Ethical Practice, Confidentiality and Information Security (Nursing)

00:02 Hi, I'm Jessica Spellman. We're going to be reviewing ethical practice, confidentiality and information security today.

00:11 The objectives of this course are for you to be able to understand and utilize the American Nurses Association Code of Ethics; review and apply ethical principles in nursing practice; review confidentiality and apply its role in ethical decision making; utilize interventions to protect health information; and understand the role of ethics committees.

00:38 Let's start by reviewing the ANA Code of Ethics. The American Nurses Association published the first Code of Ethics with Interpretive Statements in 2001. It is a dynamic, living document which means it's always changing depending on what's going on in the nursing profession.

00:54 The most recent update to the Code of Ethics was in 2010. The purpose of the Code of Ethics is to state the ethical obligations and duties of every nurse in the profession.

01:06 It's the non-negotiable standards of ethical behavior in the nursing profession and it expresses the nursing profession's commitment to the society.

01:16 There are 9 provisions in the Code of Ethics, we're gonna go through each one individually and I'm going to explain it.

01:22 The first provision is the nurse practices with compassion and respect for the dignity, worth and uniqueness of each individual. This takes the form of being respectful for human dignity regardless of economic or social status, personal attributes or beliefs, or the nature of their health problem. The nurse will deliver care without prejudice.

01:46 The nurse will respect the patient's right to autonomy or self-determination. Those words are used interchangeably at times.

01:53 And respect extends into collegial and peer relationships also.

01:58 The second provision revolves around the primary commitment of nurses to the patient.

02:03 And a patient can be individuals, family, groups or communities.

02:09 So we're not strictly talking about patients in a hospital, but the patient is the nurses primary concern.

02:14 Nurses will examine the conflicts that arise between their personal beliefs and the profession or their patients. Nurses will work with other nursing colleagues to address the healthcare needs of patients to the public. And nurses will recognize and maintain boundaries in the professional arena. The third provision, the nurse promotes and advocates for the health, safety and rights of patients. This takes the form of nurses will protect patients' right to privacy. The nurse will protect confidentiality of all patient information to preserve the trust in the patient-nurse relationship. The nurse will protect participants' decision to participate in the healthcare and give them appropriate information to make educated, informed decisions.

03:02 The nurse will voice concern for incompetent, unethical, illegal or impaired practice by any healthcare team member.

03:10 The fourth provision, the nurse is responsible and accountable for the competence of their nursing practice. So in this provision it describes that nurses will be accountable for the ethical contact that is grounded in moral principles of fidelity and respect for the dignity, worth and autonomy of patients.

03:31 They accept accountability and responsibility for their nursing judgment and actions.

03:35 And they accept responsibility for assessing their own competence level and not practicing outside of that level.

03:43 In addition to that, I wanna say education comes in this provision of lifelong learning and continuing to learn about nursing interventions that are appropriate for our populations and not just practicing outside the level, but it's important to have the education to do so.

04:01 Accept accountability for delegating nursing tasks and activities to other competent healthcare team members.

04:08 On to Code provision number 5. The nurse owes the same duties to self as to others.

04:15 We should have self-respect and interest in personal growth and competence, wholeness of character, integration of the personal and professional identities are not easily separated and we need to advocate for professional integrity.

04:31 Not withhold information, not abuse patients, not leak confidential information or falsify records. Provision six states that the nurse participates in establishing, maintaining and improving the healthcare environment and the workplace environment.

04:51 They should hold virtues of a morally good person, for example, do what is right.

04:57 They should influence ethical practice in healthcare environment, establishing peer norms, serving on ethics committees, writing policies and procedures.

05:07 And they should encourage respectful interactions between colleagues. Provision number seven.

05:12 The nurse participates in the advancement of the profession. Advancing the nursing profession by active involvement in healthcare policy is the expectation.

05:22 Developing, maintaining, and implementing professional standards in education, clinical and administrative practice. Advancing the nursing profession by engaging in knowledge development, dissemination and application to practice. In other words, using evidence-based practice to enhance the profession and move it forward.

05:46 The nurse collaborates with other professionals and the public. They meet the health safety and welfare needs of all people in the community, the nation and internationally. And nurses should be knowledgeable about health concerns and threats to safety, both professionally and individually.

06:04 And the last provision, provision number 9, nurses will be members of professional organizations that communicate nursing values, maintain integrity of the profession and shape social policy.

