Disclosure in nursing practice and healthcare privacy protection

¶ … Disclosure

This report represents a concept analysis on disclosure as it pertains to how it is used in a scientific model as opposed to a normal or ordinary sense. The objective was to gain new insights into the concept of disclosure and how it pertains to the nursing profession. The objective is to establish the groundwork for future research in the disclosure legislation as well as the day-to-day aspects of disclosure rules. The report was outlined according to Avant and Walker's Strategies for Theory Construction in Nursing. The report layout aims to give a brief description of disclosure and how it will be affected by the Health Insurance Portability and Accountability Act of 1996 and offers reasoning for why this topic was selected. The report talks about the detailed literature search that would be necessary for full topic coverage and identifies some uses of the concept with non-nursing literature also included. The report then determines defining attributes by utilizing the concept of 'Model, Borderline, Related, Contrary, Invented and Illegitimate' detailing. From there, an identification of antecedents and/or consequences is done with empirical referents related to the concept also being discussed. The conclusion entails a discussion pertaining to the theoretical framework as it relates to the disclosure.

By definition, disclosure is simply the act or process of revealing or uncovering something. However, in the medical community, privacy advocates and the technology based information age have redefined what disclosure is and what it is not. The United States healthcare system encompasses many different layers including health plans, physicians, hospitals, clinics, consumers, and public health programs. Today, as consumers go through the process of selecting either a health plan, doctor of other health professional, there are many opportunities for that individual's personal information such as a social security number, medical condition or diagnosis to make its way through the hands of many medical professionals in various capacities. "Almost all of us are aware that our personal information is being collected and stored by many different entities." (Soloye)

Two Sides of Disclosure

Consider that today, a patients medical history, personal history or financial account information is all digitized and can be passed from the healthcare system to a private insurance company or governmental system such as Medicare almost instantaneously. And this access is for twenty-four hours a day, seven days a week and three hundred sixty five days a year. Although computerization of vital data is of grave concern in regard to disclosure, there are many other aspects that although far less technical also correspond to privacy and new disclosure information legislation. Examples of privacy violation and disclosure concerns entail something as simple and common as two nurses conversing in a crowded elevator about a certain patient's condition or an innocent conversation in a cafeteria about a doctor who left a watch in a person during a surgery. The fact is that disclosure and information protection will have a long lasting affect on the nursing profession of tomorrow.

But, these expectations are not all related to patient privacy issues. For example, in 2003 the General Assembly of the Commonwealth of Pennsylvania introduced a Senate Bill that approached disclosure rules from a completely different angle as it pertains to the nursing profession and individual's privacy concerns. This particular Commonwealth bill named the 'Nursing Home Consumers Right-to-Know Act' will be used by the state's government to relegate the nursing staff to a position of ombudsman. Throughout Pennsylvania, long-term care nurses will be required to gather and report information and, in a sense, become whistle blowing employees of the state regulatory commission and the Department of Health. "...an Act requiring long-term care nursing facilities to submit nursing home disclosure forms to the Department of Health; and providing for nursing home disclosure forms." (Senate Bill, 2003)

To name just a few of the disclosure form requirements the Act requires can be considered a tell-tale sign of future disclosure legislation. The nursing home disclosure form is a 'tell all' form that should serve the state's purpose regarding a facility's fiscal year in question:

The name, address and telephone number of the facility

Actual ratio of residents to licensed nurses, reported for each shift

Actual ratio of residents to nurse aides, reported for each shift

Nursing hours per resident per day

The turnover rate for licensed nursing staff and nurse aides

Average length of service at the facility for licensed nursing staff

Current licensure status (whether facility has been subject to provisional license within previous five years or to bans on admission or license revocation)

If the facility had a master appointed to operate the facility and the dates of such status and a description of the deficiencies that brought about such status

These tidbits are only a very short list of the detailed information that has been mandated in Pennsylvania. As oversight staffing budgets are reduced and redundancy is addressed, many states will follow Pennsylvania's lead.

Discuss Literature Search Process

To gather information regarding disclosure and how it pertains to the nursing industry, comprehensive literature search will be required. The Literature Search Process will follow the guidelines of a detail oriented approach for gathering disclosure and nursing related data. The information would be acquired through various sources including:

Physical Searches: searching core journals

Database Search: electronic databases both library and internet

Studies: Student journals and Studies

Internet: web page studies

Personal Interviews: experts and relevant organizations pertaining to disclosure legislation and implementation

The objective of the detailed search would be to acquire as mush relevant information pertaining to nursing and the affects of new disclosure polices, legislation and protocol.

Determine the Defining Attributes

To clearly define attributes associated with the aspects of disclosure is a major objective of this foreshadow. First and foremost, typical nurse's obligations regarding disclosure and data privacy protection will be legally mandated and therefore they must be clearly defined. The attributes associated with disclosure principles must describe an entire industry's, individual facility's including private healthcare professional's offices, as well as any faculty or staff that must practice and therefore enter information into a medical chart, MDS or other facility record.

If one was to consider how disclosure legislation has affected nursing, consider an abused pregnant woman who was in to receive information about prenatal care. The process of gathering and reporting the data about aspects of abuse of a pregnant woman would be necessary. However, it is important to note that disclosure polices should not interfere with day-to-day operations. In other words, nursing practitioners are still required to perform their medical activities such as: prevent or control disease,