HA3002_AssessmentTemplate

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Nursing

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Apr 29, 2024

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HA3002: Ethical Issues in Health Assessment Assessment Template Instructions: For this Competency Assessment, you will respond to the following prompts based on the case study that is related to a particular health issue: HIV partner notification. Scenario: You are a nurse in the surgical unit of a large metropolitan hospital. A young woman has been admitted for an ovarian cyst removal later the same day. As you are taking her health history, she reveals that she has recently been diagnosed as HIV positive. In response to a query from you, she acknowledges that she has not yet seen a healthcare provider regarding this diagnosis. She also quickly adds that she hasn’t disclosed this condition to her new boyfriend, who is in the waiting room, or to any other family members or friends. Respond to the questions below from your perspective as the nurse providing care for this patient. Support your thoughts and ideas with appropriate citation of scholarly references. With this patient’s right to privacy and confidentiality in mind, identify those whom you need to inform about her HIV-positive status. Provide support from scholarly references for your response. (1–2 paragraphs) As the nurse, I would document this information in the patient electronic medical record. Hospitals abide by Health Insurance Portability and Accountability Act (HIPAA), the patient’s medical record can only be accessed by individuals on a need-to-know basis and is protected from unauthorized use (Secretary & OCR, 2020). This information is pertinent for the patient's care. The surgeon may feel that it is necessary to determine the patient’s current CD4 level. If the CD4 is low the surgeon may want to reschedule to reduce the risk of post-surgical infection (King Jr, 2015). Informing the surgeon of the patient’s diagnosis is solely based on providing safe and effective care for the patient. All healthcare workers are educated about using universal precautions (CDC, 2018). Using standard precautions for each patient minimizes the need for each healthcare worker the patient comes across to know their

diagnosis. During the health assessment, your patient has revealed that her boyfriend does not know about her HIV-positive status. Briefly explain how you might explore the patient’s understanding of how her HIV positive status may impact her relationship and the health of her partner. Explain why you would take this approach. Support your approach with scholarly references. (1–2 paragraphs) While speaking with the patient, I want to ensure that she trusts me. Carefully identifying ways to build rapport will help the patient feel comfortable discussing this private matter (Allinson & Chaar, 2021). I will ensure that when speaking to her I am not engaged with charting notes, and I will use active listening. I will use therapeutic communication and sit down at eye level with her, so she does not feel intimidated (Hull, 2007). Now that I have gained her trust and established a more relaxed atmosphere, I would ask her to educate me on what she knows about HIV. Once she is done talking, I will ask her if it is okay for me to tell her what I know about HIV. I will acknowledge this is a sensitive subject matter and inquire if she is sexually active with her boyfriend because I just do not want to assume. Once I have her answer, I will offer to sit with them both to discuss this with him. I will also educate her that it is a crime in Iowa if she does not disclose her diagnosis to him even if they practice safe sex (Iowa Legislature: 641.11 2017). If she does not feel comfortable with disclosing this to him, I will inform her about Iowa’s partner notification services. This service requires physicians to notify a patient’s partner if there is a belief that the patient has not discussed this with their partner. (Iowa Legislature: 641.11 2017). I want her to realize that this is a serious matter and that her boyfriend has a right to know as soon as possible. Identify two actions you would take—or ensure are taken—in this scenario to preserve patient confidentiality. Support your response with reference to the ANA’s position paper on privacy

and confidentiality. (1–2 paragraphs) The American Nurse Association (2015) states “Organizations must develop appropriate administrative, physical, and technical safeguards required to protect the confidentiality, integrity, and availability of individually identifiable health information (p. 2).” To preserve my patient’s confidentiality, I will use the following technical safeguards, protecting my username and password. This includes not writing this information down and using a password that cannot be easily guessed. Each time I am directly in front of the computer screen I will log completely out. I will use privacy screen protectors to ensure that if someone were to walk past, they cannot see the patient’s information on my screen. To physically preserve her confidentiality, when I am speaking with my patient, I will always keep the door closed and talk in a softer tone to ensure my voice does not carry on to the next room for others to hear. I will also not discuss or give shift report in public areas. Any papers that have protected health information will be stored in protected areas out of reach of unauthorized individuals. The Code of Ethics for Nurses was developed to provide guidance for administering quality and ethical care while upholding standards and obligations of the profession. Select one of the provisions of the Code and explain how you might apply this provision to guide your responses to the health assessment described in the scenario. Support your response with appropriate citations from scholarly references. (2–3 paragraphs) As a nurse Provision 3 of The Code of Ethics for Nurses is one that I would help assist me during my assessment. This particular provision explains how the nurse promotes, advocates for, and protects the rights, health, and safety of the patient (Fowler, 2015). Even though I am a nurse when I seek medical attention, I am a patient and feel more confident with discussing things with my nurse or provider knowing what I share will only be used to help them care for me. I always think about things as

