COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
CHAPTERS: Chapter 1-5
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ABSTRACT
The confidentiality promise is technically complex, politically uncertain and scientifically ill-defined to address multiple patients’ needs. This is because patients’ confidentiality provides diverse perspectives which are yet to meet thorough academic examination. Therefore, the purpose of the study was to assess circumstances that may constrain healthcare workers from keeping the confidentiality promise. The study’s objectives were to assess the impact of knowledge level of healthcare providers concerning patient confidentiality, the current trends in keeping the confidentiality of patients and assessing circumstances healthcare workers may be constrained from keeping the confidentiality promise. The study sought to achieve its purpose by adopting quantitative approach with the cross-sectional explanatory design to gather data through a survey questionnaire using 141 respondents. The respondents included healthcare providers (nurses, medical officers, health specialists and surgeons) of University of Uyo Teaching Hospital Nigeria. The data was analysed using correlation and simple linear regression via the application of SPSS. The results show that knowledge of public reporting, reporting child maltreatment and knowledge of patients’ threats to third parties significantly predicted patient confidentiality. However, knowledge of criminally inflicted injuries even though positive did not predict significantly predict patient confidentiality. The finding suggests that social media does support patient confidentiality negatively thus increase in social media activities lead to a decrease in patient confidentiality. In-service training, knowledge of patient de-identification and the use of electronic medical record system are current trends or practices are at FOCOS. The results imply that some circumstances may constrain healthcare providers from keeping the confidentiality promise, hence breaches. The study recommends that healthcare providers should be educated on the use of social media and breach of confidentiality.
CHAPTER ONE
INTRODUCTION
In this chapter, the researcher discusses the background of the study, problem statement, the objectives of the study and hypotheses. In addition, the significance of the study, definitions of key terms and the chapter organization are discussed.
1.1 Background of the Study
The origins of professional confidentiality dates back to Hippocrates, who stated, “Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret” (Hulkower, 2016). From those ancient times, Stanberry (2006) suggest that, professional confidentiality and privacy for health care providers have become a legal as well as ethical obligation. Confidentiality is the central aspect of the physician-patient relationship (Brody, 1997). Confidentiality and whatever it stood for, was largely ignored in the past. Throughout the middle Ages, for example, patients with plague like diseases routinely had their privacy abrogated and their identities publicized. Similarly, those diagnosed with leprosy had to ring bells or clappers to warn others of their approach and condition (Liu et al., 2002).
It was not until the 19th century, according to Reamer 2013, that confidentiality finally became widely recognized as an important concept with moral and ethical obligations. The French Penal Code of 1810, for example, imposed imprisonment and heavy fines on physicians who revealed medical secrets. In 1803, Thomas Percival established the first modern code of Western medical ethics, which states, “Patients should be interrogated concerning their complaint in a tone of voice which cannot be overheard. The American Medical Association’s (AMEs) original Code of Medical Ethics, adopted in 1847, was a revision of Percival’s work and formally included the principle of confidentiality. The current version of the AMEs Principles of Medical Ethics avows, “A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law” (Corrigan, 2003). The Joint Commission on Accreditation of Healthcare Organizations also holds that the patient has the right, within the law, to personal and informational privacy. Modern healthcare practice continues to recognize the importance of confidentiality (Bastable, 2017), and have included it in various oaths, principles, and rules of professional conduct. This is also enshrined in the syllabus used in the academic training of healthcare workers. Most of these codes commonly hold that confidentiality may be breached only when required by law, when in the public interest, or when necessary to prevent harm to others.
In the health literature, confidentiality is discussed in relation to patients’ rights and is an essential aspect of the trusting relationship that patients have with their health-care providers (Dobrowolska et al., 2007, Neitzke 2007). There is an understanding that patients have the right to privacy and the right to expect personal information about them to be held in trust, with security of records, and that access to such information is in some way protected (Rock & Congress 1999, Frewer & Fahr 2007). Hulkower (2016), in his review of the Hippocratic Oath also supports that confidentiality is still essential to the formation of the therapeutic relationships for patient and health- care providers, and by extension, to healthcare institutions, whereby there is an understanding that professional individuals and organizations will maintain confidentiality of patient information.
The maintenance of confidentiality is both a legal and an ethical duty of all healthcare workers, American Nurses Association. (ANA) (2001). Larkin et al. (1994) reiterate that, indiscriminate disclosure of patient confidences may disgrace patients, undermine trust, and seriously imperil patients’ relationships with their doctors and others. Patients expect that physicians will honor the implied contract of silence and fulfil their obligation as patient advocates. Moral arguments for confidentiality are rooted in the principles of utility and duty according to Utilitarian principles and this is concurred by Hayry (2013), in the Liberal utilitarianism and applied ethics.
Breaching confidentiality may be thought to weaken society’s faith in the greater institution of medicine and healthcare (Gilson 2013). The resultant distrust threatens the provision of detailed and accurate information necessary for correct diagnosis and treatment. Thus, possible long-term destruction of patient openness would continue to militate strongly against breaches in confidentiality (Cate, 2010). The ethical principles of the AMA and the American College of Physicians recognize certain exceptions to the rule of confidentiality. It is for this reason that this study intends to find out under what circumstances, are healthcare worker constrained to keeping the confidentiality promise.
The study seeks to assess the role of confidentiality as an essential aspect in patients’ information in the hospital and under what circumstances healthcare workers may be constrained from keeping the confidentiality promise. The specific objectives include the following;
Objectives:
- To assess the knowledge level of healthcare providers on confidentiality at University of Uyo Teaching Hospital in Nigeria.
- To study the current trends in the practice of confidentiality at University of Uyo Teaching Hospital in Nigeria.
- To find out under what circumstances healthcare providers may be constrained from keeping the confidentiality promise at University of Uyo Teaching Hospital in Nigeria.
The findings of this study are important for government policymakers, health institutions and researchers. The study is relevant in these areas due to the fact that it provides insight in staff perception of patient confidentiality, it identified the prevailing trends in patient confidentiality practice in the study area which can be applicable to many health facilities in Nigeria and Africa at large. The findings further provide useful information for Government and policymakers to formulate national and institutional policies on the storage and disclosure of patient information. This will help to curtail the indiscriminate disclosure of patient information either in news, print or over the social media.
The findings will help to remove barriers to patients-staff and staff-staff relationships which will translate into greater utilization of health services resulting in improved health outcomes. The findings have further enlightened clinical staff to be mindful when dealing with patient information. In addition, the findings of the study may further create an avenue for further studies to be conducted on patient confidentiality in other parts of the country, to create a ripple effect in respecting patient information in our society.
The study covered health professionals in direct patient care in a private hospital in Pantang, Accra. The study was limited to clinical staff of the selected hospital and did not cover nonclinical staff or staff from other hospitals. Therefore, generalization should be done with caution. In view of the fact that the study was to assess patient confidentiality and under what circumstance healthcare worker may be constrained from keeping the confidentiality promise, the study made use of staff who mostly have direct interaction or contact with patients. Other facilities and other categories of staff were not part of the study due to resource and time constraints.