Confidentiality In Nursing Case Study

In America, in 1893, Mrs. Lystra E. Gretter composed an adaption of the Hippocratic Oath for nurses naming it the Nightingale Pledge. Part of this pledge reads:

I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. (Florence Nightingale Pledge, 2012)

Although the times have changed, the importance of maintaining patient confidentiality and privacy has not, especially on social media. With social media use increasingly prevalent in daily life, it is important to ensure the safety and privacy of patients. Patient privacy is protected by law, and by the standards set out

by the Nursing and Midwifery Board of Australia; and health care providers, including nurses and student nurses, are required to ensure the health information of a patient is kept private and confidential at all times (Daly, Speedy & Jackson, 2014). Social media does have a place in nursing, with many institutions using it to better communication between nurses, however use should be carefully monitored and users appropriately educated to prevent privacy breaches (Spector & Kappel, 2012).
Although the increasing prevalence of social media use has many benefits to nurses in both workplaces and home, it has given rise to some issues regarding patient privacy and confidentiality (Johnstone, 2016). Presented in this essay is a scenario where a student nurse observes a fellow student posting private patient information on Facebook, a breach of the Privacy Act (Australian Government, 1988) requiring immediate action. The witnessing student nurse has an obligation to report observations of a breach in patient privacy and confidentiality to the appropriate peoples, in order to maintain patient safety. This is supported in the following discussion, which highlights the required actions of the witnessing student nurse in response to the breach. In addition to this, also discussed are the laws, competency standards for registered nurses, the code of ethics for nurses, and the code of conduct for nurses which affect the situation. Finally, a recommendation on aiding the prevention of patient privacy and confidentiality breaches on social media is also discussed.
The legal, ethical, and professional issues raised by this scenario require immediate action by the witnessing student nurse, despite any awkwardness that may occur. The Nursing and Midwifery Board of Australia (NMBA) competency standard 1.3 states that a nurse must fulfil a duty of care to patients, by performing interventions in accordance to nursing practice conventions (NMBA, 2006, standard 1.3). Therefore, the immediate action is to talk directly to the offending nurse, this should be done as soon as the witnessing nurse notices the issue. Research finds that many student nurses feel overwhelmed making decisions about ethical issues arising in clinical practice, especially if the decision requires them to go against their nursing colleagues or persons in authority (Lacobucci, Daly, Lindell & Griffin, 2013). This means the witnessing nurse may feel overwhelmed by the importance of the decision to report the offending nurse. However, the witnessing nurse has a duty of care to keep the patient and their privacy safe. Posts on social media are renown for spreading quickly and often reflecting badly on the original poster, who may have thought the post was private (Greysen, Kind & Chretien, 2010). Asking for the immediate removal of the Facebook post limits the availability of the post to be shared or copied by others. When talking to the offending nurse, the witnessing nurse should show the appropriate law and ethics that are being breached. The NMBA competency standard 4.3 states that a competent nurse contributes to the professional growth of their colleagues by encouraging the increase of knowledge, and being a role model in competent practice (NMBA, 2006, standard 4.3). In addition to this the competency standard 2.6 states that safe and effective nursing is achieved by the application of knowledge and skills. This includes ensuring the appropriate privacy and confidentiality needs are being met, as well as questioning other members of the health care team if the nurse feels these needs are being breached (NMBA, 2006, standard 2.6). By sharing with the offending nurse that their actions are inappropriate, the witnessing nurse is contributing to their professional development, as well as ensuring the safety of the patient.
After approaching the offending nurse, it is important the witnessing nurse notifies a hospital staff member of the issue, due to further implications affecting the hospital.

The code of professional conduct for nurses’ states in conduct statement 2, that a nurse must practice in adherence to the standards of their profession and the health board. In instances where a nurse observes any circumstance that goes against professional standards, or is unethical or unlawful practice, they must report this to the appropriate authorities. Further stated, is that if the issue is not resolved internally that the nurse may notify external authorities in order to safeguard their patients (NMBA, 2008a, statement 2). In this case the witnessing nurse should approach the Registered Nurse (RN) or preceptor for the clinical placement (Charles Darwin University, 2015). The elevation of the situation is important as the hospital needs to know of any breaches in its patient’s privacy. The NMBA code of ethics for nurses (2008b) states in the value Statement 7 that a nurse must ensure that the management of patient information is carried out in a safe and ethical manner. This means that not only are records correct, but the information in the records and any information about patients and their health is kept private and confidential to only the health professionals that require it. Without patient confidentiality there can be no patient confidence in the services rendered by that facility. For

