NSG 600 Module II: Discussion I Wilkes University

Using the Ethical Model for Ethical Decision Making from Chapter 5, page 78 in  Mastrian and McGonigle (2021), analyze the following ethics case study. Be succinct and demonstrate your critical thinking skills. Answer all 7 steps of the model on the case study posed.

Paul is a 12 year old male diabetic. He maintains his personal digital assistant (PDA), hand-held device, that interfaces with his glucometer and provides information based on inputted data from him and his parents. This information is transmitted to his MD/hospital, school nurse, case manager (CM), and to the parents’ home computer. All in an attempt to better control his diabetes. You are his CM.

The PDA sends an update to you since Paul’s blood glucose levels have been rising steadily for the last 5 days. The physician has left a message for you to contact this family and have them come in for an evaluation. You know that both of his parents work so you send an e-mail message to the parents’ via their home computer asking them to bring Paul in for an assessment. Since you are in a hurry and will be seeing other patients when they return from work, you decide to add more information to the message than normal reviewing with them the importance of maintaining control over the diabetes and expressing your concern since Paul has not checked in with you lately. You tell them that you think he might be over-doing it since he is trying to play football. You ask how they are doing and if they are still attending their counseling sessions.

Paul’s 4 year old sister, Lilah, sends your email out to all of the diabetic lists that both Paul and his parents belong. They interact with people on these lists regularly.

The parents call everyone including you and are outraged that this information was sent everywhere….apply the Ethical Model for Ethical Decision Making to determine your follow up plan.

Stakeholder Perspective

Organization (DNP leader): Justina, Suzanne, Kwame, Thelma, Leigh, Zelalem, Gabriella, Darnelle.

Clinician (DNP, Advanced Practitioner): Lorena, Gloria, Nancy, Alyce, Jessica Bolak, Deborah, Jessica Bonilla

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59pm EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resource module.

In the age of advancing health care technology, clinicians are learning to appreciate the accuracy and speed with which computers can generate data, with a goal of enhancing health care delivery. However, with advantages come certain disadvantages, including inadvertent dissemination of private information, or a breach of confidentiality. Human error may be partially to blame when providers allow the computer to drive patient care instead of sound clinical judgement and decision making by the provider (Kernebeck et al., 2020).

Providers and patients now utilize tools, or medical applications, designed specifically for the monitoring and management of chronic diseases and health promotion. Exhaustive measures are taken by the provider to protect patient health information. However, when a breach of information occurs, ethical dilemmas result, and the provider must investigate how the breach occurred by analyzing the data to determine a corrective plan of action. Each individual is unique and providers should consider how to best customize a plan of care for each patient (Minvielle et al.,2021).

When considering the ETHICAL Model for decision making for the scenario with twelve year old Paul, the question arises with whom the fault truly lies, as it seems the breach of confidential information is multifactorial. If the provider did not add any specific details to the original text, the breach may have been avoided. If the provider had called Paul’s parents after work, the breach may have been avoided. The provider could have tried to reach Paul instead of his parents regarding an appointment. Health care providers must always act with beneficence when dealing with ethical issues (Mastrian & McGonigle, 2021). Understanding how Paul’s parents feel and ensuring a corrective action plan is essential in re-establishing trust and rebuilding patient-provider relationships. Honesty, integrity, and virtue are integral to most healthcare providers. Preventing any additional mishaps while maintaining Paul’s independence is imperative. The provider should not include private details in an email or text, but perhaps, a phone call with simple messages asking to return the call is a better option. When there is a change in a plan of care, an in person office visit may better serve the patient. When the provider has no time to devote to a patient on a particular day, a scheduled appointment may be the answer, so there are no consequences of hasty actions. Perhaps the provider could enlist the help of the school nurse to help manage Paul’s blood sugars on school days. Information that is private is protected using the facility’s website portal for health care communications. Parental controls on the computer may help prevent younger siblings from accidentally sending emails to the wrong places.

As a provider in this circumstance, an office visit to discuss the events as well as Paul’s blood sugars is the priority. After the discussion, it should be decided jointly between the provider, Paul, and his parents whether they will share information with the school nurse, including her in Paul’s plan of care. Use of the facility’s website portal is secure for messaging is a better alternative for communicating. Additionally, installing parental controls on the home computer is strongly recommended. These recommendations will help prevent future breaches. Blaming Paul’s parents or his sister for the breach will not achieve a favorable outcome. A collaborative approach with Paul and his parents, to develop a tangible, realistic solution that is agreed upon by all parties is optimal. A customized plan of care increases patient satisfaction and improves quality of care (Minvielle et al., 2021).

