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Difficulty: HardConfidentiality and Information Security

A registered nurse is navigating situations that require balancing client confidentiality under HIPAA regulations with legal mandates and interdisciplinary care. Which of the following actions by the nurse demonstrate appropriate management of protected health information (PHI)? Select all that apply.

  1. A
    Instructing an unlicensed assistive personnel (UAP) to review the electronic health record to determine the necessary isolation precautions for a new admission.
  2. Reporting a client's confirmed diagnosis of active pulmonary tuberculosis to the public health department despite the client's explicit objections.Answer
  3. C
    Delaying a report of suspected elder abuse because the client insists their extensive bruising is just a normal physiological change related to aging.
  4. Sharing a client's medication administration record and recent vital signs with a physical therapist who is preparing to mobilize the client.Answer
  5. E
    Withholding a report of suspected child physical abuse to child protective services in order to maintain a therapeutic alliance with the family.
  6. Notifying local law enforcement that a client has arrived at the emergency department seeking treatment for a penetrating gunshot wound.Answer

Answer

The correct actions are reporting active pulmonary tuberculosis to public health, sharing information with the physical therapist involved in care, and notifying law enforcement of a gunshot wound.
The correct actions appropriately apply the exceptions to HIPAA privacy rules. Nurses are legally permitted or mandated to disclose protected health information without a client's explicit consent for purposes of interdisciplinary treatment (sharing with the physical therapist), protecting public health (reporting communicable diseases like tuberculosis), and complying with legal mandates (reporting gunshot wounds to law enforcement).

Step-by-Step Solution

1
Analyze the scenario to identify the core conflict.
The nurse must determine when protected health information (PHI) can be legally disclosed without client consent.
HIPAA generally protects PHI, but specific exceptions exist for treatment, public health, and legal mandates.
2
Evaluate each action for compliance with HIPAA treatment exceptions.
Sharing information with a physical therapist involved in care is permitted; however, directing a UAP to determine isolation precautions by accessing the EHR is improper delegation and an unnecessary privacy breach.
PHI can only be shared with interdisciplinary team members on a 'need-to-know' basis for their specific role.
3
Evaluate each action for compliance with mandatory reporting laws.
Reporting tuberculosis, gunshot wounds, and suspected abuse are all legally mandated exceptions to HIPAA. Delaying or withholding these reports violates legal requirements.
Public safety and the protection of vulnerable populations legally override individual privacy rights in these specific circumstances.

Key Concept

HIPAA privacy rules include specific exceptions that allow or mandate the disclosure of protected health information without client consent for treatment purposes, public health protection, and reporting suspected abuse or criminal injuries.
Estimated Time:1m 30s
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Confidentiality and Information Security

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