Letter to the Editor on "Notes on the Tension Between Privacy and Surveillance in Nursing"

HIPAA: How Our Health Care World Has Changed

November 28, 2005
Patricia Gonzales
in response to Notes on the Tension Between Privacy and Surveillance in Nursing

Dear Editor:

I found the article by Martin Johnson describing the tension between privacy and surveillance in nursing to be most interesting. As labor and delivery nurses, we frequently run into privacy dilemmas. We practice Family Centered Care and struggle with the question of who has the right to make the patient care decisions. Is it the patient herself or the family members? Frequently we see the baby's grandmothers and/or fathers replying to questions we ask the mother, such as whether the mother wants an epidural anesthetic or consents to a blood transfusion. It's not unusual for fathers to reply to questions we ask the mothers about breast feeding. We find that a laboring patient will say things to us privately that she won't say or agree to in front of her family and/or spouse.

About 85% of our patient population is Hispanic and very submissive to the male in the relationship. These mothers sometimes decline a tubal ligation procedure when the spouse is in the room even though they previously signed the approval for this procedure while they were receiving prenatal care. My question is this: Where should the line between Family Centered Care and Patient Privacy be drawn? Any insights will be greatly appreciated.

Patricia Gonzales, RNC
Ben Taub General Hospital
Houston, TX