The following dissertation sample is anchored on the explication of the aspects of confidentiality and privacy within the hospital setting. There is a revelation of the fact that nurses handle information that is sensitive in relation to patients, and have to ensure that they do not release it to unauthorized parties for the safety of patients. However, the study reveals that upholding privacy is critical, but does not necessarily enhance the patient outcomes. Training nurses gives them more confidence in terms of understanding confidentiality and privacy and the mode of their application even with the emerging technologies. The dissertation concludes that there is need for nurses to adhere to the set standards of respecting patient confidentiality and privacy to enhance the position of the health care system.
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CHAPTER ONE: THE PROBLEM
In the hospital setting, confidentiality entails the obligation of nurses to hold the information of patients in confidence. On the other hand, privacy is all about the right of the right of the patient to decide the manner in which their information is to be shared. Nurses are supposed to ensure that they uphold both confidentiality and the privacy of the information related to patients as part of their ethical standards. However, studies by researchers such as McMurray, Chaboyer, and Wallis (2009) reveal that there has been an increase in the rate of breach of the ethical standard with the information of many patients not protected effectively. This means that the information is exposed to unauthorized parties hence exposing the medical history of the patients, and they suffer stigma or neglect by other members of the community based on their illness. The breach of patient confidentiality and privacy emanates from various causes including carelessness on the part of nurses, intentional breach of ethical standards on confidentiality and privacy, and the lack of effective protection in the electronic patient information (Appari & Johnson, 2010). With the breach of patient confidentiality and privacy, the nurse-patient relationship has subsequently diminished discouraging patients from sharing sensitive information with nurses hence negatively impacting care.
The problem background for this study is anchored on the understanding that the respect for confidentiality and privacy is vital in terms of enhancing the relationship between nurses and patients and hence the outcomes of the patients. It is important to note that laws such as the HIPAA Privacy Rule, the Privacy Act of 1974, and the Freedom of Information Act have been put in place with the view of ensuring that the information of patients is protected from any form of exposure to the public (Strauss & Mayer, 2013). Nurses are supposed to adhere to these laws while handling the information of patients, but this tends to have remained problematic. According to the research conducted by Beltran-Aroca, Girela-Lopez, Collazo-Chao, Montero-Perez-Barquero, and Munoz-Villanueva (2016), 54.6% of confidentiality and privacy breaches are associated with disclosure of information to individuals are who are not directly involved in the patient’s primary care. More so, Beltran-Aroca, Girela-Lopez, Collazo-Chao, Montero-Perez-Barquero, and Munoz-Villanueva (2016) reveal that the breach of patient confidentiality and privacy is severe accounting for 46.7% of all cases within the hospital environment. An estimated 37.9% of these breaches of confidentiality are reported in public areas within the hospital setting hence affecting the patient-nurse relationship and subsequent patient outcomes (Beltran-Aroca, Girela-Lopez, Collazo-Chao, Montero-Perez-Barquero, & Munoz-Villanueva, 2016).
Purpose of the Study
The purpose of this study is to investigate the rate of confidentiality and privacy breaches in relation to the health information of patients by nurses in the hospital setting. In particular, the study will focus on how nurses handle the sensitive information given to them by patients, and the possible breaches that are always likely to emanate from the same (Nelson & Staggers, 2014). In line with this purpose, the study aims at identifying confidentiality and privacy as ethical standards that need to be upheld by nurses in the hospital setting with the view of supporting care and better outcomes on the part of patients. This purpose will be attained in line with several objectives indicated below.
· To investigate the ethics of patient information confidentiality and privacy at Palmetto General Hospital, Hialeah, Florida.
· To investigate the rate of breach of patient confidentiality and privacy by nurses in the hospital setting at Palmetto General Hospital, Hialeah, Florida
· To investigate the impacts of breach of patient confidentiality and privacy on patient-nurse relationships
· To provide recommendations on the improvement on patient confidentiality and privacy by nurses in the hospital setting
Significance of the Study
The significance of the study is anchored on the need to have better strategies to protect the confidentiality and privacy of patient information by nurses with the view of improving patient outcomes (Urden, Stacy, & Lough, 2013). In light of the discussed problem, it is clear that patients shy away from sharing their sensitive information in instances where they realize that there is a breach of confidentiality and privacy (Murray, Chaboyer, & Wallis, 2009). However, this study focuses on eliminating this situation by giving patients the confidence to share the sensitive information with nurses that would help in their healing and recovery process. This would be possible with the emphasis on the protection of patient information on the part of nurses by re-emphasizing the law related to the matter as well as technological tools that enhance protection of privacy and confidentiality (Murray, Chaboyer, & Wallis, 2009).
The overarching research question for this study is, what is the frequency of breach of patient information confidentiality and privacy by nurses in the hospital setting?
