Confidentiality

Confidentiality is a cornerstone in a trustful relationship between staff and residents. Upholding confidentiality is fundamental to building trust. All healthcare workers have a duty of confidentiality. Confidentiality, of course, also applies to life stories, relationships with relatives and events at the residence. The staff member must sign that they are bound by confidentiality when they are hired. Each care unit should continuously discuss what confidentiality means and how it should be handled.

There are occasionally built-in structures where habits or rituals maintain a distance between the residents and the staff. When I was at an elderly home, they were going to serve coffee. I took a cup from the cupboard and poured my coffee. A staff member came rushing and said "No, not that cup, it's a patient cup". Of course, I had to ask if they didn't wash the residents' mugs?

Sometimes you hear healthcare workers tell revealing anecdotes about what happened at the elderly home. Even if they don't mention names, it's ethically tricky to make fun of aging. It's as bad as making fun of immigrants, women, people with functional variations or homosexuals. If there is no room to talk and reflect on the difficult things at work, it can be hard to cope with what happened when the employee comes home. In the worst case, the individual may break the confidentiality because the experiences overflow.

Our view of humanity is reflected when we talk about others. Making fun of a sick person's behavior is a way to distance oneself from them. The behavior risks reducing trust in healthcare.

There may be relatives who spend a lot of time at the unit that they become like one in the team. Relatives are not bound by confidentiality and staff absolutely must not disclose information about other residents.

Freedom to communicate

The freedom to communicate is constitutionally protected. Trying to investigate the source of information that comes out in the media is a serious crime. The freedom to communicate is a vent when the quality fails. Employees in publicly funded healthcare and care are covered by the freedom to communicate regardless of whether the operation is in public or private operation. At the same time, everyone has a responsibility for when and how we use our freedom to communicate.

In short, the protection for informants means the following:

• Employees or others who are employed in the business have the right to acquire and give verbal information for publication in constitutionally protected media
• They have the right to be anonymous.
• The employer must not try to find out who has given the information.
• They must not take actions that lead to negative consequences against anyone who has used their rights according to the law.

We all have a constitutional protection of fundamental freedoms and rights such as freedom of speech and freedom of opinion among other things the so-called informant protection. The protection was extended a few years ago to include employees who work in private healthcare and care or school operations financed by the municipality, region or the state.

The rules contain several principles.

• Acquisition freedom means that newspapers, radio and TV have the right to search for and publish information about the business without being penalized.
• The freedom to communicate means the right to provide information on any subject for publication.
• Protection of anonymity means the right to request to be anonymous and a prohibition for publishers to reveal who has given the information.
• Investigation prohibition means that others do not have the right to try to find out who has given the information.
• Prohibition of reprisals means that no one has the right to take actions that lead to negative consequences against anyone for exercising their right to provide information.

The law applies if you provide information. The informant protection does not apply to documents or other records. It does not apply to information that falls under the duty of confidentiality. If there is suspicion that an employee has provided information covered by confidentiality, which is a crime, the employer must not try to find out who has given the information themselves. Instead, the employer can report the incident to the police.

Social media is usually not covered by the informant protection. Anyone who exposes their employer on social media or provides information to competitors has no protection from the freedom to communicate.

Protected Personal Data

People with protected identities are not common in elderly care, but they occur. It places special demands on the elderly home and the routines. It's important to keep track of what level of protected identity the individual has. Some journal systems can handle people with protected identities while others cannot. Special routines are required.

The person who is subjected to a serious and concrete threat can apply for protected personal data at the Tax Agency. There are three types of protected personal data: secrecy marking, remaining writing and fictitious personal data.

Secrecy marking is the lower degree of protected personal data. A secrecy marking is an administrative measure that makes it harder for others to access personal data in the population register. The secrecy marking covers all personal data for the current person.

A secrecy marking serves as a warning signal that an assessment should be made before the data is disclosed. It is therefore not absolute secrecy.
Protected census, previously called "remaining writing" provides stronger protection than secrecy marking. When a person gets a marking for protected census, he/she can be registered in the old municipality even though he/she has moved from there. The person can be registered in another municipality that he/she has no connection with. The old address data is deleted and the new address is not registered in the census, and is never spread to other authorities. An address to
The Tax Agency is registered where the mail is sent. Information about protected census is sent to the region.
For those who are exposed to particularly serious crime and threatened to life, health or freedom, a decision can be made on fictitious personal data or a new identity. This means that the person gets new identity data, for example a new name and new social security number. Decisions on fictitious personal data are made by the Police.

It is not common for older people to be exposed to such threats, but it happens. It is then important to have good routines to protect those who live under threat.

Reflection - trust in healthcare
Care Staff:
• Do you have good structures to be able to end the work shift and leave thoughts about work when you go home?
• Do your colleagues know what confidentiality means?
• Do you have conversations about how you talk about your work outside the workplace?

Manager, Nurse, Occupational Therapist and Physiotherapist:
• Is there room to document and discuss what happened during the work shift before going home?
• Have you been in situations where employees have disclosed information about the operation?
• Are you aware of the prohibition to investigate who has disclosed information to the media?

Residents and Relatives:
• Is it possible to have a good dialogue with the staff where confidentiality is respected at the same time?
• How do you handle things you see and hear in connection with visiting the unit?
• How would it affect you if negative things were written in the media about your elderly home?

Erland Olsson
Specialist Nurse
Sofrosyne - Better Care Every Day