Discuss the Nurses Duty of Confidentiality

This essay will discuss the need for confidentiality and the nurse’s duty to keep information he/she is privy to, confidential. Brown et al (1992) suggest that a duty of confidentiality can be described as information that is disclosed which ought not to be disclosed further except within the relevant limits. Confidentiality is generally defined as the process of the protection of personal information, and is regarded as an integral part of a nurse’s role.

The Nursing and Midwifery Council (NMC) are the regulatory body of registered nurses and midwives in the United Kingdom, and clause 5 of the NMC code of professional conduct states that registrants have a duty to protect confidential information (NMC, 2006). Failure to adhere to this clause could result in removal from the register, as confidentiality is something all nurses must respect and be aware of. So what is patient confidentiality and why is it so important?

The Department of Health (2003) says “A duty of confidence arises when one person discloses information to another (e. g. patient to clinician) in circumstances where it is reasonable to expect the information will be held in confidence. ” Confidential information (in the authors opinion as a healthcare student) includes but is not limited to information pertaining to an individual, e. g. name, contact details, medical details.

When in a position of trust and having access to confidential information, it is a good idea to ask yourself ‘what would I regard as confidential? What information would I not like to be shared? ’ which, when thinking about it, is: nothing personal that could identify you, or, something which is becoming increasingly more of a danger, leave you at risk of identity fraud. Protecting patient confidentiality is highly important to obtain and retain trust, and protect the patient, and sometimes, the patient’s family, not to mention to maintain professionalism at all times.

When a patient is under the care of a professional, they must be made aware that relevant personal information regarding themselves and their medical history will be told to other members of the team working on their care. An example of this is on a ward during patient handover. In the authors experience, the ‘handed over’ information usually includes the patients name, age, relevant medical history, social situation, current daily information (e. g.diet taken, environmental factors) clinical diagnosis, and treatment plans.

Most patients will expect and understand that some information will be shared between members of the multi disciplinary team (MDT) to create the best holistic care plan for them, and accept this. As healthcare providers we must understand that the type of information must be edited for each member of the MDT- for example if the patient is to be seen by the dietician, the dietician does not need to know the patients social situation.

The information shared must be relevant to whoever requires the information. This is supported by Pyne (1998) who suggests that it is not always practical to obtain the patient’s consent every time you need to share information with other health professionals or staff involved in their health care. Pyne (1998) continues to explain that it is important the patient understands that information may be shared, and with whom it will be shared.

In some cases, patients may refuse input from other members of staff, and in these cases, their wishes and privacy must be respected, as failure to adhere to their wishes is a breach of patient confidentiality. There are some occasions which will inevitably arise where a patient may tell a clinician information about themselves in confidence, which, while confidential and intimate, may be in the patients best interest to have the information disclosed to another member of the professional team involved directly in the patients care.

In such a case, the author of this essay suggests it is important to talk to the patient and tell them why the information should be disclosed, and the nurse should attempt to persuade the patient to allow the information to be shared. The only cases in which confidential information should be automatically shared, if consent to disclose if withheld by then patient, is if the information is required by order of law, or if there is an issue of public interest, a risk of personal security or mortality. This is confirmed by points 5. 3 and 5. 4 of the NMC code of professional conduct (NMC, 2006).

A nurse may feel under pressure from outside agencies, such as the police, to disclose confidential information but it must be remembered that as a professional, he/she is accountable for their actions. If a healthcare professional should find themselves in such a situation, it is perfectly acceptable and advisable to gain advice from senior colleagues (Pyne, 1998). Confidentiality should never be disclosed as a general topic of conversation, especially if there is an identifiable part to the ‘story’ such as a rare disease, a place, a name, sometimes even a pseudonym.

Siviter (2004) state that while the NMC don’t specifically mention confidentiality in written academic assignments for healthcare students, there are some key points which must be remembered about patient privacy when writing assignments; such as asking permission from patients if you want to use them as a case study, and changing the information being used so that they, as the subject are unidentifiable. “Always keep details of everyone - the trust, the staff, the patients - confidential” (Siviter, 2004). In summary, this essay has explored areas of confidentiality and what confidential information is.

It can be regarded, as stated in the introduction of this essay, that confidentiality is in integral part of nursing, and that the nurse has a professional duty of confidentiality to their patients. Confidentiality is a complex issue within nursing and healthcare, but something that nurses should always remember to maintain at all times. Nurses should always keep to the professional code of conduct laid out by the NMC, to protect themselves, and their professional registration, as well as the interest of the patient.

Nursing has long been regarded as a respected profession and as public representatives of the NHS, it is important to maintain these standards. Reference List: Brown, J. M. , Kitson, A. L. and McKnight, T. J (1992) Challenges in Caring: Explorations in Nursing and Ethics. 1st ed. London: Chapman & Hall. Department of Health (2003) NHS Code of Practice: Confidentiality (Online) London: Crown. Available from:

http://www. dh. gov. uk/prod_cons:um_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4069254.pdf (Accessed 19th February 2008). Nursing and Midwifery Council (2006) A-Z Advice Sheet (Online) Nursing and Midwifery Council. London: Available from: http://www. nmc-uk. org/aFrameDisplay. aspx? DocumentID=1560 (Accessed 16th February 2008). Pyne, R. (1998) Professional Discipline in Nursing, Midwifery and Health Visiting. 3rd ed. Oxford: Blackwell Science Ltd. Siviter, B. (2004) The Student Nurse Handbook: A Survival Guide. 1st ed. London: Elsevier Limited.