Potential risk

Further reflection allowed me to identify other areas of concern regarding lack of confidentiality. This was in relation to the use of handover proforma. This was a sheet that was being used to jot down some relevant patient details during handover. Although the proforma was useful, I felt that it could be a potential risk to breach of confidentiality if it was left hanging around on the ward. It could be dropped accidentally, or could be left anywhere and be lost. It concerned me because should it fall on the wrong hands, patient confidentiality could be breached.

However, I found that the use of the proforma was very useful as it help the nurses to remember name of the patients, nursing care given and treatments needed, etc. I have discussed my concern with my mentor and I suggested that the proforma must be shredded at the end of the shift. More importantly, nurses must ensure that they write only the minimum of identifiable information on the sheet and where possible anonymise information written on it.

The principles of data protection Act 1998, B. Diamond (1998) emphasised that personal data processed for any purpose or purposes shall not be kept longer than is necessary for that purpose. As a nursing student and an independent practitioner I must consider my actions carefully. It is upon reflection that I realised that during my initial handover I might have breached patient confidentiality. I felt that I might have done this by giving my handover at the patient’s bedside without adequate regard to assessing the risk of being overheard. On reflection, I could not remember how loud my voice during the handover was – all I knew I was trembling and I was petrified!

I was overwhelmed with ‘nerves’, I was not thinking clear. The NMC (2008) The Code- Standard of conduct, performance and ethics (2008) clearly states that as a nurse you must protect confidential information. Special training is needed to ensure that practice is consistent with policy in any authorized disclosures of personal health information because the risk of a breach is particularly great when information changes hands. The handover has traditionally taken place in an office where patients do not have the opportunity to overhear what is being said.

It is only in recent years that nurses have begun the practice of handing over care at the patient’s bedside (Greaves 1999). The current practice has changed from the type of round where the purpose was purely to check standards of care overnight, to today’s efforts to involve patients more. This shift in emphasis is a move forward in changing traditional nursing practices and has accompanied efforts by nurses to individualise patient care (Johns 1989). However Webster (1999) wrote that the bedside handover results in better nurse-patient communication and a sense of partnership.

On the other hand Smith (1986) suggests that the correct location is somewhere private, away from patients and without distractions. As a student I would somehow grow in confidence. I would like more practice doing handover in private in the office. Eventually when my confidence is stronger, I would like to gradually venture to the bedside where the patient will be personally involved. I understand that nursing is dynamic and it will continue to change to meet changing demands, for example, to facilitate better patient communication.

I have to learn to accept change and to look at the positive effects of change like the practice of handover from office to bedside. I need to understand change and the risks that go with it whilst mindful of my duty to protect patient information and confidentiality at all times. I will continue to use clinical supervision to discuss anything that I felt might affect patient confidentiality. I will continue to be vigilant and assess risks to ensure that I plan my nursing activities Everyone who becomes a patient is vulnerable to public exposure, as details about his/her personal life, treatment or care are passed around.

However how abstract it may appear, patient’s medical history forms a part of who they are. Their ‘story’ belongs to them. To ignore or minimise the precious nature of the person’s ‘story’ is to imperil them; exposing the person to anxieties and insecurities of which we may know little, and understand even less. Patient’s medical history belongs to him/her and should be treated with utmost safeguards, respect and confidentiality. I would still use the proforma because I have found it useful.

However, I will anonymise as much as possible information that I write on it. At the end of the shift, I will shred the proforma that I wrote on and discard it safely to ensure that I protect patient confidentiality. According to Grey et al (2000), the delivery of hand over is the key to the overall delivery of high quality nursing care. I believe that this particular nursing action should always have ‘patient confidentiality’ at the heart of the process. I have gained a lot of experience from my first placement and have reflected on these and my nursing actions. I have developed professionally and personally as nurse and I have a better understanding of patient confidentiality.


Atkins, S. and Murphy, K. (1994) Reflective Practice. Nursing Standard 8(39) 49-56. Burns, S. and Bulman, C. (2000) Reflective Book in Nursing, The Growth of the Professional Practitioner, MPG Books Ltd. Bodmin Cornwall. Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit, Oxford Brookes University, Oxford. Jasper M 2006 Professional Development, Reflection and decision-making Blackwell Publishing Ltd, Oxford

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