Confidentiality

Confidentiality doesn’t just cover the ‘big’ things, like a patient’s/client’s diagnosis and prognosis.

Do you see any potential for breaches in confidentiality in the following scenarios? Go through the slides and consider the confidentiality issues they pose.

Scenario 1

A patient takes you aside and asks you to ‘give him the lowdown’ on the condition of the patient in the bed opposite him.

Confidentiality is protected: You feel that this is privileged information that the patient has no right to know. You explain to the patient that this is not a matter you can discuss with him and report the issue to the nurse in charge.

Confidentiality is not protected: You tell the patient what you heard at ward handover, that the fellow- patient’s prognosis is poor. You then see him go over to his fellow-patient, and while you can’t hear what’s being said, you can see the fellow-patient is very angry.

Scenario 2

You need to discuss a plan for dealing with constipation with a hospitalised older man with hearing problems who is sitting at his bedside with fellow patients on either side.

Confidentiality is an issue: You realise that an overheard discussion on this issue is potentially embarrassing for the patient and will reveal details about his health status to other patients. You ask the patient if he would mind accompanying you to the treatment room for a little while to discuss his care over the next couple of days.

Confidentiality is not an issue: You approach the man and, speaking in a very loud voice so he can hear you, say he will receive a laxative tonight and get an enema in the morning that should clear the problem. The man thanks you but looks very embarrassed. Some of the other patients are sniggering.

Scenario 3

A neighbour says to you: ‘I believe your team is seeing John Brown. He’s a pal of mine - how’s he doing?’

Confidentiality is protected: The neighbour seems genuinely concerned, but you’re aware that providing him with information might be a breach of Mr Brown’s confidentiality. You politely explain to your neighbour that you aren’t at liberty to reveal that information, but offer to pass on his regards to Mr Brown when you next see him.

Confidentiality is not protected: The neighbour seems genuinely concerned, so you see no harm in giving him an update on Mr Brown’s condition. Later that day, you meet the neighbour’s wife in the supermarket. She tells you, unprompted, how sorry she was to hear Mr Brown wasn’t doing too well.

Scenario 4

While making Mr Anderson’s bed with a colleague, she says, in clear hearing of Mr Anderson, 'You know that woman who came into the care home last week, Mrs Bell? Did you hear about her daughter? Isn’t it terrible?’

Confidentiality is protected: You helped to admit Mrs Bell last week and really liked her, and you’re keen to hear about her daughter. However, you don’t think its right to speak about the subject in Mr Anderson’s presence. You explain to your colleague that Mr Anderson is the focus of your attention at the present time, and begin to ask him some questions about how he would like to spend the day. When you leave Mr Anderson’s room, you explain to your colleague that you didn’t wish to seem rude, but you felt it wasn’t appropriate to discuss another resident’s situation with Mr Anderson nearby.

Confidentiality is not protected: You helped to admit Mrs Bell last week and really liked her, and you’re keen to hear about her daughter, so ask your colleague to explain. You’re horrified to hear that the daughter has been admitted to hospital after a drugs overdose. Mr Anderson, who has heard the entire conversation, says ‘The poor girl must have been very depressed ... sounds like your Mrs Bell isn’t much of a mother.’

Scenario 5

A teenage girl breaks down in tears when with you and says she has no idea where to go to get contraceptive advice, but doesn’t want to speak to her mum because she doesn’t want her to know.

Confidentiality is protected: You recognise that this is a big decision for a girl so young to be making on her own, but you understand why she might not want to speak to her mother about it. You explain that you can understand her situation and that good sources of advice are available to her. You have a colleague who is very knowledgeable not only on contraception, but also in counselling young people to help them make the right choices for them. You ask the girl if she would like you to arrange for her to see your colleague, to which she replies ‘Yes, that would be great.’

Confidentiality is not protected: You feel this girl is much too young to be making these kinds of decisions on her own. You wonder how you would feel if this was your daughter and she wasn’t sharing the information with you. You tell the girl that she is being very foolish and if she doesn’t tell her mum, you will. The girl rushes away in tears, yelling ‘You’re all the same!’

Scenario 6

A staff nurse, knowing a patient is going to be visited by a medical consultant sometime in the next hour or so, leaves the patient’s notes in full view on the table at the bottom of her bed.

Confidentiality is protected: You like the staff nurse and respect his experience, but you are concerned that anyone, even another patient, might pick up the notes and have a read. You approach the staff nurse and say: ‘I’m really interested in patient confidentiality, and would like to chat to you some time about it. Right now, however, what would the situation be if someone read the notes you’ve left at the bottom of the bed? Would that be a breach of confidentiality?’ The staff nurse replies ‘It certainly would ... perhaps we should move them. Let’s take them to the staff room until the consultant arrives and, if you’ve got ten minutes, we could have a general chat about confidentiality.’

Confidentiality is not protected: This is an experienced staff nurse, so if he thinks it’s OK to leave the notes there, it must be OK. A little while later, a fellow-patient, pointing at the patient waiting for the consultant, says to you ‘She’s been through the mill, hasn’t she? Wouldn’t like to be in her shoes.’ You ask what makes her say that, and she answers ‘Well, I read her notes ... they were just sitting there, so what’s the harm?’

Scenario 7

After visiting an older person in his own home, a neighbour intercepts you and asks you to persuade the older person to give her a key for his house, ‘just in case he falls and I need to get in quick to help’.

Confidentiality is protected: You recognise immediately that you have no authority over this situation whatever, and that if you give any indication to the neighbour that falling may be a problem for your patient, you would be breaching his confidentiality. You say to the neighbour that you appreciate her concern, but that you do not have the authority to make any request to the patient on her behalf. You make a decision to discuss the issue with your supervisor right away and ask for a review of the emergency response arrangements in place for your patient to ensure they are adequate.

Confidentiality is not protected: This sounds like a very good idea to you. It could mean that help would be on hand very quickly in an emergency. You agree to go back in and ask your patient. You put the neighbour’s request to your patient, and are surprised that he becomes very angry. ‘What right have you to offer my keys to someone else?’ he shouts. ‘If she had my keys, she’d never be out the place. How dare she – and you!’

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