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

HIPAA: How Our Health Care World Has Changed

May 31, 2005
in response to Notes on the Tension Between Privacy and Surveillance in Nursing 
with reply by the author

Dear Editor:

I write in response to Martin Johnson's article, "Notes on the Tension Between Privacy and Surveillance in Nursing." It seems from my personal experiences as an RN, as a patient, and as family member, that at least in the Midwestern part of the United States privacy is more valued by nurses than is suggested in Dr. Johnson's paper. In my city, hospitals are quickly moving toward private rooms--especially in the profit-generating areas, such as maternity care and out-patient surgery. Not only are new facilities often built with only private rooms, but older facilities are quickly being remodeled. I think the main reason for this move toward private rooms is consumer-driven. This desire for privacy is a legitimate desire; these changes have lead to more comfortable health care for people. However, at the same time this move has increased the tension between the desire for privacy and the need for observation by health care providers. It can also increase the amount of time it takes for patient care, by simply slowing down the flow. It is indeed a balancing act to address adequately both the need for privacy and the need for observation and efficiency.

I do see lower levels of privacy, though, in nursing home areas, especially on the locked units where many cognitively impaired patients reside. However, I have heard friends, neighbors, and spouses of patients demanding more privacy protection for their loved ones, even those loved ones who are not aware. As the baby-boomers retire, I predict the demands for privacy will only increase. Nurses will need to adjust to these demands by determining which observations are truly necessary and how to accomplish them in the least exposing manner.

I agree with Dr. Johnson that we must work to find the balance between privacy and observation.

When we need to invade patients' privacy to make an observation, we must make an extra effort to communicate our purposes to our patients and their families. We cannot assume that they will understand out motives to be good ones. We also need to make an effort to intrude in the most private manner practical. We should make the effort to use rooms set aside for private conversations. There are small rooms available throughout many hospitals, but they are used mostly by surgeons for sharing the patient's diagnosis, and by chaplains for talking about spiritual matters. Nurses need to consider using these rooms as we interview patients.

I also think that hands-on nursing care needs to be taught with privacy in mind. Some sense of this need for privacy was conveyed in our labs years ago, when we, as students, had to act the part of patients. Although today's students have the advantage of multiple technologies in the skills lab, they have lost the experience of personal exposure via clumsy classmates! It might not have been a fun experience, but it was a valuable learning experience. A little bit of empathy goes a long way! This balancing act is a worthy topic--one that students and graduate nurses alike should ponder and strive to master!

Ursula Adrian Smith, RN, BSN
Chesterfield, Missouri