The key limitations for this study was time, which ensured that only a small size of the population were used for the collection of data (Gerrish & Lathlean, 2015). Because of time limitations for the study, it was challenging to reach out to a larger number of the population that would have played an instrumental role in boosting the reliability of the findings for this study. A small population is not an effective representative of the target population because of the variation in circumstances within the work settings (Jirojwong, Johnson, & Welch, 2014). Thus, the findings of the study in relation to the confidentiality and privacy of the information of patients cannot be generalized for the entire population, because only a small sample of the entire population is used and because of the existence of variations in the researched hospital environments.
The study encompasses several delimitations as demonstrated below;
· First, this study will not explicate the punishment that nurses who breach the confidentiality and privacy of patient information are exposed to with the view of maintaining a patient-centered focus (Nelson & Staggers, 2014).
· Second, the study does not address the effects of breach of patient information privacy and confidentiality in regard to the hospitals with the view of focusing only on the extent of breach experienced.
· Third, the study does not offer solutions to the prevention of breach for hospital settings but only advises measures for effective improvement with the view of leaving the decision-making process to implementers (Paola, Walker, & Nixon, 2010).
Definition of Terms
Confidentiality: This refers to the set of rules that limits the access to information that has been discussed between a patient and a nurse (Bauer, 2009).
Privacy: Privacy refers to the permission of the patient to allow his medical information to be shared to the public (Bogaert & GA, 2009).
Hospital setting: It refers to the environment that healthcare is delivered to patients based on their different conditions (Hiller, McMullen, Chumney, & Baumer, 2015).
Patient-nurse relationships: This is the association that exists between a nurse and a patient based on the confidence that the patient places within the nurse (Lowrance, 2012).
Patient Outcomes: With regard to confidentiality and privacy, patient outcomes refer to the treatment they get and the effectiveness of this to their health (Butts, 2008).
CHAPTER TWO: REVIEW OF LITERATURE
In tandem with literature, the confidentiality and privacy of the information of patients could be enhanced by nurses hence avoiding incidents where it is exposed to unauthorized parties. Nurses have the primary role of ensuring that the confidentiality and privacy of the information of patients is protected in the best ways possible (McNew, 2014). It is through the adherence to the rules and regulations of confidentiality and privacy that the information of patients is protected in the best way. Centers for Disease Control (CDC) and the U.S. Department of Health and Human Services has been emphatic about the need to ensure that the privacy and confidentiality of patients is upheld in the hospital setting by nurses. More so, the American Nurses Association (ANA) has also been keen on ensuring that the standards within the hospital setting. This is with the view of ensuring that all the details of patients are secured appropriately only for use by primary care givers.
The U.S has had a long history of ensuring that the confidentiality and privacy of patient information is upheld by nurses in all capacities. The focus on patient confidentiality has been treated with a high level of specialty since time immemorial. This explains why nurses have been required to take the Hippocratic Oath before getting into the field of practice (Oppenheim, 2012). The Hippocratic Oath is significant in the sense that it bestowed on nurses the commitment to keep all the information related to patients as private as possible. However, with the changes in technology and the shifts in the storage of patient information, the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 and it provided that professionals and organizations must focused on protecting the privacy and confidentiality of all patients (Oppenheim, 2012). As part of the history to enhance the protection of the information of patients, HIPAA requires the publication of relevant standards that could be applied in privacy and the health security information. HIPAA came into place as a strict measure to ensure that any details related to patients is not disclosed by nurses with the need of protecting their overall identity.
With the enactment of HIPAA, the key pieces of information that is supposed to be protected is the protected health information of the patient. Accordingly, the privacy rule aims at protecting all the health information that is individually identifiable is protected (Perry, Potter, & Ostendorf, 2015). This could be oral, paper, or electronic information and it needs to be secured at all costs to avoid the exposure of patients. The examples of individually identifiable information that HIPAA protects to date include the individual’s past, present, or future condition, the nature of healthcare provided to the individual, as well as the past, present, and future provision of medicine to the individual. Nurses must be careful to ensure that these details are protected to the full measure (Oppenheim, 2012).
Comprehending Privacy and Confidentiality
In analyzing the issues of privacy and confidentiality, Bogaert and Ga (2009) reveal that confidentiality is concerned with the value of trust that is always put in the patient-nurse relationships. Accordingly, this emanates from the fact that the patient expects the nurse will not divulge their private information to other undesirable parties. According to Bogaert and Ga (2009), the nurse is supposed to give the patient a reason to believe that their information will not be divulged to other parties. While explicating privacy, Bogaert and Ga (2009) explain that privacy has remained elusive in the hospital setting, as most patients tend to lose their significant health details. In their definition, Ramlaul and Vosper (2013) affirm that privacy entails consensus entailing the control over who can experience patients as well as information relating to individuals who can control the information of patients. In tandem with the above definitions, Bogaert and Ga (2009) impeccably offer the understanding of both privacy and confidentiality in the best ways possible. Actually, from the definition, it is quite clear that confidentiality and privacy exhibit some significant differences in terms of their approach to the information of the patient.
