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The Role of Confidentiality

In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.

The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.

The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).

1. What, if anything, did the nurse do wrong?

2. Had she moved beyond her scope of practice?

3. Could the nurse's conduct be justified under the patient advocate portion of her role?

4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?

Support your responses with evidence and cite your sources

Solution Preview

1. What, if anything, did the nurse do wrong?

The only thing that the nurse really did that could be considered 'wrong' is that she did not discuss the patient's concerns with the physician. She should have informed the doctor about the conversation and the patient's desire to know about alternative treatments. Contact was made through a nursing student, so the nurse did not approach the patient inappropriately. As the educator of the facility, that nurse is responsible for ensuring that requested information is available and delivered. So in that sense, she was just doing her job.

2. Had she moved beyond her scope of practice?

It could be argued that the nurse DID go beyond her scope of practice. As stated by the nurse herself, the treatments under discussion were not sanctioned by the medical community. As a member of the medical community she should maybe not have sanctioned it either. However, the patient did want to know about it and as the educator, her scope of practice is ALSO to educate. So in a sense the scope of her practice as both a nurse and an educator were in conflict. ...

Solution Summary

This solution provides an opinion based response to 4 questions about a case study that examines a nurse's role in patient care and wheter or not she oversteps her scope of practice and violates a patient's rights to confidentiality.