# Situation: A 29-year-old factory worker is admitted to the psychiatric unit of a general hospital two days after his wife left him. The nurse uses theoretical models to plan his care. His supervisor telephones the unit, asks whether he is confined there, and asks for his diagnosis for the company's records. He has not consented to the release of any information. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629975  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 29-year-old factory worker is admitted to the psychiatric unit of a general hospital two days after his wife left him. The nurse uses theoretical models to plan his care.

His supervisor telephones the unit, asks whether he is confined there, and asks for his diagnosis for the company's records. He has not consented to the release of any information. What should the nurse do?

## 보기

1. Confirm that he is confined but withhold his diagnosis
2. Neither confirm nor deny that he is a client on the unit **✔ 정답**
3. Give both, since his employer needs them for sick leave
4. Ask the supervisor to send the request in a signed letter

**정답: 2**

## 해설

The Mental Health Act (RA 11036) protects the confidentiality of information about a service user, including the fact of admission. Disclosure without consent is allowed only in listed exceptions, such as a court order or a life-threatening emergency, and an employer's request is none of these. The nurse gives no information and may offer to pass the message to the client, who can decide what to share.

## 심화 해설

Legal and Ethical Basis

The situation involves a request for information about a psychiatric admission from an employer who has not been authorized by the client. Under mental health legislation such as the Mental Health Act, the duty of confidentiality extends not only to clinical details but also to the fact that a person is receiving care on the unit. The nurse must neither confirm nor deny that the individual is a client, because even acknowledging admission would disclose protected information. An employer’s request for records does not fall within the recognized exceptions that permit disclosure without consent, such as a court order or an immediate threat to life. The correct action is to give no information and, if appropriate, offer to relay the caller’s message to the client so that the client can decide what to share.

Why the Other Options Are Incorrect

Confirming that he is confined while withholding the diagnosis still reveals that he is a psychiatric inpatient, which is itself confidential. Giving both the admission status and the diagnosis is a clear breach because the employer is not an authorized recipient, and sick leave paperwork does not override the legal protection. Asking the supervisor to send a signed letter does not solve the problem; written consent from the employer is not the same as consent from the client, and the nurse cannot disclose information based on the requester’s administrative needs.

Applying Confidentiality in Practice

Confidentiality in health care is not simply about keeping secrets; it is a legal and ethical duty that supports trust and effective care. Duty of confidence means that information obtained in the course of care is shared only for the purpose of providing care or when the client gives valid consent or the law requires disclosure. In psychiatric settings, the protection is often stronger because stigma and discrimination can follow a mental health admission. The nurse’s role is to protect the client’s privacy while also facilitating communication that the client chooses to permit.

| Requester | Can the nurse confirm admission? | Reason |
| --- | --- | --- |
| Client’s spouse or family | Only with client consent | Family members are not automatically entitled to information |
| Employer or supervisor | No | Not a treatment provider or legal exception |
| Court with valid order | Yes | Legal compulsion overrides confidentiality |
| Emergency care team | Yes, if needed to prevent serious harm | Life-threatening emergency exception |

Key point! The test of disclosure is not who is asking, but whether the client has consented or a recognized legal exception applies. An employer’s request for company records does not meet either condition.

Informed Consent and Disclosure

Informed consent is the foundation for sharing health information. Informed consent requires that the client understands what information will be shared, with whom, and for what purpose, and then gives permission voluntarily. In this scenario, the client has not consented to any release of information. The nurse cannot assume that employment-related needs justify disclosure. Even the fact of admission is protected, so the safest and most legally sound response is to neither confirm nor deny the client’s presence on the unit.

Nursing Advocacy and Ethical Responsibility

Nurses act as advocates for clients who may be vulnerable, including those admitted to psychiatric units. Advocacy includes protecting the client’s right to privacy and ensuring that information is not released improperly. Watch out! A well-meaning but incorrect response, such as confirming admission to help with sick leave, can cause harm by exposing the client to stigma or employment consequences. The nurse’s ethical duty is to uphold confidentiality unless the client gives consent or the law clearly requires disclosure.

Practical Response to the Telephone Call

When the supervisor calls, the nurse should state that no information can be given about any individual without proper authorization. The nurse may offer to take a message and, with the client’s permission, pass it along. This approach respects the client’s autonomy and allows the client to decide whether to contact the employer. The decision to disclose any information belongs to the client, not to the nurse or the employer.

## 임상 시나리오

Psychiatric Admission ConfidentialityProtecting the fact of care under the Mental Health Act
Confidentiality extends to the fact of admission, not just clinical details. The nurse must neither confirm nor deny that the individual is a client on the unit.

Disclosure without consent is permitted only in listed exceptions such as a court order or a life-threatening emergency. An employer's request is not one of these.

The nurse may offer to relay a message to the client, allowing the client to decide what information to share.

CautionA signed letter from the employer does not replace client consent. Even confirming admission status is a breach of protected information.

## 핵심 개념

- **Mental Health Act (RA 11036)** — Philippine law protecting service user confidentiality, including the fact of admission, with limited exceptions such as court order or life-threatening emergency.
- **Duty of confidentiality** — Obligation to protect all information about a client's care, including whether the person is receiving services.
- **Disclosure without consent** — Release of protected information without client authorization; permitted only in specific legal exceptions.
- **Authorized recipient** — A person or entity legally entitled to receive client information, typically requiring client consent or legal mandate.

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