06:18 So the Code of Ethics is a guideline for all nurses. Now, when we're practicing individually, there are a few principles that are the foundation of not just nursing ethical principles but ethics in general. So when we talk about ethics, we talk about these five items. Whether we're talking about legal ethics, medical ethics, business ethics, they have the same five characteristics. This is how we apply it to nursing, though.

06:48 So autonomy is the first principle, and in nursing that's the right to self-determination or the ability of the individual to make decisions for themselves. The second principle is beneficence. It's the duty to do what is in the best interest of the patient.

07:04 The third principle is justice. To provide fair, equitable and appropriate treatment.

07:11 The fourth is non-maleficence, or the duty to do no harm. And the fifth principle is veracity, or to be truthful in the information that you're providing to your patients.

07:23 The principle of autonomy was reviewed in the Client Rights Presentation The Patient Self Determination Act of 1990, the Patient's Bill of Rights set forth rules that govern patients' right to self determination. So we're gonna review some of the concepts from that lecture next. The Patient Self Determination Act of 1990, if you remember its purpose was to inform patients of their rights regarding decisions towards their own medical care and those rights also granted clients the right to future care in case they become incapacitated.

07:58 The specifics of the Patient Self Determination Act we're gonna review.

08:03 The first one is the right to participate in and dictate their own healthcare decisions.

08:08 The second is the right to accept or refuse medical or surgical treatment.

08:13 The third is the right to prepare an advanced directive, living will and/or durable power of attorney, for their own healthcare.

08:21 The fourth. The right to be given information on the providers policies that govern the utilization of these rights.

08:28 And five, the right to not be discriminated against or denied healthcare based upon whether they have or do not have advanced directives. So there are two basic roles of the nursing supporting clients in self determination. And that is, number one, educate them about advanced directives and assist them in completing and creating those documents. The second is to recognize and respect the rights of clients and make decisions especially when they refuse treatment. I think we have difficulty with that sometimes because we have all of these interventions and options that we can offer patients and we sometimes don't want to allow them to refuse treatment. What does the Patient Bill of Rights cover? It covers the following topics. Information disclosure.

09:18 Clients have a right to receive easy to understand information, either in writing or from their professionals, about their healthcare plans. They have a choice providers and plans.

09:30 So they have the right to choose their healthcare providers. They have access to emergency services.

09:38 They have the right to receive emergency healthcare services without having to wait for authorization or receiving a financial penalty. Participation in treatment decisions. Clients have the right to participate in treatment decisions and accept or refuse treatment.

09:53 Confidentiality of health information. They have the right and expect that the information that they share with the healthcare professionals is maintained and protected.

10:06 They have the right to complaints and appeals. Clients have a right to set forth a complaint against the hospital or healthcare organization or even a professional, and get an objective and expedient review of that complaint. And the last topic that's covered in the Patient Bill of Rights is consumer responsibilities.

10:24 The client has the responsibility to disclose accurate information to their healthcare providers about their history, medications and other information requested in order to prescribe treatment.

10:36 The nurses role on the Patient's Bill of Rights is to educate clients and families about the rights they are entitled to and the responsibilities they have regarding their own care.

10:45 And to refer clients to where they can obtain this information. And just to be cognizant of these rights and care for clients in accordance with them. In daily practices there is a few ethical principles that nurses should keep in mind for their own interactions with patients.

11:05 The first is accountability, and that's the responsibility for your own actions.

11:11 The next ethical principle is virtue. You should have compassion, trustworthiness, integrity and veracity, which is truthfulness in the information you provide patients and the care that you provide to patients.

11:23 Fidelity, faithfulness to maintain the principles of the ANA Code of Ethics.

11:28 And confidentiality in maintaining that patient privacy and preventing personal health information from being disclosed. Confidentiality has been established and governed by the Health Insurance Portability and Accountability Act, or HIPAA.

11:46 This Act was approved in 1996 and revised in 2003, and it has set forth a set of standards, national standards, for the protection of patient health information.

11:57 Under the HIPAA Act, clients have a right to receive a copy of the notice of privacy rules and practices and expect confidentiality of protected health information. And exceptions to this include information needed for billing or payment, treatment or operations of the facility.

12:18 They do have access to read their medical records and obtain copies of their health records.

