CONTEMPORARY ISSUES AND INTER PROFESSIONAL PRACTICE

THEME 1
Introduction
Interprofessional Practice (IPP) refers to a joint practice involving medical care givers
from a health work with their medical care givers from another discipline and with the
clients (patients) and their relations. For the purpose of this assignment, a scenario
has been explained in Scenario 1. This scenario explores the interprofessional
collaboration between me (a maternity support officer) and a midwife in the maternity
section of a hospital.
According to the Centre for The Advancement of Interprofessional Education in the
UK (CAIPE 2002), Interprofessional Education is defined thus:
“Interprofessional Education happens when two or more professions learn from, with
and about each other to enhance collaboration and the quality of care”
The Center for Interprofessional Practice (CIPP) at the University of East Anglia was
created in 2002 in light of the policy for social care and the wellbeing of the United
Kingdom (CIPP, 2018). Interprofessional collaboration is being taught in higher
institutions in other to prepare students for interprofessional practice during the
course of their professional career. Individuals from CIPP work together with
national and universal associates to improve health care by improving the skills and
knowledge of practitioners with the sole aim of enabling effective interpersonal
collaboration.
Overtime, there have been various reports with respect to the terrible standards of
healthcare displayed in the United Kingdom. These reports also suggested that
communication and effective teamwork is imperative for healthcare officials. The
present health trends in the United Kingdom require a workforce willing to deviate
from the 19th century means of collaboration and embrace the interprofessional
practice needed to deliver sustainable health care.
Interprofessional Collaboration is a potential answer for most of these issues as
interprofessional collaboration has helped reduce medical mistakes, improve patient
fulfilment, health and abilities of healthcare workers (Reeves et. al., 2007).
Information on various working practices and attention to various professional roles,
abilities and accountabilities are essential in driving improved human services (Dow
et. al., 2012). Collaborating for service users require cooperation and a dedication to
not only the services provided but of the providers too, which makes IPE profoundly
significant (Mickan et al, 2005).
In the United Kingdom, the General Pharmaceutical Council (GPhC), makes it a
prerequisite for Pharmacy (MPharm degree) courses to illustrate "learning that gives
knowledge of interprofessional practices and methods with other healthcare
colleagues" (General Pharmaceutical Council, 2016).
The aim of Interprofessional collaboration is to establish a committee with a shared
goal of enhancing the standard of care rendered to the patients through a pool of
interwoven skill, knowledge and expertise (Roa, 2003). With the joint efforts of
medical care givers, issues and problems which may emerge when delivering quality
care to the patients will be better handled as there is an effective synergy in the
employment of each member’s expertise and knowledge. This interprofessional
collaboration also adds to the internal sense of fulfilment felt by the medical care
giver when his/her job is performed satisfactorily.

