality may need to either expand or made more lenient as to securing, keeping, using and transmitting information (British Medical Association, 2005 as qtd in Fullbrook).
Interstate Practices and Regulations
Nurses are licensed in the state where they practice (Silva & Ludwick, 2014). Some of them have two or more licenses and apply for reciprocity in another state. States are changing their laws to adapt to trends. Countries, such as the United Kingdom and Australia, have regulatory licensing bodies for practitioners from other countries. Ethical issues have come up in the course of interstate practice. One of these is privacy or confidentiality. The others are non-maleficence, beneficence, autonomy, and justice (Silva & Ludwick).
The ethical principle on confidentiality prohibits the sharing of patient information with anyone without the authority or for un-intended purposes (Silva & Ludwick, 2014). A patient's confiding personal information with a nurse or another health professional equates to a duty on the professional's part to keep it and protect it from spreading. Interstate practice makes the observance of this principle difficult for both the patient and the nurse. More and more individuals have the need and right to patient information. Telenursing brings and receives such information with much ease and thus poses as an ethical problem (Silva & Ludwick).
Some patients, especially high-risk ones, are reluctant...
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