Essentials of Nursing Leadership and Management, 5th Edition

chapter 3 | Nursing Practice and the Law 25

the privacy of health information and improve the
portability and continuation of health-care cover-
age. The HIPAA gave Congress until August 1999
to pass this legislation. Congress failed to act, and
the Department of Health and Human Services
took over developing the appropriate regulations
(Charters, 2003). The latest version of this privacy
act was published in the Federal Register in 2002
(Charters, 2003).
The increased use of electronic sources of docu-
mentation and transfer of client information pre-
sents many confidentiality issues. It is important for
nurses to be aware of the guidelines protecting the
sharing and transfer of information through elec-
tronic sources. Most health-care institutions have
internal procedures to protect client confidentiality.
Take the following example:
Bill was admitted for pneumonia. With Bill ’s per-
mission, an HIV test was performed, and the result
was positive. This information was available on the
computerized laboratory result printout. A nurse
inadvertently left the laboratory results on the com-
puter screen that was partially facing the hallway.
One of Bill ’s coworkers, who had come to visit him,
saw the report on the screen. This individual reported
the test results to Bill ’s supervisor. When Bill
returned to work, he was f ired for “poor job perfor-
mance,” although he had had superior job evalua-
tions. In the process of f iling a discrimination suit
against his employer, Bill discovered that the infor-
mation on his health status had come from this source.
A lawsuit was f iled against the hospital and the
nurse involved based on a breach of conf identiality.

Slander and Libel

Slander and libel are categorized as quasi-intentional
torts. Nurses rarely think of themselves as being
guilty of slander or libel. The term slanderrefers to
the spoken word, and libel refers to the written
word. Making a false statement about a client’s con-
dition that may result in an injury to that client is
considered slander. Making a written false state-
ment is libel. For example, stating that a client who
had blood drawn for drug testing has a substance
abuse problem, when in fact the client does not
carry that diagnosis, could be considered a slander-
ous statement.
Slander and libel also refer to statements made
about coworkers or other individuals whom you
may encounter in both your professional and

educational life. Think before you speak and write.

Sometimes what may appear to be harmless to you,

such as a complaint, may contain statements that

damage another person’s credibility personally and

professionally. Consider this example:

Several nurses on a unit were having diff iculty

with the nurse manager. Rather than approach the

manager or follow the chain of command, they

decided to send a written statement to the chief exec-

utive off icer (CEO) of the hospital. In this letter,

they embellished some of the incidents that occurred

and took statements out of context that the nurse

manager had made, changing the meanings of the

remarks. The nurse manager was called to the

CEO’s off ice and reprimanded for these events and

statements, which in fact had not occurred. The

nurse manager sued the nurses for slander and libel

based on the premise that her personal and profes-

sional reputation had been tainted.

False Imprisonment

False imprisonment is confining an individual

against his or her will by either physical (restrain-

ing) or verbal (detaining) means. The following are

examples:

■Using restraints on individuals without the

appropriate written consent

■Restraining mentally handicapped individuals

who do not represent a threat to themselves or

others

■Detaining unwilling clients in an institution

when they desire to leave

■Keeping persons who are medically cleared for

discharge for an unreasonable amount of time

■Removing the clothing of clients to prevent

them from leaving the institution

■Threatening clients with some form of physical,

emotional, or legal action if they insist on leaving

Sometimes clients are a danger to themselves and

to others. Nurses need to decide on the appropri-

ateness of restraints as a protective measure. Nurses

should try to obtain the cooperation of the client

before applying any type of restraints. The first step

is to attempt to identify a reason for the risky

behavior and resolve the problem. If this fails, doc-

ument the need for restraints, consult with the

physician, and carefully follow the institution’s

policies and standards of practice. Failure to follow

these guidelines may result in greater harm to the