the patient, a breach in their confidentiality and privacy is confronting and can lead to feelings of anger or discouragement in the health care system. This could risk loss of confidence in the functionality of the health care system, with the patient refusing to access further health care for fear another breach could occur (National Council of State Board of Nursing [NCSBN], 2011). For the hospital a breach in patient privacy and confidentiality can also lead to a loss of reputation, as the patient may lodge a complaint. Under the ‘Health Records and Information Privacy Act’ (2002) the patient is within their rights to lodge a complaint against any health service, or educational institution, if health information is illegally dispersed. The offending nurse’s actions are a breach of the law, meaning disciplinary action can be taken out by the university, the health care facility, and even the patient (Spector & Kappel, 2012). By reporting the breach to the preceptor, the witnessing nurse can enable the situation to be dealt with efficiently and effectively, limiting the damage to both patient and hospital.
In addition to notifying hospital personnel, it is important that the witnessing nurse also notifies university coordinators. The witnessing student nurse should approach the clinical coordinator and advise them of the breach, and the steps already taken to resolve it (Charles Darwin University [CDU], 2015a). This is an important step, as not only will the hospital have privacy policies, but the university will also. The Charles Darwin University (CDU) has a social media policy which states that private information should not be published by students (CDU, 2015b). In addition to this, the CDU code of conduct states that students should act with integrity and professionalism, even within seemingly informal social media settings (CDU, 2012). The offending nurse has not adhered to these standards; therefore, it is important that the witnessing nurse notifies the university. This step is important as the breach of privacy and confidentiality also affects the university, as it could lead to the care facility rejecting further university placements. This is unfortunate as universities often find it hard to find placement opportunities as it is (NCSBN, 2011).
The immediate actions of the nurse may create the need for follow on actions from the patient, hospital and university. For example, if the breach is unable to be resolved, it would be viable for either the patient, hospital, university, or witnessing nurse to report the breach to the Australian Health Practitioner Regulation Agency (AHPRA), or the Health Ombudsman in Queensland (AHPRA, 2016). In NSW, according the ‘Health Practitioner Regulation National Law NSW’ section 144a, a complaint may be made regarding a student, if the student has been deemed to have broken the regulations of student registration (NSW Government, 2009). This is called notification and can be initiated by anyone, including voluntary notification from the offending nurse if they so choose. The notification is assessed by the relevant boards, with different degrees of disciplinary action, if any, handed down after all appropriate avenues being exhausted (AHPRA, 2016).
With the rise in social media use in nursing privacy breaches could become an increasing problem for students, and hospitals.

Therefore, it is important that student nurses, and other nursing staff, are aware of the appropriate way to interact on social media. This is essential to the continued safety of the privacy and confidentiality of patients (Spector & Kappel, 2012). As a solution to the inappropriate social media use in this scenario, one recommendation would be the implementation of a social media policy, as well as, appropriate education for students about the regulations of the policy. For example, Charles Darwin University has a social media policy for students, which states that students should act in accordance with the university code of conduct, and only publish information that is publicly available and will not affect the reputation of the university (Charles Darwin University, 2015b). Appropriate education about this policy, could have prevented this scenario from taking place. The benefits of a social media policy are that it allows for the consistent communication to employees and students of the required rules and regulations to follow when using social media (Fuduric & Mandelli, 2014). This allows students, and others, the opportunity to have a clear cut view on what is, or is not, appropriate behaviour on social media. In addition to this social media policy, education on the appropriate ways to use this policy would be beneficial. These benefits are

evidenced in the research by Greysen, Kind & Chretien (2010), which states that communication of expectations around social media between educators, students, and health professionals allows students to connect with the concepts. This connection has seen students restrict social media use while on placement, in order to avoid being seen as unprofessional to both employers and patients.
The inappropriate use of social media in this scenario highlights the ease in which student nurses can breach patient privacy and confidentiality. Also seen, is how an observant and well educated student nurse is able to meet their obligations and report the breach in an appropriate manner. The immediate action of the witnessing nurse, to approach the offending nurse and ask for the removal of the information, is in keeping with the NMBA’s standards, and is an appropriate course of action. Following this, the reporting of the breach to the hospital via the student nurse’s preceptor is in keeping with the actions required of CDU, as well as the standards set out by the NMBA. Finally, the notification of the breach to the university is in keeping with the CDU code of conduct, allowing the university to assist in the resolution of the issue. These actions by the witnessing student nurse are essential as further action may be taken by those involved if the breach is not adequately resolved, requiring notification to AHPRA and further inquiries. Recommended is the implementation of a social media policy and the appropriate education of students in its meaning and importance will further aid in the prevention of a repeat of this scenario. Social media will now always be prevalent in a nursing setting, with positive and negative implications. However, with the appropriate education of student nurses on the standards required of them in clinical placements, patient safety, privacy, and confidentiality will be retained.