Much of what has been said so far has stressed the importance of communication, understood as the exchange of information. Effective patient care demands the free exchange of information between patient and professionals, between different pro- fessionals and different groups of professionals. This free exchange of information is important for the welfare of the patient. However, information is often sensitive and in order to protect the interests of patients, both gathering and sharing such information needs to be carefully managed. While once this was taken for granted both gathering and sharing personal information are now regulated by law through the Data Protection Act (1998) and its associated guidelines.
Key issues in information-gathering include:
r protection of confidentiality;
r whether the information is essential;
r the accuracy of the information.
Often the first thing that comes to mind in the context of gathering and manag- ing personal information is the idea of confidentiality. However, before we can con- sider confidentiality, we need to think about what information should be obtained from patients or, if necessary, from their friends and family members. As a general rule, only information that is needed in order to deliver effective care should be gathered and this broad principle is reflected in the Data Protection Act (1998) and the associated data protection principles, particularly the third one which states that personal data shall be adequate, relevant and not excessive given the purpose for which it is gathered (see Chapter 4). The fourth principle requires that such information shall be accurate and, where necessary, kept up to date. These princi- ples allow considerable scope for information collection, since it is not always clear what information might be needed−for example, in relation to previous health problems or current living arrangements.
As mentioned above, confidentiality is an important aspect of the patient−
professional relationship which for medicine is considered to date back to the time of Hippocrates (c. 450 BCE) and the clause in the Hippocratic oath which demands discretion in speech. In more recent times the code of practice issued by the NMC directs nurses in this issue. Applied in the strictest sense, confidentiality would mean that we could not share any information without the permission of the per- son from whom it is gathered. However, in the context of nursing practice, for most purposes we can rely on implied consent to share information with others involved in the care of the patient on a need-to-know basis. Importantly, this principle does not extend beyond that closed group, even to close family members. Where con- fidential information has to be made more widely available the relevant code of practice should be consulted or the advice of a Caldicott Guardian be sought.
Vignette Friends, relatives and confidentiality
Jessica was admitted for minor surgery which necessitated a short stay in hospi- tal. She gave her sister as next of kin. Before she is discharged there is a telephone call to the ward and the caller asks about her and says he is her boyfriend. The nurse who takes the call confirms that Jessica is on the ward and is expected to be discharged later the same day. When she relays the information to Jessica, she becomes angry and says that she broke off her relationship with him and is worried that he might now follow her home.
What seems like an answer to casual enquiry has in this case acquired a more menacing tone and suggests a breach of confidentiality. The previous vignette also
makes it clear that even quite innocuous questions about patients need to be treated with caution. A young woman who visits a gynaecology clinic may not want her parents to collect her and someone who has had a blood test for HIV may be concerned about the information being disclosed even if the test was negative.
Seemingly routine information is not always as innocent as it seems.
Conclusion
Communication involves the exchange of information but as we have seen this is often more complex than we might realize and we need to be alert to and aware of inadvertent messages as well as the obvious ones. We also need to rec- ognize that communication is a skill which is never completely mastered. Always remember the following:
r The ethical dimension of communication should always be considered.
r The importance of unintentional non-verbal cues should never be underesti- mated when considering communication from an ethical perspective.
r Communication is a skill that must be developed and refined throughout a nurse’s career.
r The concepts of honesty, truthfulness and disclosure may present the nurse with significant ethical dilemmas, and may lead to different interpretations of information.
r An understanding of the concepts of consent and confidentiality is essential.
r Record-keeping, in addition to its legal function, has an important ethical di- mension.
r Legal and ethical dimensions of practice are supported by guidelines produced by organizations including the NMC and the Department of Health.
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