Thank you to the College of Registered Nurses of British Columbia for permission to adapt their case study.
Wendy, a home care nurse, is with her last client of the day. John has a stubborn diabetic leg ulcer that is not healing. After removing the dressing and assessing the wound, Wendy concludes that the ulcer has not improved, even after a change in wound care protocol five days earlier. Wendy will be away for the next two weeks and is concerned about John’s continuity of care. Several different nurses will be changing the dressing, making it hard to assess for any deterioration or improvement. Wendy decides to use her mobile phone to take a picture of John’s ulcer. She can then email the photo to her office computer and print a copy for John’s chart. That way, any nurse doing John’s dressing while she's away can compare the ulcer’s appearance over time. Wendy turns her phone on and takes a photo of the ulcerated area. At the sound, John glances up from his book, but doesn't say anything. She gives John a reassuring smile and dresses the ulcer according to the new protocol.
What do you think of Wendy’s actions? Was it appropriate to take a photo of John’s ulcer in this way so that she could show it to other nurses? How would you respond if Wendy asked you what you thought?
Despite Wendy’s good intentions, her actions breached John’s privacy. She neither explained her intention to John, nor obtained his consent to take the photo and to share it with her colleagues. Some might think that John’s silence implied consent. In fact, that’s not the case. It is important to not assume that when John did not say anything about having the photo taken, that he agreed with Wendy’s actions. Wendy had a professional responsibility to ensure that she discussed her reasons for wanting to take a picture of the wound and to make certain that John consented to the photograph and how Wendy was planning to share it. By not obtaining John’s consent, Wendy acted inappropriately. She infringed on John’s privacy by taking a photo of his leg ulcer without his consent. Additionally, Wendy also breached her employer policy by using her personal phone to store client information.
While Wendy’s intent was to support continuity of care for John, she needed to make sure that she followed the Practice Standards for Regulated Members and legal processes to obtain information. This includes:
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