Social Networking (Fall 2009)
There have been some intersting proposals on how social networking possiblities how we do our jobs and interact with colleagues and patients.
Are expectations different from different population groups? Are there work ethics issues? Are there liability issues?
Using the guidelines as indicated from the Fall 2009 Nursing Informatics course activity use this site to explore an opportunity to experience a social networking medium, blogging...
HH
Are expectations different from different population groups? Are there work ethics issues? Are there liability issues?
Using the guidelines as indicated from the Fall 2009 Nursing Informatics course activity use this site to explore an opportunity to experience a social networking medium, blogging...
HH
posted by UTArlington_N5308 at 2:28 PM
36 Comments:
Anderson (2004) described the need for ethical and social course content in Informatics and Medical technology courses offered by medical schools and graduate nursing programs alike. He describes how a large majority of programs do not offer social and ethical coursework alongside the Informatics education. He feels that each program must offer these topics in their coursework so that future Informatics leaders will be prepared to face dilemmas in the future practice, regardless of the work setting. After reading this article, I firmly believe that ethical and liability issues are faced by informatics leaders and professionals every single day in their work setting.
Anderson, J.G. (2004). The role of ethics in information technology decisions: A case-based approach to biomedical informatics education. International Journal of Medical Informatics, 73, 145-150.
Great blog, Helen! --Adrian Raabe
Adrian,
After all I have learned this semester about nursing informatics, the more I agree that ethical considerations related to internet blog posts, web pages, web casts, webex should be addressed. Fortunately our UTA professors included ethics into this nursing informatics course. Before our first day we were all required to take a HIPAA course.
Debbie
Adrian,
After reading your post, it got me thinking how fast the field of nursing informatics is growing, and how it can be used in many different settings. The technological advances in nursing seem to advance further all of the time, and with such rapid change, ethical questions are sure to arise. Although we may be dealing in a computerized or virtual environment, we are still dealing with patients and their healthcare information. I think it's a fantastic idea to include coursework on the ethical issues relating to informatics.
Curtin (2005) gave a very detailed explanation of the ways nursing, ethics, and information technology intersect. She cautioned that the revolution of informatics in healthcare gives tremedous power to anyone with access to a computer. There is ample opportunity for one to be careless, reckless, foolish, and even the gives one the ability to do harm such as the stealing of healthcare information or identities. The author stressed it was of the utmost importance that we as healthcare professionals be held accountable by strict, moral, legal, and ethical values.
Curtin, L.L. (2005). Ethics in informatics: The intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29, 349-352.
Wow, it took me a long time to find where to post. Informatics is a great tool to use in healthcare. We need real time information to be able to the best descisions for patients. With that being said, it does bring up new avenues of problems. Of course, privacy being a constant issue and technology being a barrier for some, in my opinion I value informatics and feel that the pros outweigh the cons.
I am still not sure if I posted correctly. I also posted on a informatic journal club??? I also posted on Web CT, so I hope I have covered all the bases.
Here is my original post on webCT:
Dainton, C. (2009, September). Physician-writers in the age of blogging. CMAJ: Canadian
Medical Association Journal, 181(5), 348-348. Retrieved September 24, 2009, from CINAHL
Plus with Full Text database.
The article above was concise and interesting. It wrote about the slippery slope that
healthcare providers (physicans in this case) have to worry about when blogging. It stated
that professionals do have the right of freedom of speech but also have an obligation of the
right of pts confidentiality. It concluded that one should err on the side of caution and be
prudent until our professions evolved enough to include such technological matters (Dainton,
2009).
Simpson, R.L.(2005). Ethics: New delimmas emerge alongside new technologies. Nursing Administration Quarterly, 29(2). 179-182.
Reference found at Cinahl
This author clarifies the difference between regulations and ethics using simple terms. For instance, a regulation is a rule that an organization has adopted and must be followed. Ethics is more of a choice rather than a requirement. Ethics in informatics is challenging. Protecting one's priviacy is a rule or requirement in healthcare, however documenting electronically opens the door for potential threats to violating privacy of others. The author shared his concern of easy false or wrong documentation about a person could cause the person to loose their insurance or could cause them to be denied their insurance. Reading this article really made me think about what I read on internet and to not take what I read as the truth and to always keep an open mind.
