Chapter 10: Patient Rights, Consent & Confidentiality

ANS: B
Correct B: A right is a claim or privilege to which one is justly entitled, either legally or morally.

Incorrect A: Rights are not required to be legally based.

Incorrect C: A right carries a corresponding obligation. Otherwise, the right loses its meaning.

Incorrect D: The rights of patients are explicit and clear through standards contained in professional codes of ethics.

ANS: C
Correct C: It is the nurse’s obligation to obtain the patient’s informed consent. The nurse must ensure that all relevant information has been provided so that the patient may exercise her right to make an informed consent.

Incorrect A: This process does not relate to the nurse’s rights.

Incorrect B: This process relates to the patient’s autonomy, not the nurse’s.

Incorrect D: Though the patient’s informed consent is needed, the patient is not obligated to give it.

ANS: D
Correct D: The nurse should report this situation to her manager in a private meeting. In many provinces, statute law requires certain patient information and conditions to be disclosed. For example, many public health laws require public health care professionals to disclose to their local medical officer of health the identity of anyone diagnosed with certain communicable or sexually transmitted diseases, including HIV/AIDS. The nurse’s manager is the most appropriate person to deal with this situation; he or she will also need to take into consideration that the nurse’s recollection may be incorrect.

Incorrect A: This is not the correct action for the nurse to take.

Incorrect B: The nurse should not discuss this issue with her colleagues, as this would violate the patient’s right to confidentiality. Precautions are already taken in the care of every patient.

Incorrect C: Rechecking with the patient for clarification of the situation is acceptable, but challenging and confronting the patient is not, especially since the nurse may be mistaken in her memory.

ANS: D
Correct D: If a patient poses a threat to himself or others, the nurse has an ethical obligation to report the information to the authorities in the institution and to the police. Provincial law also requires disclosure in cases of suspected child abuse.

Incorrect A: In most cases, discussing the matter with anyone violates patient confidentiality.

Incorrect B: The nurse may be required to disclose confidential information in a court of law; however, a regulatory review board hearing is not a court of law.

Incorrect C: Confidential information must not be discussed in any report. If the nurse needs to discuss required information with a particular team member, then this discussion should take place one-on-one, not during a report where others can hear.

ANS: D
Correct D: Only the physician or the medical records department may release information contained in the patient’s medical record to the patient. The nurse should not give the patient her medical record because not all of the information contained in the record belongs to the patient (e.g., third-party information).

Incorrect A: The nurse should not give the patient her medical record because not all of the information contained in the record belongs to the patient.

Incorrect B: The nurse should not give the patient her medical record because not all of the information contained in the record belongs to the patient. The patient’s chart—the collection and documentation of the patient’s medical information—is the legal property of the institution.

Incorrect C: The charge nurse is not normally authorized to release such information

ANS: C
Correct C: Ontario’s statute states that the purpose of information and privacy legislation is to establish rules for the collection, use, and disclosure of personal health information.

Incorrect A: The legislation does not protect health care professionals from malpractice suits.

Incorrect B: The legislation does not provide an ethical decision-making framework.

Incorrect D: The legislation is not designed to protect hospitals or health authorities.

ANS: C
Correct C: When harm occurs, the ethically responsible action is full disclosure of that harm to the patient or family. However, different facilities have different policies regarding the disclosure and documentation of errors, so the nurse should first discuss the issue with her manager, who would be most familiar with these policies.

Incorrect A: When harm occurs, the ethically responsible action is full disclosure of that harm to the patient or family. However, this should not be the nurse’s first action.

Incorrect B: The nurse should document the error on an incident report, not on the patient’s chart.

Incorrect D: Although it is difficult not to have the support of one’s colleagues, discussing errors publicly is generally not in the nurse’s best interest.

ANS: D
Correct D: Ultimately, there is nothing hospital staff can do to prevent a competent patient from leaving. The nurse should give the patient his personal effects and let him go. If a competent patient refuses to sign the waiver, the fact that he is leaving against medical advice should be carefully documented in the chart.

Incorrect A: In cases involving psychiatric patients of unsound mind, the mental health statutes of most provinces may permit such persons to be prevented from leaving if they pose a threat or danger to themselves or to others. However, the nurse should not attempt to restrain a competent patient or ask security to do so.

Incorrect B: If the patient is competent, there is no reason to alert the police.

Incorrect C: The nurse cannot legally withhold a patient’s personal effects.

ANS: D
Correct D: The purpose of a mental health act is to outline rights for patients and obligations for health care professionals in relation to mentally ill patients, such as admission to and discharge from a mental institution.

Incorrect A: Not everyone with a mental illness receives treatment.

Incorrect B: The protection of the rights of the public is one aspect of a mental health act, but not the purpose.

Incorrect C: The protection of patient rights is one component of a mental health act, but not the purpose.

ANS: F
Correct: Patients should be informed when residents are to perform a primary role during an operative procedure. A general surgical consent form would not provide this information.

ANS: F
Correct: Unless she has certain legal qualifications, the nurse is not authorized to tell the patient her diagnosis. Giving a diagnosis identifying a disease or disorder is a controlled act reserved for certain health care professionals.

Incorrect: Unless she has certain legal qualifications, the nurse is not authorized to tell the patient her diagnosis. Giving a diagnosis identifying a disease or disorder is a controlled act reserved for certain health care professionals. As an advocate for the patient, the nurse should instead endeavour to influence the physician, stressing the patient’s right to be informed.

A 34-year-old patient in the nurse’s care has explicitly given a no-CPR direction to the nurse, but this has not been documented. The patient has an unexpected sudden cardiac arrest. The nurse should refrain from calling a code and starting CPR.

ANS: F
Correct: The nurse should immediately call a code and initiate CPR until a physician either orders the code stopped or the patient transferred to the Intensive Care Unit. Although this is an ethical dilemma, if the patient does not recover from the code and the patient’s family then questions the nurse’s decision, there is no documented proof to support it. There is an obvious conflict here between the legal ramifications of the nurse’s decision and the patient’s autonomous right to refuse treatment.

Incorrect: This statement is false.

ANS: F
Correct: There is no written “no-CPR” order that the nurse is aware of, so the nurse should initiate CPR until the family either notifies the physician to stop CPR or the physician notifies the nurse to stop CPR.

Incorrect: This statement is false.