Disclosure of confidential information by mental health nurses, of patients they assess to be a risk of harm to self or others: An integrative review

Abstract

There is a duty of confidentiality on the part of mental health nurses when they handle confidential patient information. Nonetheless, it may be necessary to disclose confidential information of a patient if the patient is assessed as being a risk to self or others, to protect the patient or others from harm. However, disclosing information inappropriately may constitute a breach of confidentiality. There is a paucity of information on how mental health nurses understand the rules of confidentiality when deciding to withhold or disclose confidential information in these circumstances. An integrative review of the literature was undertaken to explore the disclosure of confidential information by mental health nurses when they assess a patient as being a risk of harm. The findings indicate the rules of confidentiality are not well understood, or are not adhered to by mental health nurses. Risk assessments were found to underpin deliberations to withhold or disclose confidential information of a patient, despite risk being difficult to predict with any certainty. For risk assessment, mental health nurses were noted to prefer their unstructured clinical judgement over actuarial methods; and defer to their clinical intuition over scores of a structured risk assessment instrument, when making structured clinical judgement‐backed decisions in this area of their practice. Gaps in the literature that may be addressed by future empirical research were revealed during this integrative review.

What mental health nurses have to say about themselves: A discourse analysis

“…For example, MHNs were described as often being the first point of contact between the healthcare system and patients who need mental health care, and there is an expectation that MHNs conduct adequate risk assessments (Conlon et al . , 2019). The authors point out that the concepts of confidentiality and privacy are often used interchangeably when they do not mean the same thing, and mental health nurses need to understand the differences.…”

“…Where the term MHN was employed, it was often quite ambiguous who was being referred to. For example, Conlon et al (2019) undertook an integrative review focusing on mental health nurses and disclosure of confidential information (MHNs = 129). Consistent with all review papers in this journal, there was no definition or discussion about what constitutes a mental health nurse, although various statements were made about MHNs and they were largely cast as being in positions of responsibility.…”

“…Consistent with all review papers in this journal, there was no definition or discussion about what constitutes a mental health nurse, although various statements were made about MHNs and they were largely cast as being in positions of responsibility. For example, MHNs were described as often being the first point of contact between the healthcare system and patients who need mental health care, and there is an expectation that MHNs conduct adequate risk assessments (Conlon et al , 2019). The authors point out that the concepts of confidentiality and privacy are often used interchangeably when they do not mean the same thing, and mental health nurses need to understand the differences.…”

“…However, they also suggested that education might benefit junior MHNs because formal undergraduate and postgraduate courses do not cover risk assessment in sufficient detail. Under the limitations of the review, the authors state that 'Approaches to mental health care and mental health nurses' practice share similarities internationally' although this is not substantiated and they state that laws related to mental health and confidentiality vary (Conlon et al 2019(Conlon et al , p. 1246. This assumption of similarities of practice across geographic boundaries and some kind of consistency in the identity of MHNs and their work was typical of most published work reviewed, as was an uncritical acceptance that MHNs were whatever authors stated they were.…”

Reporting Inpatients’ Experiences and Satisfaction in a National Psychiatric Facility: A Study Based on the Random Forest Algorithm

“…As the experience of confidentiality received the highest rating (4.72 ± 0.45) compared to its counterparts, then it is worth shedding some light on this aspect. Recent research has been steered to gain an in-depth understanding of psychiatric clinicians' confidentiality practices from both the eyes of service users and the judgment capacity manifested by the practicing clinicians themselves (43)(44)(45). Hence, excelling in the confidentiality domain can be linked to the competency of mental health professionals in terms of awareness of ethical issues, mitigation of mental illness stigma, and patient information protection standards (45,46).…”