Word spreads fast, especially if aides talk carelessly about patients’ health
Loose talk can harm everyone including your agency
Word about one’s neighbor can spread quickly in some rural areas, such as the Appalachian region of Virginia, and this can pose a problem for home care agencies that wish to keep patients’ health business private.
In addition, the habit of some aides to share intimate details about their lives and their patients’ lives, can have devastating consequences when the patients have AIDS, an education manager says.
Marlene Peters, RN, BSN, nurse manager with the Mount Rogers Health District in Bristol, VA, says aides sometimes fail to realize how dangerous thoughtless words can be.
"Getting aides to maintain confidentiality is very difficult for a home care agency," Peters says, explaining that aides quickly begin to feel comfortable with patients and might let down their guard when patients bring up other patients’ health issues.
Peters, who works for the Bristol Virginia Health Department, one of seven county and two city health departments with the Mount Rogers Health District, spoke about patient confidentiality for aides at a recent regional seminar.
"The seminar had a very positive response," Peters says. "They felt like it was an excellent program, and everyone was very positive."
Kim Hilliard, a home health aide in the Bristol office, says the seminar helped reinforce the importance of keeping patients’ information confidential.
"Ever since I started working here in 1985, we’ve always had a strict [policy] about the confidentiality of patients," Hilliard says.
Peters offers these tips on teaching aides about confidentiality:
• Emphasize how indiscretion can damage a patient.
"We have had cases in our agency where patients’ diagnoses of AIDS got out, and they lost their jobs," Peters says.
In another instance, an aide mentioned to someone outside a patient’s home that the patient had cancer, she says. "When the patient tried to go back to work, the employer had filled the job because the employer heard the patient had cancer."
One way Peters teaches aides about how important it is to keep confidentiality is through a sensitivity game. This game has aides list answers to questions about their lives, including material possessions they value, favorite physical activities, and secrets. (See sensitivity game, p. 87.)
"Then we talked about how when someone has a diagnosis of HIV, in essence, they lose all those things that are important to them," Peters says. She adds that keeping their HIV status a secret is the one important thing they shouldn’t have to lose. It’s a matter of dignity. But if someone were to let the secret out, then everyone in the community might know, and they would lose everything.
• Demonstrate how patient information can be misconstrued if it’s spread around.
Peters suggests education managers have aides play the children’s game of gossip in which one person whispers a statement to someone in a circle. Then each person will whisper the statement to the next person in the circle.
"The last person says what he or she heard, and usually it’s totally different from what it had started as," she says.
Peters had a group of aides play the game, and this quickly showed them how inaccurate gossip can be. "The original statement was correct, but they left out so much information," she says.
That demonstrated how when aides speak to someone out of the home and that person doesn’t have all the details, then things can be misconstrued, Peters explains.
"Then the wrong information can get out in a community and do a lot of damage."
• Explain to aides that while they might feel emotionally close to the patient, they can’t behave as though they are part of the family.
"They become like an adopted member of the family and the family accepts them, so they forget they’re not a part of the family," Peters says.
This can lead to problems with personal boundaries. For example, an aide might start to talk with a patient about the aide’s own relationship problems and financial problems, and it becomes difficult for them to guard against talking about the patient outside the home, she adds.
Peters tells aides that it’s not appropriate for them to discuss their personal problems or medical problems with the patient or patient’s family.
Hilliard says it’s easy for some aides to begin to feel close to their patients. "After you’ve taken care of these people for several years, they feel as you do that they’re your family, and they will tell you everything," she explains.
"I don’t tell my patients much at all about my family or anything like that, other than how many children I have," Hilliard says.
In the Appalachian region, aides’ medical discussions can lead to talk about home remedies, such as teas and herbs, and Peters has had to emphasize that these conversations also are inappropriate.
Peters tells aides that if they want to discuss a patient’s behavior or personal troubles, then the only people they can tell are the nursing supervisor, the physician, the therapist, and members of the health care team.
Discussions with other aides about patients is not allowed, she adds. "They think they’re just sharing information and relieving themselves of an experience that just happened, but we stress very strongly that this is a very inappropriate topic of conversation."
• Show aides how to respond when patients ask them who else they have visited professionally.
Peters knows firsthand how difficult it can be to maintain patient confidentiality. When she was a field nurse, she often walked into a patient’s home only to have the patient rattle off the names of some other people she had been visiting.
What happened was the patients, who often knew each other, would meet and start discussing their health care and who their nurse was. "It’s not uncommon at all for your second patient to know where you’ve been and where you’re going," Peters says.
"The patients thought I was being uppity if I didn’t say anything, and then I’d have to get in a discussion about how I didn’t tell anybody about them either," Peters recalls.
Peters suggests education managers ask how aides would handle a similar situation. Then offer them a way to respond without breaking confidentiality.
For example, if a patient asks an aide a question about a neighbor’s health problems, the aide can gently deflect the question by saying, "Why don’t you give her a call after I leave," Peters says.
That’s exactly how Hilliard handled a tricky situation involving two patients who were good friends and close neighbors.
Each time she’d visit the patients, they’d ask her how the other one was doing. "I’d say, Well, she’ll probably be calling you after a while, and you can ask her yourself,’" Hilliard says.
"I’d just have to be really careful because I’d get pulled into the middle. Now, they’ve accepted it, and so they don’t ask me anymore," she adds.
• Stress the importance of being aware that someone may overhear you.
"A lot of times patients say to aides, Don’t tell the nurse I didn’t take my medicine this morning,’" Peters says.
"So the aides will wait until they get to their next patients’ homes to call the nursing supervisor," she says. "We tell them to be careful about that because the patient could be listening, so they should call only if they’re in a private place."
Hilliard says the seminar taught her to be more careful about where she and nurses have discussions about patients.
"Sometimes a nurse and I are discussing something about a patient while we’re in an apartment building elevator, and we are not thinking about what we’re saying," Hilliard says. "And there might be somebody on the elevator who knows the person you’re talking about. So you just have to be real careful."
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