Running

Head: Ethics Paper Van Der Hyde 1

Ethics Paper

Benjamin Van Der Hyde

James Madison University

10/16/2016
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Introduction

Great emphasis has been placed on protecting patient information since the Health

Insurance Portability and Accountability Act (HIPAA) was enacted in 1996. During the

healthcare reform, HIPAA was instilled to protect not only patient rights, but the providers as

well. There are two parts to this bill. The first has to do with insurance. HIPAA allows persons to

continue to have health insurance between jobs. The second part of the act is what I will focus

most of my attention on, and has to do with protecting patient information. Rules are set forth in

this document that regulate how patients personal information is handled by their healthcare

team (Foster, 2012). Punishment for violating HIPAA may include fines, lawsuits, and/or

employee termination. Breeches in HIPAA can be costly to the institution also, costing them a

great deal of money and possibly tarnishing the reputation (Brody, 2016). Therefore, it is

important that healthcare providers understand and follow these guidelines so that effective

healthcare can be provided without putting the patient, provider or institution at risk.

Background

While observing a nursing report at clinical, something happened which made me

consider if HIPAA had been violated. While discussing the care of a difficult patient the

conversation veered from collaborating about care to delving into the patients personal life. The

patient had issues with her quality of care, which she voiced extensively. She also had a complex

background associated with her family. Social drama was being discussed, which lead to a nurse

finding the patient on social media. This sparked even more non-healthcare related banter about

the patient. In response to this situation I just continued to sit and listen as I would during any

other report. I could have responded by discouraging the social conversation, and asking a

question about the patients care.

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This is not the first time I have encountered a situation like this. At almost every clinical I

have been apart of I have heard nurse gossip which stretches beyond the scopes of healthcare.

Another similar example involved the care of a baby born to an opiate addicted mother. This

situation also brought about a lot of unprofessional judgment and gossip unrelated to the care of

the patients. This gossip will usually carry negative connotations toward the patient. I would

consider this situation to be a moral dilemma. A moral dilemma is defined as a situation where,

one recognizes that a problem exists, and that two or more ethically justifiable but mutually

opposing actions can be taken. (Jameton, 1993). If I engage in the conversation I may be putting

patient information at risk. However, if I discourage these conversations it may impact how the

nurses interact with me. It is especially difficult as a student because I want to be engaged in the

optimal learning experience with my nurse, which may be influenced by me protesting the

content of their conversation.

Method/Findings

To evaluate my response to this dilemma I used the Eight Key Questions posed by James

Madison University that aid in dealing with difficult decision making (Madison Collaborative,

n.d.). These questions stem off of eight human values that are thought to be essential to consider;

Fairness, Outcomes, Responsibility, Character, Liberty, Empathy, Authority, and Rights.

Fairness has to do with balancing all interested parties. In this situation it would mean

considering the patients well being while also considering the nurses view on what they think is

allowable. I need to analyze the situation from the viewpoint of all associated individuals.

Outcomes consider the short and long term effects of the decision. In the short term it might have

be more beneficial to keep my mouth shut so that I can continue to gain knowledge from my

nurse, and not strain our relationship. However in the long term, it might be more advantageous
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to take a stand on the topic and let people in my network know that I want to keep conversation

professional about patients and their protected information. Responsibilities have to do with what

my duties and obligations are. In this case, I think my obligation as a nurse is to discourage the

unprofessional discussion from my peers, as it does not contribute to learning or aid in their

healthcare. The question of character considers which action best demonstrates who I am and

what I want to become. I do not want to be known as a nurse that is quick to judge or be

condescending toward patients, and actively participate in gossip. In my situation, the fact that I

did not participate in the banter is good because I did not exacerbate the situation. However, the

fact that I did not discourage the gossip left my stance on the topic open to interpretation. Liberty

questions respect for freedom, personal autonomy, and consent. Gossiping about ones personal

life or decisions is not respectful. If a patient acts in a way that you disagree with, the behaviors

should still be discussed respectfully. These discussions could even include the patient, so that

they may explain their reasoning behind certain actions, before being judged by the healthcare

team. The question of empathy has to do with how my actions might change if I cared deeply

about the individual involved. If this patient was my mother, for example, I would definitely step

up and defend her against the actions of the nurses. I would not allow anyone to make judgments

about her based off her Facebook page, or her temperament during the hospital stay. Authority

notes what those in higher positions of power would expect. One of my clinical professors would

emphasize that you do not want to be known as that nurse. Meaning the nurse who does not

consider the feelings of patients or coworkers. The phrase also implies not being that nurse

who is quick to gossip. Therefore, my clinical instructor would expect me to be an advocate for

the patient in this situation or remove myself from it completely. The question of Rights

considers not only things like legal rights, but also social rights. The patient has the right to treat
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their body how they please. Legal rights associated have to do with HIPAA. If a patients

personal life is being discussed amongst many people it provides the opportunity for the

information to be overheard by involved parties.

The ANA Code of Ethics is another resource that could be used to help untangle a

complicated situation such as this. The Code of Ethics provides nine provisions that the Nurse is

expected to base their care and actions around. When faced with a difficult decision, addressing

these provisions can be beneficial because it provides basic values that can be related to the

situation, and help in responding with an appropriate behavior or action. Provision 2 is one that

stood out to me when considering my scenario. This provision states; The nurses primary

commitment is to the patient, whether an individual, family, group, community, or population

(Olsen, 2016). This reminds me that I should always think of the patients well being first.

Therefore, I should act in a way that promotes their well being over acting in a way that is

directed toward keeping my fellow nurses happy.

Conclusion

Evaluating the Eight Key Questions and ANA Code of Ethics associated with my

situation allowed me to analyze things from a different perspective. The key question that

influenced me most was the question about with empathy. The patient should be treated as

though it is someone you care about. In my situation I would have stepped forward to discourage

the actions of the nurse if it was a loved one of mine, even if it meant straining my relationship

with the nurse. However, it is possible that this action of respecting the individual may leave a

positive impact on that nurse and make them second guess their actions during the next

opportunity for gossip. The difficult part is finding an effective and respectful way to share your

opinion. Doing something like reminding the nurses to not openly discuss a patients private life
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may have been effective. Two professional alternative actions that could have been taking are

redirecting the conversation back to healthcare and reminding the nurses to not discuss patients

personal lives. This is something I believe will be easier when I am no longer a student because I

will be on the same level as these nurses rather than working under them. However, it is still

important to practice analyzing and acting upon these ethical issues as a student so that I am

prepared when I actually enter the work force.

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References

Brody, M. L. (2016). A Closer Look at HIPAA Violations. Podiatry Management, 35(4), 86-89.

Foster, C. (2012). Advocates of Privacy. HIPAA 101. Washington Nurse, 42(3), 37.

James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in action.

Retrieved from react-text: 161 http://www.jmu.edu/mc/8-key-questions.shtml

Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice.

AWHONNS Clinical Issues in Perinatal & Womens Health Nursing, 4(4), 542-551.

Olson, L. L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses With Interpretive

Statements: Resource for Nursing Regulation. Journal Of Nursing Regulation, 7(2), 9-20.