Format

Send to

Choose Destination
Nurs Ethics. 2016 Aug;23(5):576-86. doi: 10.1177/0969733015576358. Epub 2015 May 8.

Boundaries of confidentiality in nursing care for mother and child in HIV programmes.

Author information

1
University of Bergen, Norway; University of Stavanger, Norway Bodil.B.Vaga@uis.no.
2
University of Bergen, Norway; University of Stavanger, NorwayUniversity of Bergen, Norway.
3
University of Bergen, Norway.

Abstract

BACKGROUND:

Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses' follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party - the child - have attracted limited attention.

OBJECTIVE:

The study explores challenges of confidentiality linked to a third party in nurse-patient relationships in a rural Tanzanian HIV/AIDS context.

STUDY CONTEXT:

The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%.

METHODS:

Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes.

ETHICAL CONSIDERATIONS:

Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway.

FINDINGS AND DISCUSSION:

The material indicates a delicate balance between the nurses' attempt to secure the HIV-free survival of the babies and the mothers' desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient's restricted disclosure came to light during follow-up of the HIV-positive women and the third party - the child who is at risk of HIV infection through mother's milk. World Health Organization's substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion.

KEYWORDS:

Confidentiality; Tanzania; disclosure; nursing; prevention of mother-to-child transmission of HIV programmes; qualitative research; third-party dilemma

PMID:
25956154
DOI:
10.1177/0969733015576358
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center