Benefits of Interprofessional Practice

According to (Jakubowski and Perron, 2018), there is need for effective collaboration
between medical personnel from various disciplines to ensure that adequate care is
provided to the patient. For instance, the NHS (1997) policy document on
modernising the NHS from the Department of health stated that it is highly imperative
for the workforce to work effectively in groups across various medical institutions.
This implies that the team should be set up with personnel assigned as leaders and
members working together with a shared goal of improving patient’s outcome. For a
good interpersonal relationship, there is need for total understanding of each
individual’s profession, training field and skill set. The knowledge and skill set of the
team in general can be effectively employed by a clear comprehension of the
terminologies, rules and focus of each individual discipline.
Merits of Interprofessional Collaboration include reduced avoidable errors, lowered
cost of medical care, enhanced quality of care rendered to patients, good
interpersonal relationship between multidisciplinary practitioners. The knowledge
transfer between disciplines would lead to reduced labour for all medical care givers
involved as lower efforts will be utilised in knowledge acquisition. Better relationships
will be cultivated amongst co-workers when they work closely together to achieve a
shared goal.
The concept behind interprofessional practice is the ability to cooperate with the
diverse team members without disregarding the knowledge and expertise of medical
care personnel in other disciplines. To ensure the improved well-being of patients
and the society at large, it is imperative to understand duties of each member of the
team interact professionally with patients and their relatives as well as develop
lasting relationships that seeks to aid the planning and implementation of measures
to enhance the services rendered. These have been incorporated by The American
Association of Colleges of Nursing in their curriculum for Advance Practice
education. It is also present in the curriculum of other medical disciplines
(Jakubowski and Perron, 2018).
In a statement in 2010 released by World Health Organisation (WHO, 2010)
advocating for Interprofessional education, there was major emphasis on the
learning process of students to include knowledge about practitioners from other
disciplines. The learning environment should also include students from other health
related professions. When further reviewed in 2016, it was established by the
Interprofessional Education Collaborative (IPEC, 2016) that there was a focus on
four different competencies.
In other to reap the benefits of interprofessional practice, certain elements have to be
in place. These elements are itemized below:
a) Cooperation: The importance of cooperation in interpersonal practice cannot
be underestimated. It refers to the eagerness of one party to search for, listen
to and acquire knowledge from the other party. In the scenario, the midwife
refused to listen to my suggestion, thus ignoring cooperation. This could have
led to a fatal outcome.
b) Assertiveness indicates the eagerness of one party to provide information with
all certainty, value and assist his/her colleague to achieve a mutual goal. A
lack of assertiveness is borne out of Hierarchy and power-related issues. In
the scenario, I was assertive enough by carrying out all necessary checks and
was attentive enough to attend to the patient.
c) Autonomy can be defined as the authority of one party to independently judge
situations whilst carrying out a plan of care. Autonomy depends on the
individual's extent of training and individual ability. Autonomy doesn’t
contradict Cooperation. It only serves to compliment collaborative effort.
Without Autonomy, the work would get tedious and the process would be
inefficient for both parties.
d) Responsibility/Accountability includes being responsible for choices made and
moves made. It incorporates both autonomous and shared components.
Responsibility can be in form of Independent Responsibility where each
healthcare provider is solely responsible for actions taken. Shared
responsibility on the other hand refers to a situation where both parties agree
to take a joint responsibility for decision making. Referring to Scenario 1, we
shared responsibility as a result of our respective codes of conduct.
e) Communication: Communication is the backbone of every relationship and
every worker is liable for what they communicate and how they go about it. It
is imperative for team members to share important information about the
patient with each other. The form of communication should also be agreed
upon. Verbal and/or written communication have their respect advantages
and should involve the service user. The importance of a feedback
mechanism in communication should also not be ignored. The communication
process between me and the midwife was flawed as she totally ignored my
suggestions and disregarded feedback mechanism.
f) Coordination refers to the proficiency and the proper organization of the
treatment plan. Each service provider should be sure of their respective job
functions, who is responsible for what and who the leader is. This is
imperative in ensuring the treatment plan is adhered to. Service users and
their families should also be kept abreast of all happenings. Proficient
coordination helps avoid discontinuity and accidental duplication, and
guarantees that proper care is delivered to the service user.
g) Mutual respect and trust is a sort of glue that holds all other elements
together. Without trust and respect, the other elements are as good as
 useless. Trust refers to the ability of team members to rely on each other,
accepting that everybody is equipped and dependable and will act within their
very own extent of training. Respect is valuing and acknowledging the
different contributions that each professional brings to a table during
interprofessional collaboration. Being sure of "who does what" underpins
respect and trust. The midwife didn’t trust me as a result of the power
hierarchy between us and as such my ideas were ignored.

