Patient confidentiality and ethics in nursing

Peri Operative Nursing
Task 1- Safety issue

Perioperative refers to the practice of surgical procedure where patients experience
surgical intervention. Perioperative nurses are tasked with the responsibility of taking care of the
patient before, during and after the surgical intervention (Banschbach, 2016). During this time of
surgery intervention and care, many safety issues many arise. According to Ford (2012), many
safety issues such as emotional, physiological, and sociocultural safety issues may arise during
the pre-operative, intra-operative, and post-operative phases of the surgical intervention because
of the negligence of preoperative nurses.
Prior to the surgical procedure, perioperative nurses perform a patient assessment to
evaluate the nursing care to be given in the operating room and after the patient returns to the
nursing unit, or at home. This involves assessing the social, physical, and emotional needs of a
patient. From the information obtained, the perioperative nurse can then predict the suitability of
the surgical timing for the patient (Ford, 2012). However, studies have shown that during this
assessment period, perioperative nurses are bound to making social mistakes that result in social
safety issues. According to Steelman et al. (2013) perioperative nurses, at the interaction level
with the patients, may fail to actively engage the patient’s family members who can furnish
important information about the patient that can help in assessing the social and physical needs
of the patient and consequently help in determining the care to be provided. In addition,
Robinson (2016) states that sometimes the amount of and length of teaching recommended to a
patient by the perioperative nurses is not sufficient enough to prepare the patient psychologically
for the surgery type and procedure, leading to psychological safety issue during the intra-
operative procedure where the patient can be more anxious and less cooperative.

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According to the Nursing and Midwifery Board of Australia (2010), the information from
pre-operative assessment helps in determining the surgery site and procedure for a patient.
However, incorrect or insufficient information obtained from or about the patient can result in
perioperative nurses recommending wrong site surgery for the patient, thereby resulting in
physiological safety issue during the surgical intervention (Ford, 2012). Besides, insufficient or
inaccurate information from the pre-operative assessment can result in verification errors,
scheduling errors, medication error, and patient time-out errors (from the surgical room and out
of hospital) (Steelman & Graling, 2013). Thus, wrong or insufficient pre-operative assessment
can be a strong basis for physical, emotional, and social safety issues on the part of the
perioperative nurses.
Further, according to the Nursing and Midwifery Board of Australia (2010), the
information from the pre-operative assessment can be used in settling professional and legal
issues concerning the surgical treatment of the patient as it depicts proof of the medical care
provided. According to Steelman & Graling (2013), any documents completed by healthcare
practitioners during the pre-operative assessment are legal documents and can be demanded by
the court during legal proceedings concerning the health care of a patient. Thus, the pre-operative
assessment should be undertaken with utmost care and keenness especially documentations such
as pre-scribed medication, health care, and surgical areas. Ford (2012) adds that pre-operative
assessment is part of the professional duty of perioperative nurses to the patients. And as such,
accurate assessment and evaluation is a vital part of nursing practice as it forms the basis for
efficient and safe care provided to patients.

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Banschbach, K. S. (2016). Perioperative nurse leaders and their role in patient safety. AORN
Journal, 104(2), 161-164
Ford, A. D. (2012). Advocating for perioperative nursing and patient nursing. Perioperative
nursing clinics, 7(4), 425-432
Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards
for Registered nurse. Retrieved from:
Robinson, L. N. (2016). Promoting patient safety with perioperative hand-off communication.
Journal of PeriAnesthesia Nursing, 31(3), 245-253
Steelman, M., V. & Graling, P., R. (2013) Top 10 Patient Safety Issues: What More Can We Do?
AORN Journal, 97(6), 679-701. Retrieved from:
Steelman, M., V., Graling, P., R., & Perkhounkova, Y. (2013). Priority patient safety issues
identified by Perioperative nurses. AORN Journal, 97(4), 402-418

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Task 2: Patient confidentiality and ethics in nursing

