Is Patient Confidentiality Compromised With The Electronic Health Record?

Patient safety and mental health

Mental health professionals have the potential of having a big and long-lasting impact on the health outcome of the aging group. Their presences, as well as their sound knowledge, allow them to play a significant role in patients’ safety and confidentiality (Ammouri et al., 2015). This paper seeks to discuss mental health practitioner’s vigilance towards patient’s safety, confidentiality as well as how the issues impact their career.

Individuals with mental health issues are faced with distinctive patient safety issues in the course of healthcare provision. These issues have however remained too many healthcare providers specialized in caring for mental health patients. Some of the most common issues confronting these patients include aggressive behavior and violence, suicide and self-harm, seclusion and restraint use and Absconding. All these have a bearing on mental health care provision (Dewa et al., 2018). It is therefore important for health care providers dealing with mental health patients to understand such factors which may come from patient’s interaction with the system or from the system itself. This is important in improving the quality of care and maintenance of patient safety.

Mental health patients often develop behavioral health issues that may lead them to act violently or seek to cause harm to themselves or those around them. For example, among the elderly, some may even try committing suicide. These safety issues among mental health patients arise as a result of mental illness issues such as alcohol use, anxiety, and depression(Dewa et al., 2018). Safety in healthcare systems means preventing harms to patients, their families as well as their friends. Safety also means protecting the healthcare professionals, volunteers and everyone whose work brings them to healthcare care environment (Ammouri et al., 2015). Therefore, nurses in particular, as well as other health care workers, have a role to play towards patient’s safety. Over times, the nurses have come up with new roles and unrecognized greater responsibilities.

The meaning of patient safety has come up from the abstract health care movement, though with different approaches to more tangible important components. Ideally, patient safety was explained by the IOM as the protection of harm to all patients. A lot of emphases is laid on the care delivery system which is meant to protect errors and learns from the happening errors (LaSala & Nelson, 2005).  Moreover, the health care delivery system is grounded in a society of safety involving patients, organizations as well as healthcare professionals. Patient safety involves prevention from any harm within the health care system.

Meaning of patient safety

Lack of safety may lead to permanent or temporary impairment of psychological or physical body structure or function. Nurses are expected to find ways that prevent patients harm and promote patients safety. Ideally, lack of safety in towards patients is led by a communication failure between the practitioners and the sick person, typing errors, failure in tracking, and improper usage of resources, improper delegation and wrong referral (LaSala & Nelson, 2005). Different harms, as well as errors, are grouped according to their domain or where they took place across the range of health care settings and providers. Different harms are caused by latent failure, active failure, technical failure as well as an organizational system failure. Technical failure involves the breakdown of external resources or facilities whereas active failure, involves direct contact with the sick person. On the other hand, organizational system failure involves management, knowledge transfer, protocols, and organizational culture. Finally, latent failure involves the decisions that affect the allocation of resources, policies, and procedures of an organization.

Safety in patients is the cornerstone of excellent health care. Most of the work that defines patient’s practices and safety that prevent harm has concentrated on negative results of care, for instance, morbidity and mortality ( Tjia et al.,2009). Therefore, nurses are necessary when it comes to coordination as well as the surveillance that minimizes the negative outcomes. Ideally, nurses have the role of maintaining the patient’s safety thus improving health care status.

Confidentiality in health care means keeping patient’s info private. The patient’s data should be disclosed with the consent of the involved person. Ideally, confidentiality is a core duty that should be practiced within all healthcare systems. Patients normally share their personal information with their health caregivers. Therefore, confidentiality is very important to allow trust and good relationship between the practitioner and the patient ( Tjia et al.,2009). Without the protection of a patient’s personal information, the patient is likely not to share sensitive info with the practitioner, thus impacting their care negatively. Therefore, health care professionals are encouraged to create a trusting atmosphere by respecting every patient’s privacy. As a result, patients will be encouraged to share more information about them as they seek health care without fear.

Additionally, trusting environment will increase their willingness to visit health care whenever they have a sensitive health issue. For health problems that may be stigmatizing, physicians are encouraged to keep the info private. Some of the stigmatizing conditions include; reproductive, psychiatric health concerns, sexual as well as public health. In such instances, confidentiality is very important as it assures that personal data will not be disclosed to employers, friends or family without their permission( Wallace, 2015).  Health care systems should, therefore, take precautions to make sure that only certified access takes place. In an ideal world, proper care requires that information concerning the patient to be shared among healthcare professionals. All team members within the healthcare system have certified access to private info concerning the sick person, being cared for. However, electronic medical records some challenges to confidentiality. According to the Health Information Portability and Accountability Act of 1997(HIPAA), all healthcare systems are supposed to have policies that guard the patient’s private information stored electronically. The protection of the information might include processes for computer security as well as access.

Nurses’ role in patient safety

The dilemma occurs where the health professional feels naturally inclined to disclose the information about the patient. The dilemma occurs when the practitioner doesn’t know whether to respond to an inquiring wife or husband. In such a case, the standards for making an exemption to confidentiality might not be met. Until the concerned patient allows the information to be shared, it not ethically justifiable to disclose (Tran et al., 2014).In instances where the patient is at a risk of harm associated with the diagnosis, remains the patients or the local public health officers who can allow the disclosure. The physician is not allowed at all to breach patient privacy. However, unintended disclosures might happen in some ways.

