Confidentiality Nurses

Sometimes there may arise cases where ethical principles conflict. This is due to the fact that there many rules in the work place which are interrelated and the fact that nurses personal beliefs and the organizational values sometimes contradict. To resolve problems that arise when ethics conflict, the people involved in the case should sit down and discuss the way forward so that they know the way forward. It will be good to know the most important factor that a problem has and from there, they can tell which major ethic governs the problem so that a solution can be worked out from there.

i. Confidentiality and the disclosure principle An ethical principle that would be in conflict with confidentiality if is broken is disclosure. Disclosure Principle says that the organization should be aware of the activities that take place in the organization and that other people should not access patient records if they have not been authorized to. When confidentiality is broken, then patient’s information is revealed to persons who are not supposed to know it and this is contrary to what the disclosure principle talks of. ii.

An Ethical theory that supports the decision to keep or break confidentiality The deontological theory can be used to support the decision to keep or break confidentiality. The theory founded by Immanuel Kant is process orientated for this reason; it deals with the organization and the laws and regulations that govern certain professionals. “The theory states that the goodness or wrongness of an act is determined by the inherent moral significance and not the outcome (Cherry & Jacob, 2005). ” Some aspects if the deontological theory can be found in the code for nurses if well interpreted.

In this code, it states that nurses have a moral responsibility to keep patient information confidential. This is also emphasized in the standards of nursing practice and institutional policies. These confidential rules create the necessary parameters that govern morals and which will be used when the code of conduct are broken. B. Influence of culture on values Culture greatly influences the way people behave and the interpersonal relationships between persons. This is because they are raised in a certain way and follow certain traditions that dictate the things they do and how they should relate with other people.

“Culture provides restrictions or provisions that will sometimes contradict with values in different organizations (Cress, C. (2007). ” Cultures vary among persons and when they interact, there are bound to be conflicts as people will interpret things differently. That is why there has to be standards with which people can be governed so as they behave the same. “Thoughtful decision making arises from an environment that supports and values the critical exchange of ideas and promotes collaboration among members of the health care team, patients and families (Huber, 2006).

” i. Compare and contrast the cultural values related to confidentiality between Family Z and those of the providers. In this case study, there are certain cultural practices practiced by the Z family which influence the decisions that are to be made by the care givers. The husband makes all the decisions in the family and the husband’s mother is in charge of the household and depending on how the household is arranged, Mrs. Z has to accept the decisions made by the mother in law. Mrs.

Z has a lump in her right breast and when being seen by the doctor, the family like all other families would react wants to know what happens but the Mrs. Z said that her medical report or issues be kept private. This means, that the nurse as well as Dr. F; the examining physician, have to keep this matter secret. But on another appointment, the biopsy taken turns out to be positive and this requires treatment. Mrs. Z does not tell the husband who asks another colleague to find out the results. There is a dilemma on what action to take as Dr.

F And the nurse try to figure out what they are supposed to do as they are supposed to respect the wishes of the patient and at the same time provide the best care. There is a conflict of interests because most probably the wife fears what the husband will decide because he has the authority to do that and maybe that will go contrary to what they want to achieve. ii. Nursing interventions that could help reduce or resolve ethical conflict of keeping or breaking confidentiality Nurses are supposed to enhance the well being of their patients.

Some of the things that they can do to correct such ethical problems include: They can choose to keep off such issues especially when they are not involved as sometimes they are caught in a web where doctors are involved and they are dragged into such matters. They can openly say that they do not support issues of breaking confidentiality especially when they see that the results of such an action can be devastating not only to the patient but also the medical practitioners. C. Ethical decision making model Nurses are faced with many challenges in the daily running of their work.

These decisions are made with the help of other people within the organization including parents, family members and other health care gives. When the decisions are made, other people are supposed to respect them so that when they make theirs, they can also be respected. “The decisions made are either right or wrong but the best decision is what will be chosen (Chitty, 2004). ” There are several decision making models but each has unique characteristics that enable it to solve different issues. “When choosing a particular model, certain steps have to be followed.

Ethical decision models present a format of steps for nurses to follow (Bosek & Savage, 2007). ” The steps are outlined below: o Defining the problem It is very important to define the problem. This is important because it will lay a foundation for what is expected and moreover it will aid in understanding the problem so that necessary actions can be formulated. This will be known by identifying the cause of the ethical distress or dilemma and what the authority is focusing on. o Assess This in this stage, the nurse looks into the problem and identifies the underlying issues.

They also need to look for other relevant material that is related to the situation so that they can have proof and valid reasons for the decisions they want to take. o Analyze This is the part where the nurses will look critically at the various issues they have raised and found out so that they can identify the options that will work for them. This is done by using various theories. o Plan After assessing and analyzing, then they need to make a decision that they know will work for them as well as other people who are involved.

This will entail looking at each alternative courses of action so that the best of them is selected. o Implement Implementing refers to the action taken to ensure that the decision is used to serve the purpose it was intended. o Evaluate This is the stage where the nurses will monitor the results by conducting follow ups to ensure that the decisions they have come up with will continue to be used. Evaluation is necessary because it enhances continuous quality improvement of the organization as well as the health care givers (Schlabach & Peer, 87). ii.

Use the model to determine a solution to the Case study Clearly state the problem The problem that occurs in this scenario is initiated by Mrs. Z who does not want her family to be told about her medical results. The problem occurs when the husband Mr. Z being a doctor using his position to try and get the results from another doctor Dr. F. The doctor asks the nurse who consults with Mrs. Z; Dr. J, does not agree telling the nurse that it will be breaking the rule of confidentiality but at the same time they want to ensure the best treatment for their patient.

The problem therefore is about confidentiality. Assess Here, more material will have to be presented so that the doctor and nurse have a variety of things to choose from. They can ask other practitioners on what they would have done in such a situation as well as from documented literature. Analyze Here, we will look at the both sides of the coin on will happen if Dr. J discloses or does not disclose the information. If he tells the husband, then Mrs. Z will de disappointed in the doctor as she will not know what the husband can do.

Looking from another angle, the husband and the family will support her in the decision and this will be good for her treatment as they will understand what it is all about. If they choose not to say anything, Mrs. Z will be pleased but will ache on the inside because she is lying to the family and will not have the necessary support at this difficult time. Plan In the plan, they can look at the law and what it says about the decision they will make Having seen the alternatives, they now have to choose what will be best in this scenario. In this case they will have to go with telling the Mr. Z as the option has a lot of positive attributes.

Implement They will have to communicate their decision to Mrs. Z and the husband separately then together so that they are aware that the decision has been made in the best interest of the patient. To ensure that this is implemented, they will schedule the next appointment and make sure that the husband is present. Evaluating Evaluation is good as it gives people an opportunity to reflect on the dilemma and see how they can use the experience to solve other issues within the organization especially on matters related to confidentiality.

References Bosek, D. S. &. Savage, T. A. (2007). The Ethical Component of Nursing Education: Integrating Ethics Into Clinical Experience. Lippincott Williams & Wilkins p. 39 Brent, N. J. (2000) Nurses and the law: a guide to principles and applications 2nd Ed Elsevier Health Sciences p. 39-41 Cherry, B. & Jacob, S. R. (2005). Contemporary nursing: issues, trends, & management 3rd Ed. Elsevier Health Sciences, 2005 Chitty K. K. (2004). Professional nursing: concepts & challenges 4th Ed. Elsevier Health Sciences, 2004 p. 529-543 Cress, C. (2007). Handbook of Geriatric Care Management 2nd Ed.

Jones & Bartlett Publishers, 2007 Crisp, J. , Potter, P. A. , Perry, A. G. (2005). Catherine Taylor Potter and Perry’s Fundamentals of Nursing 2nd Ed. Elsevier Australia p. 428 Huber D. (2006). Leadership and nursing care management 3rd Ed. Elsevier Health Sciences, 2006 p. 391 Rumbold G. (1999). Ethics in Nursing Practice 3rd Ed. Elsevier Health Sciences, 1999 p. 151 Schlabach, A. G. & Peer, K. S. (2007) Professional Ethics in Athletic Training Elsevier Health Sciences, 2007 Scutchfield, C. D. & Keck W. (2002). Principles of Public Health Practice 2nd Ed. Cengage Learning, 2002 p. 248 confidentiality

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