Patient Confidentiality
Reporting Abuse
Objectives
 Define HIPAA
 State the purpose of HIPAA
 List protected medical information
 List examples of how patient confidentiality is protected in
daily nursing practice
 List exceptions to the confidentiality rules
 List penalties for violations of HIPAA rules
 Define nurse’s responsibilities regarding suspected cases of
abuse
HIPPA
HIPAA - What is it?
 1996: Congress passed the Health Insurance Portability and
Accountability Act
 The HIPAA provisions were tacked on to a law about health
insurance portability - or - Taking your insurance with you to
a new job
 Law was modified and finally released in 2002
HIPPA
 Covers 3 areas:
1. Insurance portability: individuals moving from one health
plan to another will have continuity of coverage and will not
be denied coverage under pre-existing condition clauses
2. Fraud enforcement (accountability): increases the federal
government’s fraud enforcement authority
3. Administrative Simplification: reductions in health care cost
HIPAA
 Purpose: To ensure the individuals right to privacy with
regard to their healthcare treatment, condition, and
information
 Requires health care organizations to protect their patients
privacy and the confidentiality of protected health
information (PHI)
 Punishes individuals or organizations that fail to keep patient
information confidential
HIPAA provisions
Patients have a right to:
 See and copy their health record
 Update their health record
 Get a list of the disclosures a healthcare institution has made
independent of disclosures made for the purposes of
treatment, payment, and healthcare operations
 Request a restriction on certain uses or disclosures
 Choose how to receive health information
HIPAA provisions
 Patient authorization is required to release information for
purposes other than
Treatment
Payment
Routine health operations
 Patient may revoke authorization at any time
Doctrine of Privileged Information
 States that individuals in a protected relationship, such as a
doctor and patient, cannot be forced, even during legal
proceedings, to reveal communication between them unless
the person who benefits from the protection agrees to it.
 Examples: MD, psychiatrist, psychologist
 State laws determine protected relationships
 Not all state laws privilege nurse-patient relationships
Health Information
Health Information includes:
 Names and all identifiers such as address, telephone and fax
number, Social Security number and any other personal
information
 The reason the patient is sick or in the hospital, office or
clinic
 The treatments he/she receives
 Information about past health conditions
Health Information includes:
 Personal information: name, address, employer, date of
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birth, telephone and fax numbers, social security number,
any other characteristics such as occupation that may identify
and individual
Patient medical records: admission history, graphic sheet
information, results of lab work and tests, medications,
consultations
Computerized information
Telephone calls, voice mails, fax transmissions
e-mails, conversations about patients between clinical staff
Health Information
 Should be accessed on a “Need to Know”
basis only
 Examples: ?
Invasion of Privacy
 Patients have a legal and moral right to privacy
 Invasion of this right:
 Constitutes an “intentional tort” or a willful wrong
committed against another person
(like assault and battery, defamation of character)
 Can be a civil or criminal offense
Invasion of Privacy - Examples
 Unnecessary exposure of patients while moving them
through a corridor or while caring for them in rooms they
share with others
 Talking with patients in rooms that are not soundproof
 Discussing patient information with people not entitled to
the information (ex: the patient’s employer or the press)
 Pressing the patient for information not necessary for care
planning
Invasion of Privacy - Examples
 Interacting with the patient’s family in ways not authorized
by the patient
 Using tape recorders, dictating machines, computers, and the
like without taking precautions to ensure the patient’s
confidentiality
 Preparing written or oral class assignments about patient
without concealing their identity
 Carrying out research without taking proper precautions to
ensure the anonymity of patients
Invasion of Privacy - Examples
 Discussing patient information in any public area where those
who have no need to know the information can overhear:
elevators, lunchroom, public transport
 Leaving patient medical information in a public area
 Leaving a computer unattended in an accessible area with the
medical record information unsecured or failing to log off a
computer
 Sharing passwords
Invasion of Privacy - Examples
 Improperly accessing, reviewing, and/or releasing the
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medical record of a patient in the following situations:
For use in a personal relationship
For the purpose of giving or selling the information to the
media
Who is a co-worker and is also a patient
To bring harm to the organization or individuals associated
with it
Scenario
 Patient admits to you that he/she thinks he might be HIV
positive. Testing confirms that this is true.
