Page 8 Complete Your CE Test Online - Click Here they both attend the same church. The nurse believes that Victoria has a right to know about results of the genetic testing. Can the nurse legally disclose information about Mrs. Davidson? No. The nurse cannot legally disclose information about Mrs. Davidson. Healthcare professionals who see an ethical obligation to disclose client information for a “greater good,” should be aware they have neither the legal obligation nor the legal right to do so. Divulging confidential information without Mrs. Davidson’s permission is prohibited, even though the nurse’s concerns about Victoria are reasonable. In this case, disclosure is not necessary to provide appropriate care; the nurse can educate Mrs. Davidson about the implications of the test results for both Mrs. Davidson and her family members. Providing this information in an objective, supportive manner may yield opportunities for further discussion, and encourage Mrs. Davidson to relay important health-related information to her daughter. HIPAA One of the most obvious laws governing privacy is the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA Privacy Rule protects all individually identifiable health information that is created or received by a healthcare provider, health plan, or healthcare clearinghouse and relates to past, present, or future physical and/or mental health conditions of an individual, to healthcare provided to the person, or to payment for healthcare provided to the person (Mathes & Reifsnyder, 2014). Here are a few examples of HIPAA mandates: Mr. Stetson is a 32-year old male who is admitted to an outpatient surgical center for a vasectomy. It is a simple outpatient procedure and Mr. Stetson is preparing to leave for home. He confides in the nurse that he made the decision to have the procedure without telling his wife, who wants more children. “We already have two kids and that’s as many as I can handle.” The nurse believes that the client’s wife has a right to know about her husband’s actions. The nurse is a casual acquaintance of Mrs. Stetson and wonders if it would be “OK” to tell her in a private, non-work-related setting. The nurse may not disclose privacy protected information to the client’s wife. Disclosure of client information is not required by law nor is it necessary for specified health purposes. Stephanie works in a large office practice setting. One of her favorite clients is an 82-year-old woman who, until recently, lived independently in her home for the past 40 years. Recently, her 50-year-old divorced daughter moved in with the client. “It is such a relief for me. I have someone in the house to help with the housework, to drive me places, and to just keep me company.” However, the nurse notices that there are several bruises on the client’s upper arms and a discoloration over her left eye. The nurse questions the client about the bruises, including asking the client if she feels safe in her home and if anyone is hurting her. The client responds by saying she does not want to cause any trouble and that her daughter is a big help “even if she loses her temper sometimes.” The nurse suspects abuse. Does the nurse have the right to disclose this information to the appropriate authorities? HIPAA allows for disclosure of suspected abuse or neglect to the extent that disclosure is required by law, if the client agrees to the disclosure, or if the disclosure is authorized by law. In most U.S. states and territories, nurses are mandated reporters of suspected abuse. In this case, the nurse is legally and ethically obligated to disclose suspected abuse (Mathes & Reifsnyder, 2014). These two examples are only a tiny fraction of the many ethical/legal issues that nurses must deal with. Further examples may help to clarify such issues as they pertain to professional boundaries. Professional boundaries Nurses must always act in the best interests of clients, and follow legal mandates and ethical principles. S/he must understand and apply the concepts of professional boundaries. The National Council of State Boards of Nursing (NCSBN) defines professional boundaries as “the space between the nurse’s power and the client’s vulnerability (National Council of State Boards of Nursing, 2014).” In essence, this means that nurses must refrain from obtaining personal gain at the expense of the client and they must abstain from inappropriate involvement in the client’s personal relationships (National Council of State Boards of Nursing, 2014). Some examples of inappropriately crossing professional boundaries include (National Council of State Boards of Nursing, 2014): ● ● Confusion between the needs of the nurse and the needs of the client, such as when a nurse excessively discloses personal information about her/himself or becomes involved in role reversal, e.g. expecting the client to help the nurse. ● ● Sexual misconduct, i.e. when the nurse behaves in ways that are seductive, sexually demeaning, harassing, or can be interpreted by the client as sexual. ● ● Accessing, or attempting to access, private knowledge about the client that is not necessary for the provision of nursing care. Professional boundary alert! Professional sexual misconduct is considered to be one of the most serious violations of the nurse’s professional responsibility (National Council of State Boards of Nursing, 2014). Some common questions related to professional boundaries and sexual misconduct include the following items (National Council of State Boards of Nursing, 2014): ● ● If a nurse wants to date or marry a former client, is this considered sexual misconduct? According to the NCSBN, the critical issue here is the word “former.” How long has it been between the end of the professional nurse-client relationship and the initiation of the personal relationship? Was the client being treated for an acute, short-term problem or is the nurse still involved in a long- term professional relationship because of a chronic or long-term condition? How will the nurse’s access to and knowledge of client information impact the future relationship? Is there any risk to the client? ● ● What if the nurse and the client live in the same community? Does this mean that the nurse cannot interact with the client in social settings? This is a complex, narrow issue. Setting appropriate boundaries can be difficult in these kinds of situations. Ultimately, the nurse must ask her/himself what actions must and must not be taken so that professional boundaries are maintained and that s/he behaves in the best interests of the client. ● ● If the client consents, does this make a sexual relationship between nurse and client acceptable? According to the NCSBN, “if the client consents, and even if the client initiates the sexual conduct, a sexual relationship is still considered sexual misconduct for a healthcare professional. It is an abuse of the nurse-client relationship that puts the nurse’s needs first.” Additional examples of crossing professional boundaries include these inappropriate behaviors (National Council of State Boards of Nursing, 2014): ● ● The nurse excessively discloses her/his person problems, feelings of sexual attraction, or other facets of her/his intimate life with the client. ● ● The nurse keeps secrets with the clients. ● ● The nurse believes that only s/he can meet the client’s needs. ● ● The nurse spends inappropriate amounts of time with certain clients, including visiting the client when off-duty. ● ● The nurse behaves in a flirtatious manner with the client. ● ● The nurse fails to recognize her/his inappropriate feelings or behaviors and fails to transfer care or consult with supervisors in order to protect the best interests of the client. In summary, the nurse must be aware of her/his feelings and behaviors, be aware of the behavior of other professionals, and ALWAYS act in the