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Case StudyUsing the scenario provided , please complete the case study based on your knowledge of ethics, HIPPA, HITECH and other standards that apply to technology in nursing practice. I have also attached some materials to help and some sites you can look at to help with the case study.Websites to View: rubricIdentifies at least 2 HIPAA Violations (10 pts each) 20 ptsCompletes flow chart with 2 outcomes for the case (10 pts each) 20 ptsIdentifies leadership behaviors essential to the case 5 ptsIncludes worksheet, utilizes provided handout, provides. 5 pts


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HIPAA and Ethics Worksheet
A nurse practitioner in the ED was treating an elderly woman for shortness of breath began to
look for the cause of her worsening condition. She ordered a drug screen, on which she tested
positive for cocaine. Her family, including her adult children, were present in the ED with her.
The NP asked the patient about the findings in the exam room and the patient told her that she
had no idea how cocaine could be in her system, which made the NP concerned she might be a
victim of abuse. One of the nurses involved in her care Googled her and discovered that she
had a previous police record for cocaine possession. The nurse emailed the NP the information
about the patient. The nurse also called social services and the family overheard her discussing
this patient on the phone in a public area.
1. Identify 2 HIPAA violation in the case. (10 pts each, 20 total)
2. Provide two possible outcomes in terms of the ethical dilemmas. (10 pts each, 20 total)
3. What leadership behaviors are essential to this case? (5 pts)
Nurs Admin Q
Vol. 29, No. 4, pp. 349–352
c 2005 Lippincott Williams & Wilkins, Inc.

Ethics in Nursing Administration
Ethics in Informatics
The Intersection of Nursing, Ethics,
and Information Technology
Leah L. Curtin, ScD (H), RN, FAAN
HE ethical questions posed by technology are fundamentally human
questions—almost all of which have to do
with how humans choose to use, or to abuse,
the powers of technology. Let us take, for example, the much discussed, and now highly
regulated, issue of information technologies
and privacy. People have been snooping into
other people’s business—and other people
have been trying to stop them—since the
dawn of time. I can almost see a neolithic
voyeur peeking around the huge pillars of
Stonehenge to get a better look! What does
technology add? You can find out more with
less effort, and spread it farther and faster
than anyone ever dreamed was possible. This,
in turn, vastly increases the impact of illicitly
gathered information.
Stealing—information, money, even a person’s identity—has always been wrong. It is
still wrong. What does technology add? It adds
greatly to the abilities of the unscrupulous to
bilk the unwary.
From the University of Cincinnati College of Nursing
and Health, Ohio. Dr Curtin is also the
Editor-in-Chief of Journal of Clinical Systems
Management and senior partner in Metier
Corresponding author: Leah L. Curtin, ScD (H), RN,
FAAN, University of Cincinnati College of Nursing and
Health, Cincinnati, OH (e-mail: [email protected]).
Accuracy in record keeping has always
been important, but rarely has the impact of
erroneous record keeping had the impact it
has today. And because we are talking about
healthcare—pain, life, suffering, and death—
the stakes are quite high. “Indeed, medical informatics is rich with ethical issues . . . privacy
and confidentiality, risks of bias and discrimination, the danger of scientific and clinical
hubris, the erosion of cherished relationships,
and the degradation of precious skills.”1
This article explores, however inadequately, the intersection of 3 vast areas of
inquiry: ethics, computing, and healthcare.
While each is a separate area of inquiry,
they all intersect in medical informatics—
and while there are, indeed, experts in
each field, rarely will there be one person proficient in all 3 fields of inquiry.1
On the one hand, the sheer power technology places in the hands of healthcare
professionals enlarges the ethical problems
they encounter, and on the other hand, it
decreases vastly the patient’s vulnerability by
allowing the patient to access vast quantities
of information about his or her condition.
