Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”
Discussion 1
Although privacy and confidentiality often go hand in hand, there are differences between the two meanings, thus these words cannot be used interchangeably. According to Burkhardt and Alvita (2014), privacy refers to ones right to secrecy, including the right to keep one’s information personal. This includes a person’s trust in another individual to keep information disclosed to them quiet (Burkhardt & Alvita, 2014, p.76). Confidentiality, on the other hand, is an ethical principle, and means that private and personal information about an individual remains just that-private. It should not be disclosed, unless authorized by that individual (Burkhardt & Alvita, 2014, p.76). In relation to nursing, all information a patient discloses to a nurse in considered private, and must remain confidential unless a patient gives consent to release information (ANA, 2015, p.25). Information in only shared between medical professionals when necessary for patient care (Burkhardt & Alvita, 2014, p.76).
After reading the case study “Making the Best Choice” (Burkhardt & Alvita, 2015, pp.77-78), It immediately made me think of a time at work in the jail, when a female inmate confided in me about what she “thought” had happened earlier that night. The female had been brought into custody for a DUI, and was highly intoxicated at intake. She was angry that she had been arrested, and was not cooperative or truthful with answering the medical screening questions asked by myself. Hours later when she had sobered up, the female approached me crying, explaining that she believed she had been raped prior to being arrested. After listening to what she had to say, I informed the inmate that it was mandatory that I informed officers so she could be sent to the hospital for a rape kit. The female became frantic and begged me not to tell anyone, telling me she just wants to sober up and go home. While I had the obligation as a nurse to keep the information between the inmate and myself confidential, I also had the legal responsibility to report this information to authorities, based on the Prison Rape Elimination Act (PREA) at the correctional facility.
In regards to the case study, while Lora has the autonomy, or freedom as an individual to make her own choices and we as nurses have the obligation to maintain patient confidentiality, we also have to advocate for our patient, maintaining the principle of beneficence, to remove Lora from harm (Burkhardt & Alvita, 2014, pp. 59-79). As nurses, we are mandated reporters, which means we have the legal obligation to notify authorities in both situations the patient is involved in. According to Merrick and Latzman (2014), when a reasonable cause of abuse such as the evidence of physical, sexual, psychological abuse or neglect is suspected, nurses are required by law to report such suspicions. The legal obligation of nurses to report overrides patient confidentiality. It is then the responsibility of child protection agencies to act upon the reports (Merrick & Latzman, 2014). Merrick & Latzman (2014) continue on and state that reporting suspected or known child abuse supersedes patient confidentiality. If not reported, nurses have the potential to be criminally prosecuted and/or punished for malpractice. Nurses are, however, safe from criminal and civil charges as long as the reports made come from a good place, and not from a malicious one (Merrick & Latzman, 2014). Whether the patient is 14 years old, or 17 and almost able to make her own decisions, the patient is still a minor and nurses have the legal duty to report the abuse and protect this patient.
American Nurses Association (2015). Code of Ethics for Nurses With Interpretive Statements [Read-only file]. Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-nurses.html.
Burkhardt, M., & Alvita, N. (2015). Ethical Principles. In M. Rosener (Ed.), Ethics and Issues in Contemporary Nursing (4th Ed., pp.59-79). Stamford, CT. Cengage Learning.
Merrick, M. & Latzman, M. (2014). Child Maltreatment: A Public Health Overview and Prevention Considerations. OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 1, Manuscript 2. doi: 10.3912/OJIN.Vol19No01Man02.
Discussion 2
The purpose of this post is to discuss the concepts of privacy and confidentiality as well as discuss the case study provided in the textbook. Privacy and confidentiality go hand-in-hand. According to Burkhardt and Nathaniel (2014), privacy is the right of every individual to control the information about themselves that others know while confidentiality is an ethical principle to keep safe information that it disclosed to you. As a nurse, these concepts are very important in caring for your patients. A patient needs to be confident that the information given to their medical provider will be kept as confidential as possible. If patients are not able to trust their care providers, essential information may not be communicated which leads to inadequate medical care.
The case study involves a 17-year-old girl that admits she is occasionally physically assaulted by her biological father after a ruptured eardrum is discovered during her exam. She recently moved in with her father after having lived with her mother and stepfather. She does not want to go back to her mother’s home because of sexual abuse by the stepfather (Burkhardt & Nathaniel, (2014). The ethical principles involved in this case includes all of those listed in the book. Autonomy for the right of the patient to choose what living situation is best for her and her ability to come to the clinic to obtain birth control. Beneficence on the nurse’s behalf to prevent or remove harm from the patient. Nonmaleficence on the nurse’s behalf to not cause harm or to remove harm by reporting the abuse. Veracity and fidelity to maintain faithfulness and truthfulness and not make promises to the patient that are said to just make the patient feel better and not able to be kept. Confidentiality of what the patient discloses to the care provider and justice for the patient to receive appropriate care.
The obligation of the nurse to report the situation does override the confidentiality the nurse has to the patient even if the patient requests it to not be reported. Nurses in Pennsylvania are mandatory reporters for potential abuse. Since the patient is not an adult, the nurse is required by law to report the suspected abuse of the father and stepfather (Pennsylvania Family Support Alliance, 2017). Though the patient is close to the age of an adult, she is still underage. If she was 14-years-old, it would be an easier decision for the nurse since the patient is not as close to the age of an adult and less able to make certain decisions relating to her well-being.
The options of the nurse at this point would be to report the suspected abuse of the father and stepfather or to continue to monitor the patient for continuing or escalating abuse. If the nurse decides to report the abuse, the patient may end up being forced to live with another relative or be sent into foster care. Since the patient stated that she is fine dealing the with the abuse of her father, it may cause emotional distress to the patient to go through a potential investigation and rehoming. If the nurse decides to monitor the patient without reporting the abuse, she may not be able to stay in contact with the patient to monitor the situation. Since it is state law to report suspected abuse, the nurse may be subject to punishment from law enforcement if it is found out that it was not reported. Some reasons the nurse may feel she doesn’t need to report the abuse would be that it is believed someone else will file a report, they are uncertain that is abuse or unsure that it should be reported (Lynne, Gifford, Evans & Rosch, 2015).
In this situation, the patient’s autonomy does not outweigh the responsibility of the nurse to report the suspected abuse. A nurse does not need proof of abuse in order to make a report. The patient has admitted that she has had past sexual abuse by the stepfather and occasionally being hit by the father. According to the Pennsylvania Family Support Alliance (2017), it is not the job of the mandated reporter to be certain of abuse, only to suspect that abuse is taking place. In my limited time as a nurse, I have not come across a situation where I suspected abuse of a patient, though I understand where hesitation to report suspected abuse can arise from especially when the patient does not wish it to be reported.
References
Burkhardt, M.A., Nathaniel, A.K., (2014). Ethics and Issues in Contemporary Nursing. (4th ed). Stamford: Cengage Learning.
Lynne, E.G., Gifford, E.J., Evans, K.E., Rosch, J.B. (2015). Barriers to reporting child maltreatment: do emergceny medical services professionals fully understand their role as mandatory reporters?. N C Med Journal, 76 (1), 13-18.
Pennsylvania Family Support Alliance. (2017). Understanding mandated reporting. Retrieved from http://www.pa-fsa.org/Mandated-Reporters/Understan…
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