Patient Privacy and Dignity

10 min read Training Guide

Protect a person's body, choices and health information during everyday care, and respond correctly when someone refuses.

Table of contents

People who need care have often lost control over a lot of their lives. Someone they barely know helps them bathe, use the toilet and get dressed. Protecting privacy and dignity is how you give some of that control back. It is also the law. Patients have the right to refuse care, and federal rules protect their health information.

What You Will Be Able to Do

  • Protect a person's body and personal space during care.
  • Offer real choices, even to someone who needs a lot of help.
  • Respond correctly when someone refuses care.
  • Explain what protected health information is and how to keep it private.
  • Handle phones, screens and family questions without breaking confidentiality.

Respect Starts at the Door

A person's room, or their own home, is their space. Knock before you enter, even if the door is already open, and wait for a response if they are able to give one. Knocking tells someone their space is theirs, and it gives them a moment to get ready.

Say who you are and why you are there. Use the name the person prefers, not "honey" or "sweetie." Ask before you touch them or their belongings. Talk to them, not over them, even if they cannot answer. Treat an adult as an adult, whatever their memory or ability.

Protecting a Person's Body

During personal care, your job is to keep the person covered except for the part you are working on.

  1. Close the door and pull curtains or blinds.
  2. Keep a bath blanket or towel over the body, uncovering one area at a time and covering it again when you finish.
  3. Help a person onto a commode or toilet, then step away if it is safe and stay within earshot.
  4. Ask whether they prefer a same-gender caregiver for intimate care, and tell the nurse or scheduler if they do.
  5. Do not discuss care in front of visitors. Ask visitors to step out before you begin.

Keep your face and voice neutral during bathing and toileting. A wrinkled nose or a joke can shame someone for days.

Offering Choices

Small choices matter. Offer them often, and offer real ones.

  • "Would you like the blue shirt or the gray one?"
  • "Do you want to wash your face first or brush your teeth?"
  • "Would you rather shower before or after breakfast?"

Encourage people to do what they can for themselves, even if it takes longer. Doing everything for them takes away independence and strength.

When Someone Refuses

Adults have the right to refuse care, including a bath, a meal, a medicine or a treatment, even when you think it is a bad idea. Your job is to respect the decision and make sure the nurse knows.

  1. Stay calm and acknowledge the choice. "All right. I hear that you don't want a bath right now."
  2. Ask why, without pressure. They may be cold, in pain, embarrassed or tired.
  3. Offer an alternative, such as a later time or a sponge bath.
  4. Tell the nurse about the refusal.
  5. Document what was refused, what the person said, what you offered and who you told.

Do not argue, threaten or force care. Forcing care on someone can be abuse. If a person refuses care that protects their safety, such as a treatment for a wound or a medicine, tell the nurse right away. The nurse will talk with them and decide what happens next.

Keeping Health Information Private

HIPAA, the Health Insurance Portability and Accountability Act, is the federal law that protects health information. Protected health information, or PHI, is any information that identifies a person and relates to their health or care. That includes their name with a diagnosis, date of birth, address, photo, medical record and even the fact that they receive care from your agency.

Follow these rules:

  • Minimum necessary. Look at and share only the information you need to do your job. Do not look up a neighbor, a coworker, a celebrity or yourself.
  • Share only with people who are entitled to know. That usually means the care team and those the patient has authorized.
  • Talk in private. Do not discuss patients in elevators, hallways, break rooms or on public transportation.
  • Protect paper. Keep charts and care plans closed and out of view.
  • Protect screens. Keep phones and tablets angled away from visitors and lock them whenever you are not actively using them. Never let anyone use your login.
  • Stay off social media. Do not post photos, stories or comments about patients, even without a name. Details can identify someone.
  • Keep it after you leave. The duty to keep information private continues after your shift ends and after you leave a job.

When a Family Member Asks

A son or daughter is not automatically entitled to information. If someone calls or asks about a patient, do not share details. Refer them to the nurse, who can check whether the patient has authorized that person. An alert adult decides who gets to know.

When It Is Safe to Share

HIPAA does not stop you from getting help. In an emergency you can tell 911, paramedics and hospital staff what they need to know to protect the person. You can also report suspected abuse or a serious threat to safety as required by law.

Common Mistakes

Mistake What it costs
Walking in without knocking The person loses privacy and trust
Uncovering the whole body to save time Embarrassment and chill
Giving up after a refusal without telling the nurse A real problem goes unnoticed
Discussing a patient on the bus or at lunch A privacy violation and possible firing
Looking up a neighbor's chart A violation even if you tell no one, and access is often tracked

Check Your Understanding

1. The door to a resident's room is wide open. Do you knock?

Yes. Knock and announce yourself. An open door does not mean you are invited in.

2. Mrs. Reed pushes the towel away, says "Not today" and looks upset. What do you do?

Respect the decision and ask gently what is wrong. Offer another time or a sponge bath, then tell the nurse and document the refusal.

3. A patient's nephew stops you in the hall and asks what is wrong with his uncle. What do you say?

Say kindly that you cannot share that, and refer him to the nurse.

4. A client collapses and the 911 operator asks about her medications and heart condition. Can you answer?

Yes. HIPAA allows sharing information needed to treat someone in an emergency.

Key Takeaways

  • Knock first and say who you are, every time.
  • Uncover only the part of the body you are working on.
  • Offer real choices, and let people do what they can.
  • Adults can refuse care. Respect it, offer an alternative, tell the nurse and document.
  • Use only the information you need, and never discuss patients where others can hear.
  • An emergency is never a reason to hold back from 911.