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chapter 3 | Nursing Practice and the Law 25 CikguOnline
the privacy of health information and improve the educational life. Think before you speak and write.
portability and continuation of health-care cover- Sometimes what may appear to be harmless to you,
age.The HIPAA gave Congress until August 1999 such as a complaint, may contain statements that
to pass this legislation. Congress failed to act, and damage another person’s credibility personally and
the Department of Health and Human Services professionally. Consider this example:
took over developing the appropriate regulations
Several nurses on a unit were having difficulty
(Charters, 2003). The latest version of this privacy
with the nurse manager. Rather than approach the
act was published in the Federal Register in 2002
manager or follow the chain of command, they
(Charters, 2003).
decided to send a written statement to the chief exec-
The increased use of electronic sources of docu-
utive officer (CEO) of the hospital. In this letter,
mentation and transfer of client information pre-
they embellished some of the incidents that occurred
sents many confidentiality issues. It is important for
and took statements out of context that the nurse
nurses to be aware of the guidelines protecting the
manager had made, changing the meanings of the
sharing and transfer of information through elec-
remarks. The nurse manager was called to the
tronic sources. Most health-care institutions have
CEO’s office and reprimanded for these events and
internal procedures to protect client confidentiality.
statements, which in fact had not occurred. The
Take the following example:
nurse manager sued the nurses for slander and libel
Bill was admitted for pneumonia. With Bill’s per- based on the premise that her personal and profes-
mission, an HIV test was performed, and the result sional reputation had been tainted.
was positive.This information was available on the
computerized laboratory result printout. A nurse False Imprisonment
inadvertently left the laboratory results on the com- False imprisonment is confining an individual
puter screen that was partially facing the hallway. against his or her will by either physical (restrain-
One of Bill’s coworkers, who had come to visit him, ing) or verbal (detaining) means.The following are
saw the report on the screen.This individual reported examples:
the test results to Bill’s supervisor. When Bill
returned to work, he was fired for “poor job perfor- ■ Using restraints on individuals without the
mance,” although he had had superior job evalua- appropriate written consent
tions. In the process of filing a discrimination suit ■ Restraining mentally handicapped individuals
against his employer, Bill discovered that the infor- who do not represent a threat to themselves or
mation on his health status had come from this source. others
A lawsuit was filed against the hospital and the ■ Detaining unwilling clients in an institution
nurse involved based on a breach of confidentiality. when they desire to leave
■ Keeping persons who are medically cleared for
discharge for an unreasonable amount of time
Slander and Libel
■ Removing the clothing of clients to prevent
Slander and libel are categorized as quasi-intentional
them from leaving the institution
torts. Nurses rarely think of themselves as being
■ Threatening clients with some form of physical,
guilty of slander or libel. The term slander refers to
emotional, or legal action if they insist on leaving
the spoken word, and libel refers to the written
word.Making a false statement about a client’s con- Sometimes clients are a danger to themselves and
dition that may result in an injury to that client is to others. Nurses need to decide on the appropri-
considered slander. Making a written false state- ateness of restraints as a protective measure. Nurses
ment is libel. For example, stating that a client who should try to obtain the cooperation of the client
had blood drawn for drug testing has a substance before applying any type of restraints.The first step
abuse problem, when in fact the client does not is to attempt to identify a reason for the risky
carry that diagnosis, could be considered a slander- behavior and resolve the problem. If this fails, doc-
ous statement. ument the need for restraints, consult with the
Slander and libel also refer to statements made physician, and carefully follow the institution’s
about coworkers or other individuals whom you policies and standards of practice. Failure to follow
may encounter in both your professional and these guidelines may result in greater harm to the