Petronio & Sargent: Disclosure predicaments arising during the course of patient care Flashcards
What is the theme of Pertronio & Sargent?
Seeking and providing information
What is the title of the piece by Pertroio & Sargent?
Disclosure predicaments arising in the course of patient care: Nurses’ privacy management
How many strategies are there to manage disclosure predicaments?
4
What is the first strategy to manage disclosure predicaments?
Preemptive and Privacy Strategies
What are preemptive and Privacy protection strategies?
The essence of this strategy is to build a “privacy protection shield” to avoid becoming a co-owner of patient disclosures
Based on concerns about emotion toll the disclosure may take on nurses
What are two sub-strategies that are used?
- Avoid hospital units that routinely involve difficult disclosures
- Focus on work tasks to appear emotionally unavailable to patients
What is the second strategy to manage disclosure predicaments?
Variable Adherence to patient privacy rules
What is part of the variable adherence to patient privacy rules?
In both cases, patient’s ask that nurses follow their privacy rules, note that the nurses took different approaches to respecting privacy rules
Nurses often respond by placing responsibility for managing disclosure back on the patient.
What is the privacy rule?
You and someone else get to know this information
(example: pillow-rule) “do not tell so and so”
What is the third strategy?
Negotiating requests for involvement in private matters
Describe the third strategy.
Requests to get involved can exploit the trust/confidentiality a nurse has developed
While families often feel they are all inside a shared privacy boundary with the patient, nurses have a special professional obligation only to the patient
Family members sometimes resent that nurses co-own information they they do not co-own.
sometimes you need to violate to be able to ask for advice
What is the fourth strategy to manage disclosure predicaments?
Managing a disclosure need
Describe the fourth strategy.
Nurses consult with one another about difficult patient cases (in the patient’s medical interests)
Patients disclose to an individual nurse, but in practice this can amount to a disclosure to the whole nursing staff.
An example of turbulence (tension) in privacy boundary management
What is HIPAA?
The Health Insurance Portability and Accountability Act which provides standards for appropriately collecting, storing, and transmitting patients’ protected health information (PHI)
True or False.
In practice, maintaining confidentiality can be complex requiring a balance between concealing and revealing information to whom, how, when ,etc)
True.
What is a ‘disclosure’?
Simply a revelation of information
The connotation is of private or sensitive information
Who are recipients of patients personal disclosures?
Medical professionals especially nurses
What are the two reasons patients disclose information?
- To provide accurate health information/context
2. For emotional release/support (these can be in tension sometimes)
True or False.
Some patient disclosures can create predicaments for nurses.
True
True or False.
Nurses are “reluctant confidants” not fully comfortable with receiving the disclosure
True.
Patients have a high need to disclose and don’t always consider how their disclosures affect recipients
Nurses need to protect their own emotional boundaries
“We always get interesting family dynamics at the bedside. They [family members] often times will explain it to us when we see arguing at the bedside or well, ‘Don’t ask them that’ or ‘Go through me’. We can’t really pick a sibling, you know, to speak with. That’s not my job. It is not my position to do that.
This is a quote from a participating nurse
What is the communication privacy management therory?
- Individuals believe they own their private information
- Individuals believe they have the right to control the flow of private information to others
- Individuals use privacy rules to guide decisions about opening privacy boundaries (disclosing) or keeping boundaries closed (concealing)
- When individuals disclose, they make recipients shareholders (co-owners) of the information and presume they will follow existing privacy rules or negotiate new ones. Privacy management becomes a collective (not individual) process.
- Privacy management can become turbulent.
What are the methods?
Data, setting, participants