From an ethical perspective, Butts (2008) affirms that confidentiality and privacy are fully embedded in the moral obligations of nurses and they are expected to uphold these obligations in the course of their dealings with their patients. A nurse who is guided by moral principles finds it easier to understand how to respect both the privacy and confidentiality of the patient (Sellman & Snelling, 2014). In this regard, it means that the nurse will not at any time share the information of the patient with anyone including fellow nurses not involved in the primary care of the patient. In the views of Butts (2008), as much as nurses are highly tempted to reveal significant information of patients to other people, they should always be willing to refer to the ethical standards. Sellman and Snelling add nurses have the moral responsibility to ensure that they always uphold the confidentiality of patients in a manner that is effective enough. While still focusing on the same issue of the ethics of confidentiality and privacy, Townsend (2009) adds that there are always challenges related to privacy and confidentiality for nurses in the rural hospital settings especially because of the overlapping nature of their relationships with patients. The long-term nature of the relationships bring about a situation when patients fully trust the nurses and can offer any particular information to them (Sridhar, 2013). However, the risk of disclosing the same information to other people is always at its highest level from the nursing perspective. For effective working with patients in rural settings, Townsend (2009) advises that nurses must be exclusive in terms of staying with the pieces of information that is offered by the patient. There should be no chance of giving the information even to relatives when the patient does not approve of it.
English and Lewis (2016) reiterate that federal laws have been instrumental in backing up the whole shape of patient information confidentiality and privacy protection by nurses in hospital settings. The federal laws indicate the appreciation of moral standards related to the respect of the patient, and aim at restricting the disclosure of the information in line with the penalties for the breach of the same. For instance, at the federal level, regulations such as the Title X Family Planning Program and the Federal Qualified Health Centers have been vital in reinforcing the ethics of confidentiality and privacy of patient information. What English and Lewis (2016) are trying to emphasize here is that as much as the protection of confidentiality and privacy is a moral principle that is supposed to come from the understanding of good practice among nurses, there needs to be stronger laws to back it up. Thus, one of the key threats that faces confidentiality and privacy is conflict where the nurse might not specifically know the kind of information to be disclosed to family members and the kind of information to be kept away from them. English and Lewis (2016) state that even as there is need to uphold confidentiality and privacy, nurses are at times in conflict situations because at times revealing patient information might be vital in saving their lives and the failure to disclose the same might be detrimental. In this article, there is an effective emphasis of the need to look at confidentiality and privacy from a regulatory perspective rather than just a moral perspective (Wheeler, 2013). As much as moral values as imparted on nurses, federal regulations are important in streamlining their practice in respect to revealing the information of patients to unauthorized parties.
In this age of technology, the protection of patient information confidentiality and privacy has become even more fundamental with the utilization of special storage devices for patient information. Bauer (2009) explains that in E-medicine, the protection of the confidentiality and privacy of patient information has become quite vital. E-medicine has made it easier for nurses to manage, store, and transmit information related to patients at any given time, and they need to be diligent enough not to disclose the same to other people. With E-medicine, Bauer (2009) asserts that the threat of breaching confidentiality and privacy of patients has increased to a great level because of the vulnerability of technology to hackers. One of the key threats that emanate from E-medicine is the threat of cookies and spyware that ensure authorized individuals have access to the important information of patients. According to Bauer (2009), cookies and spyware give unauthorized individuals the chance to track the online activities, which might subsequently expose them to the most sensitive information of the patient. The second threat is that of hackers who always find a way to access the information of patients while the third threat is the accidental disclosure of information to unauthorized people through the World Wide Web. Last Bauer (2009), explains that the high levels of incompatibility and standards with the required security measures also pose a threat to the respect of the confidentiality of patients at any given moment. The study by Bauer (2009) is vital in offering guidelines to the protection of information while utilizing E-medicine within the healthcare setting.
In the same focus on technology and its impact on the breach of confidentiality and privacy, Hiller, McMullen, Chumney, and Baumer (2015) compare the effectiveness of the U.S. to the European Union in terms of safeguarding patient privacy and confidentiality in the course of implementing technology in the hospital settings. The first important point that Hiller, McMullen, Chumney, and Baumer (2015) make in their discussion is that Electronic Health Records (EHR) are significant in the promotion of efficiency as well as cost-saving in the handling of patient information. They make it easier for hospitals to keep track of patient information while also focusing on utilizing it for the benefit of patients and their families. However, even with the cost-savings advantages, there are major risks in terms of the security of the information of patients. In the views of Hiller, McMullen, Chumney, and Baumer (2015), the key risks associated with EHRs might not be easily controlled by nurses because they are out of their way. The design of the entire system matters a lot to nurses who want to ensure that the vital details of their patients are protected at all times. For instance, the difference between the desires of patients in regard to their patient information protection design of the system affects the nature of information protection. The lack of privacy notices on EHRs makes them quite vulnerable in breaching the confidentiality and privacy of patients by exposing their information to undesirable parties. This means that nurses are supposed to be trained on the effective ways of using the EHRs to sense the breach of patient information privacy and confidentiality. While collecting the information of patients, Hiller, McMullen, Chumney, and Baumer (2015) reiterate that the information should be stored in a safe manner that does not in any way compromise its safety and the position of the patient. The authorization of patients is vital in ensuring that the information is protected well as it is only utilized at their own discretion rather than by the determination of any other person. In essence, Hiller, McMullen, Chumney, and Baumer (2015) effectively explicate the threat to confidentiality and privacy under EHRs. As much as they fail to bring out the perspective on information stored manually, they offer a reliable guideline to nurses to be sensitive to the operations of EHRs while working at the protection of important patient information in the course of their operations.
