NSG 600 Module II: Discussion I Wilkes

NSG 600 Module II: Discussion I Wilkes University

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.

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.

Module II: The Foundation of Knowledge In Nursing Informatics

As the digital age of lightning-fast communications develops, healthcare providers will be keenly aware of the growing need of protecting patients’ rights and meeting the diverse requirements of communities (Francis, 2017). As the definition of communication evolves, so will the concerns of healthcare professionals on the safeguarding of patients’ rights to privacy, autonomy, and privacy. All healthcare workers will need to be able to make ethical decisions in a systematic and adaptable manner. Most notably, the idea of nonmaleficence will be enhanced to include people and organizations that one may never meet in person but will have a professional interaction based on trust and compassion.

The daughter of the parents, Lilah, was able to easily get into her parents personal emails and disclosed her brother’s health details to the whole diabetic list. It’s probable that the case manager broke healthcare privacy regulations by emailing patient data to their personal email address. Moreover, she may have broken the code of ethics set out by the American Nurses Association, which specifies that staff must use verified communication methods when it comes to protecting patient confidentiality. The most possible alternative would have been to call the parents and speak with them over the phone about Paul needing to be brought in for a visit. The utilitarian viewpoint is appropriate here. The concepts of beneficence and nonmaleficence reflect the view that an ethical action is one that results in the greatest benefit for the greatest number of people. The rights that must be taken into account include the right to privacy and the right to receive what has been promised, fidelity. An obvious breach of an institution’s policy meant to safeguard patient information has occurred here. The case manager had faith that only the parents would have access to the data, and that it wouldn’t be shared with anybody else. The case manager, however, cannot guarantee that other parties will not be able to access the data. Moreover, the case manager is accountable for all activities that occur under her login, including the sending of sensitive, in-depth material that she opted to transmit in a rush.

The idea behind virtue ethics is that people should utilize their influence for the greater good of society. One must think about the requirements of others and the duty to provide for them (Johnson et al., 2021). At the same time, the case manager is responsible for providing care, preventing harm, and maintaining professional connections. It’s likely that this isn’t an anomaly and that the issue will reoccur again. The HIPAA administrative rules recommend that the case manager sign an agreement to protect patient data and undergo training on what constitutes acceptable and improper use of access. The case manager’s email activity could be monitored if her company uses tracking software to monitor any future violations. The company can also implement rules that all patient contact can no longer be used via email. Based on this analysis, it’s evident that alleviating the parent’s concerns is most important and mandating the case manager to complete training in HIPPA as well as how to utilize technology in the work place.

Most people who work in healthcare are reliable, trustworthy, and ethical; they also know they have a responsibility to put their patients’ needs and rights first. However, they must go about their daily tasks in a healthcare system that is always evolving due to factors such as new technology, a wide range of patients, different healthcare locations, and shifting policies from employers, insurers, and healthcare providers (Johnson et al., 2021). Misuse of these technologies, rather than the technologies themselves, is the source of most of the damage that afflicts patients. If technology is used to the patient’s benefit while still protecting the patient’s privacy, they can be useful tools for reaching out to technically inclined patients and collecting the data and information needed to meet their healthcare needs, including patient education, improve public health, and strengthen relationships with patients. As a consequence of having to keep all of these things in mind at once, ethical concerns frequently take a back seat in the healthcare industry, leaving healthcare practitioners with far too many gray areas or ethical decision-making issues with no apparent proper course of action. It is the expectation of patients that their healthcare practitioners would act ethically and treat them as individuals, taking into account their specific requirements and considering their level of independence and physical and mental capacity when making treatment recommendations.


Francis, I. (2017). Nursing Informatics and the Metaparadigms of Nursing: OJNI. On – Line Journal of Nursing Informatics, 21(1) https://wilkes.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/nursing-informatics-metaparadigms/docview/1984366214/se-2

Johnson, M. K., Weeks, S. N., Peacock, G., & Domenech Rodríguez, M. M. (2021). Ethical decision-making models: A taxonomy of models and review of issues. Ethics & Behavior, 32(3), 195–209. https://doi.org/10.1080/10508422.2021.1913593

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