In their line of duty, perioperative nurses are bound to the duty of confidentiality and
ethics. However, in executing their responsibilities, perioperative nurses find themselves in
dilemma situations with regards to ethical issues and confidentiality concerns accompanying the
sharing of patient’s health information (Ulrich et al., 2010). According to the Nursing and
Midwifery Board of Australia (2010), ensuring confidentiality of the health information of a
patient is at the core of nurses establishing and maintaining trusting relationships with patients,
patient’s families, and other health professionals. With no assurance regarding the confidentiality
of their health information, patients could be hesitant to provide sensitive yet important
information regarding their health status/condition that can help in provision of high quality care
(Price, 2015). However, perioperative nurses are faced with dilemma in situations where they
consider appropriate to share a patient’s confidential health information to his or her family
member(s) or caregiver for purposes of ensuring the patient continue to receive quality and safe
health care. The ethical implication of this action is the violation of ethics duty by the nurse as
well as the potential loss of trust in the nurse and other health professionals in the institution by
the patient or family should it be discovered that such confidential information was shared.
Additionally, in situations where the health condition of the patient deteriorates, health
professionals find themselves in a dilemma state with regards to protecting the patient’s privacy
whilst addressing the carers’ concerns about the patient’s condition (Price, 2015). For instance,
patients that have undergone brain surgery are often mentally and physically unstable because of
the nature of the surgery and as such are not in a position to interact with family as well as make
important decisions concerning their health information, which could be confidential. At the
same time, the patient’s family members might request to know about the health condition of the

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patient, being unaware and unfamiliar of the hospital procedure and policies and health care code
of ethics regarding the application of confidentiality in their context (Ulrich et al., 2010). In this
situation, disclosing the patient’s confidential health information to the family members can be a
complex task. Thus, the nurse must obtain the patient’s permission about the information that can
be shared, to who and under what circumstances to minimise possible misunderstanding with
family member(s) as well as evade possible legal implications accompanying such (Olson &
Stokes, 2016).
According to the Nursing and Midwifery Board of Australia (2010), patients have an
inherent right to autonomy, which allows for their informed consent or the withheld of this
consent. The law of informed consent holds that patients have the right to withhold personal
information unless it is required by law to provide such information; or make decisions
concerning their own treatment (Taylor, 2014). Thus, perioperative nurses have ethical and legal
obligation to respect and protect patient’s right to autonomy by allowing the patients to make
their own treatment decisions or not to provide certain personal information deemed confidential.
However, nurses may find themselves in a dilemma in situations where protecting and respecting
patient’s right to autonomy could result in harm to the patient (Olson & Stokes, 2016). For
instance, in situations such as multiple series of surgery or uneventful incidents, letting the
patient make his/ her own treatment decisions or withhold important information to health care
practitioners could result in self-harm or harm others altogether. In such scenarios, the nurse or
health professional might be compelled to violate the duty of confidentiality through such means
as disclosing important information concerning the patient to the family or deciding on the
suitable heath care for the patient through the help of family and other health professionals

Peri Operative Nursing 6
without patient’s consent. This could result in an ethical break that can have legal implications on
the nurse or health professional involved (Simek, 2016).

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Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards
for Registered nurse. Retrieved from:
Olson, L., L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses with Interpretive
Statements: Resource for Nursing Regulation. Journal of Nursing Regulation, 7(2), 9-20
Price, B. (2015). Respecting patient confidentiality. Nursing Standard, 29(22), 50-57.
Simek, J. (2014). Specifics of nursing ethics. Kontakt, 18(2), 64-68
Taylor, H. (2014) Promoting a patient’s right to autonomy: implications for primary healthcare
practitioners. Part 1. Primary Health Care, 24(2), 36-41
Ulrich, C., M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M. & Grady, C. (2010).
Everyday Ethics: Ethical Issues and Stress in Nursing Practice. Journal of Advanced
Nursing, 66(11).  doi:  10.1111/j.1365-2648.2010.05425.x

