The Role Of Confidentiality As An Essential Aspect In Patients Information In The Hospital

Medical and Health Science Project and Seminar Material

The Role Of Confidentiality As An Essential Aspect In Patients Information In The Hospital


Abstract


The confidentiality promise is technically complex, politically uncertain and scientifically ill-defined to address multiple patients’ needs. This is because patients’ confidentiality provides diverse perspectives which are yet to meet thorough academic examination. Therefore, the purpose of the study was to assess the role of confidentiality as an essential aspect in patients’ information in the hospital. The study’s objectives were to assess the impact of knowledge level of healthcare providers concerning patient confidentiality, the current trends in keeping the confidentiality of patients and assessing circumstances healthcare workers may be constrained from keeping the confidentiality promise. The study sought to achieve its purpose by adopting quantitative approach with the cross-sectional explanatory design to gather data through a survey questionnaire using 141 respondents. The respondents included healthcare providers (nurses, medical officers, health specialists and surgeons) of Kogi State University Teaching Hospital, Kogi State, Nigeria. The data was analysed using correlation and simple linear regression via the application of SPSS. The results show that knowledge of public reporting, reporting child maltreatment and knowledge of patients’ threats to third parties significantly predicted patient confidentiality. However, knowledge of criminally inflicted injuries even though positive did not predict significantly predict patient confidentiality. The finding suggests that social media does support patient confidentiality negatively thus increase in social media activities lead to a decrease in patient confidentiality. In-service training, knowledge of patient de-identification and the use of electronic medical record system are current trends or practices are at KSUTH. The results imply that some circumstances may constrain healthcare providers from keeping the confidentiality promise, hence breaches. The study recommends that healthcare providers should be educated on the use of social media and breach of confidentiality.


Chapter One


Introduction

1.1 Background of the Study

The origins of professional confidentiality dates back to Hippocrates, who stated, “Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret” (Hulkower, 2016). From those ancient times, Stanberry (2006) suggest that, professional confidentiality and privacy for health care providers have become a legal as well as ethical obligation. Confidentiality is the central aspect of the physician-patient relationship (Brody, 1997). Confidentiality and whatever it stood for, was largely ignored in the past. Throughout the middle Ages, for example, patients with plague like diseases routinely had their privacy abrogated and their identities publicized. Similarly, those diagnosed with leprosy had to ring bells or clappers to warn others of their approach and condition (Liu et al., 2002).

It was not until the 19th century, according to Reamer 2013, that confidentiality finally became widely recognized as an important concept with moral and ethical obligations. The French Penal Code of 1810, for example, imposed imprisonment and heavy fines on physicians who revealed medical secrets. In 1803, Thomas Percival established the first modern code of Western medical ethics, which states, “Patients should be interrogated concerning their complaint in a tone of voice which cannot be overheard. The American Medical Association’s (AMEs) original Code of Medical Ethics, adopted in 1847, was a revision of Percival’s work and formally included the principle of confidentiality. The current version of the AMEs Principles of Medical Ethics avows, “A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law” (Corrigan, 2003). The Joint Commission on Accreditation of Healthcare Organizations also holds that the patient has the right, within the law, to personal and informational privacy. Modern healthcare practice continues to recognize the importance of confidentiality (Bastable, 2017), and have included it in various oaths, principles, and rules of professional conduct. This is also enshrined in the syllabus used in the academic training of healthcare workers. Most of these codes commonly hold that confidentiality may be breached only when required by law, when in the public interest, or when necessary to prevent harm to others.

In the health literature, confidentiality is discussed in relation to patients’ rights and is an essential aspect of the trusting relationship that patients have with their health-care providers (Dobrowolska et al., 2007, Neitzke 2007). There is an understanding that patients have the right to privacy and the right to expect personal information about them to be held in trust, with security of records, and that access to such information is in some way protected (Rock & Congress 1999, Frewer&Fahr 2007). Hulkower (2016), in his review of the Hippocratic Oath also supports that confidentiality is still essential to the formation of the therapeutic relationships for patient and health- care providers, and by extension, to healthcare institutions, whereby there is an understanding that professional individuals and organizations will maintain confidentiality of patient information.


