Confidentiality and Privacy — Personal Health Information

Professional Responsibilities and Ethical Conduct

• CNO Code of Conduct Application: Nurses are expected to apply the six principles of the College of Nurses of Ontario (CNO) Code of Conduct in all practice encounters, including simulated experiences and classroom settings.

  • This includes acting with integrity, demonstrating respect, and maintaining professional boundaries.

• Nurses' Role: Nurses must uphold ethical and professional standards, safeguarding client well-being and maintaining public trust.

Confidentiality and Privacy: Personal Health Information (CNO Practice Standard)

• Purpose: The Personal Health Information Protection Act (PHIPA) governs health care information privacy in Ontario, aligning with the CNO practice standard “Confidentiality and Privacy – Personal Health Information.”

• Key Definition: Personal health information encompasses any identifying client information related to health status, health care history, provision of care, and personal details (e.g., name, address, family members).

• Application and Responsibilities:

  • Custodians: Healthcare organizations and individuals providing care (e.g., nurses) are designated as custodians, responsible for ensuring the confidentiality, security, and appropriate use of personal health information.

  • Nurses' Obligation: Nurses must protect client confidentiality, comply with PHIPA, and ensure personal health information is collected, used, and disclosed only for specified, lawful purposes.

• Client Rights Regarding Information:

  • Control: Clients have the right to control their personal health information, including giving, refusing, or withdrawing consent for its collection, use, and disclosure.

  • Access and Correction: Clients can request access to their own health information and have the right to request corrections for any inaccuracies under defined conditions.

• Disclosure Guidelines:

  • Consent:

    • Implied Consent: Generally applies for sharing necessary information within the circle of care for direct health care purposes.

    • Express Consent: Required for disclosures of information outside the immediate health care team or for purposes beyond direct client care (e.g., research, insurance).

  • Exceptions: Disclosure without consent is legally permissible in specific circumstances, such as during emergencies where consent cannot be obtained, to prevent harm, or when legally mandated.

• Professional Misconduct: Sharing client information in violation of PHIPA or CNO standards constitutes professional misconduct and can lead to disciplinary actions.

Therapeutic Communication and Client Relationships

• Principles of Therapeutic Communication: Consistent with the College of Nurses of Ontario’s “Therapeutic Nurse-Client Relationship” practice standard, therapeutic communication involves establishing and maintaining a professional, trusting, and empathetic relationship to promote client well-being.

  • Indicators: Active listening, empathy, respect, genuineness, self-awareness, professional boundaries, and cultural sensitivity.

• The Interview Process for Subjective Data Collection:

  • Role of the Interview: The interview is a primary method for collecting subjective data (e.g., client's perceptions, feelings, and experiences) essential for comprehensive assessment and care planning.

  • Applying Communication Principles: Nurses apply principles of effective communication during interviews using:

    • Verbal Techniques: Open-ended questions, active listening, clarification, summarization, focusing.

    • Non-Verbal Cues: Maintaining appropriate eye contact, body language, facial expressions, and personal space.

  • Safe and Effective Care: Demonstrating safe and effective care through interviewing involves creating a safe, non-judgmental environment, ensuring privacy, and establishing rapport to facilitate honest disclosure.

• Effective and Respectful Interviewing Techniques:

  • Communication Techniques: Employing a variety of communication techniques, such as reflection, silence, and confrontation (used judiciously), to enhance understanding and engagement.

  • Respectful Approaches: Interviewing techniques must be respectful of clients and families, acknowledging their autonomy, dignity, and unique perspectives. This includes being present and attentive.

  • Developmental and Cultural Considerations: Integrating an understanding of developmental stages (e.g., communicating with children versus older adults) and cultural backgrounds into communication strategies to ensure relevance, respect, and effectiveness. This includes adapting language, non-verbal communication, and addressing health beliefs.

• Adaptive Communication and Specific Older Adult Considerations:

  • Age-Related Changes (CASN ETP Gerontological Competency 1.5, 1.11): Uses adaptive communication strategies to address common age-related changes that may impact communication, such as hearing or visual impairments, or cognitive decline.

  • Strategies: Speaking clearly, using visual aids, allowing ample time for response, minimizing distractions, and rephrasing information.

  • Identifying Mistreatment/Abuse: Nurses must be vigilant in identifying actual or potential mistreatment/abuse (emotional, financial, neglect and/or self-neglect, physical, and sexual) in older persons, and respond appropriately according to professional and legal guidelines.

• Addressing Challenging Situations in Communication:

  • Strategies: Employing strategies such as de-escalation techniques, validating feelings, setting clear boundaries, referring to appropriate resources, and seeking supervision/support when encountering challenging communication scenarios (e.g., angry, anxious, or non-responsive clients).