Debbie
HealthDay (2008. Medical Blogs may threaten patient privacy. Retrieved on October 1, 2009 from http://health.usnews.com/articles/health/healthday/2008/08/07/medical-blogs-may-threaten-patient-privacy.html
The title of the article I chose is Medical Blogs may Threaten Patient Privacy. This article
from the U.S. News & World Report examined 271 medical blogs and determined that
they could identify the author's of these blogs 56.8% of the time. The blogs had not only
medical information about patients but personal photos and details of patients. Sponsors
and advertisements for medical equipment were displayed on the website. The author
explains the importance of providing information to the public, but eithics should be part
of this process. Blogging is new and guidelines and standards have not been set by
professional organizations and until this happens patient identifiable information will
remain on the net.
Blogging can be an effective tool for exploring ideas and discussing concepts, issues, problems in the work environment. Additionally, blogging can have a much more personal aspect to it as well. I still find it difficult to understand why anyone would want my opinion on a topic though, especially posted to a webpage/blog site.
For professional development a controlled blog environment can be a great medium especially as time and money are short. Nurses as well as other healthcare team members can provide input on an issue on their time, rather than holding meetings etc.
Liability and ethics are also a concern, as you can no longer say or imply anything about anyone, especially in writing without repercussions. Patient data and peer to peer issues could not be discussed using this format without very strict control and mediation.
I think blogging may have to stay with family photos and politics and out of the healthcare arena.This is my opinion, now posted to a blogsite...for what it is worth.
Article:
Ellaway, R. & Martin, R. D. (2008). What's mine is yours - open source as a new paradigm for sustainable healthcare education. Medical Teacher 30, 175-179. DOI: 10.1080/01421590701874058.
Use of the internet as a resource sharing medium is invaluable. However allowing individuals to use your information or to use the information produced by others creates liability issues.
In this article, the authors discuss the creation of an open source website where educators can share the tools they have produced. Additionally, all sharing is free and revisions, adaptations, and reworking of the original programs are encouraged.
Sharing back and forth is a great way for educators to not only develop curriculum but also adapt lessons already produced, reducing prep-time and increasing educator to student time.
In an open-share environment the liability issue of copyright infringement is removed, as all submitters to the open share site agree to share openly their content.
There were posts to the discussion board earlier in the semester on hospitals providing blogs for families to use to update family members on a patient's status. I believe this this might be a good application of the social networking medium ...blogging.
If a controlled environment and a next of kin can be established then providing the family with a venue for communication that the nurses and physicians can also access could be a powerful tool. Legally one would have to clearly identify the role of the blog in the health care setting and blogging limits, as well as length of time the blog would be open after discharge from the ICU/critical care setting/hospital.
This medium though only works if the family is comfortable with the technology required for it's use.
A second posting of my opinion to a blog...for what it's worth.
Congratualtions to all that have made it to the blog. This is the location for the discussion this week. This is the only location that will receive credit for participation for Module 12 and for this week. Way to go!
We will be looking for substantive posts in which ideas are presented regarding social networking, ethical issues, liability, etc. Please support opinion with literature.
Have a great discussion online in the blog.
Joy Don
Cosco, T., Knopp, A., & Milke, D. (2007). Investigative first steps: appropriate identification and ethical review of research and quality improvement. Online Journal of Nursing Informatics, 11(3), Retrieved from CINAHL Plus with Full Text database.
Cosco, Knopp, and Milke (2007) discusses the research and quality improvement process used in research while making an attempt to combine nursing practice, information, and technology with evidence-based knowledge and improvements in patient care. The article is mainly differentiating research and quality improvement outcomes in a study based on care. There are concerns that ethical review of a study can be inaccurately identified as research or quality improvement methods. Generating information for nursing practice is the goal of nursing informatics in research. The article is mainly focused on the research methodology and how nursing informatics is used in this process.
I believe the authors give foundational information for those desiring to perform research while using healthcare informatics for data collection. This article is very good food for thought prior to research in nursing.
