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This document contains abbreivatios, Summaries of Information Technology

University of Southern NevadaInformation Technology

Principles as the basis of our actions. Our actions are based on reason. That is, we act in accord with the reason. The basis of our judgment in ethics is the reason also as part of philosophy because Philosophy does not use theology as its basis for action but purely on reason so We are in this state in which we give principles that would at least without recourse to faith theology. We will have good actions, different when we talk about Faith, we talk about Moral law in which there is differ

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Ethical & Legal Aspects of
Nursing Informatics
(Concept 3-A)
Introduction
• The ethical and legal considerations
of nursing informatics are crucial for
ensuring that patients care is
optimized while protecting patient
privacy and confidentiality.
• Failure to comply with legal and
ethical standards can result in legal
and ethical violations that can harm
patients and damage the reputation
of healthcare organizations.
• It is important for nurses to stay
informed about legal and ethical
issues in nursing informatics and to
use technology in a way that upholds
ethical and legal standards.
Understanding Ethics:
Ethics is a process of systematically
examining varying viewpoints related to
moral questions of right and wrong.
Beauchamp and Childress (1994)
• Various ways of understanding and
examining the moral life
• Ethical approaches may be:
o Normative (presenting
standards of right or good
action)
o Descriptive (reporting what
people believe and how they
act)
o Explorative (analyzing the
concepts and methods of
ethics)
Husted and Husted (1995)
• Practice-based
• Examination of ways a person can
exercise power to bring about human
benefit in ways once can act to bring
about the condition of happiness.
Velasquez, Andre, Shanks, and Myer
(1987)
• “Well-based standards of right and
wrong that prescribe what humans
ought to do, usually in terms of rights,
obligations, benefits to society,
fairness, or specific virtues.”
• “Refers to the study and development
of one’s ethical standards.”
Common Characteristics:
• Dialectical & goal-oriented approach
to answering questions that have the
potential for multiple acceptable
answers.
Bioethics
• Study and formulation of healthcare
ethics
• Takes on relevant ethical problems
experienced by healthcare providers
in the provision of care to individuals
and groups.
• Emerged in 1970s as health care
shifted focus from mechanistic to
holistic approach (recognition and
acknowledgement of rights)
Fundamental Background (Husted, 1995)
1. The nature and needs of humans as
living, thinking beings.
2. The purpose and function of the
healthcare system in a human society
3. An increased cultural awareness of
human beings’ essential moral status
Potentials or Threats?
• Interaction, monitoring and
communication using health care
technology.
• Wearable technologies and Mobile
Devices
• Health and Social Media
ETHICAL ISSUES
1. Privacy and Confidentiality
• One of the most important ethical
issues in nursing informatics is
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Ethical & Legal Aspects of

Nursing Informatics

(Concept 3-A)

Introduction

  • The ethical and legal considerations of nursing informatics are crucial for ensuring that patients care is optimized while protecting patient privacy and confidentiality.
  • Failure to comply with legal and ethical standards can result in legal and ethical violations that can harm patients and damage the reputation of healthcare organizations.
  • It is important for nurses to stay informed about legal and ethical issues in nursing informatics and to use technology in a way that upholds ethical and legal standards.

Understanding Ethics:

Ethics is a process of systematically examining varying viewpoints related to moral questions of right and wrong. Beauchamp and Childress (1994)

  • Various ways of understanding and examining the moral life
  • Ethical approaches may be: o Normative (presenting standards of right or good action) o Descriptive (reporting what people believe and how they act) o Explorative (analyzing the concepts and methods of ethics) Husted and Husted (1995)
  • Practice-based
  • Examination of ways a person can exercise power to bring about human benefit in ways once can act to bring about the condition of happiness. Velasquez, Andre, Shanks, and Myer (1987)
  • “Well-based standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.”
  • “Refers to the study and development of one’s ethical standards.” Common Characteristics:
  • Dialectical & goal-oriented approach to answering questions that have the potential for multiple acceptable answers.