References

Kernebeck S., Busse, T.S., Bottcher, M.D., Weitz, J., Ehlers, J., & Bork, U. (2020). Impact of mobile health and medical applications on clinical practice in gastroenterology. World Journal of Gastroenterology, 26(29): 4182-4197.https://doi:10.3748/wjg.v26.i29.4182

Mastrian, K.G. & McGonigle, D. (2021) Informatics for health professionals (2^nd ed.). Jones & Bartlett Learning.

Minvielle, E., Fourcade, A., Ricketts, T., & Waelli, M. (2021). Current developments in delivering customized care: a scoping review. BMC Health Services Research, (21)575.  https://doi.org/10.1186/s12913-021-06576-0

Ethical Decision Making

The ethical dilemma presented in this case study are sharing of private health information, presumed unsecured sharing of health information and sharing of health information of a minor. The alternative ways to have approached this is to; leave a generic message for the parents to call the office to schedule an appointment. Send a secure email that doesn’t contain personal health information, one that is just asking to make an appointment. The CM could argue that she didn’t email everyone and couldn’t know that the email could have been shared that easily, that the family shouldn’t let their information that easily accessible to their young daughter. The parents could argue that the case manager shouldn’t be sharing the information about them because the kids may not have known they were going to counseling, or that they didn’t want others to know that they were having family issues that they were seeing a counselor for. As an organization I would investigate each people’s arguments and what they feel led to this dilemma. We would then compare the arguments with the alternatives that could have occurred to see where we could improve. Based on the findings I would recommend that we incorporate safe, secure messaging technology such as a patient portal that can only be accessed with user id and password so information is viewed by the intended receiver. Training to staff on private health information; what is safe to share, what makes up protected health information and scripted generic message to leave if a call is unanswered. After implementation of this scenario would be more like: After receiving the message from the doctor to call the family to have them come in the case manager calls the families home phone, the answering machine states the smiths aren’t home so the case manager leaves a message stating her name and the office name and phone requesting a call back to schedule an appointment. Alternatively, the case manager could send a message through a secure patient portal asking for them to call the office to schedule an appointment.

# Examine the ethical dilemma:

To start, it is important to notice that Previous glucose results were sent to the computer, we do not know which way the info is sent but the info is present in the computer.

As the CM, I chose to send the message via email since the increase is constant, not emergent and would not put the patient in immediate harm. Sending the email was in good faith, since the parents are working, and the info did not warrant a phone call and disturbing the latter while they are working. The 4-year-old sibling obviously has the tendency either to play with computer or touch random buttons and unwillingly sent the information to people which are not involved directly in the care of the patient hence breaking the HIPAA code. Note also that the patient is underage which even complicates the problem.

# Possible Alternatives:

First the as the CM I have  to own up to the breach and notify involved people in the care about the breach. For instance, The MD, Hospital and school nurse should be made aware of the situation with the consent of the parents since could prevent future similar episodes.

Some alternatives in the future:

Discuss with parents which is the best way to communicate in the future: Phone call, text, f2f.

-Screen lock for the computer in the event of the parents choosing email or electronic communication to protect the private information.

-Educate parents in having the habit of logging off email after use. Information in email could fall in the wrong hands and be compromised. This is a protected health information furthermore other information like identity and finances could be hacked and used for detrimental purposes.

# Hypothesize ethical arguments:

This is a typical case of Negligence. As the CM, I unintentionally but carelessly acted by emailing the protected information rather than other more safer approaches including calls or f2f encounters. (Kathleen Garver Mastrian & Mcgonigle, 2021)

The virtue ethics would work in finding an acceptable or even excellent solution to the problem. (Kathleen Garver Mastrian & Mcgonigle, 2021)

Consulting the parents for an acceptable communication channel could prevent future calamities and safeguard privacy in the future

# Investigate, compare, and evaluate the arguments for each alternative:

1-Discuss with parents which is the best way to communicate in the future: Phone call, text, f2f. Excellent in its way as it may be favored by the parents. May enhance unnecessary communication between CM and Parents since the latter will be communicated for emergent situation as well as non-emergent events which does not warrant and immediate phone call. This might bring unnecessary stress on the parents. Also, this works only until the child is a minor and hence has to be reassessed when the child becomes an adult.

2-Screen lock for the computer in the event of the parents choosing email or electronic communication to protect the private information. Might not be the best way to communicate in emergent situation. The latter though will give more access to the CM to assess the situation and use AI in certain situations whereas conforming to more conservative approaches in

others.

Choose alternative and act on your alternative:

The latter is the alternative I would recommend as it would give the CM the ability to assess every situation and chose the proper way of communication. The fact that protecting any information in the home computer is primordial in any event. Protecting the information on the computer by locking the screen and logging off different websites when the computer is not in use. Depending on the gravity of the situation, the CM could either call, text or email parents.

Reference

1-Kathleen Garver Mastrian, & Mcgonigle, D. (2021). Informatics for health professionals (2nd ed.). Jones & Bartlett Learning.