Toni
This particular article was very interesting because it talks about some of the ethical challenges in small rural healthcares. The authors acknowledge that some of the ethical dilemmas in small rural hospitals are hard to address mainly because some of the physicians in the rural areas play a double role for example, the same physician might be the private physician for hospital board members, administrators, and managers, this leads to a conflict of interest between organization loyalty and patient rights. Also because in small towns there is a tendency that majority of people knows each other therefore it is easy to excuse a conduct because of respect and relationship. This particular problem has lead to the creation of virtual peer review model and a virtual hospital ethics committee offered through the Texas A & M Health Science Center Rural Community Health Institute (R-CHI, College Station, Tx).
The virtual technology has allowed physicians from different locations to convene a meeting and discuss ethical issues. Therefore this new technology has allowed rural physicians to practice medicine without the fear of judging their peers. It has also allowed the hospital administrators in small rural towns to practice or conduct their duties without being infected by small town politics.
Reference
Bolin, J. N.,Mechler, K.,Holcomb, J.,Williams, J.,(2008). An Alternative Strategy for Resolving Ethical Dilemmas in Rural Healthcare, Ethics and Rural Healthcare, 8(4),63-65.
Adrian,
I agree with what you are saying because Information technology is advancing at a neck breaking speed and in order to keep up with it nurses need to be educated about technology prior to entering the work force. Because this seems to be the order of the day and as many have said that use of EMR has shown significant improvement in health outcomes and reducing medication errors. It has also been reported that it reduces healthcare cost. It is very efficient in gathering of data which can be sued to analyze the effectiveness of some treatment plans.
Layman (2003) discussed how the recent technologies such as health informatics presents a new ethical challenges. These technologies are designed to increase access, improve quality, and decrease the cost of care. The author pointed out the positive aspects of health informatics such as can bridge distances, improve the quality of care, allow healthcare providers to explore new ways to increase efficacy of diagnosis and therapy. On the other hand, it creates conflicts with ethicals principles of autonomy, fidelity, and justice. The author proposed solutions including regulations, standard and guidelines, honor codes, and code of ethics. I believe that healthcare providers need to be accountable on ethical, moral, and legal responsibilities in order to mantain this technology productive and useful in the patient care.
Layman, E. (2003). Health informatics: Ethical issues. Health Care Manager. 22(1), 2-15.
Milton (2007) discussed the ethical exploration and possible challenges associated with the information age in nursing research, practice, and education. He also focused on the disciplinary responsibilities for information giving and receiving. Since manual filing and storing of documents are no longer manageable in healthcare organizations, managing such information electronically brings about ethical considerations in the healthcare settings. Nurses and other members of the healthcare team have the special obligation to be ethical in handling patients' confidential information being guided by the premise that patients have the freedom to choose and access desired healthcare services (Milton, 2007). I believe that patient information though electronically accessible is manageable with the right processes in place. Educating staff of the serious implications in the misuse of such information plays an important part.In our facility, we have been trained not to look into any patient's electronic record, even your co-worker's or family's patient record, unless you are a direct caregiver or your primary role in the hospital supports it.
Milton, C. (2007). Information and human freedom: Nursing implications and ethical decision-making in the 21st century. Nursing Science Quarterly, 20(1), 33-36.
Ethics in technology and informatics is not different than ethics in healthcare and life. This article explores how to bring healthcare, ethics and computing to intertwine with each other. Ethics is discussed as a choice between right and wrong. Humans since the 1940’s have be learning and changing computer ethics. Computer ethics is defined as a field that studies computers and the code of conduct for computer professional. In healthcare you can not be part of the computer profession due to easy access or sharing of patient information via computers with or without an electronic medical record. Today’s technology and access to computers puts sensitive information in the hands of unprepared individuals. Healthcare, ethics, and informatics and its users must be good ethically, legally, and morally for the greater good of human kind.
Curtin, L.L., (2005) Ethics in informatics, the intersection of nursing, ethics, and information technology. Nursing Administration Quarterly. 29 (4). 349-352. (CINAHL)
I agree with what James shared about nurses needing some nursing informatics knowledge prior to entering the workforce. I would even suggest before going farther in one's degree plan. Jiang, Chen, and Chen (2004) conducted a research that discussed the use of competencies that will help nursing professionals to work efficiently and serve as the basis of life-long learning, enabling them to maintain up to date computer knowledge and skills. According to the research results, among the seven competency items,the domain "attitude" toward the computer, was chosen as the most important. These results can serve as a comprehensive list for nurses to check their computer competence and try to make up any shortcomings (Jiang et al., 2004).These can be used by schools in designing computer curricula and with the limited class hours, need to include the items that will be most beneficial to the students.
