Welcome back. You can read Part 1 and Part 2 of this series at the links provided.
Today, we're going to move on to a more personal case. I got this from a site on global ethics, rather than in a news story like I usually find them, but the case is still real. In this instance, we have an AIDS patient that falls in the waiting room of a hospital and starts bleeding. His nurse rushes to the scene, but an off-duty nurse has already been to help. The AIDS patient requested confidentiality of his condition, but the blood could infect the off-duty nurse, and thus additional precautions should be taken. The dilemma: should the patient's nurse inform the off-duty nurse of the man's condition?
This, I think, is a case where the safety of those treating the patient trumps the right of the patient to confidentiality. The off-duty nurse could become infected with HIV, and the knowledge that this man has HIV could force her to act with more caution. While her training should prepare her for dealing with bodily fluids cautiously anyway (I know my volunteer training at the hospital basically said to assume any bodily fluid was infected and to call someone to clean it up), people tend to be more concerned about the well-being of the patient in the case of an emergency, rather than their own well-being.
While I understand the patient's desire for the confidentiality of his condition, the fact of the matter is that it is an infectious disease (perhaps not as infectious as, say, RSV or tB, but infectious all the same). As such, I think he has the responsibility to warn anyone who could come in contact with his bodily fluids of his condition, whether it be someone he lives with or someone providing him medical attention. Since he is unconcious in this case, the nurse treating him needs to take on that responsibility.
I can see the hospital having a vested interest in this as well. If someone contracts HIV on the job, their employer is required to pay worker's compensation for it, just as they would if a construction worker was hurt on the job. I'm not sure whether an off-duty nurse would receive this compensation as well, which is all the more reason to tell her... she could be infected while doing what she was trained to do, but doesn't get compensation for it.
What do you think of this matter?
I am pretty sure that the confidentiality of this is void. The information flows freely on a need to know basis of medical and healthcare providers. To maintain everybod's health, the patients who may need special care, the care giving person, and the people that trouble could spread to. I believe in this case there is no problem.
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~T
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yourfuneralguy
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Trumps confidentially. It is even true with dead patients-from a funeral director
The safety of the person who could potentially contract HIV is far more important than the person's confidentiality. The off-duty nurse need not know the person's full name, address, viral load, etc, but should be told, at the very least, "Seek an HIV test."
http://www.progressiveu.org/blog/ediblewoman
If she comes in direct contact with blood, she should be seeking an HIV test on her own, regardless of whether or not she knows the patient is positive.
But, I agree that her safety is more important than confidentiality. The patient should be told that another nurse knows though, and it would probably be a good idea to document it in the patient's chart somewhere what happened and why someone not on his health care team was told of his condition.
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I think you're right on here. The health concern way outweighs the rights of a patient to confidentiality.
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As an interesting addition to this dilemma, I have a story to share.
I work in a hospital, and am constantly at risk of contracting a blood-bourne disease, including HIV, Hepatitis B and C, and other diseases. I've been drawing blood for several months now, and I've met a wide range of people. Some I've known are HIV positive, simply because I knew what the lab is testing their blood for (T cell count, I believe it was). When I drew this patient, he did not inform me that he was HIV positive. Then, I changed jobs and had to draw a woman up on the floor. As soon as I walked up to her with my needle, she tells me to make sure I have gloves, because she's HIV positive. I thanked her for letting me know, and she told me she was required to tell anyone who took care of her.
I just find it interesting that one person would tell me she was required to let me know, and the other wouldn't even bring it up, despite the fact that I was drawing their blood in the same basic capacity.
~C
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Interesting example.
In a perfect world we'd hope everyone would be kind enough to inform doctors and various others if they're HIV positive, but I guess this world just isn't perfect. That just makes being careful with blood all the more serious for you doctor/nurse types.
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