Confidentiality and risk assessment: case studies of the professional judgements of nurses, social workers and hospital chaplains

This research examines the relationship between professional codes of
ethics and ethics in practice. Key issues explored include: (a) to what
extent do professionals use their ethical code when making decisions
involving ethical dilemmas; (b) how frequently do they disclose
information against clients' wishes and how is this justified; (c) are
professional judgements so consistent that a common practice standard can
be determined; (d) what differences in decision-making exist between
nurses, social workers and chaplains and is this related to the extent of
'professionalization' of the occupation into an integrated network?
Vignettes describing low-risk community mental health cases, posing
ethical dilemmas for the research participants about the disclosure of
confidential information, were used as a focus for lengthy semi-structured
interviews with 27 nurses, 21 social workers and 7 chaplains. Data was
collected about respondents' professional membership and understanding of
legal/professional/employer guidance about confidentiality. Responses were
analyzed in relation to themes of 'consistency', 'conflict of loyalties',
and 'rationalization' of choices.
Confidentiality was breached more than it was maintained, although there
were considerable differences both within and between professional groups
about the points of disclosure. In addition, no standard recipients for
information could be determined. Vignettes were sometimes interpreted
differently. Disclosure was justified through loyalties conflicting with
responsibilities to the named client. This included loyalty to fellow
professionals, to third parties, and to oneself. Disclosure could be
motivated by desire to obtain a 'good result'. Participants displayed
generally poor knowledge of legal/professional/employer frameworks for
decision-making, and referred to their codes of ethics rarely as a reason
behind decisions.
Implications for professional training and employer policy are discussed.
Problems in professional accountability are raised, for practitioners,
professional bodies, and employers. The utility of a code of ethics which
espouses a standard of confidentiality so far removed from day-to-day
practice is questioned.