 Can you:
 Discuss this with your co-workers?
 Discuss this with the patient’s spouse or any
family member
 Discuss this in the elevator
 Discuss this with the patient’s physician
 Discuss this with your nurse manager
HIPPO’s Gossiping
HIPAA Regulations - How they affect
nursing practice
 Patient census boards: provide only the minimum
information necessary
 Medical records and MAR (medication administration
record): Information must be placed face down when it can
be visible to the public; not left unattended in public places
 Nurses should find out from patients which family members
can be included in updates about the patient’s condition
HIPAA regulations - How they affect
nursing practice
 Voicemail messages: minimal information should be left
 Sign-in sheets: Minimal information
 Confidential conversations between nurse and the patient,
MD, other healthcare team members involved in this
patient’s care: voices should be kept low
 Information on paper no longer needed (yesterday’s MAR,
report record) should be put in shredder bin
HIPAA violations
 May be punishable with civil and criminal penalties
 Punishments may include monetary penalties as well as
imprisonment
 Criminal penalties for release of health information
 Fine of $50,000 and up to 1 year imprisonment
 If false pretenses are involved: $100,000 and 5
years imprisonment
 Intent to sell or transfer information: $250,000 and
up to 10 years imprisonment
Permitted Disclosure of PHI
 Public Health Activities:
 Tracking disease outbreaks
 Statistics related to dangerous drugs or medical equipment
 Law enforcement and judicial proceedings
 Medical records crucial to criminal investigation and
prosecution
 Medical records to identify crime victims
 Medical records regarding abuse, neglect or domestic
violence
 Medical records released according to subpoena
Permitted Disclosure of PHI
 Deceased Individuals
 PHI needed by coroners, medical examiners, funeral
directors
 PHI needed to facilitate organ donations
 PHI needed to investigate a death involved in a potential
crime
HIPAA and student nurses
How does this affect you as a student nurse?
 You can access the medical record of the patient to which you
are assigned
 You can copy down information which is necessary to
prepare for an assignment (including medications, lab values,
progress notes, admission notes)
 You cannot duplicate any part of the medical record
 Any information taken from the unit should have the patient’s
identifying information obliterated
HIPAA and student nurses
 Do not obliterate the patient’s name on the MAR
(medication administration record)
 Do not discuss patients in the elevator, lunchroom, or any
public place
 Respect patients’ privacy when providing care
Reporting Abuse
 Abuse:
Neglect: a situation wherein a basic need of the client is
not being provided
2. abuse: an incident involving some type of violation to the
client
3. Domestic violence: a pattern of controlling behavior and
assaults including physical, sexual and psychological attacks
and economic control that some adolescents and adults use
against their intimate partners
1.