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Significance and Costs of Confidentiality and Privacy Breach
In evaluating the significance of ensuring that the confidentiality and privacy of patients is protected, Donner, VandeCreek, Gonsiorek, and Fisher (2008) affirm that upholding the standards of confidentiality and ethics promote the trust of the patient in nurses. There is nothing good in the hospital environment as patients trusting nurses who turn out to be their caregivers in the course of their stay or visit to the hospitals. According to Donner, VandeCreek, Gonsiorek, and Fisher (2008), trust in the nurse-patient relationships is desirable and is only encouraged when the nurse becomes responsible enough to uphold the details related to the information of patients. With trust in the nurse, the patient is always free to offer the most sensitive information to them without any fear or doubt about the security of this information. The sensitive information always needs to be effectively secured with the view of ensuring that the patient has trust in the healthcare system or the particular healthcare system. New patients are able to return to hospital facilities that believe in the continued protection of their confidential information because of the confidence that they will be treated with the desirable level of respect in these settings.
More so, there is always an improvement in patient outcomes in situations where the level of confidentiality and privacy of patient information is upheld by nurses in the hospital setting. Lowrance (2012) explains that patients give nurses sensitive information because of the understanding that it will be applied in the course of their treatment. They offer confidential information with the focus on the positive outcomes of the process of their recovery. On most occasions, patients focus on the ability of nurses to apply this health information efficiently with the view of ensuring that they are treated in the required way. Lowrance (2012) informs that the patient is always able to be treated in the best ways possible when the ethics of confidentiality and privacy are upheld. The outcomes are always improved to a great extent and nurses have the duty to ensure that the outcomes continue being improved toward the positive direction by nurses who keep the information for the benefit of patients. For the sake of patients’ recovery, nurses must be on the leading front in respect to protecting the information given to them by patients. The goal is to attain the best possible outcome for patients should be advanced by upholding the level of confidentiality and privacy of their information in the best ways possible. It is frequent breaches that interfere with the recovery process of these patients.
The cost of breaching the principles of confidentiality and privacy are quite high according to the researches by Jackson (2015) and English, Summers, Lewis, and Coleman (2015). Specifically, Jackson (2015) reveals the cost of breach of confidentiality and the privacy of patient information by pointing to the position of the Department of Justice and the Federal Bureau of Investigation. There are always law suits to for the hospital setting to face as a result of the breach of confidentiality and privacy at any given moment. In the views of Jackson (2015), the breach of HIPAA regulations on privacy subsequently lead to law suits that ensure the respective hospitals use huge sums of money in the case as well as compensation to the patients whose rights to confidentiality and privacy are breached. To clarify this, Jackson (2015) refers to the Indiana case involving A Clarion call where the plaintiff was awarded $1.8 million as a result of the breach of these standards on confidentiality and privacy. English, Summers, Lewis, and Coleman (2015) add to the understanding of the costs of breach of confidentiality and privacy by asserting that both nurses and hospital settings should be directed on avoiding these costs by respecting the information of patients. They should not think of giving it out to any particular party whatsoever to avoid the costs that come with it.
This chapter has offered an in depth understanding of the nature of confidentiality and privacy within the hospital setting by nurses. It emphasizes the view that nurses are supposed to be guided by both the ethical standards on confidentiality and privacy and the federal laws restricting the sharing of the information of patients. More so, the technological challenges that are always likely to expose patients to the loss of confidentiality should be considered appropriately to give patients the opportunity to share their most sensitive information for better healing. Otherwise, hospitals that do not effectively uphold the ethical standards on confidentiality and privacy are always likely to suffer legal suits as well as the loss of trust from patients.
CHAPTER THREE: METHODOLOGY
Introduction to Research Design
It is always important to ensure that the required data is collected using the best strategies possible to enhance its reliability and credibility for the formulation of conclusions and recommendations to research. This particular study is focused on the utilization of the quantitative research design, which is perceived advantageous for the role it plays in the presentation of data statistically leading to the answering of the research question (Maltby, Williams, Mcgarry, & Day, 2014). More so, the population that the data is expected to be collected from must be appropriately determined for purposes of consistency leading to the attainment of the objectives of the research. An appropriate determination of the population of research is also instrumental in boosting the consistency of information. For this study, the target population is made up nurses from Palmetto General Hospital, Hialeah, Florida, which has been previously found in breach of the HIPAA standards on confidentiality and privacy (Gerrish & Lathlean, 2015). Questionnaires with ten questions would form the basis of understanding the level of confidentiality and privacy within the hospital setting.