The disclosures of the personal information might occur when a physician has been pressed by an issue for a while and feels the need to share some information to the public, for the sake of their health. In such cases, upholding privacy might not be possible any longer. However, when sharing information associated with any patient in a conference, the information that might identify him or she should be removed. The information might be shared but without pointing out the name of the patient or anything that would make him or her known thus, protecting patient privacy ( Wallace, 2015).  However, the patient’s information should not be taken away from the security of the health care system or rather should be encrypted. Otherwise, the patient’s privacy is breached when such lapses happen.

In situations where a healthcare practitioner believe a legal or an ethical exception towards confidentiality exists, should always himself questions such as; will lack this information cause harm to a certain group or an individual? In case the answer is yes, then it is improbable that an exemption towards confidentiality is legally or ethically warranted. In any case, the violation is being considered; it is appropriate to seek legal advice before the disclosure.

Online Module Three

Reporting

The discharge of patients from the hospital, the responsibility of caregiving is transferred from nurses to family caregivers. In some instances, these new responsibilities on informal family caregivers affect their thoughts and reflections. The discharge process comes with new experiences for family caregivers. The period of predischarge and the first days spent by patients at home lead to an emotional overload for family caregivers. The most affected are family caregivers without prior experiences in playing the role of a caregiver in the family setting. Part of the new experience includes being responsible for everything touching on their patients, doing tasks that their patients are unable to do including personal hygiene and mobility (Joyce & Lau, 2013). They are also responsible for ensuring a conducive environment, provision of emotional support and supervision, managing patient’s behaviors, dealing with financial issues and making a decision on their behalf.

Confidentiality

Most caregivers are therefore faced by numerous challenges including the inability to meet transport, food and medication needs of their parents due to financial challenges. These challenges may end up compromising patient’s health and wellbeing. The role also isolates them and denies them an opportunity to engage in other productive activities (Plank, Mazzoni & Cavada,2012). Meeting the needs of their patients also denies them an opportunity of spending time with family and friends. This may end up affecting their mental and physical health.

Responding

I felt pity for family caregivers for what they have to go through while taking care of their patients. The whole situation saddened me. I also felt sorry for them due to their isolated nature and the fact that they do not have time for family and friends. Their withdrawal from many productive activities may also end up affecting their health as well. I feel a strong need for helping caregivers to help them cope with the challenges that come with the new role (Plank, Mazzoni & Cavada,2012).

Relating

Transitioning a patient from hospital to home environment can be particularly challenging especially if family members have no previous experience. For such patients they require specialized attention, medication, and diet that are different from family members (Zarit &Zarit, 2015).I have found this to have a large impact on families. Apart from straining them emotionally, the new role strains them financially too (Plank, Mazzoni & Cavada,2012). Family caregivers often complain about the overburdening that comes with taking care for patients. I have witnessed how this new experience affects them both emotionally and physically.

While the new role can be deemed demanding for family members, it is a significant part of the patient’s recovery process. The patient needs this specialized care in the home setting to hasten their recovery process (Tsai et al., 2015). Family Caregivers should, therefore, receive the necessary support in taking care of such patients. They should be supported in meeting the spiritual, psychological, physical and social; needs of their patients (Plank, Mazzoni & Cavada,2012). Volunteers and health professionals work in collaboration with patients and their families to help meet these needs. With the challenges faced by family caregivers, they may require constant support through confidence building and support.

Due to the challenges faced by family caregivers, programs such as those centered on counseling and provision of financial support should be put in place to help caregivers cope with caring for patients (Plank, Mazzoni & Cavada,2012). Nurses and other healthcare professionals should also play an active role and constantly visit patients in their home setting to monitor their progress and offer any necessary support.

References

Ammouri, A. A., et al. “Patient safety culture among nurses.” International nursing review 62.1 (2015): 102-110.

Dewa, L. H., Murray, K., Thibaut, B., Ramtale, S. C., Adam, S., Darzi, A., & Archer, S. (2018). Identifying research priorities for patient safety in mental health: an international expert Delphi study. BMJ open, 8(3), e021361.

Joyce, B. T., & Lau, D. T. (2013). Hospice experiences and approaches to support and assess family caregivers in managing medications for home hospice patients: a providers survey. Palliative Medicine, 27(4), 329-338.

LaSala, K. B., & Nelson, J. (2005). What contributes to professionalism?. Medsurg nursing, 14(1), 63.

Ovens, A., & Tinning, R. (2009). Reflection as situated practice: A memory-work study of lived experience in teacher education. Teaching and Teacher Education, 25(8), 1125-1131.

Plank, A., Mazzoni, V., & Cavada, L. (2012). Becoming a caregiver: new family carers’ experience during the transition from hospital to home. Journal of clinical nursing, 21(13-14), 2072-2082.

Tjia, J., Mazor, K. M., Field, T., Meterko, V., Spenard, A., & Gurwitz, J. H. (2009). Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. Journal of patient safety, 5(3), 145.

Tran, K., Morra, D., Lo, V., Quan, S. D., Abrams, H., & Wu, R. C. (2014). Medical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism. Journal of medical Internet research, 16(5).

Tsai, P. C., Yip, P. K., Tai, J. J., & Lou, M. F. (2015). Needs of family caregivers of stroke patients: a longitudinal study of caregivers’ perspectives. Patient preference and adherence, 9, 449.

Wallace, I. M. (2015). Is patient confidentiality compromised with the electronic health record?: A position paper. CIN: Computers, Informatics, Nursing, 33(2), 58-62.

Zarit, S. H., &Zarit, J. M. (2015).Family caregiving. In Psychology and Geriatrics (pp. 21-43)