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A familiar face
Dilemma A familiar face Background M y parents separated w h e n I was very young and I have one brother. M y m u m met Bob and has been in a long term relationship with h i m since !969. They never married. My brother and I feel that Bob is our father because he has always been there for us, he brought us u p and treated us both as his own. He had been married previously and had two boys from this marriage. Following the divorce his ex-wife and children m o v e d from the area and he never saw them again. Over the years Bob often talked about finding them and explaining w h y he had not seen them. My mother and Bob n o w live overseas.
Scenario Whilst in charge of a Sunday evening shift in an inner city Accident and Emergency (A & E) department, I had relieved the triage nurse for her evening tea break. A young m a n hobbled into the reception area and booked in to see the doctor. I observed him for a few minutes, thinking he looked very familiar, and beckoned him over to the desk to take his casualty card. I examined his ankle and asked the appropriate questions, and then turned to document m y findings. On noticing his name I panicked, and felt myself breaking out into a sweat. I turned to him and checked the biographical details on the card to ensure they were correct. Then I just could not stop myself. 'I know your father' I heard myself say. 'You can't do, he's dead' came the reply. 'No, he's not' I said, and I quickly gave him an overview of his family history. I never thought of the consequences or the confidentiality issues surrounding this encounter. I never asked if he wanted to know. I wanted him to know! It was just spontaneous. The triage nurse returned from her break. The y o u n g m a n went to sit at the back of the waiting area; he was eventually seen, treated and discharged. He then approached the triage nurse asking to speak to me, and I invited him into the office where we could talk in private.
9 1999 H a r c o u r t Brace & Company Ltd
His mother had always told the boys that their dad had died and this was always reiterated by his grandparents. Recently his mother and grandmother had died. We exchanged telephone numbers, both shocked by what had happened. He asked me to inform Bob that I had met him, and take it from there. 'That makes you m y step sister, in a w a y ' he said. I had not thought of it that way. I contacted Bob w h o was very apprehensive, but he flew home to meet his sons. Only one of them wanted to meet him, but that was OK, Bob could understand. Father and son spent a week getting to k n o w each other and s w a p p e d addresses and telephone numbers, and Bob flew back aware that his sons were healthy and happy. Since then they have spoken on the telephone once, and have not visited each other. I have often wondered if this was the right thing to do, professionally?
Legal reply Imagine that this same scenario took place at a party, wedding, or other gathering where one meets strangers. You seem to recognize someone's face and after a brief chat discover that there are links. What confidentiality has been broken? What legal issues arise? Probably none. The important issue is whether the step father would have approved of the disclosure and consented to what might possibly have been seen
Accident and Emergency Nursing(1999) 7,
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Dilemma
as confidential information, i.e. that he was father to the person being spoken to. On the facts it would appear that Bob was sad that contact with his sons had been broken and would rejoice in renewed acquaintance with them. Should the nurse not have told the person because he may have suffered too great a shock, hearing that his father was still alive? Certainly there are dangers here, and she could have been more sensitive in how she conveyed the startling information, but it does not seem that the son suffered any harm. Coincidences of this sort are the delight and joy of life. I was once on holiday in America and was speaking to an American couple who were interested to learn that I was from Cardiff as they had once lived here. So the conversation progressed ... 'which part of Cardiff?' ... 'Llandaff'. 'Amazing, that's where I live'. 'Where in Llandaff?' ... and so on until we discovered that they had lived in the house I now live in. So much of a coincidence that it is almost spooky! However, no breach of confidence, no legal problems arise. Now, let us put this same scenario back into the A&E context. What confidences have been breached? Providing Bob would have consented to her discussing him with his son, the answer must be none. The nurse is not in breach of any confidentiality relating to the patient, since she is giving him information, not disdosing information about him to other people. Furthermore since the patient asked her to tell Bob about him and gave her his telephone number, she is not in breach of confidentiality by telling Bob about the encounter. It would have been different had she used her access to the hospital records to pass that information on to Bob without the patient's consent. Possibly she could be criticized for a possibly insensitive way of imparting the information, but it dearly did not cause harm to
the patient, who was apparently pleased to have the information, otherwise he would not have sought her out after being treated. The nurse should rest assured that as a result of one of life's chance coincidences, she has been able to link an estranged father with his long lost son. However, an important point arises. The nurse did not stop to think about her actions, but just impetuously blurted out what she knew. It so happens that there was no resulting professional misconduct or legal issues. However, had the facts been different there may well have been and the nurse could have been held guilty of 'conduct unworthy of a nurse' (the definition of misconduct for the purposes of the UKCC professional conduct rules) (UKCC 1996). The Guidelines for Professional Practice published by the UKCC (UKCC 1996) state that 'the Code of Professional Conduct places a professional duty upon her at all times' (p 11, paragraph 14). The legal implications of this have been considered elsewhere. (Dimond 1997) and it is certainly an onerous duty. The implications of this constant professional duty means that whether you are on duty or at a party, the UKCC requires from you the same professional standards: a breach of confidentiality, whether at work or on holiday, could therefore be the subject of professional conduct investigations.
