Concept analysis and disclosure practices

¶ … 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.

Concept Discussion

In our current setting, healthcare organizations are legislatively driven to follow strict disclosure polices in order to shield patient related and other protected data yet still these facilities and staff will be required to provide superior customer service. Thus, the information age has strained governmental legislation bolstering individual patient's privacy. "In the past decade, we have undergone a dramatic transformation in the way we shop, bank, and go about our daily business -- changes that have resulted in an unprecedented proliferation of records and data." (Soloye)

This vast amount of information that has been created or has suddenly become available now requires all new regulations regarding disclosure of medical information. The nursing profession has obviously been affected.

For example, nursing staffs often must get written permission to disclose, discuss or review a patient's situation with a non-immediate family member. In other words, to give nursing staffs permission to use or disclose medical information about a Down syndrome newborn with the patient's family or friends as needed, the new mother must revoke her own privacy in writing.

Nursing staffs must be fully cognizant if and when a patient revokes the permission to use or disclose his or her medical information. There is a fine line associated with previous foreclosures made with permission which creates a new documentary crisis. Nurses will be required to retain even more detailed records of care provided and often special footnotes will be required in the nursing logs when a revocation has occurred.

The new Health Insurance Portability and Accountability Act of 1996 is the legislative attempt to create a semblance of patient care privacy regulations. The objective of this act aims to assist the entire healthcare industry with the electronic data overload but just as critical the act will address all healthcare related data such as nursing logs and other detail care accounts. Of course the most crucial issues will be related to computer data and a great deal of the disclosure related concerns will fall on governmental agencies that have to meet the very strict HIPAA standards health plans, clearinghouses, and providers will be required to comply with.