Nursing informatics is a critical area in professional practice. Nurses need to develop competencies and knowledge in ethical decision-making (Brennan, 2002). An ethical model is a basis for evaluation of clinical situations that require critical thinking skills for appropriate decision-making. The acronym E.T.H.I.C.A.L is one of the models. According to McGonigle and Mastrian (2015), the acronym stands for:
E=examining the ethical dilemma
T=thoroughly comprehend the possible alternatives available
H =hypothesizing the ethical argument
I=mean investigate, compare, and evaluate the arguments for each alternative
C=to choose the alternative you will recommend
A=act on your chosen alternative
L=look at the ethical dilemma and examine the outcomes while reflecting on your ethical decision (p.89).
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E and Technology
Ethical situations require critical thinking. The electronic bulletin boards and barcode medication technology provide necessary information for daily operations and dosing. They provide nurses with adequate information. Any misinformation can create a serious ethical situation for nurses, patients, and administrative staff. The barcode technology allows nurses to verify medications before administration ensuring that all the medication “rights” are fully followed.
T and IT
Computers may be used privately against organization’s policy. An ethical situation may arise due to log in misuse and unassigned access to patients’ information. Online virtual conferencing through organization’s portal is a good platform for professional decision-making. The IT department can regulate and operationalize this decision support strategy.
H and IT
Nurses need to implement policies and make decisions that will keep them from ethical litigations. Understanding procedures and applying nursing principles are valuable guides for nurses. For the nurse to avoid errors, a computerized order entry system needs to be implemented to support a decision-making process. A computerized provider order entry (CPOE) system will reduce dosing errors and nurses can easily verify through HER for new orders. CPOE offers patient safety and quality of care.
I and Informatics
Personal digital assistants (PDAs) aid in documentation of routine encounters with patients. The daily contact is enhanced, and interventions are carried out timely. Through the PDAs, decision-making is improved. Providers can order lab tests, perform diagnosis, and make a determination if emergency visit is needed.
C and IT
Emails are necessary communication tools used by healthcare professionals. This aspect of ethical evaluation and critical thinking is based on utilitarianism, an ethical theory that encourages decisions that are taken for the benefit of the majority. Emailing and text messaging can be used to enhance decision-making.
A and IT
When an action path is developed, it has to be implemented. Electronic bulletin boards, emails notifications, social media platforms allowed by the organization can be used to inform management or other colleagues about situations that present as ethical dilemmas.
L and IT
Decision-making can be improved by consultation, feedback, and evaluation. Thus, telemedicine technology and other interactive voice response, PDAs, and text messaging are helpful in such situations helping providers offer solutions in real time.
HITECH Act 2009
The health information technology economic and clinical health (HITECH) Act of 2009 is design to improve healthcare data protection through proper information gathering, use, storage, and transfer across the country by providers. It is to encourage policy formulation, research, error prevention, disparity reduction, and quality improvement (McGonigle & Mastrian, 2015). It is an ethical issue because it concerns patients’ information privacy, confidentiality, and healthcare quality.
References
Brennan, P. F. (2002). A Discipline by Any Other Name ... Journal of the American Medical
Informatics Association: JAMIA, 9 (3), 306-307.
McGonigle, D. & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett.