Nursing reply
In this dilemma we are given the hindsight of knowing that the outcome is reasonable in that Bob, her mother's partner, is reunited with one of his sons, by a previous marriage, after a number of years. However, the outcome could have been very different and could have resulted in much psychological and emotional trauma for at least two families. One of the issues that this dilemma raises is that of dealing with mistakes made by yourself or your colleagues.
This dilemma is about providing personal information to a stranger in an inappropriate situaflo~an d at an inappropriate time. The nurse is brought up by her mother and partner, who she regards as her father. Whilst working in triage she recognizes a patient as her stepbrother, from his biographical details, and spontaneously tells him who she believes herself to be - his step sister.
104 Acc|dent and Emergency Nursing (1999)
7, 103-105
References UKCC Guidelines for Professional Practice 1996 UKCC, London Dimond B 1997 The midwife's duty of care. M o d e m Midwife 7(4): 20-21
Professor B. Dimond MA, LLB, DSA, AHSM, Barrister-at-Law, Emeritus, Professor of the University of Glamorgan, UK
0 1999 H a rco u rt Brace & Company Ltd
Dilemma
Firstly the nurse can be seen as breaching various parts of the Code of Conduct (UKCC 1992), particularly with reference to being able to 'justify public trust and confidence.' This m a y lead to the nurse being subjected to disciplinary action. In dealing with the nurse's actions y o u m a y need to consider the following: 9 H o w does the patient feel about the situation? H o w would he like to have the situation handled? For example would he like to complain formally, or have the matter handled informally by the department manager? 9 What would the patient suggest w o u l d be the most appropriate action to be taken against the nurse? 9 Does the patient require any other help or support? In summary: 9 The nurse provided a patient with information relating to his and her personal lives. The nature of her information was such that it would have a substantial impact on both their lives and the lives of their families.
9 1999 H a r c o u r t Brace & Company Ltd
9 It is not so much whether it was right or wrong to provide the information, for this is a debate in itself, but rather the nature in which it was divulged that makes up the essence of this dilemma. It could be argued that the nurse used her position and the patient's vulnerability to ensure the passage of information, and it is this that has to be questioned. 9 The m a n a g e m e n t of this dilemma could be handed over to the patient, under the guidance of the d e p a r t m e n t manager. In this w a y the patient m a y feel he is able to gain some control of the situation. Reference UKCC 1992 Code of Professional Conduct. UKCC, London
My thanks to everyone who has helped shape the response to this dilemma. Dr Lynn Sbaih, Lecturer, School of Nursing, Midwifery & Health Visiting, University of Manchester, Manchester UK
Accident and Emergency Nursing (1999)
7, 103-105
105
Scenario Whilst in charge of a Sunday evening shift in an inner city Accident and Emergency (A & E) department, I had relieved the triage nurse for her evening tea break. A young m a n hobbled into the reception area and booked in to see the doctor. I observed him for a few minutes, thinking he looked very familiar, and beckoned him over to the desk to take his casualty card. I examined his ankle and asked the appropriate questions, and then turned to document m y findings. On noticing his name I panicked, and felt myself breaking out into a sweat. I turned to him and checked the biographical details on the card to ensure they were correct. Then I just could not stop myself. 'I know your father' I heard myself say. 'You can't do, he's dead' came the reply. 'No, he's not' I said, and I quickly gave him an overview of his family history. I never thought of the consequences or the confidentiality issues surrounding this encounter. I never asked if he wanted to know. I wanted him to know! It was just spontaneous. The triage nurse returned from her break. The y o u n g m a n went to sit at the back of the waiting area; he was eventually seen, treated and discharged. He then approached the triage nurse asking to speak to me, and I invited him into the office where we could talk in private.
9 1999 H a r c o u r t Brace & Company Ltd
His mother had always told the boys that their dad had died and this was always reiterated by his grandparents. Recently his mother and grandmother had died. We exchanged telephone numbers, both shocked by what had happened. He asked me to inform Bob that I had met him, and take it from there. 'That makes you m y step sister, in a w a y ' he said. I had not thought of it that way. I contacted Bob w h o was very apprehensive, but he flew home to meet his sons. Only one of them wanted to meet him, but that was OK, Bob could understand. Father and son spent a week getting to k n o w each other and s w a p p e d addresses and telephone numbers, and Bob flew back aware that his sons were healthy and happy. Since then they have spoken on the telephone once, and have not visited each other. I have often wondered if this was the right thing to do, professionally?
