Confidentiality and HIPAA
P.H. is a 22-yr-old woman who recently tested positive for chlamydia.
You tell her to tell her sexual partners of the infection. She refuses to
tell her boyfriend because he will know that she has had sex with
another partner. You later learn that the nursing student who was in
the clinic for the day is a friend of her boyfriend and told him that he
should have STI testing.
Ethical/Legal Points for Consideration
• Each state has requirements for reporting communicable diseases
and other health-related data. Inform the patient of the reporting
requirements for communicable diseases.
• Nurses and other HCPs have both a legal and an ethical
obligation to maintain confidentiality of patient information. The
Health Insurance Portability and Accountability Act (HIPAA)
ensures the privacy of personal health information.
• The duty to maintain confidentiality is not absolute and may be
limited, as needed, to protect the patient or other parties, or by
law or regulation, such as mandated reporting for safety or
public health reasons.
• Your main obligation is to the patient seeking care. Patient
teaching is one way to establish a partnership with this woman.
Share information about the effects of the disease, the
consequences of reinfection, and the effect of the disease on
others who may not know that they are infected. Then encourage
the patient to tell her partners of the diagnosis and discuss the
option of expedited partner therapy (EPT) where applicable.
• What are your state’s requirements for reportable conditions?
• In your opinion, what is the best way to balance the needs of an
individual patient with those of the public?
• What are the risks to agencies for the breach of confidentiality
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