1.2 Statement of the Problem

The maintenance of confidentiality is both a legal and an ethical duty of all healthcare workers, American Nurses Association. (ANA) (2001). Larkin et al. (1994) reiterate that, indiscriminate disclosure of patient confidences may disgrace patients, undermine trust, and seriously imperil patients’ relationships with their doctors and others. Patients expect that physicians will honour the implied contract of silence and fulfil their obligation as patient advocates. Moral arguments for confidentiality are rooted in the principles of utility and duty according to Utilitarian principles and this is concurred by Hayry (2013), in the Liberal utilitarianism and applied ethics.
Breaching confidentiality may be thought to weaken society’s faith in the greater institution of medicine and healthcare (Gilson 2013). The resultant distrust threatens the provision of detailed and accurate information necessary for correct diagnosis and treatment. Thus, possible long-term destruction of patient openness would continue to militate strongly against breaches in confidentiality (Cate, 2010). The ethical principles of the AMA and the American College of Physicians recognize certain exceptions to the rule of confidentiality. It is for this reason that this study intends to find out under what circumstances, are healthcare worker constrained to keeping the confidentiality promise.


1.3 Purpose of the Study

The purpose of the study is to assess the role of confidentiality as an essential aspect in patients’ information in the hospital


1.4 Objectives of the Study

The study seeks to assess under what circumstances healthcare workers may be constrained from keeping the confidentiality promise. The specific objectives include the following;

Objectives:

  1. To assess the knowledge level of healthcare providers on confidentiality
  2. To study the current trends in the practice of confidentiality
  3. To find out under what circumstances healthcare providers may be constrained from keeping the confidentiality promise

1.5 Research Questions

  1. What is the knowledge level of healthcare providers on confidentiality?
  2. What is the current trends in the practice of confidentiality?
  3. What circumstances are healthcare providers constrained from keeping the confidentiality promise?

1.6 Significance of the Study

The findings of this study are important for government policymakers, health institutions and researchers. The study is relevant in these areas due to the fact that it provides insight in staff perception of patient confidentiality, it identified the prevailing trends in patient confidentiality practice in the study area which can be applicable to many health facilities in Nigeria and Africa at large. The findings further provide useful information for Government and policymakers to formulate national and institutional policies on the storage and disclosure of patient information. This will help to curtail the indiscriminate disclosure of patient information either in news, print or over the social media.

The findings will help to remove barriers to patients-staff and staff-staff relationships which will translate into greater utilization of health services resulting in improved health outcomes. The findings have further enlightened clinical staff to be mindful when dealing with patient information. In addition, the findings of the study may further create an avenue for further studies to be conducted on patient confidentiality in other parts of the country, to create a ripple effect in respecting patient information in our society.


1.7 The Scope of the Study

The study covered health professionals in direct patient care in a teaching hospital in Kogi State, Nigeria. The study was limited to clinical staff of the selected hospital and did not cover nonclinical staff or staff from other hospitals. Therefore, generalization should be done with caution. In view of the fact that the study was to assess patient confidentiality and under what circumstance healthcare worker may be constrained from keeping the confidentiality promise, the study made use of staff who mostly have direct interaction or contact with patients. Other facilities and other categories of staff were not part of the study due to resource and time constraints.


1.8 Operational Definitions

Patient:

The person to whom the doctor or health facility owes a duty of care.

Patient Information:

Data given directly by patients to healthcare professional. This also includes data generated from other investigations or procedure details of the said patient.

Confidentiality:

Confidentiality refers specifically to the handling of information that has been shared between doctor and patient

Privacy:

May be the physical sphere within which others may not intrude, freedom of choice for important decisions (Autonomy), and privacy as control over personal information.

Disclosure:

Giving out patient information

Healthcare Professionals:

Professionals trained to provide healthcare services to patients. Includes doctors, nurses, and members of allied health


1.9 Organization of the Study

This study was organized into four chapters. Chapter One is the introduction to the study. It includes the background information, problem statement, specific objectives of the study, research questions, scope, significance of the study and operational definitions. Chapter Two is a literature review. Literature was reviewed in three sections; theoretical, empirical literature and a conceptual model on patient confidentiality. The literature review was done taking cognizance of the stated objectives of the study. Chapter Three covers the methodology which comprises the study design, the study type, the study variables (independent and dependent variables), the procedure used for data collection, sampling procedure and sample size, study population, data collection methods, quality control measure as well as plans for dissemination of the findings. Chapter Four comprise of data analysis, which made use of the findings obtained from the respondents to generate answers to the stated objectives and the reviewed literature. This is followed by a discussion of the findings with respect to the study objectives and literature review to find out whether the findings conform to literature or not. Then finally, Chapter Five presents a summary of the main findings, the implication of the study, conclusion and recommendation with regards to the findings.


1.10 Limitations of the Study

As a result of the quantitative approach that was adopted, the underlying causes and reasons for the findings in this study were not revealed. Also, the generalisability of the findings to other Hospitals may be limited since the study concentrated on a single hospital with a sample that is not representative of the entire health sector of Nigeria. These notwithstanding, the findings of this study are credible and the information provided is very useful.