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Task 3: Reflection

The perioperative period includes various processes and procedures that bring about
multiple and challenging changes to a patient (Nursing and Midwifery Board of Australia, 2010).
A major surgical intervention is accompanied with multiple stressful components such as worries
about survival, length of admission to hospital, one’s physical condition after the surgery,
separation from the family, and the financial implication, factors that significantly impact on a
patient’s recovery (Gouin and Kiecolt-Glaser, 2012). For example, based on my reading, the
patient revealed that during pre-operative phase, he experienced psychological stress and anxiety
brought about by the thoughts of fear of death, physical deformity related with the surgical
intervention, longer stays in the hospital, longer recovery period, and the cost of the whole
surgical procedure and care. He affirmed that the fear, anxiety and stress slowed his recovery
(Hudson & Ogden, 2016).
The physical environment of a patient such as lights and sounds can also affect a patient’s
recovery (Nelson, et al., 2016). The patient also described the sounds from the equipment and
people in the vicinity of the recovery unity as having affected his sleep and sensory, occasionally
bringing back the thought of the surgery procedure. This deprived him of emotional peace.
Besides, the patient described his confinement to the hospital bed in the recovery unit under the
extensive monitoring machines as a painful and scary experience that distressed him (Hudson &
Odgen, 2016). According to Gouin and Kiecolt-Glaser (2012), pain and distress during
perioperative period can be influenced by emotions triggered by the physical environment factors
result in physical changes in a patient, thus slowing his recovery period.

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Surgery also results in inability on the patient. During the perioperative period, a patient
is unable to engage in certain duties, responsibilities and activities. This leads them to have low
self-esteem and feels insecure (Marks, 2015). The patient also described that during his recovery
period, he experienced sudden changes in his social and family life as he could not return
immediately to his normal life and perform the duties he valued most. This made him loose sense
of self-esteem and raise insecurity concern on his part. Besides, having to live with a life-
changing diagnosis for the rest of his life was traumatizing and frustrating altogether as it was
associated with some form of isolation from friends and family. Nonetheless, he acknowledged
the contribution of his carers (immediate family and clinicians) who gave him hope in life
(Hudson & Ogden, 2016).
Having read the patient’s experience, I have come to appreciate the need for social and
spiritual support for a patient undergoing major surgical intervention. The social support is
crucial for enabling the patient understand the aftermath implications of the surgery and
consequently prepare him on how to live with it. Spiritual support offers the needed help to a
patient to have hope in life again during and after the surgery and treatment procedure (Hudson
& Ogden, 2016). Conclusively, I have come to understand the need for perioperative nurses to
understand the possible implications of the illness from the patient’s perspective to facilitate their
recovery and offer the needed emotional support during their recovery period (Nelson et al.,

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Gouin, J., & Kiecolt-Glaser, K., J. (2012). The Impact of Psychological Stress on Wound
Healing: Methods and Mechanisms. Immunol Allergy Clin North America, 31(1), 81-93
Hudson, B., F. & Ogden, J. (2016). Exploring the Impact of Intraoperative Interventions for Pain
and Anxiety Management During Local Anesthetic Surgery- A Systematic Review and
Meta-Analysis. Journal of PeriAnesthesia Nursing, 31(2), 118-133
Marks, R. (2015). Non-Operative Management of Knee Osteo-arthritis Disability. International
Journal of Chronic Diseases & Therapy (IJCDT), 1(2), 9-16
Nelson, G., Altman, A., D., Nick, A., Meyer, A., L., Ramirez, P., T., Achtari, C., Antrobus, J.,
Huang, M., S., Wijk, L., Acheson, N., Ljungqvist, O., & Dowdy, C., S. (2016).
Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced
Recovery after Surgery (ERAS) Society Recommendations- Part 1. Gynecologic
Oncology, 140(2), 313-322
Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards
for Registered nurse.