Bioethics

  • Study and formulation of healthcare ethics
  • Takes on relevant ethical problems experienced by healthcare providers in the provision of care to individuals and groups.
  • Emerged in 1970s as health care shifted focus from mechanistic to holistic approach (recognition and acknowledgement of rights ) Fundamental Background (Husted, 1995)
  1. The nature and needs of humans as living, thinking beings.
  2. The purpose and function of the healthcare system in a human society
  3. An increased cultural awareness of human beings’ essential moral status Potentials or Threats?
  • Interaction, monitoring and communication using health care technology.
  • Wearable technologies and Mobile Devices
  • Health and Social Media

ETHICAL ISSUES

1. Privacy and Confidentiality - One of the most important ethical issues in nursing informatics is

the need to protect patient privacy and confidentiality.

  • Nurses have access to a wide range of patient data, including personal and sensitive information
  • Access must be restricted to authorized personnel and that it is kept confidential. Privacy
  • An individual’s right to keep their personal information and healthcare data confidential Confidentiality
  • Obligation of healthcare providers to protect the privacy of their patients’ information 2. Informed Consent
  • Nurses have a responsibility to ensure that patients are fully informed about the use of their data and that they have given informed consent.
  • Patients have the right to know how their data is being used, who has access to it, and how it is being protected. 3. Data integrity and Accuracy
  • Patient data must be accurate and complete
  • Inaccurate or incomplete data can lead to errors in patient care and can compromise patient safety. 4. Professional Standards and Conduct
  • Ethical and Legal standards must be upheld 5. Inter-professional collaboration
  • Ethical standards must be upheld when collaborating with other healthcare professionals to protect patient privacy and confidentiality. 6. Patient safety and Quality of Care
  • Promote patient safety and autonomy while adhering to the due standards of care Ethical Dilemmas and Morals
  • Ethical Dilemmas o Arises when moral issues raise questions that cannot be answered with a simple, clearly defined rule, fact, or authoritative view.
  • Morals o Social convention about right and wrong human conduct that is widely shared.
  • Moral Dilemmas o Arise with uncertainty; occurs when a person is confronted with contradicting evidence as to whether an action is morally right or wrong.
  • Uncertainty o A stressful event that arises from inconclusive evidence on both sides of the dilemma and arises from unanticipated effects or unforeseeable behavior responses to actions or the lack of action. Ethical Decision Making
  • Process of making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong
  • Reflects an understanding of the principles, standards, and philosophical approaches of ethical decision making
  • The cause of any moral weakness is not a matter of character flaws but rather a matter of ignorance
  • Plato emphasized that to lead a moral life and not succumb to immediate pleasures and gratification, one must have a moral vision. 4 Cardinal Virtues: Wisdom, Courage, Self- control, Justice

Care Ethics

  • Responsiveness to the needs of others that dictates providing care, preventive harm, and maintaining relationships.
  • Less stringently guided by rules, but rather focus on the needs or others and the individual’s responsibility to meet those needs. (Benjamin and Curtis, 1992) “Critical reflection and inquiry in ethics involves the complex interplay of a variety of human faculties , ranging from empathy and moral imagination on the one hand to analytic precision and careful reasoning on the other.” Applying Ethics to Informatics
  • The goal of any ethical system should be that a rational, justifiable decision is reached.
  • The information concerning an ethical dilemma must be viewed in the context of the dilemma to be useful.
  • To make ethical decisions about informatics technologies and patients' intimate healthcare data and information, the healthcare provider must be competent in informatics. The Ethical Model ➢ Examine the ethical dilemma (conflicting values) ➢ Thoroughly comprehend possible alternatives ➢ Hypothesize ethical arguments ➢ Investigate, compare, evaluate each alternative ➢ Choose alternative you recommend ➢ Act on chosen alternative ➢ Look at ethical dilemma and Examine outcomes Examine the Ethical Dilemma
  • Use problem-solving, decision making, and critical-thinking skills.
  • What is the dilemma?
  • What needs to be decided?
  • Who should be involved?
  • Who are the interested players or stakeholders? o Reflect on viewpoints and value systems
  • How can you generate the greatest good? Thoroughly comprehend the possible alternatives available
  • Create a list of the possible alternatives and predict associated consequences of each.
  • Ask the following: o Do any of the principles or rules, such as legal, professional, or organizational, automatically nullify this alternative? o If this alternative is chosen, what do you predict as the best-case outcomes outweigh the worst-case outcomes? o Could you live with the worst- case scenario? o Will anyone be harmed? If so, how? o Does the benefit overcome the risk of potential harm that it could cause to anyone? Hypothesize Ethical Arguments
  • Determine which of the approaches to apply
  • Identify Moral Principles
  • Ascertain whether approaches generate converging or diverging