Nursing Responsibilities
 Responsible for knowing the law, especially about mandatory
reporting of domestic violence and abuse
 National Domestic Violence HOTLINE
 1-800-799 -7233 (SAFE)
Domestic Abuse
 Usually is one of the following:
 Child abuse
 Abuse of a spouse or domestic intimate partner
 elder abuse
Domestic Abuse
 Def: when one person in a marital or intimate relationship
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tries to control the other person. The perpetrator uses fear
and intimidation and may threaten to use or may actually use
physical violence. Domestic abuse that includes violence is
called domestic violence
Key elements:
intimidation
Humiliating the other person
physical injury
Domestic Abuse - Types
 Physical violence
 verbal or nonverbal abuse (psychological abuse, mental
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abuse, emotional abuse)
sexual abuse
stalking or cyberstalking
economic abuse or financial abuse
spiritual abuse
Physical Abuse
 Includes:
 pushing, throwing, kicking
 slapping, grabbing, hitting, punching beating, tripping,
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battering, bruising, choking, shaking
pinching, biting
holding, restraining, confinement
breaking bones
assault with a weapon such as a knife or gun
burning
murder
Emotional Abuse
 Includes:
 threatening or intimidating
 destruction of the other person’s personal property
 yelling or screaming
 name-calling, belittling, insulting
 constant criticizing, blaming
 embarrassing, mocking, humiliating
 excessive possessiveness, isolation from friends and family
Sexual Abuse
 Includes:
 sexual assault: forcing someone to participate in unwanted,
unsafe or degrading sexual activity
 sexual harassment
 sexual exploitation: forcing someone to participate in
pornography
Financial Abuse
 Includes:
 withholding economic resources such as money or credit
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cards
stealing from or defrauding a partner of money or assets
exploiting the partner’s resources for personal gain
withholding physical resources such as food, clothes,
necessary medications, or shelter
preventing the partner from working or choosing an
occupation
Spiritual Abuse
 Includes:
 Using spouse’s religious or spiritual beliefs to manipulate
them
 preventing the partner from practicing their religious or
spiritual beliefs
 ridiculing the other person’s religious or spiritual beliefs
 forcing the children to be reared in a faith that the partner
has not agreed to
Child Abuse
 Consists of any act or failure to act that endangers a child’s
physical or emotional health and development.
 A person caring for the child is abusive if he or she fails to
nurture the child, physically injures the child, or relates
sexually to the child
 Child abuse HOTLINE
 1-800-4-A-CHILD (1-800-422-4453)
Child Abuse
 Types:
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Physical abuse
Sexual Abuse
Emotional abuse
Neglect
Exploitation
Physical Abuse
 Includes:
 beating, whipping, punching, slapping or hitting
 pushing, shoving, shaking, kicking or throwing
 pinching, biting, choking or hair-pulling
 burning
 severe, inappropriate physical punishment
Sexual Abuse
 Any sexual act between an adult and a child
 privacy violations
 exposing children to pornography
 exposing a child to adult sexuality
Neglect
 Failure to provide for the child’s basic needs
 Physical: failure to provide adequate food, clothing, shelter,
lack of supervision, abandonment, inadequate hygiene
 Educational: failure to provide an education
 Emotional: lack of emotional support and love, domestic
violence in the child’s presence, drug or alcohol abuse in the
child’s presence
Emotional Abuse
 ignoring, withdrawal of attention or rejection
 lack of physical affection
 lack or praise, or positive reinforcement
 yelling or screaming
 threatening or frightening
 belittling, humiliating
 scapegoating or blaming
Symptoms of Child Abuse
 Physical: unexplained cuts, bruises, burns, bite-marks, anti-social
behavior, fear of adults, self-destructive or suicidal behavior
 Emotional: apathy, depression, hostility, lack of concentration,
eating disorders
 Sexual: inappropriate interest in or knowledge of sexual acts,
seductiveness, nightmares and bedwetting, drastic changes in
appetite, fear of a particular person or family member,
withdrawal, secretiveness, or depression, suicidal behavior, eating
disorders, self-injury
 Neglect: unsuitable clothing for weather, being dirty,
extreme hunger, apparent lack of supervision
Reporting suspected cases of Abuse
 Nurses are legally and ethically required to report all
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suspected cases of abuse
Legislation varies, so nurses should be aware of what cases
need to be reported and to whom
Abuse includes: physical, verbal, sexual and emotional
attack; neglect and abandonment
Targets of abuse: infants, children and adult men and women
of all ages
Abusers: men and women of all ages, races, socioeconomic
groups and religious backgrounds
Reporting suspected cases of abuse
 In some states, failure to report abuse is a crime
 Nurses are protected from lawsuits from suspected abusers if
report of suspected abuse is submitted in good faith