Ethical Dilemmas in Patient Confidentiality: A Case Study of Unintentional Disclosure in an Iranian Emergency Department

Ethical Dilemmas in Patient Confidentiality: A Case Study of Unintentional Disclosure in an Iranian Emergency Department | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Ethical Dilemmas in Patient Confidentiality: A Case Study of Unintentional Disclosure in an Iranian Emergency Department payam nikjo, Donya Rahmati, Paria Nikjo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6515152/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Confidentiality is a cornerstone of nursing ethics and a critical determinant of patient trust and safety. In culturally conservative societies, breaches of confidentiality can result in disproportionate social, psychological, and familial consequences, especially for sensitive medical issues. Case Presentation: This case study examines an ethical dilemma in an emergency department in western Iran involving a 26-year-old unmarried woman whose early pregnancy was unintentionally disclosed by a staff member. Despite initial adherence to confidentiality protocols, a colleague congratulated the patient in front of others, triggering a cascade of personal and social fallout. The patient’s partner denied paternity and informed her family, leading to her abrupt removal from care and loss to follow-up. Discussion : The incident underscores critical ethical gaps in team communication, cultural competence, and institutional safeguards. In high-pressure clinical settings, confidentiality must be proactively managed through structured ethical training, contextual risk assessment, and design of patient-centered communication environments. This case highlights how a lapse in discretion can escalate into a cultural crisis, demanding system-level reforms and a redefinition of ethical responsibility from individual to institutional. Conclusion : Maintaining confidentiality in culturally sensitive contexts is not a passive obligation but an active, dynamic responsibility. This case calls for a paradigm shift in ethical nursing practice—one that integrates cultural awareness, proactive communication, and systemic accountability to prevent harm and uphold patient dignity. Nursing ethics confidentiality emergency care cultural competence reproductive privacy Iran ethical dilemmas Introduction Maintaining patient confidentiality is a fundamental ethical and legal obligation in the nursing profession and across all areas of healthcare. It protects patients’ personal and sensitive health information, ensuring it is shared only with authorized individuals. Any breach—intentional or accidental—can result in significant psychological, social, and legal consequences for the patient and may undermine trust in the healthcare system.( 1 , 2 ) Such breaches are particularly prevalent in emergency departments due to their fast-paced, high-pressure, and often overcrowded nature, which increases the risk of unintentional disclosures.( 3 ) In culturally conservative societies like Iran, revealing sensitive medical information—such as an unintended pregnancy—can lead to serious social and familial repercussions, especially for unmarried women. These realities highlight the need for enhanced ethical vigilance, culturally sensitive care, and strict adherence to professional nursing codes of conduct.( 4 , 5 ) This case study presents a real-life ethical dilemma encountered in an emergency department in Iran, where the unintended disclosure of a patient’s pregnancy by a nurse led to a serious breach of confidentiality and significant consequences for the patient. The case underscores the real-world implications of ethical lapses and calls for systemic improvements in staff training, institutional protocols, and ethical preparedness tailored to the cultural context. Case Presentation A 26-year-old unmarried woman presented to the emergency department of a general hospital in western Iran with complaints of lower abdominal pain and mild vaginal spotting. She was accompanied by a man who introduced himself as her fiancé. The initial clinical evaluation, including a urine pregnancy test, revealed a positive beta-hCG result, confirming early pregnancy. The attending nurse, having reviewed the test results, respected the principle of confidentiality and refrained from disclosing the pregnancy status openly. However, another nurse—unaware of the sensitivity of the information—congratulated the patient and her companion in the presence of others, thereby unintentionally disclosing the pregnancy. The unexpected public announcement provoked an immediate emotional reaction from the man, who denied paternity and expressed visible shock. The situation quickly escalated when he contacted the patient’s family. Shortly afterward, family members arrived at the hospital visibly distressed and removed the patient from the emergency