Integrated Decision Making Model: Privacy and Confidentiality

Integrated Decision Making Model: Privacy and Confidentiality

Ethical issues in nursing

Ethical decisions are critical to the wellbeing and safety of patients despite the clinical prowess of health care practitioners such as nurses. An ethical problem in health care could be an issue that possesses difficulties in finding solutions, handling it or overcoming it (Nora, Deodato, Vieira, & Zoboli, 2016). In most cases, health care personnel usually solve similar ethical problems by coming to unethical conclusions or adopting inconsistent decision-making processes. Health care professionals tend to make ethical decisions without a proper assessment of all the comprehensive and procedural decision-making processes or evaluating any practical alternatives which necessitate the need for a properly structured model of making ethical decisions. The integrated model consists of six stages which include identifying the ethical issue; the gathering of any additional information for problem identification and development of solutions. Additionally, it helps in developing alternatives for comparison and evaluation; justification and selection of the best options, developing practical and diverse measures for the implementation of the ethical actions and decisions and lastly, evaluating effects and developing strategies for the prevention of similar occurrences.

First stage: identification of the ethical issue

The ethical issue, in this case, is the protection of patient confidentiality and privacy. Patient confidentiality is the obligation of health care officials to hold patient information in utmost confidence while patient privacy is the right of patients to make decisions on how their personal information can be shared. Patient confidentiality and privacy create a trusting environment which increases patient willingness to seek care (Beltran-Aroca et al., 2016). There are situations, however, where a breach in confidentiality is necessary thus creating a dilemma in health care ethics.

Second stage: gathering additional information and developing solutions

Health care has four fundamental ethics which include nonmaleficence, autonomy, justice, and beneficence. There are different situations in healthcare where nurses have to ensure disclosure, privacy or confidentiality (Anthony & Stablein, 2016; Beltran-Aroca et al., 2016). For instance, patients may opt to share personal details with the nurses and the nurses are to keep the information confidential. It is not ethically justifiable to share the information with family members without the patient’s consent even when the nurse is inclined to. However, some cases demand a breach of confidentiality. An example of such a situation is when a patient is suffering from a communicable disease and the law mandates reporting an incident like that to the public health authorities. Also, while third-party access to patient medical records is legally wrong, there are cases where the third party access is necessary if the information contained in the file can prevent the patient from harm.

Stakeholders in the ethical issue of protecting patient confidentiality and privacy include nurses, patients, the state or national and public health authorities and the family or guardians of the patient.

Since patient confidentiality and privacy protection is a significant dilemma in health care, solutions have to be developed. Health care centers and personnel like nurses have to adhere to the HIPPA security rules for the protection of medical information. Nurses have to be trained on how to ensure confidentiality and privacy information while understanding how to weigh interests and exercise flexibility if the information could prevent the patient from harm or prevent the exposure of the general public to an infectious disease (Anthony & Stablein, 2016; Beltran-Aroca et al., 2016).


Third stage: developing alternatives for evaluation

One alternative for the solutions discussed in the second stage is equipping patients with personal electronic devices that contain their health records which would give them the flexibility of managing their health information. This solution should be accompanied by educating the public or patients who are in a position to fully comprehend information on their rights to confidentiality and privacy. Nurse education process should also enlighten them on the possibilities and instances where a breach in the rights could be necessary and how the violation may be handled (Anthony & Stablein, 2016).

Fourth stage: justification and selection of the best alternatives

The adherence to HIPPA security rules by the health care institutions and professionals is a valuable alternative. Training nurses and other healthcare professionals on how to uphold the rights and when and how to conduct a breach them is also essential in ensuring that the breaches are not carried out blindly (Anthony & Stablein, 2016). Educating patients on their medical rights and the situations that call for their breaching is another important alternative since this ethical dilemma concerns them.

Fifth stage: developing measures for implementation

Healthcare institutions are to make appointments of an officer who is to be in charge of all the medical data. The officer is to handle assessments of data protection needs and implementing solutions such as finding the best data encryption techniques (Anthony & Stablein, 2016). The officer is also to foresee the training of staff on the protection of confidential and private patient information. Proper legislation and clear guidelines are to be set on when and how to carry out confidentiality breaches effectively.


Sixth stage: development of strategies to prevent reoccurrence

In attempts to avoid the reoccurrence of patient privacy and confidentiality violations, there should be stricter state and national legislation. All the stakeholders in these ethical issues should be made aware of the dire consequences of violating the set patient privacy and confidentiality protection laws.

Ethical arguments to dissuade opposition against the program

It is unethical and illegal to violate the privacy and confidentiality of patients. On the other hand, there exist situations that necessitate the breaching of confidentiality (Anthony & Stablein, 2016). This program is flexible enough to handle conflict situations. The plan not only proposes measures for medical protection such as the appointment of officers who ensure that institutions adhere to the HIPPA standards but also measures to ensure that the breaching of patient confidentiality is done in accordance to the set guidelines. Patients are also to be involved in this issue by helping them understand their rights and flexibilities affected.




Anthony, D. L., & Stablein, T. (2016). Privacy in practice: professional discourse about information control in health care. Journal of Health Organization and Management, 30(2), 207-226.

Beltran-Aroca, C., Girela-Lopez, E., Collazo-Chao, E., Montero-Perez-Barquero, M., & Munoz-Villanueva, M. (2016). Confidentiality breaches in clinical practice: what happens in hospitals. BMC Medical Ethics, 17(1), 52.

Nora, C., Deodato, S., Vieira, M., & Zoboli, E. (2016). Elements and Strategies for Ethical Decision-Making in Nursing. SCIELO, 25(2), 25-35.