NSB 204: Mental Health Nursing Case Report on Patient Confidentiality

This report analyzes a mental health case involving a patient, Mrs. Duvall, accused of murder, and explores the ethical dilemmas of patient confidentiality and stigmatization within a nursing context. The student, a graduate nurse, utilizes the 5Rs of reflection to examine the impact of societal biases and media influence on the treatment of mentally ill patients, particularly those with a criminal background. The report highlights the importance of upholding nursing ethics, protecting patient privacy, and preventing discrimination, drawing on relevant literature to support the arguments. It emphasizes the role of healthcare professionals in fostering a supportive environment and advocating for the rights of vulnerable individuals, while addressing the potential consequences of breaching confidentiality and perpetuating stigma. The student concludes by reflecting on the learning experience and outlining strategies to promote ethical practice and overcome personal prejudices.

Running head: Mental health- nursing
Mental health- nursing
Name of the Student
Name of the university
Author’s note

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Reporting.
In this report, I will be discussing over the case of Mr. Duvall, who is a mental health
patient and had been alleged with the charge of murdering the officer in chief. The main context
of discussion would be about confidentiality and stigmatization related to the mental health
patients. I will use 5Rs of reflection in order to describe my perception about this issue.
Stigmatization is an important health concern when it comes to mental health. There are two
facets of stigma- the enacted stigma and the felt stigma. Enacted stigma can be referred to
perceived act of discrimination against an individual having a stigmatized condition (Corrigan,
Druss & Perlick, 2014). In this case, it can be clearly seen, that Mrs. Duvall is an acute mental
health patient and additionally she has been alleged of a murder, it is natural that, if she is being
taken out, people will stigmatize and in extreme cases, the health care professionals might also
refuse treatment for all who had been in federal jail and will be taken to a mental health. Another
issue that is of utmost importance is, confidentiality of the patient’s condition. It has been
mentioned in the case report, that few of the guards will be appointed to take care of the alleged
patient in the hospital. There can be a possibility, that the health information of these patients
will be disclosed to the media, which is the breaching of confidentiality in the nursing
professional ethics.
Responding
I am a graduate nurse and is currently being placed in an acute mental health ward in a
clinical setting. I have got the report that Ms. Duvell will be arriving at the institution soon, with
the three men. I was well aware of the case of the women that topped the headline of the news.
The entire situation perplexed me, as I had never experienced this before, and I ever had in my
life cared for a mental health patient, who had been in jail and had been alleged of a murder. This

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kind of a perception has developed in me, probably due to the fact that our society has no
tolerance towards a criminal (Testa, 2015). Limited tolerance is true for those having direct
contact with the mental ill patient. The rationale behind this thought is that, in such patients, we
give priority to the background of the patient, rather than focusing on the strength based
approach for the recovery of the patients. Such thoughts might affect patients who are at care.
Relating
I have always considered stigmatization and breaching of privacy to be totally against
nursing ethics, as I learned since the start, that each and every patient has got the get treatment,
irrespective of their cast, creed and orientation of the problem (Henderson et al., 2017). My
personal belief is guided by my culture, where I had born, or people with whom, I had been
staying so long. My personal beliefs and culture supports that everyone should get the
opportunity to get the essence of life and the basic human rights for these types of patients
should be restored. Reflecting on the role of media, on manipulation of the thought process, it
can be said that media is the lifeline of the society and we generally start holding a perception,
which might not be accurate (Maier et al., 2016). We also conform to the social norms and might
get swayed away and begin to change our beliefs based on what the society had been thinking.
My this change in the perception can be supported by Goffman’s theory of social stigma, that
states public stigma is aggravated by social norms, causing impacts like health care disparities
(Katz, 2014).
Reasoning
As already stated, I am well aware of the ethical norms like stigmatization and
confidentiality. I am well aware of the fact, that social stigma on the mental health patients will
turn the situation worst. This makes people with mental illness robbed of the qualities to lead a

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better life (Fisher eta l., 2014). Mental health treatment institutions provides treatments to these
vulnerable population not in terms of medicines, but also used many strength based approach for
bringing back these patients to the normal pace of life. Protection of the confidential health
records are one of the important factors of human rights. Hattingh et al., (2016) have stated that
one of the main aim of maintaining confidentiality is to prevent stigmatization. Patient
information will only be disclosed in case it is a matter of public security. With reference to this
context, it can be said that the guards who had been appointed for looking after the patient needs
to maintain confidentiality and should not leak any patient information outside.
Reconstructing
From this case, I have learnt two main issues like stigmatization and confidentiality. This
case has lead me to believe that stigmatization of the mental health patients give rise to self-
perceived stigma, that not only provides disparities in health care and also makes a delay in the
treatment (Moore, Stuewig & Tangney, 2016). I have also learnt, how breaching of privacy of
the patient information might lead to unfair care and stigmatization. This will case a breaching of
the professional ethics of nursing (Callard et al., 2016).
In order to implementing it to practice, I would make sure to remain updated with the
nursing privacy or the confidentiality rule, such that the guidelines are not breached (Bourgeois,
Nigrin & Harper, 2015). Again, personal awareness, looking inside one’s own self and self-
regulation will eradicate any feeling of prejudice towards any individual.

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REFERENCES
Bourgeois, F. C., Nigrin, D. J., & Harper, M. B. (2015). Preserving patient privacy and
confidentiality in the era of personal health records. Pediatrics, 135(5), e1125-e1127.
Callard, F., Broadbent, M., Denis, M., Hotopf, M., Soncul, M., Wykes, T., ... & Stewart, R.
(2014). Developing a new model for patient recruitment in mental health services: a
cohort study using Electronic Health Records. BMJ open, 4(12), e005654.
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on
seeking and participating in mental health care. Psychological Science in the Public
Interest, 15(2), 37-70.
Fisher, W. H., Hartwell, S. W., Deng, X., Pinals, D. A., Fulwiler, C., & Roy-Bujnowski, K.
(2014). Recidivism among released state prison inmates who received mental health
treatment while incarcerated. Crime & Delinquency, 60(6), 811-832.
Hattingh, H. L., Knox, K., Fejzic, J., McConnell, D., Fowler, J. L., Mey, A., ... & Wheeler, A. J.
(2015). Privacy and confidentiality: perspectives of mental health consumers and carers
in pharmacy settings. International Journal of Pharmacy Practice, 23(1), 52-60.
Henderson, C., Noblett, J., Parke, H., Clement, S., Caffrey, A., Gale-Grant, O., ... & Thornicroft,
G. (2014). Mental health-related stigma in health care and mental health-care settings.
The Lancet Psychiatry, 1(6), 467-482.
Katz, I. (2014). Stigma: A social psychological analysis. Psychology Press.

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Maier, J. A., Gentile, D. A., Vogel, D. L., & Kaplan, S. A. (2014). Media influences on self-
stigma of seeking psychological services: The importance of media portrayals and person
perception. Psychology of Popular Media Culture, 3(4), 239.
Moore, K. E., Stuewig, J. B., & Tangney, J. P. (2016). The effect of stigma on criminal
offenders’ functioning: A longitudinal mediational model. Deviant behavior, 37(2), 196-
218.
Testa, M. (2015). Imprisonment of the mentally ill: A call for diversion to the community mental
health system. Alb. Gov't L. Rev., 8, 405.