Discussion: Provider-Patient Confidentiality with School-Age Children and Adolescents
When treating pediatric patients in clinical settings, you also treat patients' families. With younger patients, this tends to be a seamless process. However, as patients age and grow into the adolescent years, the provider-patient-family relationship becomes more complex. The change in this dynamic often creates questions in provider-patient confidentiality. As the advanced practice nurse providing care for school-age children, adolescents, and their families, how do you handle these confidentiality issues? If a child is a minor, do you have to maintain provider-patient confidentiality? When is it appropriate to allow patients privacy? When is it your legal and ethical duty to involve family members? How do you facilitate the care of a minor when you have to work with parents and still maintain patient trust?
Consider the following three case studies.
Case Study 1
You receive a phone call from a mother who is concerned that her son is using drugs. The 16-year-old boy is seeing you in the afternoon for a follow-up for acne. The mother requests that you obtain a drug test during the visit, but she does not want her son to know he is being screened or that she requested screening because "I don't want him to stop trusting me."
Case Study 2
A 17-year-old girl comes to your office with a complaint of abdominal pain and missed periods. She thinks she may be pregnant. She requests pregnancy testing and does not want you to tell her parents if she is pregnant.
Case Study 3
The father of a 10-year-old boy calls your office to request assistance with an Individualized Educational Plan (IEP) for his son who was recently diagnosed with attention deficit hyperactivity disorder (ADHD). He wants you to contact the school and to facilitate getting an IEP developed.
To prepare:
- Review this week's media presentation, as well as "Developmental Management of School-Age Children" and "Developmental Management of Adolescents" in the Burns et al. text and the Schapiro article in the Learning Resources.
- Think about confidentiality laws regarding providers, school-age children, adolescents, and their families.
- Select one of the three provided scenarios. Reflect on the provider's role and responsibility regarding confidentiality between the patient and the patient's family in the scenario.
- Consider the appropriate way for the provider to respond and facilitate the care of the patient in the scenario you selected. Think about interventions and strategies that the provider should use to address the issues presented.
Provide a thorough response at least 250 words (select a case study)
1. Post an explanation of the provider's role and responsibility regarding confidentiality between the patient and the patient's family in the scenario you selected.
2. Explain how the provider should appropriately respond and facilitate the care of the patient in the scenario.
3. Include interventions and management strategies that the provider should use to address the issues presented.
Required Readings
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
-Chapter 7, "Developmental Management of School-Age Children" (pp. 92-109)
This chapter presents guidelines for the assessment of school-age children, including psychosexual, social and emotional, cognitive and problem-solving, and moral development. It also explores common developmental issues and red flags for school-age children.
-Chapter 8, "Developmental Management of Adolescents" (pp. 110-129)
This chapter explores adolescent development and anticipatory guidance during adolescence. It also examines common issues in adolescents related to physical and sexual, psychosocial, and cognitive development.
-Review: Chapter 10, "Nutrition" (pp. 166-185)
This chapter describes nutrition-related health problems in pediatric patients. It also provides guidelines for diagnosing and managing different types of nutrition disorders.
-Chapter 13, "Physical Activity and Sports for Children and Adolescents" (pp. 218-255)
This chapter provides guidelines for promoting and supporting physical activity for children and adolescents. It also identifies high-risk conditions for sports participation and presents strategies for evaluating and managing sports participation for athletes with health conditions.
-Review: Chapter 14, "Sleep and Rest" (pp. 263-272)
This chapter provides strategies for the prevention and management of sleep problems in pediatric patients. It also identifies special considerations for children with chronic disorders.
-Review: Chapter 17, "Role Relationships" (pp. 334-344)
This chapter explores circumstances that create role-relationship problems in family units such as violence, neglect, maltreatment, and physical and sexual abuse. It also presents strategies for assessing and managing families presenting with these circumstances.
-Chapter 18, "Sexuality" (pp. 345-357)
This chapter covers the assessment and management of normal sexual development. It also identifies red flags for abnormal sexual behavior among children and adolescents.
Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics.
-Review: "Promoting Healthy Nutrition" (pp. 121-145)
This chapter examines the impact of environment and culture on patient behaviors related to food and nutrition. It also explores essential components of nutrition for children from preconception through adolescence.
-Review: "Promoting Physical Activity" (pp. 147-154)
This chapter describes physical activity as a growing problem. It also identifies strategies for promoting physical activity, including age-appropriate activities for infants, children, and adolescents.
-"Promoting Healthy Sexual Development and Sexuality" (pp. 169-176)
This chapter explores strategies for promoting healthy sexual development and sexuality among pediatric patients from infancy through adolescence. It also examines sexual behaviors among adolescents, including onset of intercourse, pregnancy rates, and sexually transmitted infections.
-Review: "Promoting Safety and Injury Prevention" (pp. 177-191)
This chapter explores two categories of issues relating to safety and injury prevention and examines strategies for promoting safety among infants, children, and adolescents.
-"Middle Childhood" (pp. 463-514)
This chapter explores the care of children from ages 5 to 10 years. It identifies concerns related to their growth, health, behavior, school progress, and safety. It also presents common parental concerns and strategies for educating parents and children about health issues and puberty.
-"Adolescence" (pp. 515-575)
This chapter explores the care of adolescents ranging from 11 to 21 years. It focuses on their physical, cognitive, emotional, and social transitions relating to their family, friends, school, and jobs.
Schapiro, N. A. (2009). Confidentiality and access to adolescent health care services. Journal of Pediatric Health Care, 24(2), 133-136.
This article explores the development of adolescent confidentiality policies in the United States. It also examines confidentiality issues related to adolescent health care, focusing on reproductive health, access to health services, and parental rights.