In tandem with this study, the quantitative research design will be utilized. It is important to understand that the quantitative research design is the approach that expresses data in the form of statistics or mathematically. The quantitative research design will utilize descriptive statistics and it will play an instrumental role in ensuring that the research question for this study is answered successfully with the objectives also attained in the required manner (Henly, 2015). Therefore, the quantitative research design is preferred for this study for several reasons. First, the choice of the quantitative research design utilizing descriptive statistics is justified by the fact that it presents information in the clearest manner possible through statistics. It was easier to interpret the data collected in the study based on the raw information that was collected through questionnaires. The easier interpretation of the data was vital in the answering of the research questions of the study in a manner that is simple (Henly, 2015). More so, the ability of the quantitative research design to handle large amounts of data justified its selection for use in this study. It was expected that there would be many responses that needed to be understood and effectively interpreted for understanding. The quantitative data made it quite easier toward this understanding. Last, the quantitative research design was justified for application in this study because of its ability to unfold naturally without the researcher interfering with the research process (Jirojwong, Johnson, & Welch, 2014). With the natural nature of the approach and adherence to the research plan, there was no chance of breach of independence on the part of the researcher hence ensuring that the results remained consistent and reliable.
Description of Participants
The participants of this study would be basically nurses from Palmetto General Hospital, Hialeah, Florida. The health institution was selected for study of its diversity of nurses and potential incidences of confidentiality. Thus, it offered a better opportunity for the researcher to gain an in depth understanding of the nature of confidentiality and privacy within the hospital setting (LoBiondo-Wood & Haber, 2014). More so, nurses were selected as the best participants for the study because they are directly involved in the handling of patient information. Specifically, out of the sampled population of (N) of 180 nurses, the sample population (n) of 50 participants was selected for participation in the study. The researcher deemed the sample population (n) of 50 participants adequate for this study for two key reasons. First, the population was easily manageable on the part of the researcher. This is to say that the researcher had an easier opportunity to administer questionnaires and collect them from respondents in an easier manner. More so, the population of 50 participants was also deemed appropriate for this study because it offered an opportunity on the part of the researcher to collect more information for application into the study. Such a population was made up of different views hence giving plenty information that was effectively utilized in the study for the understanding of confidentiality and privacy.
Access of Permissions
The research permissions were sorted from the participants through the organization in the first instance (Gerrish & Lathlean, 2015). This was done through formal notification in the form of an official letter. An official letter addressed to the head of the hospital was written and copied to the human resource manager to request for permission to conduct the study utilizing the organization. In the permission, the researcher pointed out the nature of the study, which is to understand confidentiality and privacy as it relates to patient information within the hospital setting (Jirojwong, Johnson, & Welch, 2014). Clarifying the topic was vital because it meant that the researcher was as open as possible. Openness is key to the success of the research and the reflection of ethical standards (Maltby, Williams, Mcgarry, & Day, 2014). The second element that was captured in the permission letter was the benefits of the research on both the organization and practice. Pointing out the benefits meant that the research was well-understood not as a tool of victimizing the organization, but benefitting it in respect to boosting the protection of patient information moving into the future.
After the permission to study the organization was guaranteed, it was also vital to seek permission from nurses who were the key participants in the study. Permission was acquired through consent forms that were given to the potential participants of the study (Gerrish & Lathlean, 2015). The consent forms were to be read and signed by the participants with the view of ensuring that they only take part in the study voluntarily. They needed only to take part in the study at their willingness and could withdraw from the study when they deemed fit (LoBiondo-Wood & Haber, 2014). Thus, participants were informed of their rights in the course of participating in the study, and were subsequently assured of their own confidentiality based on the information presented. Last, the benefits of the study to their own roles as nurses in the hospital setting were addressed to make them realize the advantages of the study to the promotion of the welfare of the patients that they handle. The protection of the identity of the participants was critical in ensuring that they are not victimized in the course of participating in the study (Henly, 2015).
Data Collection Method
Questionnaires were used to collect the data used for this study. This was first preceded with by the simple random sampling approach. In line with the simple random sampling approach, the participants of the study were able to be selected easily through the classification into different characteristics such as the direct handling of patient information (Jirojwong, Johnson, & Welch, 2014). The simple random sampling approach was also advantageous because it gave every participant the chance to participate in the study on equal measure. Questionnaires were used in the collection of the data that was applied to the study. It is important to assert that questionnaires were preferred because they facilitate the collection of data from a large number of participants (LoBiondo-Wood & Haber, 2014). They are answered within the same time and this makes it easier for them to apply to many participants leading to larger data. Additionally, questionnaires were preferred for their time-saving attributes. This is also because they are always filled at the same time and collected within the same time interval. There is no need for waiting on each individual participant to answer questions alone hence a time-saving measure for the researcher.