conclusions about what ought to be done, Investigate, compare, and evaluate the arguments for each alternative

  • Is there ambiguous information that must be evaluated?
  • Rate the ethical reasoning and arguments for each alternative in terms of their relative significance. o 4 = extreme significance; 1 = minor significance
  • Compare, contrast and reflect alternatives
  • Refer to professional codes of ethical conduct Choose the alternative you would recommend
  • Make a decision about the best alternative available.
  • Golden Rule: Does your decision treat others as you would want to be treated?
  • Does your decision take into account and reflect an interest in the concerns and welfare of all of the key players?
  • Become your own critic Act on Chosen Alternative
  • Formulate an implementation, plan an implement
  • The plan should maximize benefits, minimize risks and take into account all resources necessary Look at the ethical dilemma and examine the outcomes while reflecting on your ethical decision
  • Monitor, evaluate, revise as necessary Case Scenario 1: Maria is a nurse who works in a hospital's intensive care unit (ICU). She is responsible for taking care of a patient who has been on a ventilator for the past week. The patient is in a critical condition and requires constant monitoring. One day, while Maria is checking the patient's electronic health record (EHR), she notices that the patient's medical history includes a note about a genetic condition that increases the risk of certain complications. Maria is concerned that the patient's medical team is not aware of this information and that it may affect the patient's care. Maria is torn between her obligation to maintain patient confidentiality and her duty to provide the best possible care to the patient. She wonders whether she should bring the genetic information to the attention of the medical team or keep it to herself. 1.What ethical considerations are involved in this scenario?
  1. What should Maria do in this situation?
  2. How can Maria balance her duty to maintain patient confidentiality with her duty to provide the best possible care to the patient?
  3. How can nurses navigate situations where there may be conflicting ethical and legal obligations?
  • Ethical considerations in this scenario include patient confidentiality, informed consent, and patient autonomy. Maria must weigh her obligation to maintain the patient's confidentiality against her duty to provide the best possible care to the patient.
  • Maria should consult with the patient’s medical team and discuss her concerns about the patient's medical history. She should provide the information she found in the EHR and ask for guidance on how to proceed.
  • Maria can balance her duty to maintain patient confidentiality by limiting the disclosure of the genetic information to the medical team and only sharing it with those who have a need to know. She can also obtain informed consent from the patient

