Ethical/Legal Risks Assessment
21st, November, 2012
Informatics continues to change nursing in different ways. Like other professions, nursing informatics is faced with different issues, which could be ethical or legal in nature. This arises out of the patient-nurse relations, which comprise the nursing practice. An important factor that largely contributes to ethical issues in nursing informatics is the patients’ confidentiality. This comes in different forms, including the patient’s medical records, their privacy, security, and confidentiality, which matter a lot in nursing ethics. This issue mainly arises due to the automation of the patients’ medical records (Hunt, Sproat & Kitzmiller, 2004). Before informatics, patient information was in hard copy and stored away in prohibited cabinets to ensure privacy of the information. However, with the introduction of computers, laws that governed this issue were loosened. This paper addresses ethical issues by presenting a case of ethical risks, their analysis according to the nursing ethical codes, and the appropriate strategies for resolving them. The conclusion will give the summary of important insights, which are discussed in this paper.
Sometimes, most healthcare institutions break the rules, which govern the privacy of patient medical records either knowingly or unknowingly. Personal observation at my place of work led to the realization of many of such cases of ethical risks, where nursing practitioners breach these laws. First, sometimes safeguarding of patient information is not observed. Occasionally, patients are interviewed in the presence of their family members, and in an open environment, where outside parties can hear the conversation. In addition, some health workers still chart the medical information of patients in computers in the presence of other people.
Another issue is about the confidentiality and security of the patients’ personal data on the system. Different staff members access patients’ information bearing their names, since some computers do not have passwords. In addition, patients’ medical information is given to medical research bodies in support of evidenced-based practice in conducting epidemiological researches, or developing predictive models. When researchers use the available data, they get realistic results, in addition to this being cost-effective. However, there arises the safety issue when such large data sets are used. This way patients’ privacy is put at risk.
All health workers are professionally charged with ensuring the privacy of patients’ personal and medical data. Health workers therefore need to safeguard all the information that their patients share with them (Gerdin-Jelger, et al 1997). By interviewing the patients in an open environment and in the presence of family members, that breaches the privacy of the patients. The patients also have a right to decide whom they want to share their information. In addition, only the patients can decide which information will be shared and which one will not be shared. When a patient discloses their personal health conditions to the health worker in the presence of other people, this confidential information is made known to different parties, thus violating the privacy of the patient.
With the introduction of computers technology in nursing, the confidentiality issue raises many concerns. According to the nursing informatics, code of ethics, the confidentiality, and security of patients’ medical records on computers is their right. When the records of patients are put on the computer, it is easy for other health care professionals to get access to it. This way, the medical records of many patients can be accessed more than before when hard copies were still in use.
In nursing informatics, data security has three different aspects. First, the nursing professionals must ensure the accuracy of information by entering the correct data. Failure to do this may lead to misdiagnosis and wrong prescriptions, which is detrimental to the involved patient. Secondly, the patient’s medical records must be protected; this is to avoid access by unauthorized parties, who may be inside or outside the health care institution. When different parties access patients’ medical data, there is risk of tampering with patients’ records. In addition, giving out the patients’ medical records for use by research firms without hiding their identity is a case of violation of the confidentiality of the patients’ information. All this must be upheld according to the Health Insurance Portability and Accountability Act, which was passed by the congress in 1996. This law was to serve the purpose of protecting the privacy of the patients in contemporary healthcare. Healthcare professionals are therefore obliged to embrace this in informatics, or any other way.
There exist different strategies through which the highlighted ethics risks could be resolved. For the privacy problem, health professionals must interview the patients in the absence of any third party. The environment should be closed, and all the relatives and friends of the patient should be asked to leave the patient alone with the health professional. The patient should also be given choice to decide what kind of information they want to share with their family. Users of computers must make sure they do not tamper with the patients’ personal information (Hunt, Sproat & Kitzmiller, 2004).
To avoid access of patients’ data by unauthorized parties, an effective authentication method should be adopted. The most preferable authentication method is biometrics, where physiological characteristics such as voice print, fingerprints, or retina scans are used. Alternatively, a card or key entry system with a password may be used. Use of a username and password only is commonly employed, yet it is the least secure method for ensuring patient privacy (Hunt, Sproat & Kitzmiller, 2004).
During automation of patients’ data, appropriate confidentiality standards need to be adopted. Additionally, a quality assurance or ethics committee should be set up to monitor the compliance to the nursing code of ethics of the institution (Guido & Watson). In addition, in order to maintain the integrity of data, data entry quality-systems should be put in place to also monitor complete and accurate data entry. This speeds up communication and detection of errors in data. The authorized user could also protect the information from unauthorised access by not letting out computer password to people anyhow. Alternatively, the files containing the patients’ information could be encrypted.
Protecting the confidentiality of patients’ record when data is used for medical research is the patients right. Health care institutions therefore need to ensure this is upheld and balance between research needs and patients’ confidentiality. One method that could be used to ensure this is the ambiguation of patients’ data. This way, the privacy of the patients is ensured, since anonymity is upheld. However, this is not assured to be effective in ensuring patients privacy. Ambiguating the patients’ information may also not allow for subsequent use of the data. The best way to ensure anonymity is deleting any elements in the patients’ information, which could act as identifiers. However, this method will also render the data useless in future. Nonetheless, for privacy to be observed, such strict logarithms should be applied (Guido & Watson).
Protection of data is also important to ensure it does not get lost. Data can be prevented from getting lost by backing up all data in the system. The data back-up must then be stored away in a secure place, to ensure safety. Alternatively, an institution could devise and test a disaster recovery plan so that in case of data loss, it can be retrieved again easily (McGonigle & Mastrian, 2011).
The contemporary healthcare struggles to ensure that patients are attended to in the most comfortable environment and that their rights and integrity are upheld. It is therefore important for nursing informatics to also embrace and fulfil the healthcare code of ethics in the nursing practice. The medical information of patients must be safeguarded, as this is important and confidential personal information. The safeguarding of patients’ electronic medical records today is however not as easy as it sounds. This is because of the advanced technology, which increases the risk of violating patients’ information rights. The advances in technology today therefore present new ethical challenges to healthcare today. Such technologies have been instrumental in increasing the access of unauthorized people to the medical databases (McGonigle & Mastrian, 2011).
However, technology has increased the quality of work and information in nursing informatics, in addition to decreasing the cost of healthcare. Some aspects of this technology propagate a number of conflicts with most of the ethical principles of nursing such as autonomy, justice, and fidelity. To resolve this issue, infoethics is the best strategy that can be used in the examination of the resulting conflicts. However, one lasting solution to the conflicts is the incorporation of adherence to the set up rules and regulations. In addition, adherence to codes of ethics and conduct is important, as well as the development of a culture of infoethics. If all these are upheld, there will be a balance between patients’ rights and nursing practice.
Gerdin-Jelger, U., Gerdin, U., Tallberg, M. & Wainwright, P. (1997) Nursing Informatics’97: The
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Guido, G. & Watson, A. (n.d). Ethical and Legal Guidelines for Nursing Practice. Chapter 4. Retrieved
Hunt, E., Sproat, S. & Kitzmiller, R. (2004). The Nursing Informatics Implementation Guide. New
McGonigle, D. & Mastrian, K. (2011). Book Only: Nursing Informatics and the Foundation of
Knowledge: Nursing Informatics and the Foundation of Knowledge. London: Jones & Bartlett
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