Page 59 - Essentials of Nursing Leadership and Management, 5th Edition

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46 unit 1 | Professional Considerations CikguOnline
that will most likely require intensive therapies and without revealing an individual’s name can be a
treatments for a lifetime, adding up to more breach in confidentiality if the situation and the
millions of health-care dollars? In the social and individual are identifiable. It is important to realize
business world, welfare payments are based on that what seems like a harmless statement can
need, and jobs and promotions are usually distrib- become harmful if other people can piece together
uted on an individual’s contributions and achieve- bits of information and identify the patient.
ments. Is it possible to apply these measures to Nurses come into contact with people from
health-care allocations? different walks of life. Within communities, people
Philosopher John Rawls addressed the issues know other people who know other people, and so
of justice as fairness and justice as the foundation of on. Individuals have lost families, jobs, and insur-
social structures. According to Rawls, the idea of ance coverage because nurses shared confidential
the original position should be used to negotiate information and others acted on that knowledge
the principles of justice.The original position based (AIDS Update Conference, 1995).
on Kant’s social contract theory presents a hypo- In today’s electronic environment, the principle
thetical situation in which individuals act as a of confidentiality has become a major concern.
trustee for the interests of all individuals.The indi- Many health-care institutions, insurance compa-
viduals, known as negotiators, are knowledgeable nies, and businesses use electronic media to trans-
in the areas of sociology, political science, and eco- fer information. These institutions store sensitive
nomics. However, they are placed under certain and confidential information in computer databases.
limitations referred to as the veil of ignorance.These These databases need to have security safeguards to
limitations represent the moral essentials of origi- prevent unauthorized access. Health-care institu-
nal position arguments. tions have addressed the situation through the use
The veil of ignorance eliminates information of limited access, authorization passwords, and
about age, gender, socioeconomic status, and reli- security tracking systems. However, even the most
gious convictions from the issues. Once this infor- secure system is vulnerable and can be accessed by
mation is unavailable to the negotiators, the vested an individual who understands the complexities of
interests of involved parties disappear. According computer systems.
to Rawls, in a just society the rights protected by
justice are not issues for political bargaining or sub- Veracity
ject to the calculations of social interests. Simply Veracity requires nurses to be truthful.Truth is fun-
put, everyone has the same rights and liberties. damental to building a trusting relationship.
Intentionally deceiving or misleading a patient is a
Fidelity
violation of this principle. Deliberately omitting a
The principle of fidelity requires loyalty. It is a part of the truth is deception and violates the prin-
promise that the individual will fulfill all commit- ciple of veracity.This principle often creates ethical
ments made to himself or herself and to others. For dilemmas. When is it permissible to lie? Some
nurses, fidelity includes the professional’s loyalty to ethicists believe it is never appropriate to deceive
fulfill all responsibilities and agreements expected another individual. Others think that if another
as part of professional practice. Fidelity is the basis ethical principle overrides veracity, then lying is
for the concept of accountability—taking responsi- permissible. Consider this situation:
bility for one’s own actions (Shirey, 2005).
Ms. Allen has just been told that her father has
Confidentiality Alzheimer’s disease.The nurse practitioner wants to
The principle of confidentiality states that anything come into the home to discuss treatment. Ms. Allen
said to nurses and other health-care providers by refuses, saying that the nurse practitioner should
their patients must be held in the strictest confi- under no circumstances tell her father the diagnosis.
dence. Confidentiality presents both a legal and an She explains to the practitioner that she is sure he
ethical issue. Exceptions exist only when patients will kill himself if he learns that he has Alzheimer’s
give permission for the release of information or disease. She bases this concern on statements he has
when the law requires the release of specific infor- made regarding this disease. The nurse practitioner
mation. Sometimes, just sharing information replies that medication is available that might help