Legal Aspects of NURSING INFORMATICS ● DATA PRIVACY ACT ● CYBERCRIME PREVENTION ACT ● HITECH ACT HITECH Act HIPAA Act

  1. Describe the purpose of the Health Information Technology for Economic Clinical Health Act.
  2. Determine how the HITECH Act and its impact on HIPAA apply to nursing practice. HITECH Act (Health Information Technology for Economic and Clinical Health Act) ● Development, adoption, and implementation of HIT policies and standards and provides privacy and security protections for the client. ● Enacted due to less than 8 % of US hospitals used a basic EHR system in at least one of their clinical units. ● And, less than 2 % of US hospitals had an EHR system in all of their clinical settings. (Ashish, 2009 as cited in McGonigle & Mastrian ( 2015 ) ● Health information technology (HIT) industry is an opportunity by the lawmakers to stimulate economy and improve the delivery of healthcare. GOAL HITECH Act ● seeks to change the situation by providing each person in the US and EHR. ● Access to the person’s EHR will readily be available to every healthcare provider who treats the clients no matter where. (Definitions under the stipulations of the HIPAA Act) 1. CERTIFIED EHR TECHNOLOGY
  • An EHR that meets specific government standards for the type of record involved whether:
  • Ambulatory EHR by office-based practitioners
  • Inpatient EHR used by hospitals 2. ENTERPRISE INTEGRATION
  • Electronic linkages of healthcare providers, health plans, the government and other interested parties.
  • Enables electronic exchange and use of health information among all the components in the health care infrastructure. HEALTHCARE PROVIDER
  1. Hospitals
  2. Skilled nursing facilities
  3. Nursing homes
  4. Long-term care facility
  5. Home health agencies
  6. Pharmacies & pharmacists
  7. Physicians & therapists
  8. Hemodialysis centers
  9. Clinics
  10. Community health centers HEALTH INFORMATION TECHNOLOGY
  • Hardware, software, integrated technology or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use of healthcare entities or clients for the creation, maintenance, access or exchange of health information.

QUALIFIED EHR

  • Contains a patient’s demographic and clinical information, including medical history and list of health problems, and is capable of providing support for clinical decision and entry of physician orders. PURPOSE
  1. Improve healthcare quality by enhancing coordination of services between and among the various healthcare providers a patient may have, fostering more appropriate healthcare decisions at the time and place of delivery of services and preventing medical errors.
  2. Reduce the cost of health care by addressing inefficiencies, such as duplication of services within the healthcare delivery system, and by reducing the number of medical errors.
  3. Improve people’s health by promoting prevention, early detection and management of chronic diseases.
  4. Protect public health by fostering early detection and rapid response to infectious diseases, bioterrorism, and improve healthcare quality by enhancing coordination of services between and among the various healthcare providers a patient may have, fostering more appropriate healthcare decisions at the time and place of delivery of services and preventing medical errors.
  5. Improve people’s health by promoting prevention, early detection and management of chronic diseases.
  6. Protect public health by fostering early detection and rapid response to infectious diseases, bioterrorism, and other situations that could have widespread impact on the health status of many individuals.
  7. Facilitate clinical research
  8. Reduce health disparities
  9. Better secure patient health information.
  10. End other situations that could have widespread impact on the health status of many individuals.
  11. Better secure patient health information. HIPAA Act (Health Insurance Portability and Accountability Act) - Summarized Provisions: (Hellerstein, 2000 )
  12. Define protected health information as “Information relating to one’s physical and mental health, the provision of one’s healthcare, or the payment for the health care, that has been maintained or transmitted.”
  13. Propose that authorization by patients for release of information is not necessary when the release of information is directly related to treatment and payment for treatment.
  14. Specific authorization is not required for research, medical and police emergencies, legal proceedings, and collection of data for public information pertinent to the issue at hand. = All release must be properly documented
  15. Establish ownership of healthcare record and allow for patient-initiated corrections and amendments.
  16. Mandate administrative requirements for the protection of health information= All healthcare organizations are required to have:
  • a privacy official and
  • an office to receive privacy violation complaints

administrative, physical and technical)

  1. Requires entities to implement policies and procedures to protect the privacy and safety on the use and disclosure without individuals consent
  2. Individuals have the right to access and control their health information and covered entities are required to provide notice to the patient.
  3. Applies to all covered entities (HCP, health plans, clearing houses and business associates)
  4. Provisions on simplification such as standardizing electronic transactions, code sets and improve efficacy in operations QUIZ 3 M: