Patient Rights, Informed Consent, and Confidentiality
This domain tests the nurse's role in protecting patient rights, supporting valid informed consent, and safeguarding health information. Key sources include KRS 216.515 on patient rights, KRS 304.40-320 on informed consent, HIPAA, and Kentucky confidentiality statutes such as KRS 214.625 for HIV information.
Patient rights and consent
- KRS 216.515 establishes rights to respectful care, privacy, confidentiality, information, refusal of treatment, advance directives, pain management, and grievance procedures.
- Informed consent under KRS 304.40-320 requires the provider to disclose risks, benefits, and alternatives. The patient must have capacity and consent voluntarily; emergency exceptions apply.
- The nurse verifies and witnesses consent and confirms the patient's understanding, but does not substitute for the provider's disclosure. Minors generally require parental or guardian consent, subject to statutory exceptions.
Confidentiality
- HIPAA permits disclosures for treatment, payment, and health care operations, with minimum necessary use. Kentucky law may be stricter for HIV, mental health, and substance-use information.
- Disclose only to those with a need to know or with a valid authorization, unless a law requires or permits disclosure.
Worked example. An adult patient's family asks the nurse what the biopsy showed. The nurse confirms the patient has not authorized disclosure and explains that results cannot be shared. The nurse asks whether the patient wants family involved. If the patient lacked capacity, the nurse would follow the advance directive, guardian authority, and emergency exceptions rather than assume the spouse has automatic access.
Traps. Assuming a spouse has automatic access; accepting a signed consent form without confirming identity and procedure; discussing patients in public areas; releasing the entire record when a summary was authorized.