Confidentiality and the Sexual Assault Victim

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Forensic nurses must be alert to possible breaches of victim confidentiality and privacy.

After a sexual assault, victims turn to forensic nurses who work as sexual assault nurse examiners (SANEs) for medical treatment and evidence collection. SANEs, in turn, must balance victims’ rights to confidentiality and privacy with the duty to collaborate with law enforcement and the judicial system.

Confidentiality is an ethical obligation under professional nursing licensure and mandated under federal and state laws. Victim service organizations that receive federal funding face stiff penalties for breaking victim confidentiality and privacy. In their duties, SANEs are required to understand the rules and laws as they pertain to victims and be prepared to explain the limits of the laws.

“Confidentiality is an underlying value of a trauma-informed, victim-centered response to sexual assault,” the National Sexual Violence Resource Center (NSVRC) said. “SARTs (sexual assault response teams) committed to building such a response must understand both the policy considerations behind confidentiality and the ways in which confidentiality benefits the work of the team and empowers victims.”

Working as part of a SART or as a SANE in a hospital, forensic nurses must be alert to possible breaches of rape victim confidentiality and privacy. These breaches are not only illegal, they also erode at victim trust. Registered nurses (RNs) considering an MSN career as a forensic nurse must understand the complexities involved in confidentiality.

Understanding Confidentiality

Forensic nurses often work as part of coordinated community response (CCR) teams or SARTs, both of which have the ultimate goal of assisting sexual violence survivors and bringing perpetrators to justice. In their work, forensic nurses must understand the difference between confidentiality, privacy and privilege:

  • Confidentiality

A forensic nurse’s responsibility to keep victim information private.

  • Privacy

A victim’s right to disclose or not disclose information.

  • Privilege

An evidentiary rule prohibiting the release of private information without the victim’s consent.

When working a case, forensic nurses must follow confidentiality laws and regulations, including the:

  • Violence Against Women Act (VAWA)
  • Family Violence Prevention and Services Act (FVPSA)
  • Victims of Crimes Act (VOCA)
  • Health Insurance Portability and Accountability Act (HIPAA)

 VAWA, FVPSA and VOCA are federal regulations that prohibit the sharing of identifying victim information without written consent. The VAWA and VOCA also prohibit organizations from requiring confidentiality waivers as a condition of receiving treatment. The regulations allow victims to waive their confidentiality rights so information can be shared with providers for a specific purpose during a specific time period. Because many local sexual assault assistance centers, medical centers and hospitals receive federal funding, VAWA, FVPSA and VOCA apply to most victims.

HIPAA, also a federal mandate, requires providers to keep private medical information confidential in accordance with the patient’s preferences. Patients can waive their right to confidentiality as necessary.

The NSVRC said some of the information that is considered confidential with regard to the federal regulations includes:

  • Privileged communication between the victim and some professionals (including counselors and medical service providers)
  • Information that would identify the victim
  • Identities of the mandated reporters

Ethics and Privacy as a Forensic Nurse

In addition to the federal and state regulations that limit the release of information, the International Association of Forensic Nurses (IAFN) and the American Nurses Association have codes of ethics to guide practice.

In its Vision of Ethical Practice, the IAFN said forensic nurses must respect patient confidentiality, including advising patients about their rights to confidentiality and privacy. The ANA said confidentiality and the protection of privacy are a foundation for a trusting provider-patient relationship.

Overall, Jessica Mindlin, the Victim Rights Law Center’s (VRLC’s) national director of training and technical assistance and director of the organization’s Oregon office, said breaching privacy and confidentiality can be detrimental. When privacy and confidentiality are violated, victims may be less likely to come forward for help, she said.

“Start by building trust, recognizing that everyone who comes to the table has something important to bring and that you aren’t always going to be advancing your goals by sharing survivors’ personal information,” she said on the NSVRC website.

For RNs who hope to work as forensic nurses, learning how to apply privacy and confidentiality regulations is crucial to safe and helpful practice. RNs who pursue an online master’s in nursing degree at Duquesne University learn about the importance of following patients’ wishes and federal and state laws.

About Duquesne University’s Online Master’s in Nursing — Forensic Nursing

Duquesne University’s online MSN in forensic nursing program works in partnership with the university’s Cyril H. Wecht Institute of Forensic Science and Law. RNs learn about the legal and ethical issues involved in privacy and confidentiality from experts in the fields.

The 100% online program allows RNs to continue working in their current positions while advancing their careers. Graduates go on to work as SANEs, forensic nurse investigators, nurse death investigators and expert witnesses. Students can also add a concentration in nursing education or transcultural nursing to the coursework. Duquesne also offers an online Post-Master’s Certificate in forensic nursing for RNs who already have an MSN.

For more information about the programs, contact Duquesne University today.




 Confidentiality: NSVRC

Confidentiality: VAWA, FVPSA and VOCA: Technology Safety

HIPAA, Privacy & Confidentiality: CDC

Vision of Ethical Practice: IAFN

Privacy and Confidentiality: ANA