One of the key methodological assumption for this study was that participants took part in the study voluntarily. It was assumed from the methodology that the data offered by participants was credible and voluntary (Gerrish & Lathlean, 2015). No participant was coerced to take part in the study and this meant that they offer all the study details at their own discretion. This was vital in enhancing the ethical nature of this study. Another methodological assumption was that the use of the quantitative approach would present data in an easier manner that is able to be interpreted for the benefit of the practice of handling patient information.
Data Processing and Analysis
Data processing and analysis was done utilizing ANOVA. The ANOVA entails statistical models that play a vital role in the analysis of differences among a group (Henly, 2015). This will make it easier to process data and analyze data on the differences in the maintenance of privacy and confidentiality among the participants in the study. ANOVA was advantageous because it ensured that the approaches to the handling of patient health information is compared and contrasted in the best ways possible within the hospital environment and reliable conclusions made in regard to the study (Maltby, Williams, Mcgarry, & Day, 2014).
CHAPTER 4: RESULTS AND ANALYSIS
The results for this study were collected from 50 nurses at the Stanford Health Care. It is worth noting that a total of 10 questions was posed to the nurses and they gave their different views on the subject of confidentiality hence leading to the formation of the results as illustrated in the graphs below.
Question 1: Do you understand the difference between patient confidentiality and privacy? In respect to this question, 42 nurses (84%) stated that they have a clear understanding of the difference between confidentiality and privacy. On the other hand, 8 of them (16%) indicated that they were not aware of the differences. This is demonstrated below.
Question 2: Do you know the HIPAA guidelines on confidentiality and privacy? In regard to this question, 40 nurses (80%) indicated that they understand the HIPAA guidelines on patient safety. On the other hand, 10 nurses, (20%) stated that they do not know these guidelines. This is as demonstrated below.
Question 3: Do you uphold your Hippocratic Oath in practice? The question was anchored at understanding the discipline of nurses in terms of upholding their Hippocratic Oath. In line with the question, only 5 nurses (10%) of the nurses stated that they uphold the oath while the other 45 nurses (90%) stated that they do not uphold the Hippocratic Oath in the course of their practice. This is illustrated below.
Question 4: Does technology affect your adherence to patient health information confidentiality and privacy? In tandem with this question, 3 nurses (6%) indicated that technology affects their adherence to the level of confidentiality they uphold while 47 nurses (94%) brought out the view that technology use does not affect their observation of privacy and confidentiality in the course of their practice. This is reflected in the graphs below.
Question 5: Does your hospital uphold ethical standards on patient confidentiality and privacy? In regard to this question, 49 nurses (98%) revealed that their hospital effectively upholds ethical standards in terms of patient confidentiality and privacy. This is graphically demonstrated below.
Question 6: Is there a routine monitoring of patient information confidentiality and privacy? In regard to the routine monitoring of confidentiality and privacy, 35 nurses (70%) revealed that routine measures have been put in place while 15 (30%) indicated the view that routine measures are not in place to regulate patient confidentiality and privacy. The results are indicated as below.
Question 7: Have you ever been involved in breach of patient information privacy and confidentiality? On this question, 0 nurses (0%) revealed that they have not been involved in any case of confidentiality and privacy breach. Thus, 50 nurses (100%) indicated that they have been adherent to the stated rules on privacy and confidentiality related to patients as indicated below.
Question 8: Do you feel comfortable holding sensitive patient information? On holding sensitive information, 49 nurses (98%) revealed that they are comfortable holding all confidential information given by patients. On the other hand, 1 nurse (2%) indicated that they are not comfortable handling confidential information. This is demonstrated below.
Question 9: Do you think upholding patient information confidentiality and privacy boosts patient outcomes? On this question, 0 nurses (0%) indicated that upholding confidentiality and privacy does not necessarily improve patient outcomes. Therefore, all the 50 nurse (100%) were of the view that upholding confidentiality and privacy comes with negative results in some instances affecting patient outcomes. This is demonstrated below.
Question 10: Recommendations for upholding privacy and confidentiality. On this question, all the 50 nurses (100%) indicated that they recommend the need for upholding privacy and confidentiality in the hospital setting. The information on recommendations is as demonstrated below.
In tandem with the results presented above, it is quite clear that confidentiality and privacy are vital aspects in the hospital setting. However, there is some gap in the understanding of the difference between confidentiality and privacy as a large number of nurses 8 (16%) indicated that they are not aware of the difference that exists between the two terms. This implies that Stanford Health Care hospital setting might not have an in depth explanation of these terms to their nurses. This subsequently limits their knowledge on the matter of confidentiality and privacy (Beik, 2012). It is the lack of understanding of the differences between the two terms that tends to lead to the breach of both confidentiality and privacy in the healthcare setting.
More so, it was positive from the interview that 40 nurses (80%) interviewed are aware of the HIPAA rules protecting the confidentiality and privacy of nurses. It is this knowledge that sets the ground for upholding confidentiality and privacy rules. Nevertheless, there is still a gap as 10 nurses (20%) revealed that they do not understand the HIPAA rules on confidentiality and privacy. The 10 nurses are a massive risk to the information of patients, as they would not be guided by HIPAA rules in ensuring that the information is protected in a desirable manner. Many patients at a risk of losing their personal information to the public through these nurses (Davis & LaCour, 2016).
