Saturday, October 5, 2013

Health Informatics - Week 3: Ethical Practice and Privacy

"Ethics is not definable, is not implementable, because it is not conscious; it involves not only our thinking, but also our feeling." 
- Valdemar W. Setzer

Everyday we are challenged to live life in our personal standard of ethics. To me, ethics does not draw a clear line between the right from the wrong; there will always be a grey area in a situation that will challenge me to reconsider what is truly ethical. 

In week 3 of my Health Informatics class, we discussed the ethical and privacy issues that may be brought up during our professional practice in the future. We focused on two cases. The first case involves a nursing student using her phone to take notes, search up medications, and connect on social media in a hospital unit. The second case involves a nurse Google searching her client's information on social media because a co-worker told her that her client has been convicted for rape and abuse. I will now be responding and reflecting on these two cases in addition to what was discussed in class. 

Case 1: Student Nurse using her phone while on shift 
Describe
Interpret
Evaluate
- a new nursing student has recently been placed at a hospital unit
- the nursing student....
- uses her phone while she is on her shift despite the hospital not having a 'bring-your-own-device' policy
- uses her phone during patient care (distributing medication and interacting with patient)
- uses her phone to search up drug interactions and dosage requirements
- describes that she uses her phone to document her findings about her patients, and then she transfers the records onto the database
- also uses her phone for social media purposes such as going on Twitter to share her experiences
- has 604 followers on Twitter  

- the nursing student is...
- breaking the hospital's policy
- not treating the patient therapeutically
- eager to learn more about distributing the right dosage and medications
- breaching her patients' confidentiality and privacy
- acting unprofessional while working
- the nursing student is breaking the hospital's policy because she is using her cell phone while she is on her shift and the hospital does not permit employees from using cellular devices. She should ask her supervisor if she can use a cellular device.
- the nursing student is not treating her patients therapeutically because instead of interacting with her patients, she is busy on her phone (documenting, searching up medications, etc..) the nursing student should be engaged with her patients to learn more about their health*
- the nursing student appears to be eager about knowing more about the medication she is distributing to her patients because she is searching them up on her phone.**
-  the nursing student may be breaching her patients' privacy by recording her findings on her phone. I think that the nursing student should ask her supervisor if she is allowed to document on her phone. In addition, she should set up a password on her notepad so no one can assess it
- the nursing student is unprofessional because she is using her phone for social media purposes while she is on her shift. She should not be sharing her experiences on any social media to avoid breaching confidentiality. In order to prevent the breach of confidentiality, the nursing student can be vague in her messages. ie. "I closed up a patient's wound with stitches" should be used as opposed to "Today, I closed up a patient's wound on her forehead with 5 stitches"
- the nursing student can avoid misunderstanding between herself and her patients by informing them why she is on her cell phone. If I were the nursing student's patient, I would feel that she is unprofessional because she does not seem interested in my care.
* According to the Professional Standards from the College of Nurses of Ontario (2009), the nursing student is not being accountable for her actions. A nurse should show accountability in her practice by "identifying her/himself and explaining her/his role to clients" (p. 4). The nursing student is not explaining her purpose for using her phone during clinical practice because the nurse is unaware of the student's actions.  
** The student nurse is demonstrating continuing competency in her practice because she is enhancing her practice by being knowledgeable of what kind of medications are distributed and why (College of Nurses of Ontario, 2009). 
Although the nursing student may be educating herself and documenting on her cell phone, she is not truly meeting her patients' needs and providing a therapeutic relationship. A nurse-client therapeutic relationship is based on respect, empathy, trust, and power-with decision making (College of Nurses of Ontario, 2009). The nursing student does not show respect or empathy when caring for her patient because she is busy on her phone.

Case 2: Nurse Google Searching her Client 
Describe
Interpret
Evaluate
- nurse works at a clinic that is addressed towards vulnerable women, mainly sex workers
- a male client who has been convicted of rape and abuse happens to visit this clinic; he is described as a predator in the clinic
- after the nurse cares for the male client, she Google searches him and finds that he has had previous convictions of rape and abuse
- nurse believes that the male client should be banned from the organization to ensure safety for both staffs and other clients

 - nurse is judging her male client by Google searching him and wanting him banned from the clinic
- nurse is behaving unethically in this situation
 - nurse is making unethical decisions because she wants the male client banned from the clinic*
- nurse is breaching her client's confidentiality and privacy
- nurse is acting unprofessional because she is breaching professional conduct such as terminating her care for the male client**

*The nurse is behaving unethically because she wants the male client banned from the clinic since she believes that she will be keeping everyone safer that way. This is an unethical approach to resolving the issue because the nurse should confront the male client of intentions of visiting the clinic instead of judging his past. According to the CNO, the nurse is unable to identify appropriate options to resolve the issue (College of Nurses of Ontario, 2009).
**The nurse is unprofessional because she is terminating her care for the male client since she believes that he is a threat to the clinic. If the nurse does consider the male client a threat, then she should inform her supervisor of her actions and confront the client. The CNO states that if a nurse is to terminate her client's care, then she must arrange for an alternative service for the client and provide an explanation to the client (College of Nurses of Ontario, 2013). 
I think that it is legally and ethically right for the nurse to Google search her client for the safety of the staff and patients. However, it is unethical of the nurse to base biases on her male client. The nurse does not know if the information she found on Google has been fabricated, nor does she know if he has changed for the better. The nurse should use her clinical judgement skills to understand the male client. Instead of banning him from the clinic without giving him a second chance, the nurse should confront him of his intentions for visiting the clinic. In addition, the nurse should also refer her client to another clinic that may be more suitable for his care. 

Are you concerned about your social media profile? 
No, I am not too concerned about my social media profile. There are privacy settings that I can adjust to limit the amount of viewers from browsing through my profile. I am consciously aware of what I post and say online, and for that reason, I do not post things that are too personal to share on social media. 
If you are concerned about others invading your social media profile, then you should be consciously aware of what you post and what the consequences of disclosing the information, if any. If you feel uncomfortable that another user may be reading your posts, then you can readjust your privacy settings or do not post at all. 
In short, a person should think before he/she acts.


References
College of Nurses of Ontario. (2009). Professional standards. Toronto, ON: Retrieved from www.cno.org/Global/docs/prac/41006_ProfStds.pdf
                College of Nurses of Ontario. (2013). Reference document: Professional conduct professional misconduct. Retrieved from http://www.cno.org/Global/docs/ih/42007_misconduct.pdf
Thinkexist.com. (2013). Valdemar w. setzer quotes. Retrieved from http://thinkexist.com/quotes/valdemar_w._setzer/

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