department against medical advice. Subsequent follow-up efforts to contact the patient were unsuccessful. Her clinical condition and psychosocial well-being remain unknown. This case illustrates the serious consequences that may result from even brief lapses in ethical conduct, particularly in conservative cultural environments where breaches of confidentiality can trigger significant personal and social harm. Discussion Confidentiality stands as one of the most sacrosanct pillars of ethical nursing practice, with implications that extend far beyond legal compliance. It is a profound manifestation of respect for patient autonomy, human dignity, and psychological safety. The case presented in this study illustrates how a single, momentary breach—particularly in sociocultural contexts where honor, family reputation, and traditional values weigh heavily—can cascade into devastating personal and systemic consequences.( 6 , 7 ) In this scenario, while the primary nurse adhered to confidentiality protocols, the inadvertent disclosure by a colleague reveals a deeper systemic issue: the fragmentation of ethical accountability in team-based care. It is no longer sufficient to consider ethical conduct as an individual responsibility. In high-stakes, high-flow settings such as emergency departments, ethical integrity must be embedded institutionally, reinforced operationally, and internalized collectively.( 8 ) From a cultural standpoint, the disclosure of a pregnancy outside of wedlock in Iranian society is not merely a personal revelation—it is a sociocultural crisis. The ethical mishandling of such information can trigger stigma, familial rejection, and even long-term psychosocial trauma. Thus, cultural competence in nursing must not be reduced to superficial awareness or symbolic gestures; it must involve deep ethical sensitivity, proactive risk anticipation, and nuanced communication skills tailored to local realities.( 9 ) Furthermore, this case exposes a critical blind spot in many healthcare systems: the absence of structured ethical preparedness for real-time decision-making. While codes of ethics such as those by the ICN or ANA provide broad principles, what is urgently needed are dynamic, scenario-based ethical simulations, routine interprofessional debriefings, and the integration of contextual ethics into continuing education curricula.( 10 , 11 ) On an institutional level, spatial design and workflow protocols should be reassessed. Open-plan nursing stations, overcrowded triage zones, and lack of designated private consultation areas are not just logistical challenges—they are potential ethical landmines. A patient-centered design must include privacy as a clinical priority, not an afterthought.This case also invites us to reconsider how ethical failures are addressed. Blame-oriented approaches are not only counterproductive but may suppress disclosure and learning. Instead, a systems-thinking approach is essential—one that investigates root causes, promotes a culture of ethical reflexivity, and empowers every team member to serve as a guardian of patient dignity. Ultimately, confidentiality in nursing is not just about silence—it is about strategic, culturally-informed discretion exercised with emotional intelligence and professional maturity. In societies where a word can unravel a life, ethical nursing is both a science and an art of protection. The lessons drawn from this case demand not only acknowledgment but also actionable transformation—in policy, in practice, and in pedagogy.( 12 , 13 ) Conclusion This case study sheds light on a stark and often underappreciated reality: a single ethical misstep, even when unintended, can precipitate irreparable harm—especially in socioculturally sensitive contexts. In emergency departments, where urgency can outpace ethical reflection, confidentiality must be actively protected, not passively presumed. The incident described here transcends a mere breach of protocol; it exemplifies a systemic failure to anticipate and address the ethical vulnerabilities embedded in everyday clinical routines. The profound cultural consequences of disclosing reproductive information in conservative societies highlight the urgent need for a more nuanced, context-aware ethical infrastructure in healthcare systems. Safeguarding patient confidentiality demands more than adherence to codes—it requires institutional commitment, interprofessional vigilance, and culturally competent communication. To prevent similar events, healthcare organizations must move beyond theoretical ethics and invest in dynamic, practical strategies: targeted education, scenario-based training, and privacy-conscious system redesign. In essence, ethical nursing care must evolve from a personal virtue to a collective imperative—one that is consciously cultivated, structurally supported, and relentlessly prioritized. Abbreviations Not applicable. Declarations Ethics approval and consent to participate Not applicable. This case report does not involve any experimental interventions and does not contain identifiable personal information that would require formal ethical approval. Consent for publication Written informed consent for publication of this case report was obtained from the patient’s mother, who is the legal guardian. A signed consent form is available upon request. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions Payam Nikjo conceptualized and wrote the manuscript. Donya Rahmati contributed to the clinical analysis and critical revisions. Paria Nikjo contributed to literature review and manuscript editing. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Olorunfemi O, Oyegoke EO, Abiodun OO, Kunle-Abioye FB, Ayeni BA. Achieving a balance between ethical and legal obligations with regard to confidentiality and patient privacy. Amrita J Med. 2024;20(3):90–3. Price B. Respecting patient confidentiality. Nurs Standard (2014+). 2015;29(22):50. Brenner JM, Delpier MY, Simon JR, Geiderman JM, Marco CA, Moskop JC, et al. Privacy and confidentiality of emergency department patient information: Contemporary considerations and challenges. JACEP Open. 2024;5(2):e13130. Jafari H, Khatony A, Abdi A, Jafari F. Nursing and midwifery students’ attitudes towards principles of medical ethics in Kermanshah, Iran. BMC Med Ethics. 2019;20:1–6. Ghavi A, Valizadeh L, Powers K, Zamanzadeh V. Professional ethical challenges and suggested strategies in nursing: a qualitative study. J Med Ethics History Med. 2024;17. Rashidi K. Invasion of Privacy, Breach of Confidentiality, and Related Factors and Consequences: A Case Report. Iran J Med Ethics History Med. 2023;16(1):68–76. Leyva-Moral JM, Feijoo-Cid M. Participants’ safety versus confidentiality: A case study of HIV research. Nurs Ethics. 2017;24(3):376–80. Mantel J. Ethical integrity in health care organizations. J Law Med Ethics. 2015;43(3):661–5. Nematollahi M, Farokhzadian J, Nayeri ND, Darban F, Faramarzpour M. Explaining the educational challenges in the path of cultural competence: The experiences of Iranian nursing students. J Prof Nurs. 2022;42:140–7. Firn J, Rui C, Vercler C, De Vries R, Shuman A. Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis. J Interprof Care. 2020;34(4):453–60. Lyle K, Weller S, Samuel G, Lucassen AM. Beyond regulatory approaches to ethics: making space for ethical preparedness in healthcare research. J Med Ethics. 2023;49(5):352–6. Våga BB, Moland KM, Blystad A. Boundaries of confidentiality in nursing care for mother and child in HIV programmes. Nurs Ethics. 2016;23(5):576–86. Dillard-Wright J, Valderama‐Wallace C, Canty L, Perron A, De Sousa I, Gullick J. What nursing chooses not to know: Practices of epistemic silence/silencing. Nurs Philos. 2023;24(3):e12443. Additional Declarations No competing interests reported. Supplementary Files care.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6515152","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":461490722,"identity":"7f8df3ed-a608-475b-8e8a-b0ae78385d0c","order_by":0,"name":"payam nikjo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIie3PPUvEMBjA8YTAU4fWrpWD+wyRQu/us7jkOOjUrNLhXjKdS8H1DuT8CorQuaXQLoVbFZeK4OTQMZvG3uLSdBXMfwh54PlBgpDJ9FdjEsaIWFXLYjURIobJW3LuI8sOUVv/EDxMcAPjuXBRgPfbbtaTiVVftswOsCAofHcOqyv3RhEZp71klkS+x6YhUe+pfCet+K7AAif1ay+hWUQ9ZpeACGIjJy25UITgrYYcP33J4MtWhI6cu5LfD5LnKPAYgKdIcLEXS/4wRGa7j+vpPAEKxF7Qtsz4oyK57i8Td/H0IiVsbt0qb9hyzQ/HIm9krHkYOqPdBU5z0Z1Z735HrOb3vNYtm0wm0z/tG4bpWSViCKxMAAAAAElFTkSuQmCC","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"payam","middleName":"","lastName":"nikjo","suffix":""},{"id":461490723,"identity":"fa580d9a-6b02-4e39-a476-01fa1dccf93d","order_by":1,"name":"Donya Rahmati","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Donya","middleName":"","lastName":"Rahmati","suffix":""},{"id":461490724,"identity":"126461d4-e931-4fe3-8261-ec07ad83d5b5","order_by":2,"name":"Paria Nikjo","email":"","orcid":"","institution":"Islamic Azad University Ardabil","correspondingAuthor":false,"prefix":"","firstName":"Paria","middleName":"","lastName":"Nikjo","suffix":""}],"badges":[],"createdAt":"2025-04-23 19:23:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6515152/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6515152/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85672591,"identity":"fbe242e5-4670-409d-b435-88523b684e4b","added_by":"auto","created_at":"2025-06-30 14:02:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":345966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6515152/v1/d7bf4204-445b-4a37-be6a-ec0efa33061c.pdf"},{"id":83435011,"identity":"eddca7c2-1912-4f6c-9f1d-ec74bfe4c79a","added_by":"auto","created_at":"2025-05-26 