Another problem is seen in the fact that many patients do not uphold the Hippocratic Oath in the course of their practice. The inability of upholding the Hippocratic Oath is also a sign of noncommitment to the confidentiality and privacy of patients. Surprisingly, 45 nurses (90%) of the nurses do not uphold the Hippocratic Oath and this poses a massive risk to the confidentiality and privacy issue. The information of patients would be safer in instance where more of these nurses would be committed to their Hippocratic Oath, as there would be no chances of breach on their part (Dimond, 2014). Otherwise, non-adherence is quite tempting in respect to losing confidentiality.
Technology tends to be a massive challenge when it comes to adherence to patient privacy and confidentiality. In tandem with the questionnaire results, 47 nurses (94%) indicated that technology has a significant influence on their ability to protect confidentiality. They are likely to expose all the patient details through unprotected technological applications. More so, forgetting to put passwords on patient databases increases the risk of loss in confidentiality in respect to their information (Dziegielewski, 2013). Proper management of technology within the organization is vital for milestones on the protection of the confidentiality and privacy of patients. Nevertheless, weaker information channels or structures continue to expose patients to increasing risks of loss of confidentiality and privacy (Ehrlich & Coakes, 2016).
On the positive side, it was clear from the nurses that the hospital upholds all the effective rules on confidentiality and privacy. For instance, 49 nurses (98%) of those interviewed gave this positive information indicating the ethical standards of the company and insistence on their attainment. As much as the hospital upholds the ethical standards on privacy and confidentiality, it must ensure that it keeps monitoring, as there are some deficiencies in the monitoring process. For instance, 15 nurses (30%) were of the view that there is no continuous monitoring. The lack of continuous monitoring poses a loophole for breaching the standards that have already been put in place by the company (Forrester & Griffiths, 2011). There will be always weaker links in case of inefficient monitoring because of the relaxation of the rules on monitoring. Positive enough, all the 50 nurses revealed that they have not participated in any cases of breaching the confidentiality of patients.
Almost all nurses 49 (98%) are comfortable holding private and confidential information from patients. This is illustrative of the confidence and professionalism that these nurses exude in the course of their careers. It is always a challenge to find such high levels of confidence in the handling of sensitive information among patients. Thus, this is a unique case of focus and confidence among the nurses. It also illustrates their dedication to the attainment of their goals and objectives as nurses in their respective specializations (Harman, Flite, & Bond, 2012). Nevertheless, nurses were quick to dismiss the fact that upholding confidentiality boosts the outcomes of patients in the hospital setting. All the nurses who participated in the interview, 50 of them or 100% of them, brought out the view that there is no correlation between handling the confidentiality and privacy of patients and their outcomes. They specifically illustrated the views that outcomes are hinged on how the treatment is administered to the patient and not necessarily the protection of the information related to their conditions (Lo, 2012). In some instances, it might be inevitable to leak the information of the patient to the public to ensure that they are getting the required help to boost outcomes through proper management of their conditions. By explaining this, all nurses also agreed that future strategies need to be adopted to secure the information of patients more (Madsen, 2014). It is vital to promote confidentiality and privacy with the view of not only promoting ethics, but also the respect for patients in the course of their recovery process in the hospital.
CHAPTER 5: SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Technological advancements have generally changed the manner in which health care is conducted in the current world. As a result, the retrieval, recording and sharing of information in the health centers is very swift. These facilities have resolved to exploit the advantages of technology and therefore they are using electronic gadgets to transfer and share information across the world. Records are crucial entries that must be made to fast track the progress of any organization. The level and magnitude of the competitive markets demand that electronic records should be kept because they can be retrieved easily. Due to this milestone, the health sector has information regarding types of diagnosis, prescriptions and insurance which must be availed to relevant patients when needed.
The minimal levels of privacy have had a detrimental effect on the patients’ relationship with those who have the responsibility to take care of them. Consequently, there is a reduced quality level in health care as a result of patient mistrust in the medical staff. Patients deliberately conceal their health concerns with the fear that the attendants would share the predicaments with other third parties. There are laws that protect the patients against the demeaning tendencies by service providers. Nevertheless, most patients are reserved and do not wish to disclose their problems for the fear that they would be discriminated at the work places. They may also be wary about the insurance cover which they may be denied upon telling the truth about themselves. Some of them have a feeling of embarrassment when they narrate their health issues.
Therefore, it is the responsibility of both the patients to collaborate with the attendants in order to avert the stigmatization effects that hinder quality medical care. This will foster lasting relationships between the two parties. The reputation of the institutions will go to higher levels because there would be a mutual understanding, minimizing levels of friction between patients and the health care staff. Hospital staff includes nurses who can assist in formulation of laws which will be used to protect the privacy of patients. The laws would safeguard the confidentiality aspect too.