Relating this to our class, the competency checklist that we completed prior to starting the class determined what aspects in informatics needed improvement. Knowing what aspects needed work, with the help of the learning contract, I was able to work on such deficiencies. This will help me in keeping abreast with the ever changing technology. I also need to make sure that I keep up with further technological changes in the future.
Jiang, W. W., Chen, W., & Chen, Y. C. (2004). Important computer competencies for the nursing profession. Journal of Nursing Research, 12(3), 213-225.
Thanks Ms. Helen for this blogsite!
Adel
Tonya,
I agree with what you are saying that "ethics in technology and informatics is not different than ethics in health care and life" but one thing we must admit as Black and Anderson, (2007) states that electronic medical records presents new challenges to the continuing quest to maintain patient-physician confidentiality.
Tonya, I beg to disagree with your statement that "today’s technology and access to computers puts sensitive information in the hands of unprepared individuals." The reason why I disagree with this statement is because confidentiality is covered in the nurses Code of Ethics Provision 3.2 states "the nurses promotes, advocates for and strives to protect the health, safety and rights of patients."The physicians also have Code of Medical Ethics which address confidentiality Opinion E-5.07 which states"the utmost effort and care must be taken to protect the confidentiality of all medical records, including computerized medical records (Council on Ethical and Judicial Affairs 2006,155)."(Black and Anderson, 2007).
Black and Anderson, (2007) recommend patient education about electronic health records and disclosure of information because of the fear employment or insurance discrimination.
References
Black, L., & Anderson, E. E. (2007). Physicians, patients and confidentiality: The role of physicians in electronic health records. American Journal of Bioethics, 7(3), 50-51. Retrieved from EBSCO.
Nurses Code of Ethics
Melinda,
Your post on an open-shared educational environment intrigued me. Through this class we've learned about copyright, and how it need not be taken lightly. I love the idea of a shared environment, where copyright is not an issue. I also think the person taking advantage of this shared environment should be very cautious of the information that they obtain from it. It seems the information may be free for all, but as we've learned, we must evaluate that information and not take it all as verified information.
McBride & Cohen (2009) briefly wrote about potential violations of professional nursing conduct through the use of social networking sites. Many challenges mentioned in the article have been previously discussed, such as HIPAA violations. One slippery slope mentioned that I had not considered is the "friending" of patient & nurse relationships on these social sites. Participants may not be aware that employer boundaries extend to these sites, or these sites may blur these boundaries that were established to protect the privacy of both the patients as well as staff.
McBride, D. & Cohen, E. (2009). Misuse of social networking may have ethical implications for nurses. ONS Connect, July 2009, 17.
While health care is not the only profession that must be careful, it is concerning to me that social networking can blur the lines between personal life & professional life. Privacy seems more difficult to maintain amid these constant interactions. I can see how easy it is to fall down this slope: a patient looks up a nurse on Facebook or a nurse is invited by a patient to follow their journey of cancer treatment on their Caring Bridge blog. Technology seems to be going so fast that these issues must be discussed now!
-Marie R.
Dienneman & Van de Castle (2003) discuss how informatics effects not just nursing but the healthcare field as a whole. There are nurses as well as physicians who are resistant to the implementation of any type of computer charting. What I found interesting is as nurses, we were not given a choice. We were required to learn the computer system. As for physicians, many have adapted to the system. Others continue to spat verbal orders or pull a busy nurse aside to put their orders in. In addition, hospitals hire scribes to do work for them. We have been told to write physicians up who are noncompliant with the putting their own orders in. I have started to do so.
Informatics is a great subject that is still controversial. Patient information, blogs, webpages should be used with caution. I just read this morning that a woman is being taken to court over what is displayed on her blog site. I take these matters very seriously. While doing my webpage, I typed out a consent for one of my co workers who is on my subject to sign, she laughed.I told her, 'Please read and sign.' She signed but thought I was crazy. Anyway, I enjoy discussing issues such as this.
