Confidentiality Discussions and Private Time With a Health-Care Provider for Youth,United States, 2016

Purpose

The objective of the study was to define factors associated with adolescent and young adult (AYA) experiences with private time and having discussed confidentiality and the impact of these experiences on improving delivery of clinical preventive services.

The internet and nurse education

Participation in a community of practice through asynchronous writing is useful for learning in higher education. We argue that such computer-mediated communication via the internet is valuable in nurse education, but that it often should take place at sites protected from search with access restricted to a limited group to make the students confident and enable learning.We further argue why we think discussion of patient stories in educational settings often should be done without computers. Reflection around patient stories is a fundamental part of the education of a clinician, but should be done either with fictional cases or as face-to-face activities to protect patient confidentiality.     

Decision-making processes of a nurse working in mental health,regarding disclosure of confidential personal health information of a patient assessed as posing a risk

BackgroundNurses working in mental health routinely face difficult decisions regarding confidentiality and disclosure of patient information. There is public interest in protecting patient confidentiality, and there is a competing public interest in disclosing relevant confidential information to protect the patient or others from harm. However, inappropriate disclosures may constitute a breach of confidentiality. Despite the gravity of this situation, there is a paucity of literature to guide nurses’ decision-making processes regarding confidentiality and disclosure.AimTo examine decision-making processes of a nurse working in mental health, regarding disclosure of personal health information of a patient assessed as posing a risk.MethodsQualitative interpretivist approach using thematic analysis of data derived from an instrumental case study of NK v Northern Sydney Central Coast Area Health Service 2010, a Civil and Administrative Tribunal matter in New South Wales, Australia.FindingsThree important legal concerns relevant to nurses’ decision-making processes are illuminated. Firstly, for risk assessment there was an emphasis on a static notion of dangerousness. Secondly, rules of confidentiality and disclosure were not adequately observed. Thirdly, confidential information was disclosed without valid justification.DiscussionInappropriate decision-making processes that may lead to a breach of patient confidentiality were evident in the findings. Gaps in understanding nurses’ decision-making processes pertaining to confidentiality and disclosure of patient information that may be addressed by future research were also revealed.ConclusionFuture research that addresses gaps in understanding nurses’ decision-making processes identified by this instrumental case study would provide greater guidance for nurses when making decisions regarding confidentiality and disclosure related to risk.     

Information governance--a view from the NHS

In this paper, a range of issues influencing and affecting NHS information governance policy and practice will be considered. The expansion of electronic information services within the NHS and with its other information partners has reinforced the need for effective security and confidentiality arrangements to apply at multiple levels and in a variety of different business contexts. Added to these, the need to consistently address issues of data protection, records management and data quality, has resulted in a NHS information governance initiative. This initiative is intended to provide approved tools, methods and guidance that may be applied consistently throughout the NHS and that will be underpinned through appropriate support and helpdesk services. This paper emphasises the need to consider a range of applicable topics when determining a responsible and extensible approach to the governance of information collected, used and shared by healthcare organisations.     

Confidential storage and transmission of medical image data

We discuss computationally efficient techniques for confidential storage and transmission of medical image data. Two types of partial encryption techniques based on AES are proposed. The first encrypts a subset of bitplanes of plain image data whereas the second encrypts parts of the JPEG2000 bitstream. We find that encrypting between 20% and 50% of the visual data is sufficient to provide high confidentiality.     

Medical confidentiality and patient privacy: the Jewish perspective

This article presents the approach of Jewish law to the major issue of medical confidentiality and patient privacy. For an extensive discussion of Jewish medical ethics and an in-depth presentation of the Jewish view of 39 major issues in medical ethics, the reader is referred elsewhere [15]. Briefly, the Jewish view toward medical ethical subjects is predicated on the general principle of the supreme value of human life. In Judaism, all biblical and rabbinic laws are temporarily waived in order to save a human life. Physicians are obligated to heal patients from their illness, to induce remission and cure of disease whenever possible. Similarly, patients are obligated to lead healthy lifestyles, to consult physicians when they are sick and to be compliant with the physician's therapeutic recommendations. The Jewish view on medical confidentiality and patient privacy as presented in this essay flows from these general principles of Jewish medical ethics.     

与未成年人相关的心理咨询与治疗的保密原则

保密原则对心理咨询/治疗有重大的影响,在未成年人心理咨询或治疗时这一伦理议题尤为突出。本文将从法律层面、未成年来访者自主权、父母或监护人的权利等方面了解青少年(未成年人)心理咨询与治疗中的保密原则,深入探讨其限制及与成人咨询保密原则的差别。从事青少年心理咨询的咨询师或治疗师可能会面对保密相关的伦理困境,本文为他们提供相关的伦理信息和职业信息,并有助于尽早制定出适用于未成年来访者的伦理守则。     

Adolescents, contraception and confidentiality: a national survey of obstetrician--gynecologists

Background

Given recent legislative efforts to require parental notification for the provision of reproductive health care to minors, we sought to assess how obstetrician–gynecologists (Ob/Gyns) respond to requests for confidential contraceptive services.

Study Design

Mailed survey of 1800 US Ob/Gyns, utilizing a vignette where a 17-year-old college freshman requests birth control pills and does not want her parents to know. Criterion variables were the likelihood of encouraging her to abstain from sexual activity until she is older, persuading her to involve her parents in this decision and prescribing contraceptives without notifying her parents. Covariates included physicians' religious, demographic and clinical characteristics.

Results

Response rate 66%. Most (94%) would provide contraceptives without notifying her parents. Half (47%) would encourage her to involve a parent, and half (54%) would advise abstinence until she is older. Physicians who frequently attend religious services were more likely to encourage her to involve her parents (OR 1.9), and to abstain from sex until she is older (OR 4.4) but equally likely to provide the contraceptives.

Conclusions

Most obstetrician-gynecologists will provide adolescents with contraceptives without notifying their parents.