The study has only cited but a sample of the regulations that are supposed to be upheld by the medical practitioners to restore the security and privacy of patients. Technology has brought many challenges especially in the management of information pertaining health. Regulations have been violated and many institutions are violating the rights of patients. As a result, the moral standards in health centers have been compromised and the quality of patient care has deteriorated. The world has embraced technology in all fields. Despite the advantages that come with these developments, the challenges concerning patience privacy keep increasing.
The challenges can only be managed by designing strategies whereby the information will be governed by implementing strict policies. For instance, health facilities can hire managers who are qualified medical personalities. These individuals are able to manage systems and can exercise high ethical standards. The laws should be applied in reprimanding those who do not live by the standards set by the medical stewards. People who access patient information are numerous. They include clinicians and information experts among other parties. Patients have the right to have their information held in privacy. They are entitled to privacy and they ought to be protected. The ownership of patient information is solely vested upon the patient.
More often, hospital staff mistakes their roles and imagine they can disseminate patient information to anybody at will. However, this is unwarranted and a patient has the liberty to reprimand anyone who undertakes such a malpractice in the courts of law. There are extremes where the public may get interested in the health status of a patient who is a public figure or was involved in crime. The information about such parties is normally provided with a sense of balance. The information stewards have to use their discretion to weigh the kind of information that the people may access. Some of the information may cause tension amongst friends and relatives thus the damage is not a preserve of the patients. There is a deliberate attempt by some states to offer training to individuals who can handle sensitive information concerning health matters. The United States is one of the countries that have people enrolling for programs in health information. It also has individual professionals in health centers.
There are various implications in the breach of the confidentiality stands by the doctors or nurses. A breach of confidentiality means that the doctor or any other authorized attendant discloses information regarding the health of a patient to a third party without the patient’s consent. Legally, a doctor is under obligation to withhold information of any patient even when they are dead. In special circumstances such as political assassinations, the information can be availed to the pubic but not entirely the whole detail. In the event that a doctor violates the rights of the patient, it implies that such a doctor is liable to face the law. The magnitude of aggression and the discretion of the judges will determine the fate of the doctor. Some doctors have risked losing their jobs after sharing crucial information with third parties.
Another implication is that some patients will shun from disclosing their health issues with the medics. Generally, there are some diseases that are caused by recklessness of the lifestyles that people lead. For instance, many patients suffering from venereal diseases avoid medical care because they get the imagination that the medical staff would talk about their lifestyles to other people. Therefore the major implication is that the quality of healthcare will go down given the stigmatization impact that would reduce patient submissions.
Another implication is that many families would be traumatized by the fact that their relatives were exposed. Patients are human beings who have close relatives taking care of them. Some form of revelations can be embarrassing for a family. For instance, HIV/AIDS is a dreaded pandemic that any family would wish to conceal from any form of exposure. This is an issue of reputation and the levels of stigma are too high for this condition. If patients suffering from this disease are discussed in public places, there will be widespread resentment which will have a lasting damage on the reputation of a family or group of people.
The last implication is that many resources in terms of time and money would be spent in settling court cases relating to patient rights violation. These resources would be utilized in more meaningful activities as opposed to legal battles upon issues that would otherwise be avoided.
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There are a number of recommendations that can be adopted to better the conditions at the health centers. If they can be implemented by the relevant authorities, then the patients will enjoy their rights to privacy and confidentiality. The first measure to be considered is adoption of the computer based patient record (CPR). This method can be formalized as the standard means of reporting in all medical centers. All patient records must be recorded using similar software to avoid discrepancies.
The computer based patient record institution has not been established yet. Therefore a deliberate attempt by the governments together with other private entities must be undertaken to build such an institution. The role of it would be to develop, implement, and disseminate record program. The implementation strategy calls for research and other programs that will demonstrate the functionality of the CPR system. It calls for heavy capital investment thus the aforementioned parties must be able to raise adequate funds to fund the establishment of the institution.
This system would be highly computerized. The databases would contain several names of all patients and the details of their ailments. To avoid a crisis and mix up of information, a uniform data entry and processing standard should be developed to ensure that the CPR system is fruitful.
Confidentiality should not be confined only to the records of patients. Oral information and the images should also be kept secret. The treatment agents must act professionally to conceal the information concerning the patient’s health status. Another recommendation is that patients should be provided with a clear explanation by the doctors and clinicians on how their information is being recorded and by which parties. By doing this, there will be accountability among the hospital staff and legal action can be taken against them if information leaks to unintended quarters.
Hospitals should be compelled to enhance safety levels in terms of administration and how patient information is handled. The availability of patient information should happen in administrative sections rather than any department of the health facilities. In most cases, an administration that has little regard for patient confidentiality will lead to complacency in the entire health institution.
Lastly, legal frameworks should be used to enhance the regulations that are more stringent. Once individuals violate the patient privacy clauses, they should be severely punished to prevent future violations. The reporting professionals should be protected by the same law.