Love your blog Helen!
Dienemann,J. & Van de Castle, B. (2003). The impact of healthcare informatics on an organization. Journal of Nursing Informatics, 33(11),557-562.
Marie,
I agree that social websites are dangerous in the nurse patient relationship. The nurse has a duty to keep his/her distance. I have never been a nurse who gets emotionally involved. I see former patients in public and just speak. That's all. I learned this morning that 'defriending' is now in the new Webster's dictionary bc it is used so much. Also, nurses have to be careful how they present themselves on these social networks. I have seen some unflatering photos and comments.You are judged by how you appear, not just in person. I have even heard where a co worker printed out comments of another and placed them under their manager's door. It is inappropriate but true.
Sorry correction: 'defriend' is in the New Oxford American Dictionary (2009); not Webster's
New Oxford American Dictionary.(2009).Oxford University Press:USA.
Social networking has been somewhat of a new concept for me this year because until Summer 2009, I did not even know what Facebook was! So I have learned that this type of "social gathering" has become addictive. Now, since the semester is almost done, I have absolutely no time to participate in the social networking. I am actually doing good to keep up with my Informatics class. I have been impressed with how much I have learned or should I say how much I did not know about the technology right in front of me. I believe that the healthcare networking can completely benefit those who are willing to take the time and go outside of their comfort zone. This has been my obstacle this year! There is so much that can be learned from one another in a common setting whether it be at the hospital or outpatient setting, and it can be done at your leisure (most of the time). It is really important for those participating in this type of networking to not let their gards down. Confidentiality continues to be the important factor therefore should be protected by those who wish to use this type of networking system for business. I believe so much can be done in a lot less time, but comfort barriers may need to be broken.
Toni
Marie,
I have to agree with you. I read the same article you referenced and those are issues that our unit if facing right now. All of us are on facebook (not like we need to keep in touch - we work together) so our coworkers can see pictures of our families and all of the other aspects of our lives that are not work. I have "friended" a mother whose twin infants I took care of about 4 years ago. I was so close to them - even went to their first birthday party. I never thought of that mother being able to read comments on my site that my coworkers wrote. We did have one conversation that took place on my wall (I was not apart of it but it was on my wall) and it came close to crossing HIPPA lines. I deleted the conversation and there was a mass email sent out by our nursing director on this topic. The admin sup for our unit was a "friend" with me as well as a lot of others and had seen the comment. One practitioner actually deleted her account because a conversation took palce on her wall (she was not even a part of) and she was counseled.
I know this area is still a lot of gray but we need to be more aware of what we write.
Tiff
In an article written by Forsyth (2009) the author identifies the continuing struggle for areas overseeing law making to develop what is and is not appropriate behavior between employers and employees in social networking. We all know that employees being fired from the place of employment over what they said, did, or posted on a social networking site is becoming a "norm" now. It happens everyday and is on the news every evening. One item that Forsyth (2009) pointed out is that 45% of employers were screening social networking sites of potential employees. That is crazy! Next thing you know you have to do a background check for criminal offenses and social networking sites. There is a part of the article that listed "rules" for nurses using social networking sites. This was the best part because most of these seem common knowlege... guess not! Some examples: don't fake a sick day and then post it on your site and don't post photos or comments engaging in ocnduct in the workplace which you know would be inappropriate (Forsyth, 2009). One that I would add - do not update your status from work! The date and time is noted when you update and it can be traced back to see if you were at work!
Tiff
Forsyth, L. (2009). What you need to knw about social networking. Queensland Nurse, 28(5), 22-23.
Where do we draw the line??? I see both sides to this. I do think that HIPPA violations on a social networking site should be handled accordingly. That is not different than nurses discussing patient information in the hospital cafeteria. Now... employees being fired because they made a comment about how unsatisfied they were, they didn't like someone, etc - there is the freedom of speech issue and it is there opinion. I know there is the issue of slander and defamation of character but who are we to tell people they can not say the things they want to? I don't know - very tricky subject.
