Rural areas challenge confidentiality policies
Talking over the fence can get staff in trouble
Neighborliness can have its disadvantages. In small rural communities where everyone seems to know everyone else, maintaining patient confidentiality can be a real chore.
Ask Paula Salhany, RN, FNP, director of home care services at Baptist Community Home Care in Centerville, TN. Baptist Community serves a population of about 13,000, but most of these people live in rural pockets of several thousand.
"It’s a constant vigil to protect patient confidentiality and agency confidentiality," says Salhany. "You may be [talking about a patient] in the post office, grocery store, or restaurant, and probably three or four people will know whom you are talking about."
Baptist recently offered an inservice, part of which pertained to patient confidentiality. Staff need to be trained in what they can and can’t divulge when questions are asked, Salhany explains. (For more information about medical records confidentiality, see p. 123.)
"[People in the community] see you go down the road, or they see you go across to the neighbor’s house. Maybe they have known the neighbors all their lives."
A neighbor seeing staff come out of the house next door, for example, may inquire about what the patient’s blood pressure is. Maybe the neighbor had talked about blood pressure with the patient on the phone yesterday and knew it had risen.
"We’re trying to give staff intervention tools on how to answer these questions," Salhany says. "You have to say it’s the policy of our agency not to give out information from our visits. Or tell the neighbors they’ll have to ask the patient how [he or she] is doing. Or you can turn the question around and ask, Do you need to see a nurse today? Are you having any problems?’
"It’s a challenge here every day not to offend people when they ask questions," she adds. "I’m sure they have good intentions."
Patients, on the other hand, can tell their neighbors anything they want. "It’s fine if the patient wants to divulge what the staff were doing in there and what the outcome was."
To complicate matters further, the staff are caring for their own neighbors and friends.
"You’re visiting friends. You’re visiting people you go to church with," Salhany says.
Staff have to remember they’re in a professional role during their visits, she adds. "You have to stay on your toes because you can so easily slip into discussing patients with people you both know."
Staff can slip and ask about other patients, as well. "[Staff] will say to each other, Well, Tammy, you’re working with so-and-so, or I saw you down at so-and-so’s house. Is he sick?’"
To remind staff about the agency’s confidentiality policy, Salhany says she holds inservices at least quarterly.
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