08:22:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":12602,"visible":true,"origin":"","legend":"","description":"","filename":"care.docx","url":"https://assets-eu.researchsquare.com/files/rs-6515152/v1/859e611dff3b2c3d2824608f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ethical Dilemmas in Patient Confidentiality: A Case Study of Unintentional Disclosure in an Iranian Emergency Department","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMaintaining patient confidentiality is a fundamental ethical and legal obligation in the nursing profession and across all areas of healthcare. It protects patients\u0026rsquo; personal and sensitive health information, ensuring it is shared only with authorized individuals. Any breach\u0026mdash;intentional or accidental\u0026mdash;can result in significant psychological, social, and legal consequences for the patient and may undermine trust in the healthcare system.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSuch breaches are particularly prevalent in emergency departments due to their fast-paced, high-pressure, and often overcrowded nature, which increases the risk of unintentional disclosures.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn culturally conservative societies like Iran, revealing sensitive medical information\u0026mdash;such as an unintended pregnancy\u0026mdash;can lead to serious social and familial repercussions, especially for unmarried women. These realities highlight the need for enhanced ethical vigilance, culturally sensitive care, and strict adherence to professional nursing codes of conduct.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis case study presents a real-life ethical dilemma encountered in an emergency department in Iran, where the unintended disclosure of a patient\u0026rsquo;s pregnancy by a nurse led to a serious breach of confidentiality and significant consequences for the patient. The case underscores the real-world implications of ethical lapses and calls for systemic improvements in staff training, institutional protocols, and ethical preparedness tailored to the cultural context.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 26-year-old unmarried woman presented to the emergency department of a general hospital in western Iran with complaints of lower abdominal pain and mild vaginal spotting. She was accompanied by a man who introduced himself as her fianc\u0026eacute;. The initial clinical evaluation, including a urine pregnancy test, revealed a positive beta-hCG result, confirming early pregnancy.\u003c/p\u003e \u003cp\u003eThe attending nurse, having reviewed the test results, respected the principle of confidentiality and refrained from disclosing the pregnancy status openly. However, another nurse\u0026mdash;unaware of the sensitivity of the information\u0026mdash;congratulated the patient and her companion in the presence of others, thereby unintentionally disclosing the pregnancy.\u003c/p\u003e \u003cp\u003eThe unexpected public announcement provoked an immediate emotional reaction from the man, who denied paternity and expressed visible shock. The situation quickly escalated when he contacted the patient\u0026rsquo;s family. Shortly afterward, family members arrived at the hospital visibly distressed and removed the patient from the emergency department against medical advice.\u003c/p\u003e \u003cp\u003eSubsequent follow-up efforts to contact the patient were unsuccessful. Her clinical condition and psychosocial well-being remain unknown. This case illustrates the serious consequences that may result from even brief lapses in ethical conduct, particularly in conservative cultural environments where breaches of confidentiality can trigger significant personal and social harm.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eConfidentiality stands as one of the most sacrosanct pillars of ethical nursing practice, with implications that extend far beyond legal compliance. It is a profound manifestation of respect for patient autonomy, human dignity, and psychological safety. The case presented in this study illustrates how a single, momentary breach\u0026mdash;particularly in sociocultural contexts where honor, family reputation, and traditional values weigh heavily\u0026mdash;can cascade into devastating personal and systemic consequences.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this scenario, while the primary nurse adhered to confidentiality protocols, the inadvertent disclosure by a colleague reveals a deeper systemic issue: the fragmentation of ethical accountability in team-based care. It is no longer sufficient to consider ethical conduct as an individual responsibility. In high-stakes, high-flow settings such as emergency departments, ethical integrity must be embedded institutionally, reinforced operationally, and internalized collectively.