2. Agenda
Confidentiality and Privacy: Personal Health Information Slide No.
Objective 3
Introduction to Vignette 5
Legalisation 7
Personal Health Information 10
Client Perspectives 12
Professional Misconduct 14
Quality Practice Settings 16
Case Study 18
Final Thoughts 21
References 22
3. Objective
Demonstrate how Practice Standards based on legislation
guide our responses and decisions
To have a clear understanding of the client’s rights and a
nurses responsibility to maintain confidentiality and privacy
of health information
Apply this knowledge to future practice in a
variety of practice settings
Unlimited Learning Resources. HIPPA logo. [Photograph]. Retrieved from http://tinyurl.com/qhgcr9u
4. Introduction
Vignette 1: Reproduction Care Scenario Vignette
There is so much happiness that people want to share in the Family
Birthing Unit. I am finding it really challenging about who I can share
information with. We focus on family centered care, so it seems
reasonable that we communicate with family. Sometimes it is hard to
figure out who the family is. I just took a phone call from a woman who
said she is the mother-in-law of Valerie Hill, one of our new admissions.
When I told her she was doing well after her caesarean section, she asked
me why that had happened – she was supposed to have a natural birth.
She got very worried about Valeria and the baby and why the midwife
hadn’t been able to deliver her and was asking all sorts of questions. I
wanted to make her feel better so I gave her a few details to calm her
down. Now I am not so sure that was the right thing to do.
5. QUESTION:QUESTION:
WHAT CAN I SAY AND TO WHOM??WHAT CAN I SAY AND TO WHOM??
123RF. Thinking nurse. [Photograph]. Retrieved from http://tinyurl.com/q7j9nwl
6. What suggestions would you give?
What suggestions would you give to the nurse in
this vignette on what things she can say and to
whom?
Think back to the required readings/video and
how you would apply this to our vignette.
7. According to theAccording to the
College of Nurses of Ontario:College of Nurses of Ontario:
“Nurses have ethical and legal responsibilities to maintain the privacy
and confidentiality of clients' personal health information obtained
while providing care. Personal health information is any identifying
information about clients, in verbal, written or electronic form. This
includes information collected by nurses during the course of
therapeutic nurse-client relationships. The Personal Health Information
Protection Act, 2004 sets consistent rules for the management of
personal health information and outlines clients' rights regarding their
personal health information” (College of Nurses of Ontario, 2009).
College of Nurses of Ontario. (n.d.) CNO logo. [Logo]. Retrieved from
http://www.sources.com/Listings/Subscribers/L440.htm
8. PHIPA:PHIPA: Personal Health InformationPersonal Health Information
Protection Act, 2004Protection Act, 2004
Governs health care information privacy in Ontario for the collection, use
and disclosure of personal health information within the health sector
This means the client has the right to control how his/her personal health
information is collected, used and disclosed
PHIPA sets consistent rules for how to keep this information confidential and
secure, while allowing for the effective delivery of health care
(Information and Privacy Commissioner of Ontario, n.d.)
9. QCIPA:
Quality of Care Information Protection Act, 2004Quality of Care Information Protection Act, 2004
Applies to hospitals, independent health facilities, long-term care homes,
licensed medical laboratories and specimen collection centres
Encourages health professionals in these settings to share information and
hold open discussions to improve patient care, without fear that the
information will be used against them
Examples where QCIPA provides protection to Nurses:
The College’s Quality Assurance Program
Safety Occurrence Reporting (SORs)
(College of Nurses of Ontario, 2009;
Ontario Ministry of Health and Long-Term Care, n.d.)
10. What is Personal Information?
Clients do not have to be named for information to be considered personal
health information.
Information that could serve as a Patient Identifier:
Physical or mental health, including family health history
Care previously provided (including persons who provided care)
A plan of service (Use of Home Care, Long-Term Care Facility)
Donation of body parts or substances (e.g., blood)
A person’s health card number
The name of a client’s substitute decision-maker
(College of Nurses of Ontario, 2009)
11. Disclosure defined as …
“Making information available or releasing it to another custodian or person”
“Express consent is needed when personal health information is disclosed
outside of the health care team or is not used to provide health care”
(College of Nurses of Ontario, 2009)
However, PHIPA allows the disclosure of personal health information without
consent, for the following reasons:
• to manage risk • to support quality of care programs
• to allocate resources • to obtain payment
• to do research, if a research plan has been approved by a research
ethics board
13. Yes or No?
So let’s reassess:
From what we’ve learned so far, do you think
it was right or wrong for the nurse to disclose
personal health information to an unknown
family member over the telephone?
Think about the Practice Standard,
required readings, and the required
video you watched.
NUR56100. Bedside nurse. [Clip Art]. Retrieved from http://tinyurl.com/p7qh8h5
14. The College of Nurses considers this act to be …
Professional misconduct.
According to the Practice Standard: Confidentiality and Privacy – Personal
Health Information,
“giving information about a
client to a person other than the client or his or her
authorized representative, except with the consent of
the client or his or her representative, or as required
or allowed by law”
(College of Nurses of Ontario, 2009).
