How to Support Patient Privacy

Healthcare Training Resource
September 2, 2013 — 1,159 views  
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There are common scenarios where nurses may not be sure how to or if they are maintaining their patient’s privacy during a routine bedside handoff. For example, a patient’s spouse may be visiting when it is time for a bedside shift change. Computers and wireless devices save time when conducting a shift change handoff and may be a bit more difficult for the patient and others in the room except the operator to view, but they do not substitute for maintaining a secure patient privacy environment. Although a patient may have a private room and there are open and congenial relations between the patient and his or her spouse or others, in keeping with the HIPAA and other privacy acts, the visitor/spouse should be asked to leave the room while the shift change routine is conducted. Upon entering the patient’s room with the computer, the nurse ending their shift may explain it is time for a shift change and report, introduces the next shift nurse, and asks the visitor to please wait outside (or offered to visit the cafeteria or other visitor units) until the shift handoff is concluded. The nurse then asks the patient if it they consent to the nurses openly discussing his or her care and proceed accordingly. After the handoff is concluded, the patient may be asked if he or she requires anything in particular, and the visitor is then permitted to return to the patient’s room. The patient’s privacy and security is respected in accordance with HIPAA and patient privacy policies. The shift change handoff and report are completed calmly and accurately, and it has little impact on the visitor(s).

Semi-private rooms present a different privacy issue since the other patient’s privacy is equally important. Routinely a nurse is finishing up their rounds when the oncoming nurse appears to do the shift change handoff report. Although the patient in the semi-private room that is the concern of the report may not have visitors and shift change report may be completed quietly, the other patient in the semi-private room may have visitors. Similarly to the previous scenario, the visitors should be informed of the shift change and need for reporting and asked to please step outside the patients’ room, offered a waiting area or place in the building where they may relax with a snack or purchase items their patient needs or they would like him or her to have. 

After the other patient’s visitors are removed, appreciation should be conveyed to the patient and the nurses may pull the privacy curtain and resume conducting the shift change handoff. Quietly the nurses discuss and electronically record their current assessment of the patient’s condition, medications, and pending medical treatments. They check the patient’s IV, dressings if applicable, general condition and determine and document further care, oversight, and goals. Upon completion, the privacy curtain is pulled back according to the patient’s wishes and the other patient’s visitors, if around, are notified they may return and continue their visit.

In another scenario, the shift change nurses encounter a patient in a semi-private room that has teenage children visiting. The nurses introduce themselves and ask if the patient consents to a beside handoff report procedure. The patient is apprehensive with her children in the room, and the nurses give the patient the option to do the handoff outside of the patient’s room or the children may be directed to the cafeteria or waiting area until the shift change procedure is completed. A patient safety check, including checking the patient’s IV and dressings, is routine. In some circumstances, at the patient’s consent, the safety check may be performed before asking the family, spouse, or intimate visitor to exit the patient’s room. Also in some cases, as part of the patient’s overall care, it may be of some comfort to have a family member, spouse, close friend present for the safety check. 

Again, the curtain is pulled, the safety check is performed and the children are asked to step outside the room until the shift change handoff is completed. The patient, when alert, may review written communications about their condition and proposed changes in their care. All verbal communications are discreet.

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