Current Issues affecting the Workplace

The implementation of interprofessional Practice in the United Kingdom has always
been met with various challenges. Issues such as deficient training, professional
boundaries, organizational barrier and perceived knowledge have plagued the
implementation of Interprofessional practice. These issues were also highlighted in
the scenario.
A research carried out by Saw et. al. (2017) and Loffler et. al. (2017) showed that
professional boundaries was a major impediment to Interprofessional Collaboration.
Examples of Professional boundaries are limited work experience between both
parties, negative previous experience and negative attitude related to previous
experience. A negative opinion of the co-worker has been reported to affect
communication as a result of assuming each other’s responsibilities and overlapping
responsibilities (RIeck, 2014). The midwife I worked with felt I didn’t have the
requisite experience to handle such an issue. Instead, she solely relied on her own
work experience.
Another impediment to Interprofessional practice is a distorted view of the function of
the other professional and difficulty in figuring out who should do which work. This
usually occurs when the roles of both parties are not clearly spelt out (Tan et. al.,
2014). The midwife in Scenario 1 didn’t have an idea of what my job functions were
as these were not documented. She rather preferred I played second fiddle to her. In
addition, collaboration can be hindered when one party expects the other party to
function independently (Legault, 2012).
According to Maidment et al. (2016), another issue that can result in ineffective
collaboration is power related issues and hierarchy. In such cases, one party sees
the other party as being inferior, therefore refusing to take advice from them. Related
to this issue is a lack of respect and trust as stated by Weissenborn et. al. (2017). In
other to build trust and respect in a collaborative relationship, factors such as
effective communication, understanding of each other’s job and willingness to
cooperate must be imbibed (Rathbone et al., 2016). As stated earlier, the midwife
didn’t trust my ability as a result of the power hierarchy between us.
Bidwell & Thompson (2015) research highlighted a negative perception of the
second party skills as a factor that affects collaboration. There are also cases where
one party might refuse to divulge necessary information to the other party as a result
of fear for the patient’s confidentiality. These perceived difficulties have resulted in
poor delivery of healthcare to service users. In conclusion, these and many other
issues can be sorted out by providing the relevant education and training to
healthcare givers. These trainings should encompass the importance of
interprofessional collaboration and elements that aid its successful implementation.

The Importance of Supporting Service Users

Service Users are individuals who utilize the healthcare services. In this case study,
the service user was the pregnant lady. For interprofessional collaboration to be
effective, the service users should be at the heart of all decision making. This will
help improve their self-esteem, emotional well-being and empower them. A research
carried out by Kelly et. al., (2013) suggested that interprofessional teams should
partner with services users and their families in other to make sure that the decisions
made are in their best interest. The basic functions of collaboration for service users
is provision of support, confidence, solace and improved satisfaction (Longtin et al,
2010).
The major aim of interprofessional collaboration is to improve the healthcare of the
supporting user (Nancarrow et al, 2013). In other to provide the needed services for
the service user, it is imperative that all healthcare workers imbibe interprofessional
collaboration by effectively combining their skills and knowledge. I and the midwife
failed to provide the necessary care and satisfaction for the service user as a result
of our failed interpersonal collaboration. This could have led to a fatal outcome if not
properly handled. According to the Bridges et al (2011), the elements of professional
collaboration are accountability, trust, assertiveness, respect, communication,
responsibility and coordination. A lack of these elements often results in a poor
outcome for the service user such as deaths, increased hospital stay, lack of
coordination, poor communication, and high service cost.

THEME 2
Core Competencies for Interprofessional Collaborative Practice
The codes of conduct for the maternity support worker and the midwife are
highlighted in scenario 2. The Interprofessional collaborative Practice core
competencies were created by a committee of professionals under the
Interprofessional Education Collaborative. Professional Education institutions had
delegates that sat on the committee. These delegates were drawn from six unique
professional education institutions. In 2016, the core competencies were reviewed
and revised (IPEC, 2016).
 Interprofessional Practice Principles:
"A conducive environment fostered through shared goals and reciprocated respect
should be maintained while working with members from different professionals."
(IPEC, 2016).
To achieve the shared goal of ensuring high standard of health care is provided to
the patient, there must be reciprocated trust, clarity, ethical procedures and respect
when dealing with associates from other medical disciplines.

 Roles/Responsibilities:
"The needs of the patients and the society would be suitably evaluated and tackled
through the implementation of the pooled knowledge of the unique responsibilities of
each member of the interprofessional team” (IPEC, 2016).
A clear comprehension of the responsibilities and duties of each member of
interprofessional team ensure that a wholesome, productive and efficient health care
is provided to the patients.

 Interprofessional Communication:
"A team based approach should be maintained when communicating with clients,
their relatives, the society and members from other medical disciplines to ensure
improved overall health” (IPEC, 2016).
Effective communication in interprofessional relationship is achieved by active
listening, mutual respect in responding and advocating for common grounds during
dialogue. The midwife clearly shunned this as explained in scenario 1.

 Teams and Teamwork:

"A plan that is centered around delivering quick, safe, productive, equivocal and
efficient healthcare to patients/ populaces through careful application of team
building principles to ensure each members fully understand and respect their
individual roles and that of their counterparts" (IPEC, 2016).
Team work is encouraged by the careful understanding of the dynamics of team
building, continuous development and conflict resolution.

