ETHICAL ASPECTS OF NURSING INFORMATICS  Interaction, monitoring and communication using
healthcare technology
UNDERSTANDING ETHICS
 Ethics is a process of systematically examining varying
viewpoint related to moral questions of right and wrong
1. Beauchamp and Childress (1994)
 Various ways of understanding and examining the
moral life
 Ethical approaches may be:
a) Normative (presenting standards of right or
good action)
b) Descriptive (reporting what people believe
and how they act)
c) Explorative (analyzing the concepts and
methods of ethics)
2. Husted and Husted (1995)
 Practice-based
 Examination of ways a person can exercise power
to bring about human benefit in ways one can act to
bring about the condition of happiness
3. 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 of development of one’s ethical
standards
Common Characteristics:
- dialectical and goal-oriented approach to answering
questions that have the potential for multiple acceptable
answers
BIOETHICS
 Study and formulation of healthcare ethics
 Taken on relevant ethical problems experienced by
healthcare providers in the provision of care to
individuals and groups
 Emerged in 1970s as healthcare shifted focus from
mechanistic to holistic approach (recognition and
acknowledgement of rights)
FUNDAMENTAL BACKGROUND (HUSTED, 1995)
1. The nature and needs of human 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
POTENTIAL OR THREATS
 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 CONFIDENTIALITY
- An individual’s right to - obligation of healthcare
keep their personal providers to protect the
information and healthcare privacy of their patients’
data confidential information
- In patient’s care = - In patient’s care =
respecting patient’s human protection of patient
dignity 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 error in
patient care and can compromise patient safety
4. Profession 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
1. Ethical Dilemmas
 Arises when moral issues raise questions that
cannot be answered with a simple, clearly defined
rule, fact or authoritative view
2. Morals RULES FOR GUIDING ACTIONS (PRINCIPALISM)
 Social convention about right and wrong human 1. Substantiative
conduct that is widely shared  Veracity
 Confidentiality
3. Moral Dilemmas  Privacy
 Arise with uncertainty  Fidelity
 Occurs when a person is confronted with
contradicting evidence as to whether an action is 2. Authority
morally right or wrong  Indicates who may or should perform procedures
 Respondeat superior
4. Uncertainty
 A stressful event that arises form inconclusive 3. Procedural
evidence on both sides of the dilemma and arises  Procedures to be followed
from unanticipated effects or unforeseeable
behavioral responses to actions or the lack action THEORETICAL APPROACHES
 Casuist Approach
ETHICAL DECISION MAKING  Case-based ethical reasoning that analyzes the facts
 Process of making informed choices about ethical of a case in a sound, logical, and ordered or
dilemmas based on a set of standards differentiating structured manner
right from wrong  Facts are compared to decisions arising out of
 Reflects an understanding of the principles, consensus in previous paradigmatic or model cases
standards, and philosophical approaches of ethical
decision making  Husted Bioethical Decision-Making Model
 Requires a systematic framework and flexibility  Centers on the healthcare professional’s implicit
 Values clarification agreement with the patient or client
 Guiding principles  Based on six contemporary bioethical standards:
 Theoretical approaches 1. Autonomy
 Model for Ethical Decision-Making 2. Freedom
 Four Guiding Ethical Principles (Beauchamp and 3. Veracity
Childress, 1994) 4. Privacy
1. Respect for autonomy 5. Beneficence
 Individual’s freedom from 6. Fidelity
controlling interferences by others
and from personal limitations that  Virtue Ethics
prevent meaningful choices  Emphasizes the virtuous character of individuals
 2 Elements: who make the choices
 Liberty  The cause of any moral weakness is not a matter of
 Individual’s capacity for character flaws but rather a matter of ignorance
intentional action  Plato emphasized that to lead a moral life and not
2. Nonmaleficence succumb to immediate pleasures and gratification,
 Obligation not to inflict harm one must have a moral vision
intentionally
 Negligence - departure from the  4 Cardinal Virtues
standard due of care towards others 1. Wisdom
 If there is the risk to safety 2. Courage
3. Self-Control
3. Beneficence 4. Justice
 Actions performed that contribute
to the welfare of others  Care Ethics
 Must not be unjust or cause harm to  Responsiveness to the needs of others that dictates
others providing care, preventing harm, and maintaining
4. Justice relationships
 Fair, equitable, and appropriate
treatment
  Less stringently guided by rules, but rather focus on
the needs of 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
 Rate the ethical reasoning and arguments for each
alternative in terms of their relative significance
(4=extreme significance; 1=minor significance)
 Compare, contrast and reflect alternatives
 Refer to professional codes of ethical conduct
5. Choose alternative you 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 the key
players?
 Become your own critic
6. Act on chosen alternative
 Formulate an implementation plan and implement
 The plan should maximize benefits, minimize risks
and take into account all resources necessary

THE ETHICAL MODEL 7. Look at ethical dilemma and examine outcomes

1. Examine the ethical dilemma (conflicting values)  Monitor, evaluate, revise as necessary
 Use problem-solving, decision making, and critical
thinking sills
 What is the dilemma?
 What needs to be decided?
 Who should be involved?
 Who are the interested players or stakeholders?
 How can you generate the greatest good?

2. Thoroughly comprehend possible alternatives

 create a list of the possible alternatives and predict
associated consequences of each
 Ask the following:
- Do any of the principles or rules automatically
nullify this alternative?
- if this alternative is chosen, what are the best and
worst-case scenarios?
- do the best case outcomes outweigh the worst case
outcomes?
- could you live with the worst-case scenario>
- Will anyone be harmed?
LEGAL ASPECTS OF NURSING INFORMATICS
- does the benefit overcome the risk of potential
harm that it could case to anyone?
HITECH ACT (Health Information Technology For
3. Hypothesize ethical arguments Economic And Clinical Health Act)
 Determine which of the approaches to apply  Development, adoption and implementation of
 Identify moral principles HIT policies and standards and provides privacy
 Ascertain whether approaches generate converging and security protections for the client
or diverging conclusions about what ought to be  Enacted due to less than 8% of US hospitals used a
done basic EHR system in at least one of their clinical
units
4. Investigate, compare, evaluate each alternative  Less than 2% of US hospitals had an EHR system
 Is there ambiguous information that must be in all of their clinical settings
evaluated?  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 an EHR
 Access to the person’s EHR will readily be available to
every healthcare provider who treats the client no matter
where
DEFINITIONS (under the stipulations of the HIPAA Act)
 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
 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 component in the
healthcare infrastructure
 Healthcare Provider
- hospitals, skilled nursing facilities, nursing homes,
long-term care facility, home health agencies,
pharmacies and pharmacists, physicians &
therapists, hemodialysis centers, clinics, 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 HCPs a patient may have, fostering more
appropriate healthcare decisions at the time and place
fo 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)
1. 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.”
2. 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.
3. 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.
4. Establish ownership of healthcare record and allow
for patient-initiated corrections and amendments.
5. 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
 a specific training program for employees that
include a certification of completion
  a signed statement by all employees that they
will uphold privacy procedures must be
developed.
 all employees must re-sign the agreement to
uphold privacy every 3 years.
 sanctions must be clearly defined and applied.
6. Mandate that all outside entities that conduct
7. Allow protected health information to be released
without authorization for research studies. Patients may
not access their information in blinded research as it can
influence the study’s reliability.
8. Propose that protected health information may be
deidentified before release in such manner that the
identity of the patient is protected. = deidentitification
may be done through coding
9. Applies only to health information maintained or
transmitted by electronic means.