I have chosen to focus this reflection on an issue arisen at a meeting with myself, a client and his social worker whilst on placement with an nhs drug and alcohol service. This critical incident and professional awareness reflection includes aspects of opportunistic learning. It follows a structured model of reflection based on that of Rolfe et al (2001). All names and places have been changed to maintain confidentiality, as required by the Nursing and Midwifery Council Code (NMC 2008). The client shall be referred to as Sam (C.O; 1).
Due to issues around risk to both staff and the client, the appointment could not take place at the client’s home address. For this reason the appointment took place at a local, following negotiation with both Sam and my mentor (S.O; 25). Having a meeting at a public brings about confidentiality issues on its own (C.O; 1, 2, 3). I realised I would have to be careful not to divulge any personal information and be aware of other people in the listening in intently and of the need then to adjust the manner in which the appointment was proceeding.
I was also aware of my client’s own potential feelings about his care being discussed in such a public place and remained vigilant as to his state of mind, in particular paying attention to his body language with regards what he was saying (C.O; 5). It was important for me to not come across as though I did not wish to discuss matters with him that he wished to discuss, despite the public nature of the venue and also to realise that he was very comfortable with discussing his past with people and did not appear to be embarrassed or try to conceal certain parts of it from others. I had to be confident that this was his choice and one he had capacity to make.
During the course of the appointment Sam, a client with both physical health and opiate dependence problems, divulged that he had not been taking his Diazepam for quite some weeks and felt better for it. Sam said he had more energy and felt more physically well now not on them. Sam said he had been giving these to a friend who had requested he give them to him. This friend was apparently non-threatening in his approach to getting the diazepam from Sam, although was already being prescribed diazepam by his own GP for anxiety.
On questioning Sam further about this matter it became clear Sam did not understand the risks of benzodiazepine use and had not thought about either the legal or ethical and moral implications of giving a prescription only drug away. I explained to Sam the physical risks of taking too many benzo’s and that we had no way of knowing what dose his friend was on but that his doctor would have prescribed a safe dose knowing all the facts. I then explained to Sam the complications that could potentially arise with his own methadone script with him giving drugs away. Sam was very receptive to this and said he would contact his GP that afternoon to cancel the diazepam and say he hadn’t been taking them and did not need it. I genuinely felt Sam had just not thought about the consequences and also that he would put a stop to it that afternoon, as he had said.
I felt that having had this information divulged to me I had to think about divulging it to appropriate persons. Having got to know Sam reasonably well and genuinely believing he would cancel the diazepam and be truthful with me about doing so I decided not to tell anybody else. The social worker with me said she had not thought about the duty of care to protect others applying in this situation but on reflection she believed it did as I had pointed out the consequences of the friend taking too many benzodiazepines could be fatal and a coroners court hearing would reveal where the diazepam came from and potentially also that myself and herself were aware they were being given away (S.O; 26). Gillon (1986 cited by Cain 1998) says that a universally accepted condition of confidentiality is that the confidant… “undertakes, explicitly or implicitly promises, not to disclose another’s secrets”.
I interpret this as describing an explicit trust and Cain (1998) states that trust is the key to confidentiality. I feel as nurses we are entrusted with personal and private information and are considered to be sworn not to break that trust. I feel that as nurses we have a duty to ensure our clients are aware of the conditions in which we are duty-bound to break confidentiality and divulge information to relevant others as clients not only have the right to know that, but I feel it helps maintain the relationship in realm of professional but also ensures nursing as a profession is less likely to come into disrepute in the event of confidential information having to be revealed against the client’s wishes.
Cain, P. (1998). The Limits of Confidentiality. Nursing Ethics. 5: 158-165 Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC