Privacy can be defined as one’s ability for free association, expression, and existence in any given setting or environment, without undue interference or influence from outside sources. In the contemporary world, privacy is increasingly becoming a highly contentious and sensitive topic of discussion and discontent. The changing trends occasioned by globalization have resulted in a world that is open and that employs better communication strategies, technologies, and mechanisms. In the health care environment, privacy is an issue that is beginning to take root as a sensitive subject that should be addressed. It has influenced a multifaceted role in healthcare due to the different aspects that affect different areas of the healthcare environment (Myers, Frieden, Bherwani and Henning, 2008). Privacy is mainly concerned with the patient’s welfare since patients form the heart of any health care institution. Other areas where privacy can be applied include worker’s rights, institutional privacy, and health records maintenance. This shows that the issue of privacy within the health care environment provides a multiplicity of avenues to assess it. However, in this analysis, focus will be placed on patient privacy within the hospital, with consideration of such issues as cross-cultural diversity being one of the prime areas for assessing this research topic.
Contraventions of Patient Privacy
One society where cross-cultural privacy can be applied in the healthcare environment is the United Arabs Emirates. This is a country whose population has been invaded by immigrant workers drawn from different countries across the globe. According to statistics, foreigners represent approximately 11% of the population and approximately 39% of the total work force in the UAE. In this context, this is a country with strong cultural influence from outside sources drawn mainly from the foreigners. For instance, strong Muslim laws and culture that are representative of the UAE advocate for decency in dressing mainly by women, while the western culture advocates for freedom of dress code among women. Women are required to adorn a headscarf at all times and males are not allowed to view a woman’s naked or partially dressed body without being married to her. However, in the health care setting, there are male medical practitioners such as physicians and nurses who are mandated under their competence standards to ensure that patient medical histories and examinations are collected with due attention to detail (Yerby, 2013). In some instances, female patients may visit the hospital for such issues as breast screening, maternal health, or other related ailments. Is it not plausible for the male medical practitioners to ensure that they collect all relevant information? If some of the tests require close examination of the female patient, would it be considered as an infringement of their privacy due to their cultural orientation?
Aside from physical privacy infringement, another cross-cultural privacy infringement is concerned with the information given to medical practitioners. This information is two thronged; information received and information stored within the hospital records. According to the Muslim culture, information sharing should be limited to only the essential things as they may consider some of it as over sharing (Porrit, 2007). For instance, if a woman has been infected with a sexually transmitted disease, under the Muslim culture, the source of this infection should not be disclosed lest it acts or seems as disrespect to the husband, or is considered as a form of adultery by the woman. Therefore, if a woman shares some of this information, it may be considered as a contravention of her privacy since she could be giving information regarding her sexual life with her husband. Based on the records being taken, their storage is another issue where privacy can be infringed on. As earlier stated, information sharing with persons outside authorization should be an issue that is of great concern not only on the privacy of the patient, but also on the conduct of the medical practitioners responsible for the poor storage of the information.
Another area where cross-cultural privacy of the patients can be infringed is based on their stay while at the hospital. In a majority of public hospitals, patients could be forced to share a room with one or more persons with curtains being used to separate one bed from the other. Physicians conducting examinations or diagnosis on the patient could do it in a manner where other people close to this patient can see or hear the contents of the examination and derive their own ideas on the problem ailing the patient (Johns, 2007). Nurses attending to the daily needs of the patient such as washing could also perform it with close curtains, which could sometimes be partially closed allowing for people outside to view the happenings inside the curtain. Additionally, some patients of similar genders may be forced to share the same room separated by curtains. All these problems are considered as possibilities for the patient’s rights of privacy to be infringed. Aside from this, some instances may witness more than one attendee dealing or caring for a patient at any one time. For instance, two or more nurses can be present to perform duties such as cleaning and medication for the patient. Some patients may consider this as too open and affects their privacy, as the nurse giving the medication is not entitled to view the naked patient (Khalaf, 2010). In a cross-cultural environment, such lapses in patient privacy can be considered as having detrimental effects on their dignity, self-esteem, and beliefs.
Tackling the Issues
Culture is considered to be the major identity of a people residing within a given region, religious affiliations, or ethnic backgrounds. Its preservation is important since it defines the customs, beliefs, and mannerisms of people. In most cases, instances where their beliefs are contravened, it can be considered as unfair and improper for the individual affected. Therefore, it is paramount that all people strive to build a culture of respect and consideration for this cultural diversity. In Rashid hospital, one of the strategies being used to counter the effects of this cultural diversity is the employment of a work force drawn from multicultural backgrounds (Ife, 2008). This ensures that patients visiting the health care institutions are cared for by people with a similar cultural backgrounds as them, or are treated with medical practitioners that are in constant communication with experts in a particular culture. The latter would entail the employment of a central person who is responsible for advising and training other work colleagues on ways and means of dealing with patients from a particular culture. In tandem with ideology and strategy, privacy of these individuals is also enforced by respecting the constituents and analogies of their cultures (Keh-Luh, Chi & Chiu-Mei, 2012).
In retrospect, it is paramount that cross-cultural diversity not become a thorn in the flesh for health care institution since its prevention and control is manageable if the proper systems and structures are effected within the institution (The office of the national coordinator for health information technology, 2013). However, caution should be taken to ensure that this adaption of respect for cultural diversity does not affect the performance of duties for the medical practitioners. For instance, the nursing competency standards mandate them to conduct themselves in a manner that promotes equitable allocation and provision of health care to all people regardless of their demographical backgrounds. These competency standards should be followed strictly and should only be contravened if there is a legal reason preventing the provision of certain forms of health care. For instance, in the US, medical practitioners are required to ensure that the type of care being provided to any patient is in consideration of their beliefs and cultural backgrounds. A good example of this ideology is the religious inclinations of some citizens in the US who do not prefer medical treatment even when they are brought in while unconscious (Doyle, 2012). To avoid contravening the right of such individuals, the law requires them to have an identifiable mark or object that the medical practitioner could see before giving medical care. Putting this into perspective, by ensuring that such a system is followed at Rashid hospital, the privacy and rights of the individual can be maintained medically, legally, and culturally.
However, in spite of this development, unauthorized personnel, which could result in an infringement of their privacy, can access information through many other aspects. One of these is the record keeping area, where all information regarding a patient’s health as diagnosis, treatment, medication, and medical history is preserved. In the digital age, all information collected from a patient is required to be stored both on paper, and on servers or computers. The latter is a prerequisite that has been enforced as a means to increase efficiency, as well as improve care delivery for patients (Wager, Lee & Glaser, 2009). In their bid for Rashid hospital to maintain the privacy of the patients, information is centralized and security features such as passwords and firewalls embedded in the systems to prevent unauthorized access. Further, different of security have been provided to ensure that patient records and information are accessed depending on one’s level of access. For instance, a finance officer in a hospital can view information such as medication, room allocation, and types of treatment provided, but are not allowed to view the patient’s illness or medical history (Beaver, 2002). A nurse, on the other hand, is allowed to view a patient’s medical records and information regarding diagnosis and treatment, but is not authorized to view their financial payments. However, its effects have been adverse due to the loopholes that allow for unauthorized access either through hacking or through negligence of medical practitioners when using the services and forgetting logging out. Therefore, information storage is another area where privacy can be infringed but it can be corrected through the integration of a system of authorization for different types of information.
Finally, the last strategy that can be employed at Rashid hospital to curb the effect of cross-cultural communication affecting privacy is the utility of education and training of all staff working within the hospital. This is important since it allows the employees to learn, understand, and respect cultural diversities for different people. The Campinha-Bacote model advocates for nurses to embrace a need to learn and practice various cultural presentations. In the UAE, medical practitioners drawn from different regions outside of the country would greatly benefit from this scheme since it would also help them learn the Muslim culture and all its laws and guidelines. It would serve to ensure that some male staff does not treat female patients for some diseases since the latter could consider this as a contravention of their privacy. For instance, while measuring heart rate and breathing using a stethoscope, the medical practitioner may be forced to place it close to the bust of the woman, which in Muslim may be considered as inappropriate (Howard, 2009). Therefore, through education and training, the medical practitioners can seek the help of other female staff when performing such tasks, or may allocate other employees to this duty. Human rights activists would consider as gender inequality and may abhor it. However, if the right measures are taken to ensure that certain actions are taken for only specific diseases, treatments, and prognosis, then this issue of gender inequality can be sorted. Further, it is paramount that the privacy and dignity of the patient be maintained using the Campinha-Bacote model. Using education and training, the medical practitioners could learn different methodologies to perform some checkups without infringing on the dignity of their cross-cultural patient thus ensuring provision of medical care, as well as respect of cultural diversity (Patterson and McMurray, 2002).
According to the Campinha-Bacote model, one of the methodologies being suggested by Rashid hospital is the implementation of a model where the medical practitioners are endeared to learn different cultures. This model is crafted to promote a culture of learning and appreciation for people of different and diverse cultures and ethnicities. It ensures that the learners acquire skills, knowledge, and competencies that would be essential when dealing with a multicultural work force and patients. In this regard, learning the culture is not simply a requirement, but should also be an inherent need in particular individuals. This is because one can learn different cultures, but generating the necessary respect for these cultures can be difficult. This is because this individual may be unappreciative of some of the constituents of these new cultures that he may consider as being overly sensitive to his ideologies and beliefs. For instance, if a westerner learnt that Muslim culture that one man is allowed to marry several wives, this westerner may consider this as going against his beliefs and could result in a disdain in this new culture. This means that learning is not simply the answer under the Campinha-Bacote model, but should also be blended by a need to sensitize the individual on accepting the constituents of these new cultures with favor, prejudice, or bias. The Campinha-Bacote model, advocates for openness and flexibility when acquiring new knowledge and skills.
Under the Campinha-Bacote model, dignity of the patients can be highly promoted through application of a definitive set of strategies. The dignity of patients is related to their need for humanity and having a sense of appreciation and understanding to their conditions. Dignity does not revolve around one’s personal privacy being infringed, but could also be manifested by one’s feeling of helplessness. Therefore, in spite of a medical practitioner performing his duties as best as possible for a patient, if the patient is psychologically prepared to deal with and understand his condition, then they may continue to have low dignity. The Campinha-Bacote model can be used to resolve this problem. This is because it blends both culture and psychological understanding of the medical practitioner. For instance, men in society have been always been pegged as the pillars and are required to always be the providers and care givers for others. Therefore, if a man is faced with a situation where he is bedridden and is dependent on other people to cater to his needs, he may have a low sense of dignity (Keh-Luh, Chi & Chiu-Mei, 2012). However, this perception is merely a cultural foresight that has been in existence for millennia.
The medical practitioner can approach this issue first by assurance of the patient that his health impairment is not an inability, but rather is only a phase to be experienced in the journey to recovery. This assurance can be accompanied with examples of other cases and their outcomes, as well as educating the patient on their condition to develop a sense of understanding for the condition that they may be facing. This psychological education is important since it taps into the cultural beliefs of the patients and seeks to identify ways and means for the patient to change their attitudes and mannerisms. It should in a manner that promotes an understanding for the patient’s condition to ensure that the patient can develop a sense of trust and acceptance for the individual giving the psychological education. According to the nurse competency standards, the nurse is mandated to give education to patient that can both be medical and psychological. This education doe not only involve the patient, but could also extend to their family and friends (Patterson and McMurray, 2002). Provision of this extensive education to the patient and his close family and friends ensures that the patient can receive psychological support from not only the medical practitioner, but also from those around him. This is important since in spite of the medical practitioner learning and practicing the culture of the patient, the people closest to the patient have the most experience in application of culture to the patient. Therefore, according to the Campinha-Bacote model, culture learning by the medical practitioners is insufficient to completely give the necessary care to the patient that would have a positive impact on the health.
Care delivery is an intricate task that requires the application of a multiplicity of strategies to enhance its results and core principles. Privacy is one area that is of great concern to all health care institutions. At Rashid Hospital, there are varied methodologies that are being used in the achievement of this objective. Key among them is the enhancement of better service delivery by the staff to avoid cases of patient maltreatment, or poor medical care. These two principles are the core base for privacy promotion within the hospital. According to the medical practitioners, the hospital has set up a strict policy where the rights and freedoms of the patients within the hospital are highly upheld. This policy has given way to sub-policies that have been forwarded to the human resource department to ensure their implementation and success (Beaver, 2002). For instance, the hospital has directed the human resource department to ensure that all workers are aware of issues, which can be deemed as contravening the rights of the patients. Further, these medical practitioners are required to sign contracts that clearly outline their acceptance of the hospital to learn, understand, and uphold the rights of all the patients visiting or admitted to the hospital. In this regard, one of the core strategies being used by the human resource department is the sensitization of patient rights through training and education. This is achieved by provision of notice boards and memos where medical practitioners can read the rights. Additionally, there are workshops and seminars organized by the human resource department geared towards sensitizing the medical practitioners on the latest trends in the promotion of patient privacy and rights. However, some critics contend and argue that education and training of the staff is insufficient to ensure that the privacy of the patients is maintained. Therefore, the human resource has come up with systems and strategies to monitor how the medical practitioners are dealing with patients.
One of the methodologies being employed is the creation of a feedback system that allows patients to give their views and suggestions regarding the level of care they received within the hospital. This feedback system also allows the patients to pinpoint particular medical practitioners whom they believed performed exemplary, or contravened on their duties. Since all medical practitioners are required to wear name tags at all times within the hospital setting, this makes it easier for the patient to identify and relate with each medical practitioner attending to them. This feedback system serves a two-thronged benefit for the hospital. Foremost, it allows for the human resource department and supervisors to identify people who are contravening the hospitals polices. It acts as a means for the hospital to access the success and applicability of their systems and policies when medical care is being given. This statistics can be useful in analyzing how the systems and strategies can be improved upon to increase productivity and effectiveness of the staff. The individuals identified as contravening the hospital’s policies can be selected and using communication as the primary tool, they can be questioned on where they feel unable to carry out their duties effectively, or the causalities for refusal to adhere to the hospital policies. The second benefit derived from the feedback system is the ability of the hospital to identify areas where representation of patient’s rights, as well as possible measures to counter them is lacking. This is esteem since the hospital cannot achieve complete productive and effective systems and strategies for accomplishing their mandate definitively and wholesomely. Therefore, the feedback system allows for policy makers and human resource managers to assess the current systems and make changes to their application within the hospital to enhance their suitability in maintain better service delivery for their patients.
The researchers reported the influence of nurses’ attitudes, subjective norms and perceived behavioral control on maintaining patients’ privacy during hospitalization. Our organization respects the patient privacy in order to achieve high quality service and care, it provides a clear policy statement for such procedure and responsibility for example: during history taking, during examination, during discussion of patient’s condition, during operation, during transport. This policy is applicable to all Rashid Hospital, prepared and revised by Patients Family Rights Committee. The advantage of that shown in the minimal incident report takes place in our organization. Additionally, the policies created within the hospital have been carefully crafted to ensure that their applicability to both the staff and patients does not contravene the modus operandi of the hospital. They are designed in accordance with an adherence to laws and regulations guiding not only the medical practice, but also the laws contained in the constitution of the UAE. This is vital since it ensures that the medical practitioners within the hospital are protected from legal suits being filed against as a consequence of a contravention of a patient’s rights or privacy. Due to the cultural diversity of the hospital, measures are being taken to integrate a multicultural work force within the hospital to deal with this issue and to formulate better strategies for dealing with a multicultural patient population visiting the hospital. Further, it is paramount that all medical practitioners within the hospital have an inherent need to respect and adapt to these changing trends in the healthcare environment in the UAE.
There are myriads of means through which privacy of patients can be infringed. Culture plays an integral role in this issue mainly due to the beliefs and customs of diverse patients. Therefore, it is paramount that medical practitioners utilize their knowledge, skills, and mandate in a manner that ensure that culture is not used as an impediment to health care provision, nor as an avenue through which the privacy of individuals can be infringed (Coxon, 2005). There are various measures that medical practitioners can utilize to achieve this outcome, albeit with varying degrees of success. Meshing culture and privacy is an intricate process within the medical field that requires using strategies such as information management, education and training of personnel, and adherence to professional codes of conduct for the medical personnel. There are other myriads of areas of application of privacy infringement in the medical field, though one commonality remains if privacy is contravened. This commonality is that legally, a contravention of one’s privacy is a contravention of the law and its consequences could be adverse.
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