Legal reply Imagine that this same scenario took place at a party, wedding, or other gathering where one meets strangers. You seem to recognize someone's face and after a brief chat discover that there are links. What confidentiality has been broken? What legal issues arise? Probably none. The important issue is whether the step father would have approved of the disclosure and consented to what might possibly have been seen
Accident and Emergency Nursing(1999) 7,
103-105
103
Dilemma
as confidential information, i.e. that he was father to the person being spoken to. On the facts it would appear that Bob was sad that contact with his sons had been broken and would rejoice in renewed acquaintance with them. Should the nurse not have told the person because he may have suffered too great a shock, hearing that his father was still alive? Certainly there are dangers here, and she could have been more sensitive in how she conveyed the startling information, but it does not seem that the son suffered any harm. Coincidences of this sort are the delight and joy of life. I was once on holiday in America and was speaking to an American couple who were interested to learn that I was from Cardiff as they had once lived here. So the conversation progressed ... 'which part of Cardiff?' ... 'Llandaff'. 'Amazing, that's where I live'. 'Where in Llandaff?' ... and so on until we discovered that they had lived in the house I now live in. So much of a coincidence that it is almost spooky! However, no breach of confidence, no legal problems arise. Now, let us put this same scenario back into the A&E context. What confidences have been breached? Providing Bob would have consented to her discussing him with his son, the answer must be none. The nurse is not in breach of any confidentiality relating to the patient, since she is giving him information, not disdosing information about him to other people. Furthermore since the patient asked her to tell Bob about him and gave her his telephone number, she is not in breach of confidentiality by telling Bob about the encounter. It would have been different had she used her access to the hospital records to pass that information on to Bob without the patient's consent. Possibly she could be criticized for a possibly insensitive way of imparting the information, but it dearly did not cause harm to
the patient, who was apparently pleased to have the information, otherwise he would not have sought her out after being treated. The nurse should rest assured that as a result of one of life's chance coincidences, she has been able to link an estranged father with his long lost son. However, an important point arises. The nurse did not stop to think about her actions, but just impetuously blurted out what she knew. It so happens that there was no resulting professional misconduct or legal issues. However, had the facts been different there may well have been and the nurse could have been held guilty of 'conduct unworthy of a nurse' (the definition of misconduct for the purposes of the UKCC professional conduct rules) (UKCC 1996). The Guidelines for Professional Practice published by the UKCC (UKCC 1996) state that 'the Code of Professional Conduct places a professional duty upon her at all times' (p 11, paragraph 14). The legal implications of this have been considered elsewhere. (Dimond 1997) and it is certainly an onerous duty. The implications of this constant professional duty means that whether you are on duty or at a party, the UKCC requires from you the same professional standards: a breach of confidentiality, whether at work or on holiday, could therefore be the subject of professional conduct investigations.
Nursing reply
In this dilemma we are given the hindsight of knowing that the outcome is reasonable in that Bob, her mother's partner, is reunited with one of his sons, by a previous marriage, after a number of years. However, the outcome could have been very different and could have resulted in much psychological and emotional trauma for at least two families. One of the issues that this dilemma raises is that of dealing with mistakes made by yourself or your colleagues.
This dilemma is about providing personal information to a stranger in an inappropriate situaflo~an d at an inappropriate time. The nurse is brought up by her mother and partner, who she regards as her father. Whilst working in triage she recognizes a patient as her stepbrother, from his biographical details, and spontaneously tells him who she believes herself to be - his step sister.
104 Acc|dent and Emergency Nursing (1999)
7, 103-105
References UKCC Guidelines for Professional Practice 1996 UKCC, London Dimond B 1997 The midwife's duty of care. M o d e m Midwife 7(4): 20-21
Professor B. Dimond MA, LLB, DSA, AHSM, Barrister-at-Law, Emeritus, Professor of the University of Glamorgan, UK
0 1999 H a rco u rt Brace & Company Ltd
Dilemma
Firstly the nurse can be seen as breaching various parts of the Code of Conduct (UKCC 1992), particularly with reference to being able to 'justify public trust and confidence.' This m a y lead to the nurse being subjected to disciplinary action. In dealing with the nurse's actions y o u m a y need to consider the following: 9 H o w does the patient feel about the situation? H o w would he like to have the situation handled? For example would he like to complain formally, or have the matter handled informally by the department manager? 9 What would the patient suggest w o u l d be the most appropriate action to be taken against the nurse? 9 Does the patient require any other help or support? In summary: 9 The nurse provided a patient with information relating to his and her personal lives. The nature of her information was such that it would have a substantial impact on both their lives and the lives of their families.
9 1999 H a r c o u r t Brace & Company Ltd
9 It is not so much whether it was right or wrong to provide the information, for this is a debate in itself, but rather the nature in which it was divulged that makes up the essence of this dilemma. It could be argued that the nurse used her position and the patient's vulnerability to ensure the passage of information, and it is this that has to be questioned. 9 The m a n a g e m e n t of this dilemma could be handed over to the patient, under the guidance of the d e p a r t m e n t manager. In this w a y the patient m a y feel he is able to gain some control of the situation. Reference UKCC 1992 Code of Professional Conduct. UKCC, London
My thanks to everyone who has helped shape the response to this dilemma. Dr Lynn Sbaih, Lecturer, School of Nursing, Midwifery & Health Visiting, University of Manchester, Manchester UK
Accident and Emergency Nursing (1999)
7, 103-105
105