The protection of patient information remains a major concern for many people even with the expansion of the world into a global village by the internet. The Canadian healthcare system assures patients and service users of the same. Thus, privacy and confidentiality, security, accountability, dignified treatment, and patient's best interest principles are termed as the cornerstone of the healthcare system ( Ewashen et.al, 2013 p 327). The aspects have an impact on the patient-physician relationship and are embedded in the Canadian Nursing Association (CNA) policies and ethics as well as the Personal Health Information Protection Act , 2004. However, nurses and healthcare professionals may find themselves in contradiction of the law either knowingly or inadvertently. The use of social media and personal smartphones at work proves to be one of the areas that are challenging for nurses. This presents a challenge on drawing a line on what is considered a patient’s personal health Information that is conventional and those that are not clear such as pictures. This paper seeks to discuss the ethics and ethical implications of abuse of patient privacy.
In a scenario where a nurse takes a picture of a patient and posts it on social media or sends to friends, the nurse breaches confidentiality. This would be classified as patient identifying information especially because the nurse captioned the picture with the location. The picture can be traced using the caption to get further information about the patient, which leads to a loss of confidentiality. Every patient is assured that their information will be confidential with few exceptions on the disclosure and use of the information. Certainly, the disclosure of patient information does not involve pictures that can lead to the patient. Additionally, the patient's information can be shared only with other healthcare professionals with the intention of using it for healthcare.
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Breach of confidentiality translates to the loss of confidence between the patient and the doctor. According to CNA’s Code of Ethics, confidentiality is considered a pillar of the patient- nurse relationship. The relationship is built on trust with the patient believing that the doctor will undertake all measures to protect the information. Similarly, nurses and physicians have fiduciary obligations, which are used to enable honest communication on the personal health of the patient. Although the patient in the case is an infant, the patients or significant other act on behalf of the patient to ensure that they receive the required services. Thus, the nurse patients may lose confidence in the professional and ultimately the nursing profession. Additionally, this can result in lawsuits against the institution.
Posting a patient's information without their consent is the breach of patient's right to privacy. Patients have a right to determine the information that can be disclosed to other people. The principle prohibits health care professionals from sharing patient information to non-medical people and those that are not authorized by the patient (Potter et.al, 2018 p. 25). Similarly, the physician is obliged to inform the patient of their rights to privacy and the limitations. In the case of trainees, the Canadian Institute for Health Information provides training recommendations for all professionals to ensure that they are well equipped for practice.
Disclosing patient pictures to the public is against the principle of self-determination. Patients have the right to self-determination and deciding what they would like during the process of receiving health care. This principle is to be respected by the nurse even when the patient is viewed to be unable to make a decision since they have family or people authorized to provide consent. The better option would have been to ask the parents to allow them to take pictures at the newborn unit. This would have to be followed by the use of the picture after asking for consent (Gagnon & Sabus, 2015 p 408). Providing the reason for doing so would offer the patients all the information they need in order to give consent. Additionally, the nurse is required to be honest. Nonetheless, there are disadvantages to posting such information on Facebook or any other social media platform as the person loses control of what could happen to the picture.
Security of information shared online on various platforms is a concern for patients. Therefore, it is unethical for nurses to share information using platforms and systems that have not been created for that purpose. There are various software applications that are meant for nurses and healthcare professionals. Many of the systems are compliant with the rules and regulations of privacy. Ewashen et.al 2013 p. 326 highlights the principle of no maleficence, which obliges the nurse to act in a manner that avoids harm to the patient. However, posting the patient’s information on social media has a security. The data could be intercepted and used to plan and harm the patient. Additionally, it could be used for cyber bullying or intimidation of the patient and his family. Thus, nurses should endeavor to ensure that the information shared does not provide leads to the patient. The security concern is also echoed in the Canadian Privacy, Data Protection and Cybersecurity law highlighted as the seventh principle of data protection ( Brown, 2017 pg 3). The law bestows the responsibility of safeguarding personal information to the institution as opposed to individual nurses.
Patient’s information should always be treated in a way that does not infringe on the patients right to dignified treatment. This includes pictures that may be deemed unsuitable to rely on the public. For instance, some patients may find photos showing their faces while seek to be demeaning. Nurses should act in the best interest of their patients by putting various factors into consideration. The factors are however not limited to the legal and ethical matters but also morality. Thus, the nurse would be able to judge a situation and analyze whether it is moral or not. In the case of taking pictures with babies, it is morally and ethically wrong to use a client's pictures without their consent. Additionally, the content of the picture can be demeaning and thus be viewed to be infringing on the patients right to dignified treatment. In some cases, nurses and healthcare professionals meet patients when they have lost control of the situation. For instance, patients from accident scenes, assault, and mental illness may lack control. Taking advantage of the power differential to take pictures of the patients can be detrimental to the patient psychologically. For instance, in the US, nurses working in a senior citizen home decided to take photos of their patients half naked ( Ornestain, 2017 pg. 3). This was considered morally and ethically wrong because the nurse posted the pictures online. Although the faces were not identifiable, this was considered gross misconduct as it was demeaning and disturbing for many families who have their patients in such homes. Despite having power differentials, healthcare professionals ought to treat patients with respect.
Nurses are bound by the principle of nonmaleficence and ensuring that the patients get maximum benefits. However, posting on social media in most cases are meant for individual gains. Many people want their friends and followers to praise or approve of their behavior. This clearly does not benefit the client especially when the nurse has not asked for the consent of the patient. the many likes and comments are good for the ego and online life of the nurse. However, nurses are bound by moral and ethical obligations which should lead them to act in a manner that is keen on the interests of the patient. Healthcare professionals should act with integrity and accountability, which is part of the nursing ethics. This includes reading and having knowledge of the laws and policies regarding the protection of patient information. Whenever such an incidence occurs, the nurse will be required to inform the management.
CNA recognizes that healthcare professionals use social media for personal and professional purposes. These uses can have an impact on the reputation of the professional. Nonetheless, the professional should endeavor to take stringent measures to say with the demarcations of privacy and ensure that patient information is secure. Social media use by nurses and other healthcare professionals can make it difficult to separate personal and professional life. Most people post about their lives and the events that interest them on social media. However, posting on social media platforms is not exempt from the laws and regulations of security. Thus, healthcare professionals should understand the impact of sharing information online. Additionally, information that is sent electronically is not anonymous as t can be traced to the source and possibly breach the privacy and security principle.
Despite the various ethical issues, the use of smartphones and social media has helped to enhance communication within the hospitals. A study on the utility of smartphones found that 67% of doctors use social media for their own professional use and to their followers. 60% of social media users tend to trust all posts shared by the healthcare professional while 55% trust the posts by hospitals. The gadgets make communication of vital information to their clients easy which lessens the cost of interagency communication (Bromwich & Bromwich, 2016 p. 855). Doctors and nurses can share information and even test results using email, pictures, voicemails, and notes on phone. However, this should remain within the regulations of security.
The expansion and use of internet in healthcare system raise concerns about privacy, confidentiality and the security of patient information. The use of social media has further blurred the line between the use of personal and professional sharing. Nonetheless, nurses are mandated to ensure that information which is classified as protected is secure and protected to ensure that privacy and confidentiality are in place. Institutions and healthcare professionals are mandated under section 45 of PHIPA 2004 to maintain patient privacy and data protection.
References
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Brown S. (2017). The Privacy, Data Protection and Cybersecurity Law Review 4th Edition Canada. Retrieved via https://thelawreviews.co.uk/edition/the-privacy-data-protection-and-cybersecurity-law-review-edition-4/1151278/canada
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