Professional Accountability of Care

Accountability is an essential part of maternity care practice. Maternity specialists
must be qualified to provide the essential observation, care and guidance to women
during labour and after delivery of the baby. They are also responsible for the care of
the new-born (Nursing and Midwifery Council, 2018).
As indicated by their professional code of conduct, a registered healthcare worker is
responsible for his/her practice and in carrying out their professional duties, they
must function in a collaborative manner with other officials involved in providing
healthcare to service users. They must also recognize the responsibilities of their
colleagues during the course of providing healthcare (United Kingdom Central
Council for Nursing, Midwifery and Health Visiting, 1993). For midwives, their
professional code of conduct instructs them to function collaboratively with doctors
and caregivers in pathological cases. Another term for this is Clinical governance.
Clinical governance is defined by NHS (2007) as a situation whereby caregivers are
held responsible for the efficacy of healthcare offered to service users.

Legal and Policy Framework

While the world is battling with a lack of healthcare workers, policymakers are
seeking strategic means of creating regulations and policies that should improve the
healthcare workforce worldwide. One of such policy frameworks is the Framework
for Action on Interprofessional Education and Collaborative Practice (WHO, 2018).
This framework discusses the present state of interprofessional practice globally and
suggests methods that can help improve interprofessional collaboration as well as
action items that can be utilised within various localities. The ultimate objective of the
framework is to create ideas and methodologies that will assist policy makers to
effectively execute interprofessional collaboration in their individual locality.
Additionally, there is a need for service agencies and service users to be involved in
the creation of an adoptive framework alongside healthcare professionals. The role
of the patient or service user is usually ignored. In recent times, there has been a
dearth of frameworks for interprofessional practice (Charles et. al., 2011).The
requirement for a consistent set of skills for interprofessional practice in healthcare
has been emphasized (Tataw, 2011). It is recommended that models or frameworks
of training for interprofessional practice ought to completely reflect about the
significance of reflection-on-practice on those skills and capacities. Experts and
teachers will learn and be positively impacted, and these frameworks should be
revised overtime.

THEME 3
Power Hierarchy
There are levels of authority present in interpersonal collaborations. In Scenario 1, I
tried to convince the midwife about the situation on ground based on my personal
observation but she shunned my opinion as the power hierarchy was high and she
had a lot of experience compared to me.
Power Hierarchy can be shown in various manners in the field of healthcare.
Hierarchy is often present between the various forms of medical personnel which
include doctors, nurses and other medical staffs. In a fair patient-provider
association, decision making should be communal. For an instance, a healthcare
provider making deliberations on the suitable treatment options by taking into
cognisance the patient’s daily routine and lifestyle.
If there is a disagreement or inadequate transfer of information among medical
professionals, the patients will be greatly impacted. Results of study of
Interprofessional education and practice by researchers show that hierarchy is a
major source of disagreement in a team comprising of different healthcare disciplines
(Schaik, Plant, & O’Brien, 2015). In times past, the hierarchical framework of
healthcare structures often place physicians at the helm of the team. They take on a
seemingly leadership position and are often known to be the sole decision makers of
the team (Lancaster, Kolakowsky-Hayner, Kovacich, & Greer-Williams, 2015).
In 2003, the Institute of Medicine published a report which implied that preventable
medical errors that occur may be accrued to hierarchical communication as a result
of the disparity in the professional standing of the team members, in addition, there
is no established leadership, role delegation and accountability train existing in the
health care team (Institute of Medicine, 2003). In a study by Feiger & Shmidt (1979),
a relationship was established between the degree of power hierarchy existing in a
medical care team and the outcome of the patient. These show that hierarchy would
have an unfavourable impact on the state of patients.
This power hierarchy often describes the society’s relational gap. This refers to the
gap between members in elevated positions (parents, instructors, medical
professionals e.g. doctors) and in subordinate positions (children, students, patient,
other medical professionals – non doctors). The subordinates tend to be silent to
ensure peace and harmony. Unavoidably, this results in a one way communication
stream such as instructions instead of dialogue, for instance, a parent-child
communication, physician-patient communication. Most times, if two healthcare
providers do not meet eye to eye about the appropriate treatment option for a
patient, the healthcare provider who is of lower standing would remain silent as a
sign of respect to his superior. This is not ideal as it may threaten the safety of the
patient.
For these power gaps to be overcome, mutual trust and an equal two way
partnership communications should be encouraged. This is sadly hindered by the
ever increasing workloads on the professionals and limited time frame for
consultation with the patients. In addition the disparity in background of education
[between the patient and physicians coupled with the subpar conversational skills of
medical personnel make two-way communication seem quite unachievable.
Trust is imperative in managing power hierarchy as it traverses disciplinary and
organisational limits. It necessitates a belief not just in one self but in the
competencies and principles of other participating individuals. There is need to be
confident that the other party will conduct himself in a manner that is fair and clear
and would not be driven by gutless ambition. Trust is an important element of
Interprofessional relationships associated with respect, capability and professional
character. Trust is often said to be earned and grows deeper as time advances. In
the absences of personal relationships, regulations, norms and rules can serve in the
place of trust.
Pain Management
Scenario 1 highlights a case where the midwife ignored pain management for the
patient and assumed she was pretending. She was clearly wrong about this and
should have handled it better. Labour, for most women is the most extreme pain they
have ever encountered. Pain is relative to the individual subjected to it (Whitburn et.
al., 2017). To some it may be enjoyable and to others excruciating. In a few cases,
both sensations have been recorded to occur simultaneously (Jones et. al., 2015).
Labour pain of women is often influenced by physiological (e.g. position of the baby
at birth), mental concerns (worry, trepidation) (Lundgren et. al., 1998) and the
relationship that exists between her and her health care giver (Karlsdottir et. al.,
2014). Though some women can go through this pain without medication, for other
women it is quite unbearable. Their health care givers need to apply a medically
conventional or unconventional approach to reduce the pain felt by their patients
(Jones et. al., 2012). This has made pain management an imperative element of the
health care plan created for pregnant women.
Though most qualified childbirth attendants asserted that they are well- informed in
managing labour pains, it was further discovered that the knowledge possessed by
them were grossly insufficient. In addition, they bore insufficient perceptions about
employing pain relief during the birth process. It can possibly be as a result of health
care givers being resolute in what they have been thought and not going further to
learn more in view of the changing times. Moreover, they are grossly ignorant of the
fact that what they know about pain management is inadequate (Lui, 2008). The
initial step in effective pain management is Pain Assessment. A harrowing 79% of
respondents picked the incorrect tool of pain assessment even though they alleged
to be conversant with pain management (Martensson and Bergh, 2011). Some
researchers discovered that most times, midwives wrongly assess labour pains. This
is equivocal to an inaccurate judgement which would affect the type, quality and
magnitude of pain relief given to the woman in labour (Mugambe et. al., 2007). This
puts the safety of the patient at great risk.
Poor labour pain management can be detrimental to the results of the labour. Many
researchers have found a link between labour pain management and labour
outcome with maternal satisfaction about child birth and the mother’s quality of life
(Hawkins. 2010). It is important to employ the correct tools of pain assessment and
management to prevent a harrowing experience for a woman in labour. In
interprofessional teams, it is the responsibility of the nurse-midwives to evaluate,
tend and monitor the pain felt by the patient during labour. Hence, they should be
knowledgeable on the principles and directives on pain management (Onibokun,
2009). They need to be very familiar with contemporary guidelines on pain
management. Labour pain management is considered as a fundamental human
right (Abushaikha, 2005). Therefore, Health workers have been mandated to ensure
that the labour pain of patients is controlled and reduced. This is to ensure that the
goals of maternity health care workers which are improved birth results and fulfilment
are achieved (Hodnett, 2002).
If pain relief is requested for by the patient, it is the responsibility of the midwife to
advice and help the woman conclude on the most suitable method in view of the
contextual situation. If this is a first time labour for the woman, it will not be easy to
develop strategies of pain management before the appointed delivery pain. The
intangibility of labour pain means that its magnitude and form is highly unpredictable.
Some critical judgements/conclusion may affect the labour itself. During antennal
classes, the midwives should discuss with the patient and enlighten her on the pain
relief methods available for the patient to decide. A recorded birth plan should be
kept and reviewed before the woman can finally conclude on which to adopt.

Conclusion
According to Mackenzie et. al., (2014), all 7 elements of success must be present for
interpersonal collaboration to be successful. From scenario 1, the collaborative
practice wasn’t strong enough and lessons have been learnt. The initial step in
collaborative practice is acquiring knowledge on other medical professions. This void
in knowledge transfer between two professions is mainly due to lack of active and
deep interaction (Silver et. al., 2009). During their education, students of the same
field often drift away together and unavoidably develop uninformed impressions of
the responsibilities of students of other medical professions.
For an effective interprofessional team, there was be a clear comprehension of each
member’s input as regard to their learning, focal point of practise as well as the
hindrances they face in their professions. A good team takes this into consideration
and build bridges to maximise the strength of the unit as a whole. Usually, the patient
himself in addition with his family stands to be ignored although they are members of
the healthcare team. This should not be so as they should be integrated into the
suitable health care plan. The success of every collaborative effort comes is
dependent on respect for other. Hence mutual respect and trust is the core of
collaboration (Lawn et. al., 2014). A patient’s care is not the responsibility of just one
single person. Each team member must trust in the competency of his/her fellow
team mates.
According to Grant et. al. (1995), Impediments to collaborative practice can be
overcome by:

 unanimous agreement on the primary goal being the care of patient

 reaffirm stand towards achieving the main objective of collaboration
 acquire knowledge about other medical disciplines
 do not disregard another’s knowledge and expertise
 Foster team work through trust building
 Accountability and delegation of responsibility for the care of the patient
 Open communication to deliberate and reaffirm goals and responsibilities
 Frequent dialogue for effective conflict resolution between team members
 Willingness to further work on overcoming impediments
SCENARIOS
Scenario 1
I was stationed to work as a maternity support officer whilst assisting the midwife on
duty in the maternity section of a hospital. I was going about my normal business
during my shift when this pregnant lady arrives the triage (the accident and
emergency section of the maternity ward). Immediately, she got in, she informed me
she was contracting and I abandoned all I was doing to make her my sole concern. I
picked up the assessment triage sheet and also gave her a urine pot as I felt she
would be needing it. Thereafter, I took her to the room, checked her vitals, did her
urinalysis, then I wrote down my observation on the assessment sheet. I wasn’t an
expert yet, so I had to call in the midwife on duty. I handed the observation sheet
over to her and explained the predicament of the patient. She said the pregnant
woman was lying as she only said she was contracting to escape their immediate
environment. This sounded logical as the patient came alone but I wasn’t sure she
lied to me about her contractions.
After a short while, I heard the sound of the buzzer and I attended to the patient who
continually complained of severe pain. I ran out of the room to inform the midwife of
the patient’s predicament. She replied that she has been a qualified midwife for the
past 15 years and had a lot of experience with situations like this and she knows
when a woman is actually contracting. I tried to convince her but there was little I
could do as the power hierarchy was high and she had a lot of experience compared
to me.
About thirty minutes later, the midwife entered the room to connect the
Cardiotocography (CTG) monitor to the patient and left immediately. Within another
ten minutes, the alarm on the monitor bleeped and I went in to check on her only for
me to realize that the baby’s heartbeat was going down. Ideally, a baby’s normal
heartbeat rate is around 110 to 160 beats per minute, but the patient’s baby
recorded a heartbeat of about 60 to 80 beats per minute. I had to quickly pull the
emergency buzzer to intimate others of what was going on. Within a short time, all
medical professionals were in the room and I was told to get a scanner to scan the
baby.
A decision was made by the professionals shortly and the patient was wheeled into
the theatre to save the baby’s life. The decision made was to carry out an
emergency caesarean section within the shortest possible time. This was the only
way we were able to save the mother and her child.

Scenario 2 – Code of Conduct

I work as a maternity support worker and my code of conduct is to respect individual
cultural values. I also has to ensure I worked in collaboration with the midwife to
ensure the delivery of high quality, safe and compassionate healthcare, care of
support.
My job descriptions are:

 Preparing clinical area

 To support and reassure the woman and birth partner
 To assist midwives with instrumental deliveries
 To sterilize feeding equipment
 Restock and re-order equipment
 To do observation e.g. blood pressure, temperature, pulse rate
 Check urine
 Record observation
 Obtain urine from mother
 Recognize signs of ill health in mothers and report to midwives
 Assisting with the care of babies
 Reporting to midwives

I worked with a midwife and her code of conduct are:

 To be honest, open and transparent with patients when something goes

wrong in their care.
 To communicate in an open and effective way
 To respect people’s right to confidentiality.

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