Chapter Five


Summary, Conclusion and Recommendations

5.0 Introduction

This section of the study presents a summary of the study by indicating the key findings and providing adequate conclusions as well as proposing appropriate recommendations for practice and research.


5.1 Summary

The purpose of the study was to assess the role of confidentiality as an essential aspect in patients’ information in the hospital. The study sought to achieve its purpose by adopting quantitative approach with the crosssectional explanatory design to gather data through a survey questionnaire using 141 respondents. The respondents included healthcare providers (nurses, medical officers, health specialists and surgeons) of Kogi State University Teaching Hospital Nigeria. The data was analysed using correlation and simple linear regression via the application of SPSS. The summarized results of the study are presented based on the objectives of the study.

5.1.1 Objective One: Knowledge Level in Confidentiality

The results show that knowledge of public reporting significantly predicted patient confidentiality. Also, the results indicated that reporting child maltreatment also significantly predicted patient confidentiality. The results equally proved that knowledge of patients’ threats to third parties positively and significantly predicted patient confidentiality. These results demonstrate the knowledge level of healthcare providers in reporting sensitive issues while maintaining anonymity significantly enhances patient confidentiality. Again, knowledge of criminally inflicted injuries even though positive did not predict significantly predict patient confidentiality.

5.1.2 Objective Two: Current Trends

The results revealed that the current trends in the practice of confidentiality consider in-service training in keeping confidentiality as important. Majority of healthcare providers have knowledge about patient de-identification but not from conferences. The sure ways of collecting and keeping data are through the use of electronic medical records system and central saver respectively. It is generally not easy to access medical records at the Kogi State University Teaching Hospital in Nigeria. The finding suggests that social media does support patient confidentiality negatively thus increase in social media activities lead to a decrease in patient confidentiality.

5.1.3 Objective Three: Breaches of Confidentiality

The results implies that circumstances may constrain healthcare providers from keeping the confidentiality promise (breaches) and this can impede patient confidentiality which has to do with trust between two parties.


5.2 Conclusion

To assess under what circumstances healthcare workers may be constrained from keeping the confidentiality promise is technically complex, politically uncertain and scientifically ill-defined to address multiple patients’ needs. This is because patients’ confidentiality provides diverse perspectives which are yet to meet thorough academic examination. This study has contributed largely to this on-going debate in how to keep patient confidentiality. The study concludes that reporting sensitive issues about patient actually help in enhancing confidentiality. Again, the study concludes based on the findings that social media does not help in keeping patient confidentiality promise and care should be taken in breaching the confidentiality promise as this impacts patient negatively. Overall, even though there is the need to keep the confidentiality promise, sensitive circumstances demand reporting the situation which may be beneficial to both the patient and others.


5.3 Recommendations

The recommendations of the study are based on the following:

5.3.1 Recommendation for Practice and Policy

First and foremost, the findings indicate that reporting sensitive issues concerning patient are helpful in the confidentiality promise. Therefore, the Kogi State University Teaching Hospital should encourage healthcare providers to report sensitive issues such as contagious or infectious disease while keeping the anonymity of the patient. This reporting behavior will help the Hospital keep track of spreading certain diseases, educate others to take precautionary measures and inform future decisions regarding healthcare delivery.

The study recommends that a full electronic health record system should be adopted in the Hospital.
This will help the healthcare providers to keep full track of patients’ confidential information with encryptions. The electronic health record system also helps facilitate the processes in the Hospital and enhances efficient healthcare delivery.

The study recommends that healthcare providers should be educated on the use of social media and how social media should not interfere in their quest to keeping the confidentiality promise.

The study recommends that in breaching patient confidentiality, the situation must be well examined in order not jeopardized the patient. A breach of confidentiality may be required during sensitive situations which are determined by the healthcare providers (workers).

5.3.2 Recommendation for Future Studies

Future studies could replicate this study to examine the influences of knowledge of confidentiality and social media on patient confidentiality in other Hospitals. Also, this study was done using one Hospital within in Nigeria thus, future studies could extend this study to other Hospital and even compare public and private Hospitals.

Furthermore, this study employed the quantitative method; future studies could employ other methods to unearth the underlying reasons for the findings in this study and also to reveal where the study falls short with regard to the variables used.


5.4 Limitations of the Study

As a result of the quantitative approach that was adopted, the underlying causes and reasons for the findings in this study were not revealed. Also, the generalisability of the findings to other Hospitals may be limited since the study concentrated on a single hospital with a sample that is not representative of the entire health sector of Nigeria. These notwithstanding, the findings of this study are credible and the information provided is very useful.


The Role Of Confidentiality As An Essential Aspect In Patients Information In The Hospital


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