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if I were in my patient’s seat. I never leave my computer unlocked, discuss information only with other professionals that need to know the information treating the patient. I do the right thing if I hear another professional not following the code of ethics I speak up. I would relate to my patient this in the hopes that she would start to understand how everything a nurse does is for the better good of our patients. This provision is very important and helps when forming a trusting relationship between a nurse and the patient. As a nurse, your patient must trust you so that they can feel comfortable discussing private health matters with you. When speaking with this patient about her HIV status I want her to understand that what is discussed between us will only be discussed with her physician for her care ( Your Rights Under HIPAA 2020). Going further in this provision to 3.1 Protection of the Rights of Privacy and Confidentiality. I will also explain to her that as a nurse I must protect her privacy and confidentiality. I will explain to her that Health Insurance Portability and Accountability Act (HIPAA) is in place for the protection of patients. Therefore, just because someone has access to her medical record HIPPA forbids them from accessing this record unless they are providing care ( Your Rights Under HIPAA 2020). Once your patient has revealed her HIV-positive status to you, what else do you need to think about and do in providing quality care? With a holistic approach to this woman’s care in mind, describe one subsequent action you might take. Explain how this action is in alignment with the Code of Ethics for Nurses. Support your response with appropriate citations to scholarly references. (2–3 paragraphs) Provision 1 states that the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. This provision is something that I always keep in mind. I would try to show empathy with the patient about her diagnosis, using therapeutic communication, placing my hand on her shoulder, or

holding her hand when speaking, whichever one is more appropriate when we are talking (Ashton, 2015). I will sit at eye level with her, so she understands she has my undivided attention (Ashton, 2015). Reading deeper into this provision under 1.3 the nature of health states the nurse is responsible for the health of the patient and the public (Fowler, 2015). In this incident, I would consider her boyfriend “the public” in my eyes. I am not ultimately his nurse but by educating my patient to seek further care I would be protecting him. I would educate her that just because she has this diagnosis her life is not over and ask her if she would allow me to make a referral to an infectious disease provider. I would hand her pamphlets and point out that with the proper medications her viral load can become undetectable, which means her boyfriend’s chances of becoming positive are very low (CDC, 2021). Soon after revealing her HIV-positive status to you during the health history, the patient appears to regret bringing it up. She is clearly worried and asks you if any of this information will be sent to her home, which she shares with her parents, or to her employer. Briefly explain how you would respond to her. Support your response with scholarly references. (2–3 paragraphs) I would go over what the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to better her understanding. Ensuring her that she is in control of who can see her health records (Secretary & (OCR), 2020). At the current time, I will assist her with going over how she wants mailing delivered to her, contact number, and if it is okay to leave voice mails. I will also inform her that the only individuals who can obtain her health information are those she signs a release of information for. I will also go over the current consents she has previously signed with the hospital to see if there were any she would like to revoke. I will inform her that HIPPA also protects her employer from contacting the hospital to obtain her records. Only if she signs a release of information stating her employer can receive

this information (Secretary & (OCR), 2020). I will explain that health insurance companies also follow HIPPA laws and that her employer cannot contact the insurance company for information even if she receives insurance through them. Resources

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Allinson, M., & Chaar, B. (2021, February 12). How to build and maintain trust with patients . The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/ld/how-to-build- and-maintain-trust-with-patients . Ashton, P. (2015, May 29). Therapeutic Communication Techniques. Self Development Journey. https://selfdevelopmentjourney.com/therapeutic-communication-techniques/ #:~:text=Touching%20such%20as%20holding%20a%20hand%2C%20giving%20a,better %2C%20and%20help%20strengthen%20the%20bond%20of%20trust. American Nurses Association Position Statement on PRIVAC ... (n.d.). https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/position-statement-privacy- and-confidentiality.pdf. Centers for Disease Control and Prevention. (2016, January 26). Standard Precautions for All Patient Care . Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html. Centers for Disease Control and Prevention. (2018, June 18). Standard Precautions . Centers for Disease Control and Prevention. https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/ standard-precautions.html . Centers for Disease Control and Prevention. (2021, April 21). Factors That Increase HIV Risk . Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv- transmission/increase-hiv-risk.html. Hull, M. (2007). Building a rapport with patients. The Foundation Years , 3 (3), 103–104. https://doi.org/10.1016/j.mpfou.2007.03.006 King Jr, J. (2015, April 1). Postoperative Mortality in HIV-Infected Patients . JAMA Surgery. https://jamanetwork.com/journals/jamasurgery/fullarticle/2130715 Mary, F. M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. In Guide to the code of ethics for nurses with interpretive statements: development, interpretation, and application (p. 44). essay, American Nurses Association. Privacy and Confidentiality - ANA Position Statement . ANA. (n.d.). https://www.nursingworld.org/practice-policy/nursing-excellence/official-position- statements/id/privacy-and-confidentiality/. Secretary, H. H. S. O. of the, & (OCR), O. for C. R. (2020, December 10). Privacy . HHS.gov. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html

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