15. Professional Misconduct: Now What?
Agency Specific, but here are some first STEPS:
Contact your Union Rep – they can help guide you
through the process
Manager/Educator
Client – find out the disclosure process with your Agency
before performing this step
Centre for Professional Practice
Learning Plan
Educate your fellow colleagues with new learning
(Make a negative experience into a positive!)
16. Quality Practice Settings
The College of Nurses of Ontario ENCOURAGESENCOURAGES
employers and nurses to use strategies to develop
and maintain a quality practice setting
Employers should promote a learning environment to
try and establish a process that may aide in helping
staff members deal with issues and/or conflicts that
may arise in the workplace relating to privacy and
confidentiality of personal health information
National Alliance for Partnerships in Equality. Male nurse. [Photograph]. Retrieved from
http://tinyurl.com/nfbg4s8
17. Meeting the Standard
Some steps nurses can do to meet the standard:
Before the disclosure of client’s personal information outside the health
team to people such as family members or friends, obtain the client’s
expressed consent
Inform clients that at any point, they may withhold or withdraw their
expressed consent to disclose their name, location in the facility and general
health status
Inform clients that at any point, they may withhold or withdraw their
expressed consent to disclose their name to a person representing his/her
religious organization
If client is incapable of providing informed and knowledgeable consent,
seek consent from the substitute decision maker
(College of Nurses of Ontario, 2009)
18. Discussion
Can you think of other examples where this practice guideline
applies/is transferable?
Case Study – Transfer your new knowledge to a different setting
Darkcoin Foundation. Keyboard. [Photograph]. Retrieved from http://tinyurl.com/ngqrrb7Hommersen, R. Fake facebook. [Image screenshot].
19.
20. Social Media: Think before you post
Build your brand
Transparency
Honesty
Respectfulness
Add value
Nurses are perceived as trustworthy and our profession as honorable.
Nurses/nursing students shall conduct themselves in a manner that not only
maintains this perception, but also builds upon it.
Be diligent
Stay engaged
Protect your privacy
When in doubt, don’t post
Get off the Internet
(Registered Nurses’ Association of Ontario,
21. Time to wrap things up …
Any final thoughts?
Keith-Harris.com. Questioning man. [Clip Art]. Retrieved from http://tinyurl.com/qagd4oc
22. References
College of Nurses of Ontario. (2014). Professional conduct.
Professional misconduct. Retrieved from
http://www.cno.org/Global/docs/ih/42007_misconduct.pdf
College of Nurses of Ontario. (2013). Social media: Reflect before you post.
Retrieved from http://www.cno.org/learn-about-standards-
guidelines/educational-tools/webcasts/social-media-reflect-before-you-
post/
College of Nurses of Ontario. (2009). Confidentiality and privacy:
Personal health information. Retrieved from
http://www.cno.org/Global/docs/prac/41069_privacy.pdf
23. References
Information and Privacy Commissioner of Ontario. (n.d.). PHIPA:
Personal health information protection act, 2004. Retrieved from
https://www.ipc.on.ca/english/phipa/
National Council of State Boards of Nursing. (2011). A Nurse’s guide to
the use of social media. Retrieved from
https://www.ncsbn.org/NCSBN_SocialMedia.pdf
Ontario Ministry of Health and Long-Term Care. (n.d.). Legislation: Quality of
care information protection act, 2004. Retrieved from
http://www.health.gov.on.ca/en/common/legislation/qcipa/
Build your brand – Are you speaking as yourself, with or without your ‘nursing hat’ on? Tone and context can often be misinterpreted. Building your voice or online persona will help to minimize confusion when it comes to the tone of your comments.
Transparency – Identify yourself, write in the first person, and don’t be afraid to show your personality. Own your voice. Social media is all about continuous dialogue. Be smart, post smarter.
Honesty – Do not make false or misleading comments/statements. If you make a mistake, take responsibility for it. It’s ok! It’s better to own it and clarify than to deny or ignore and open yourself to further criticism.
Respectfulness – Exercise discretion and confidentiality when referring to others, including coworkers, patients and clients. Do not post identifiable information and/or content unless you have permission to do so. Avoid harassment, intimidation, abuse or threats (both when posting and responding to posts). Not all conversations are worth participating in. Anything you post online becomes public information and may remain online indefinitely, even if you attempt to modify or delete your post. Avoid fights and personal attacks.
Add value – Stick to what you know. Post meaningful comments, and aim for quality. Interested in gaining new knowledge? Ask! Someone will likely post back to you!
Be diligent – Check your sources. Separate opinions from facts. Know the difference between offering suggestions and offering health-related advice. Offering advice could lead to liability.
Stay engaged – Stay informed, post regularly, and respond to comments in a timely manner.
Protect your privacy – Never disclose your personal information. Once it’s posted, it’s there for good. Keep your personal information personal. Get to know your privacy settings.
When in doubt, don’t post – Many social applications have timers built in. If you’re unsure about posting something, ask yourself ‘is this something that MUST be posted right now?’ ‘Am I posting out of emotion?’ If you are afraid of losing your thought, type it out and put it on a delayed post. Come back to it later. Social media is very fleeting. By the time you decide it wasn’t worth posting, the topic might be irrelevant on social media.
Get off the Internet - Be aware of the amount of time you spend on social media. Don’t let it negatively affect your life. There’s nothing wrong with unplugging.
