ETHICAL ASPECTS OF NURSING INFORMATICS
 Interaction, monitoring and communication
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
using healthcare 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 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 protection of patient
human 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 3. Beneficence
1. Ethical Dilemmas  Actions performed that
 Arises when moral issues raise questions that contribute to the welfare of
cannot be answered with a simple, clearly others
defined rule, fact or authoritative view  Must not be unjust or cause
harm to others
2. Morals 4. Justice
 Social convention about right and wrong human  Fair, equitable, and appropriate
conduct that is widely shared treatment

3. Moral Dilemmas RULES FOR GUIDING ACTIONS (PRINCIPALISM)

 Arise with uncertainty 1. Substantiative
 Occurs when a person is confronted with  Veracity
contradicting evidence as to whether an action  Confidentiality
is morally right or wrong  Privacy
 Fidelity
4. Uncertainty
 A stressful event that arises form inconclusive 2. Authority
evidence on both sides of the dilemma and  Indicates who may or should perform
arises from unanticipated effects or procedures
unforeseeable behavioral responses to actions  Respondeat superior
or the lack action
3. Procedural
ETHICAL DECISION MAKING  Procedures to be followed
 Process of making informed choices about
ethical dilemmas based on a set of standards THEORETICAL APPROACHES
differentiating right from wrong  Casuist Approach
 Reflects an understanding of the principles,  Case-based ethical reasoning that analyzes the
standards, and philosophical approaches of facts of a case in a sound, logical, and ordered
ethical decision making or structured manner
 Requires a systematic framework and flexibility  Facts are compared to decisions arising out of
 Values clarification consensus in previous paradigmatic or model
 Guiding principles cases
 Theoretical approaches
 Model for Ethical Decision-Making  Husted Bioethical Decision-Making Model
 Four Guiding Ethical Principles (Beauchamp  Centers on the healthcare professional’s implicit
and Childress, 1994) agreement with the patient or client
1. Respect for autonomy  Based on six contemporary bioethical standards:
 Individual’s freedom from 1. Autonomy
controlling interferences by 2. Freedom
others and from personal 3. Veracity
limitations that prevent 4. Privacy
meaningful choices 5. Beneficence
 2 Elements: 6. Fidelity
 Liberty
 Individual’s capacity for  Virtue Ethics
intentional action  Emphasizes the virtuous character of individuals
2. Nonmaleficence who make the choices
 Obligation not to inflict harm  The cause of any moral weakness is not a
intentionally matter of character flaws but rather a matter of
 Negligence - departure from the ignorance
standard due of care towards  Plato emphasized that to lead a moral life and
others not succumb to immediate pleasures and
 If there is the risk to safety gratification, one must have a moral vision
  4 Cardinal Virtues
1. Wisdom
2. Courage
3. Self-Control
4. Justice
 Care Ethics
 Responsiveness to the needs of others that
dictates providing care, preventing harm, and
maintaining relationships
 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
THE ETHICAL MODEL
1. Examine the ethical dilemma (conflicting values)
 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?
3. 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
4. Investigate, compare, evaluate 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 (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
7. Look at ethical dilemma and examine outcomes
 Monitor, evaluate, revise as necessary

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?
- does the benefit overcome the risk of
potential harm that it could case to anyone?

LEGAL ASPECTS OF NURSING INFORMATICS
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
 Less than 2% of US hospitals had an EHR
system in all of their clinical settings
 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.