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFrom a cultural standpoint, the disclosure of a pregnancy outside of wedlock in Iranian society is not merely a personal revelation\u0026mdash;it is a sociocultural crisis. The ethical mishandling of such information can trigger stigma, familial rejection, and even long-term psychosocial trauma. Thus, cultural competence in nursing must not be reduced to superficial awareness or symbolic gestures; it must involve deep ethical sensitivity, proactive risk anticipation, and nuanced communication skills tailored to local realities.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore, this case exposes a critical blind spot in many healthcare systems: the absence of structured ethical preparedness for real-time decision-making. While codes of ethics such as those by the ICN or ANA provide broad principles, what is urgently needed are dynamic, scenario-based ethical simulations, routine interprofessional debriefings, and the integration of contextual ethics into continuing education curricula.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOn an institutional level, spatial design and workflow protocols should be reassessed. Open-plan nursing stations, overcrowded triage zones, and lack of designated private consultation areas are not just logistical challenges\u0026mdash;they are potential ethical landmines. A patient-centered design must include privacy as a clinical priority, not an afterthought.This case also invites us to reconsider how ethical failures are addressed. Blame-oriented approaches are not only counterproductive but may suppress disclosure and learning. Instead, a systems-thinking approach is essential\u0026mdash;one that investigates root causes, promotes a culture of ethical reflexivity, and empowers every team member to serve as a guardian of patient dignity.\u003c/p\u003e \u003cp\u003eUltimately, confidentiality in nursing is not just about silence\u0026mdash;it is about strategic, culturally-informed discretion exercised with emotional intelligence and professional maturity. In societies where a word can unravel a life, ethical nursing is both a science and an art of protection. The lessons drawn from this case demand not only acknowledgment but also actionable transformation\u0026mdash;in policy, in practice, and in pedagogy.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case study sheds light on a stark and often underappreciated reality: a single ethical misstep, even when unintended, can precipitate irreparable harm\u0026mdash;especially in socioculturally sensitive contexts. In emergency departments, where urgency can outpace ethical reflection, confidentiality must be actively protected, not passively presumed.\u003c/p\u003e \u003cp\u003eThe incident described here transcends a mere breach of protocol; it exemplifies a systemic failure to anticipate and address the ethical vulnerabilities embedded in everyday clinical routines. The profound cultural consequences of disclosing reproductive information in conservative societies highlight the urgent need for a more nuanced, context-aware ethical infrastructure in healthcare systems.\u003c/p\u003e \u003cp\u003eSafeguarding patient confidentiality demands more than adherence to codes\u0026mdash;it requires institutional commitment, interprofessional vigilance, and culturally competent communication. To prevent similar events, healthcare organizations must move beyond theoretical ethics and invest in dynamic, practical strategies: targeted education, scenario-based training, and privacy-conscious system redesign.\u003c/p\u003e \u003cp\u003eIn essence, ethical nursing care must evolve from a personal virtue to a collective imperative\u0026mdash;one that is consciously cultivated, structurally supported, and relentlessly prioritized.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This case report does not involve any experimental interventions and does not contain identifiable personal information that would require formal ethical approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of this case report was obtained from the patient’s mother, who is the legal guardian. A signed consent form is available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePayam Nikjo conceptualized and wrote the manuscript. Donya Rahmati contributed to the clinical analysis and critical revisions. Paria Nikjo contributed to literature review and manuscript editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOlorunfemi O, Oyegoke EO, Abiodun OO, Kunle-Abioye FB, Ayeni BA. Achieving a balance between ethical and legal obligations with regard to confidentiality and patient privacy. Amrita J Med. 2024;20(3):90\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice B. Respecting patient confidentiality. Nurs Standard (2014+). 2015;29(22):50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrenner JM, Delpier MY, Simon JR, Geiderman JM, Marco CA, Moskop JC, et al. Privacy and confidentiality of emergency department patient information: Contemporary considerations and challenges. JACEP Open. 2024;5(2):e13130.