Martha,
Your article mentioned how the recent technologies such as health informatics presents new ethical challenges. This relates to an article that I read that discussed how the ED physicians play an important role in information technology and their roles in developing and implementing a national health information technology strategy (Dinh & Chu, 2006). The authors further stated that inspite of the barriers to implementation such as cost, disruption in workplace practices, data security, and lack of evidence, there are also potential benefits. These are process optimization, quality control, and interconnectivity (Dinh & Chu, 2006).
Dinh, M. & Chu, M. (2006). Evolution of health information management and information technology in emergency medicine. Emergency Medicine Australasia, 18, 289-294.
Thanks,
Adel
As a PMH-NP, I often consider how my treatment plans support, or subtract from, a patient's autonomy. Where do paternalism and autonomy start and stop? As healthcare changes, it becomes important to identify a logical justification for paternalistic interventions that override individual autonomy, especially regarding unhealthy behaviors. The author suggests the PMH-NP should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Given the power a nurse has in contrast to the chronically ill patient's lack of power, mental health professionals should address ethical lines between autonomy and paternalism. The author presents recommendations for initiating this process.
Buchanan, D. R. (2008). Autonomy, paternalism, and justice: Ethical priorities in public health. American Journal of Public Health, 98(1), 15-21.
doi:10.2105/AJPH.2007.110361
(PsycINFO Database Record (c) 2008 APA, all rights reserved) (from the journal abstract)
REFERENCE:
Rosenbaum, S., Abramson, S., & MacTaggart, P. (2009). Health information law in the context of minors. Pediatrics, 123(1), S116-S121. doi:10.1542/peds.2008-1755M
Annotation:
This article explores the development of health information law with respect to minors. Rosenbaum et al., believe uses of health-related technologies take place within a legal framework that guides the minor's healthcare, but they add that privacy laws and autonomy principles existed before health information technology and are therefore evolving and being questioned. The authors posit that technology shapes the law, and this can be expected as health information technology use evolves. Child-related health information privacy is even more complex because the relationship between privacy law and children is itself complex. Legal precedents argue minor children need special protection against harm and risk exposure, and this concern extends to privacy. Regardless of whether minors can shield health information from parents, parents have the power to control the release of information to outside entities. The authors predict a freer flow of information as the security and safety of information sharing improves.
Aronoff, D. and Bartkowiak, B.A. Review of the Medical weblog, clinical correlations.Clin Med Res. 2010 July; 8(2): 104–105.
doi: 10.3121/cmr.2010.926.
This article comments on the usefulness of medical blogs in speaking with credentialed experts or those who have been through the same medical experience. They speak about one blog in particular, Clinical Correlations, a peer-reviewed internal medicine blog focused on clinical issues.A team of experts discusses clinically important topics and review them for a two week period before the information is released o the blog.I found this very interesting and made it seem much more reliable to me as the information is actually researched before it is published for the public. Since Blogging is open to anyone sometimes the information retrieved on a blog site may not seem like it is professional or accurate. This particular blog combats the dilemmas and tries to make the blog objective and current with credentialed professionals contributing to it.
Melissa
Boyd, K.M. Ethnicity and the ethics of data linkageBMC Public Health. 2007; 7: 318.doi: 10.1186/1471-2458-7-318.
This article spoke of using the US census data to obtain and link information on health status of the ethnic minority populations. There is limited availability of ethnicity on health information and it is a priority of the Health department to identify health needs of all ethnic groups including minority populations. This article proposes linking the two systems in an attempt to retrieve the most reliable and up to date information. There may some ethical issues involved in this link of information as one is not giving consent for all access to information when filling out census information. I can see how linking the information is beneficial but I do wonder if this is a breach of ones ethical and human rights. for the population that is uneducated and ill informed a person could easily share more information than what they originally planned.
Privacy and confidentiality are definitely keys to the success of Nursing informatics.It seems so very easy to access and obtain private information of anyone out there, both in the medical environment as well as the social networking end. I do have to admit I do have a fear of sharing tho much information. But I also recognize the advantages of having data so readily available. It is very important in the work place to have a team that monitors the proper use of the medical record meaning only those that need to see can see...without penalty that is. I have worked in several different hospitals where this is in effect and it makes a big difference. I have seen several medical workers get fired for the inappropriate use of the medical record, as they should be.This makes workers more cautious and more apt to do the right thing when they know they are being monitored.
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