Ethics of Patient Confidentiality 1
RUNNING HEAD: Ethics of Patient Confidentiality
The Ethics of Patient Confidentiality: To Tell or Not To Tell
Puja Desai
Medical University of South Carolina
Nursing 385: Professional Nursing and Nursing Practice
Ethics of Patient Confidentiality 2
The Ethics of Patient Confidentiality: To Tell or Not To Tell
Patient A is a 21 year old healthy and fit woman admitted to the hospital for an
appendectomy due to appendicitis. The RN assigned to take care of her is a 22 year old
woman working as a first year nurse. Patient A recently moved in with her boyfriend,
who visited her along with her mother every day. Both seemed supportive towards
Patient A. Before living with her boyfriend, Patient A lived with her mother and stepfather. She had never met her biological father.
The two young women got along well and shared many of the same interests.
Both were cyclists, newly out of college, and had been good friends earlier. The two
women exhibited a trusting relationship and friendly rapport. One day the RN was
helping Patient A change her clothes. She noticed severe bruising on the patient’s back
and right shoulder The RN also noticed how quickly Patient A put her clothes on in
attempt to hide the bruises from her. As the RN commented on what she saw, the patient
admitted it was quite sore. When asked how the patient had gotten the bruise, she asked if
the RN would shut the door and said, "You're my friend so you won't tell anyone will
you? I just need to tell someone to make myself feel better”. Eager from anticipation, the
nurse nodded her head immediately. It was her job to know. The patient had originally
told another RN that the bruise was from a cycling accident. However, to this particular
RN, the patient admitted to being hit and pushed against the wall by her boyfriend.
Patient A felt that her boyfriend did this “on accident” and would never hurt her again.
He had apologized numerous times. Patient A confided that her biggest fear was that she
would be sent home to live with her mother and stepfather, whom she did not get along
Ethics of Patient Confidentiality 3
with. She felt that if she returned home old problems between her mother and herself
would resurface (Voyce, 2009).
The Ethical Issue
It is written in the Prayer of Maimonides, "...Grant that my patients have
confidence in me and my art..."(Cochran, 1999, p. 12). Without trust and confidence
between a nurse and her patient, all concerned are at a serious disadvantage.
Confidentiality refers to how a nurse and other health care professionals treat client
private information after being disclosed (Potter & Perry, 2009). The Nursing Council
requires a nurse to ensure all I clients' privacy and to safeguard confidentiality of
information obtained within the professional relationship. Confidentiality can be seen as
the thread that builds the rope of trust and confidence between nurse and patient.
Frequently, patients are reluctant to share personal information until being fully informed
of their rights to privacy. Privacy is the right of patients to keep personal information
from being disclosed (Potter & Perry, 2009).
Ethics is the study of the ideals of right and wrong behavior (Potter & Perry,
2009). These ideal includes good conduct, character and motives, and is concerned with
determining the best outcome for all involved (Voyce, 2009). An ethical dilemma is “an
ethical problem in which the ethical choice involves ignoring a powerful non-ethical
consideration . . .” (Voyce, 2009, p.12). In the scenario above, two conflicting ethical
principals make up the ethical dilemma. The RN views the situation based on the three
ethical principles: respect for persons, beneficence, and justice (Btoush, 2009). The
Ethics of Patient Confidentiality 4
principle of concern is primarily beneficence. Beneficence requires one to act in such a
manner as to avoid causing deliberate harm or risk of harm to the patient. It is the
caretaker’s duty to keep her patient safe and out of harm’s way. The patient, however,
views the dilemma from a utilitarian point of view. This theory of ethics refers to an
action being good or bad determined solely based on the outcome (Voyce, 2009). The
theory focuses on doing good for as many involved as possible (Lanik, 1989). The
dilemma for the nurse concerns choosing between failures to implement patient
confidentiality by notifying others of information discoursed to her in privacy or risking
the well being of her patient. Additionally, an important factor in the scenario involves
the personal friendship between the nurse and patient.
Nurses Actions
The nurse’s action involves accountability and autonomy. Accountability involves
being responsible for the choices being made. Autonomy involves the ability to execute
an action independently. The initial step of nursing action in the situation presented by
the case scenario should involve the nurse becoming clear about her feelings about the
situation at hand (Lanik, 1989). In this case, the situation involves domestic violence. The
nurse must eliminate preconceived judgments based on her personal experiences and
emotions in order to take an objective stand on the situation. The nurse must also work to
keep the integrity of her position as caretaker intact. In order to do this, she must put the
personal relationship between her and Patient A aside. The next step of action should
involve the thoughtful weighing of both outcomes. If the nurse does not notify someone
Ethics of Patient Confidentiality 5
who can help Patient A, she would be putting the patient at risk for an incident of the
same manner or a more detrimental manner. If the nurse does notify another, she could
possibly avoid a future incident. Also, the nurse has no way of knowing if others
involved in the situation are at risk as well. By notifying the correct authority, the nurse
may be protecting others involved in addition to Patient A. However, this outcome
includes the possibility of jeopardizing a personal friendship.
The American Nurses Association (ANA) Code for Nurses states: "The nurse
safeguards the client's right to privacy by judiciously protecting information of a
confidential nature. With a few exceptions, only information pertinent to a client's
treatment and welfare is disclosed. Furthermore, it is disclosed only to those directly
concerned with the client's care” (Cochran, 1999, p. 45). This scenario presents itself as
an exception. Although, respecting nurse-patient confidentiality is a large part of the
nursing code an RN is expected to uphold, there is currently no state that mandates nursepatient confidentiality (Cochran, 1999). Therefore, it is evident the nurse should stay
accountable to her practice and report the situation according to the rules of the institution
even at the cost of confidentiality of her patient. The correct authority may be a head
nurse, a social worker, or even the police depending on the regulations of the institute
involved. The best possible outcome of this action would include the protection of all
people involved from the abuser without legal and social ramifications for the nurse.
Ethics of Patient Confidentiality 6
Conclusion
It is important for a nurse to maintain nurse-patient confidentiality. However, it is
equally as important for a nurse to protect the well being of their patient. Being presented
with an ethical dilemma is always difficult. However, the likelihood of being presented
with an ethical dilemma in the health field is high. The outcome of an action taken due to
a dilemma can put a nurse at risk of losing integrity, accountability, and autonomy.
Therefore, a caretaker must always be prepared to think clearly, objectively, and quickly
in a situation involving an ethical dilemma.
Ethics of Patient Confidentiality 7
References
Btoush, R., & Campbell, J. (2009). Ethical conduct in intimate partner violence research:
challenges and strategies. Nursing Outlook, 57(4), 210-216.
http://search.ebscohost.com
Cochran, M. (1999). The real meaning of patient-nurse confidentiality. Critical Care
Nursing Quarterly, 22(1), 42-51. http://search.ebscohost.com
Lanik, G., & Webb, A. (1989). Ethical decision making for community health nurses.
Journal of Community Health Nursing, 6(2), 95-102. http://search.ebscohost.com
Potter, P.A. & Perry, A.G. (2009). Fundamentals of Nursing, (7th Ed). St. Louis: Mosby
Elsevier.
Voyce, A. (2009). Working through an ethical dilemma. Kai Tiaki Nursing New
Zealand, 15(1), 12-13. http://search.ebscohost.com
Ethics of Patient Confidentiality 8
Copy of Search:
http://search.ebscohost.com/login.aspx?direct=true&db=rzh&bquery=(Ethics+AND+nurs
ing)&cli0=RV&clv0=Y&cli1=SB1&clv1=Nursing&type=1&site=ehost-live
http://search.ebscohost.com/login.aspx?direct=true&db=rzh&bquery=(confidentiality+A
ND+nursing)&cli0=RV&clv0=Y&type=1&site=ehost-live