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafari H, Khatony A, Abdi A, Jafari F. Nursing and midwifery students\u0026rsquo; attitudes towards principles of medical ethics in Kermanshah, Iran. BMC Med Ethics. 2019;20:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhavi A, Valizadeh L, Powers K, Zamanzadeh V. Professional ethical challenges and suggested strategies in nursing: a qualitative study. J Med Ethics History Med. 2024;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRashidi K. Invasion of Privacy, Breach of Confidentiality, and Related Factors and Consequences: A Case Report. Iran J Med Ethics History Med. 2023;16(1):68\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeyva-Moral JM, Feijoo-Cid M. Participants\u0026rsquo; safety versus confidentiality: A case study of HIV research. Nurs Ethics. 2017;24(3):376\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMantel J. Ethical integrity in health care organizations. J Law Med Ethics. 2015;43(3):661\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNematollahi M, Farokhzadian J, Nayeri ND, Darban F, Faramarzpour M. Explaining the educational challenges in the path of cultural competence: The experiences of Iranian nursing students. J Prof Nurs. 2022;42:140\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFirn J, Rui C, Vercler C, De Vries R, Shuman A. Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis. J Interprof Care. 2020;34(4):453\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyle K, Weller S, Samuel G, Lucassen AM. Beyond regulatory approaches to ethics: making space for ethical preparedness in healthcare research. J Med Ethics. 2023;49(5):352\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eV\u0026aring;ga BB, Moland KM, Blystad A. Boundaries of confidentiality in nursing care for mother and child in HIV programmes. Nurs Ethics. 2016;23(5):576\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDillard-Wright J, Valderama‐Wallace C, Canty L, Perron A, De Sousa I, Gullick J. What nursing chooses not to know: Practices of epistemic silence/silencing. Nurs Philos. 2023;24(3):e12443.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nursing ethics, confidentiality, emergency care, cultural competence, reproductive privacy, Iran, ethical dilemmas","lastPublishedDoi":"10.21203/rs.3.rs-6515152/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6515152/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Confidentiality is a cornerstone of nursing ethics and a critical determinant of patient trust and safety. In culturally conservative societies, breaches of confidentiality can result in disproportionate social, psychological, and familial consequences, especially for sensitive medical issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e This case study examines an ethical dilemma in an emergency department in western Iran involving a 26-year-old unmarried woman whose early pregnancy was unintentionally disclosed by a staff member. Despite initial adherence to confidentiality protocols, a colleague congratulated the patient in front of others, triggering a cascade of personal and social fallout. The patient’s partner denied paternity and informed her family, leading to her abrupt removal from care and loss to follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e: The incident underscores critical ethical gaps in team communication, cultural competence, and institutional safeguards. In high-pressure clinical settings, confidentiality must be proactively managed through structured ethical training, contextual risk assessment, and design of patient-centered communication environments. This case highlights how a lapse in discretion can escalate into a cultural crisis, demanding system-level reforms and a redefinition of ethical responsibility from individual to institutional.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Maintaining confidentiality in culturally sensitive contexts is not a passive obligation but an active, dynamic responsibility. This case calls for a paradigm shift in ethical nursing practice—one that integrates cultural awareness, proactive communication, and systemic accountability to prevent harm and uphold patient dignity.\u003c/p\u003e","manuscriptTitle":"Ethical Dilemmas in Patient Confidentiality: A Case Study of Unintentional Disclosure in an Iranian Emergency Department","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 08:14:52","doi":"10.21203/rs.3.rs-6515152/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"977a9e43-2c6b-4d09-9c75-c569c7f69f76","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T13:54:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 08:14:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6515152","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6515152","identity":"rs-6515152","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}