A practical nurse (PN) on a medical-surgical unit encounters several different situations involving requests for client information. Match each clinical scenario with the appropriate nursing determination regarding confidentiality and disclosure.
- A representative from the local health department requests medical records for a client newly diagnosed with active pulmonary tuberculosis.Permissible disclosure required for public health reporting.
- A neighbor visiting the hospital stops the PN in the hallway to ask how the client is recovering from a recent stroke.Impermissible disclosure; requires explicit client consent.
- The physical therapist assigned to the client asks to review the electronic health record to check the timing of the client's last pain medication dose.Permissible disclosure under the need-to-know basis for care coordination.
- An unlicensed assistive personnel (UAP) assigned to transport the client to radiology asks if the client has a specific bloodborne infectious disease.Impermissible disclosure; standard precautions apply regardless of the specific diagnosis.
Cevap
Health department request maps to permissible for public health; neighbor inquiry maps to impermissible without consent; physical therapist request maps to permissible for care coordination; UAP inquiry maps to impermissible because standard precautions apply universally.
Each scenario is evaluated against HIPAA guidelines and the practical nursing scope of practice. Disclosures to direct care team members and public health authorities are legally permissible. Conversely, disclosures to unauthorized visitors or staff without a direct need-to-know violate client confidentiality.
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Under HIPAA, client information may only be disclosed on a 'need-to-know' basis for treatment, payment, or healthcare operations, or when legally mandated (e.g., public health reporting).