12:23 They may have documentation to fill out in order to get that information, but they do have the right to access that information.

12:29 They need to be notified if there's a breach of confidentiality. So that's a review of the HIPAA policy. What you need to know as a nurse, though, to make sure that this happens and in order to protect the confidentiality of patient information, you need to hold the information in the strictest of confidence and only used for authorized purposes.

12:52 You should only access the PHI of clients that meet the minimum necessary information to do your job and not access the medical records of clients you're not caring for. And do not share personal health information with anyone unless you are sure they are authorized to receive such information.

13:09 Once you share that information, you can't get it back. So waiting until you're sure if someone is authorized to receive it, before you disclose it. Keep documents containing protected health information in a safe place. Do not remove protected health information from the facility in which you work.

13:28 And then destroy documents containing protected health information as designated by the facility in which you work.

13:36 HIPAA added on the Security Rule in 2003 due to high demand of how individuals and institutions can implement security measures to protect confidentiality.

13:47 The Security Rule establishes national standards that protect individuals' electronic personal health information that is created, received, used and maintained by a health organization.

13:58 It outlines appropriate safeguards that organizations need to take in order to promote confidentiality, integrity of information and security of electronic protected health information.

14:11 It also protects a subset of information covered by the privacy rule that individually identifiable health information covered entity receives, maintains and transmits the electronic information from organization to organization. It's called the electronic protected health information, or e-PHI. It does not apply to protected health information transmitted verbally, or in writing. Provisions need to be met in order to secure protected health information and institutions may uphold these provisions how they see fit.

14:51 So we're not telling them exactly what they have to do, but we're telling them the guidelines that they have to follow.

14:56 So they have to ensure the confidentiality, integrity and availability of all e-PHI they create, receive, maintain or transmit. Identify and protect against reasonably anticipated threats to the security or integrity of the information. Protect against reasonably anticipated impermissible uses or disclosures, and ensure compliance by their workforce.

15:22 So nursing tips for promoting confidentiality of protected patient health information.

15:28 Don't share computer log-ins or passwords with anyone.

15:32 Never leave medical records unattended in public areas. Dispose of items containing protected health information appropriately. Be sure to log out of computers and data systems containing protected health information. Follow security systems for remote access of protected health information and activate the security settings of PDAs if they contain protected health information. And avoid discussing patients in public places.

16:02 I wanna add to this, encrypting data if you're gonna send it electronically, is also another way that we can promote patient confidentiality and protect patient health information privacy. In addition to keeping patient healthcare information confidential, nurses must keep information private. So don't discuss patient information with anyone not directly related to the patient's care. Do not tell friends, family or acquaintances about your patients in any way that they may be identified.

16:40 And do not use social media to share information about patients.

16:45 Do not discuss a patient's case even with a colleague if you're in an area where the conversation may be overheard, such as an elevator, in the cafeteria, in the hallway, etc.

16:58 And do not read a chart or patient information belonging to someone who you are not caring for.

17:04 Nurses need to be aware that health organizations have ethics committees.

17:10 The purpose of them is to help nurses and other healthcare professionals identify and resolve ethical decisions about patients and families. The committees work with all the parties involved to address all of the issues and resolve the dilemma. And nurses usually make up a part of those committees and can refer patient issues to them that need addressed. So the purpose of ethics committees are to promote patient rights; to promote collaboration between patients and healthcare providers when disagreements in care arise; to promote fair policies and procedures that help achieve positive, patient-centered outcomes; and to enhance the support of the ethical environment of healthcare professionals in healthcare institutions.

18:01 The ANA published the Code of Ethics for nurses to outline the ethical standards that nurses agree to uphold.

18:08 Ethical principles that guide the nursing profession are non-maleficence, beneficence, autonomy, justice and veracity. Ethical principles that guide nurses and clinical practice, respect, autonomy, fidelity and confidentiality should be upheld.

18:28 Privacy and confidentiality of patient information is regulated by HIPAA and the Security Rule.

18:35 Nurses are expected to be aware of issues that can compromise privacy and confidentiality of patient health information and how to protect it. And the role of ethics committee are to evaluate patient and family concerns regarding the care of loved ones and support healthcare professionals to make difficult decisions. Nurses can and are encouraged to serve as members on ethics committees.

19:01 This has been Ethical Practice, Confidentiality and Information Security and I'm Jessica Spellman.