Confidentiality In Nursing

Confidentiality refers to the privacy of information. Confidentiality is a vital component of the nurse-patient relationship, and without it there would be little trust between the parties, leading to implications on both sides; the nurse needs to trust that the patient has disclosed all necessary information honestly, whilst the patient needs to trust the nurse in order to be able to do so (Edwards, 2009). This essay will discuss the professional duty of a student nurse with regards to the Nursing and Midwifery Council’s (NMC) statement “You must respect people’s right to confidentiality”. The professional, ethical, and legal aspects of confidentiality will be discussed in detail, with a focus on nursing adults.

Confidentiality in healthcare
is a legal responsibility that has been derided from Common and Statute law. Common law decisions are made by the courts, and are applied by referring to cases similar in content. Because of this, Common law can be said to be based on precedent (Department of Health, Social Services and Public Safety, 2014). However, there are circumstances when confidentiality can be breached. Confidentiality may be breached with the consent of the patient with whom the confidential information regards and this consent may be explicit or implied. Conversely, there are some exceptional circumstances when confidentiality may be breached without the consent of a patient. Confidentiality may be breached without the consent of a patient when the law requires it and when it is in the public’s interest, for example if an individual admits to rape or child abuse. As a result of this we cannot say confidentiality is absolute.
Unlike Common law, Statute law is an act of legislation that has been passed by parliament and asserts, prohibits or commands something. Statute law is written down in legal documents (Elliott 2014). An example of Statute law with regards to confidentiality includes The Data Protection Act (1998). The Data Protection Act (1998) was introduced to provide increased protection of individual’s data and the act applies to all forms of media, including personal records (Department of Health 2003).
One legal issue with regards to confidentiality is that common law is often complex and can be conflicting. For example, an adult patient who was unable to make decisions for himself selected his next of kin to do so, his next of kin then wished to see his medical and council records but was refused by the council and it was found that the under The Data Protection Act that it allowed the disclosure to the next of kin but also the right of the council to refuse disclosure (Beech, 2007).

Ethics are related to the fundamental principle of what is right and wrong. Nurses will be expected on a daily basis to make decisions on what they feel is best for particular patients and the purpose of ethical theories and principles is to ensure that the decisions made by nurses are evidence based.
There are three over-arching theories of ethics and these include utilitarianism, deontology and virtue ethics.
Utilitarianism, also referred to as consequentialism, is based on the principle that the consequences of an action solely determine whether it is right or wrong, and the higher the amount of positive consequences of an action, the more right it is. Deontology on the other hand is strongly associated with duties and rights and encourages judgements on the rightness of actions based on duty of those involved irrespective of any real or predicted consequences or outcomes. Virtue ethics unlike the other two theories, does not focus on the consequences or rules but instead focuses on moral character and is based on the principle that an action is only right if it is an action that a ‘virtuous’ person would carry out in the same
circumstances.
The NMC code is reinforced by ethical principles, and Beauchamp and Childress’ (2001) four principles are one of the most commonly used framework of principles. The four principles include respect for autonomy which refers to respecting the decision making capabilities of individuals. Beneficence which refers to the balanced benefits of treatment against the risk and the cost and non-maleficence which refers to avoiding causing harm and although most treatments will cause some form of harm, the harm caused by the treatment should not be out-weighed by the benefits.
One ethical issue with regards to confidentiality is that a nurse following the utilitarianism theory may whistleblow because they feel that doing so will produce the greatest good, however, breaching this confidentiality may cause more harm than good, as there could be a disruption to healthcare system in order to solve the problems highlighted, which may then result in patients losing faith in the healthcare system (Wilmot 2000).
Another ethical issue with regards to confidentiality is that a nurse who maintains confidentiality of one patient may actually be causing harm for another individual.
For example a patient may be diagnosed with a disease that is hereditary and they have children, but do not wish their family to know their diagnosis. Toren and Wagner (2010) suggest that, by maintaining the patient’s confidentiality, the nurse would be acting in a non-maleficent way. However, upholding the patient’s confidentiality risks harm to relatives of the patient, so it could be argued that the nurse is not acting in a non-maleficent way at
all.
Being a student nurse means that you are currently not bound by the NMC code, however, the NMC code outlines the professional codes of conduct that registered nurses are required to follow, and it is vital that student nurses have an understanding of the codes and follow them at all times. The NMC code integrates confidentiality in the four core principles and states that nurses should “Respect a person’s rights to confidentiality” (NMC code 2008). This demonstrates how important confidentiality is with regards to our professional duty as a student nurse. The NHS constitution (National Health Service (NHS), 2013) provides a set of principles and values that all roles within the NHS must adhere to. It indicates the aspiration of the NHS to work to the “highest standards of excellence and professionalism”, and specifies that this includes the maintenance of patient confidentiality.
One professional issue with regards to confidentiality is that in breaching confidentiality without a valid reason, a nurse is no longer abiding by their code of conduct, which can result in a number of serious outcomes, including disciplinary procedures or criminal procedures, depending on the severity of the offense. A well-known example of a nurse breaking a confidentiality agreement was a nurse called Margaret Haywood, who exposed poor standards of care in a hospital by recording films in secret, and then sending them to BBC Panorama. Although there may have been good intentions behind her actions, they were neither legal, professional, or ethical, which resulted in her losing her nursing registration (Wainwright, 2009).