Provided, of course, that the information is
accurate. Technologically improved tools
not only compress time but also dramatically
increase the impact of error—or of carelessness, foolishness, recklessness, and, for that
matter, malevolence. But they also enable
anyone with access to learn far more, far
faster than ever before.
For the sake of both brevity and clarity,
ethics can be defined as a discipline in which
one attempts to identify, organize, analyze,
and justify human acts by applying certain
principles to determine what is the right thing
to do in a given situation.2 A “human act”
is a choice, and a choice always involves a
value judgment.3 The concept of choice necessarily involves freedom (the ability to make
a choice) and with it the responsibility for
the results of that action. Values, simply put,
are matters of such importance that a person is willing to suffer, sacrifice, or even
die—or perhaps go on living—for them. To
at least some extent, all choices are value
choices. What then distinguishes an ethical
choice from any other choice? Ethical choices
share certain characteristics: (1) they always
involve fundamental value conflicts; (2) because the choice involves fundamental values (matters of utmost importance) rather
than facts (provable truth), scientific inquiry
may influence the choice, but cannot provide answers; and (3) because these choices
involve the placing of one value above another, and because by definition values are of
the utmost importance, any decision reached
will have profound, multiple, and often unanticipated impact on many areas of human
Because medical and healthcare professionals are almost always involved with choices
that affect significant, personal choices
of other human beings (patients/clients),
the foundation, form, and balance of values within that relationship are of great
importance.4 Professionals, by and large, are
educated in an elitist tradition that assumes
the professional is the expert, and it is the
professional who knows and weighs the
options and makes and implements the
decisions. Burgeoning technology, multiple
options, and diffusion of knowledge have
rendered this command ethic obsolete. Trouble is, few professionals are prepared to make
the transition to a more humble provision
of assistance in decision making—the communication of support and guidance rather
than authority and control. That being said,
however, in some instances, professionals
are surrendering both technical and moral
authority to patients, perceiving themselves
quite simply as tradesmen selling a service.
And that, too, is wrong. Are professionals
moral agents, or are they merely instruments
of the desires of others?
Ethics in the health professions is a discipline in transition, for professionals in transition, in a society in transition. We have yet
to develop an ideal model of adult patient/
professional relationship—one that optimizes
the contributions each partner in this relationship has to offer, and emphasizes mutual guidance, support, and shared decision
making. We are just beginning to sort out
who ought to be making decisions about
Into this volatile mixture, we now add medical informatics—with all the promise and
peril it offers. Medical informatics has been
emerging as a discipline in its own right over
the past quarter century. During that evolution, there have been a number of notable attempts along the way to define the field in scientific, formal yet succinct terms, and in many
cases each has built on its predecessors. However, for the purposes of this article, we shall
use the American Nurses Association’s definition of nursing informatics as “the specialty
that integrates nursing science, computer science, and information science in identifying,
collecting, processing and managing data and
information to support nursing practice, administration, education, research and the expansion of nursing knowledge.”∗
∗ For more information, visit the American Nurses Association’s Web site,, and type “informatics” into the search field.
Ethics in Informatics
From the 1940s through the 1960s, there
was no discipline known as computer ethics.
In the mid-1970s, Maner coined the term
computer ethics and defined it as a field in
which one examines “ethical problems aggravated, transformed or created by computer
technology.”5 In her book, Computer Ethics,
Johnson defined the field as one that studies
the way in which computers “pose new versions of standard moral problems and moral
dilemmas, exacerbating the old problems, and
forcing us to apply ordinary moral norms in
uncharted realms.”6 Like Maner before her,
Johnson recommended the “applied ethics”
approach, but she did not believe that computers create wholly new moral problems.
Moor defined computer ethics as a field concerned with “policy vacuums” and “conceptual muddles” regarding the social and ethical
use of information technology.7 Moor holds
that computer technology is genuinely revolutionary because it is logically malleable. According to Moor, the computer revolution is
occurring in 2 stages. The first stage was that
of technological introduction, and the second
stage—one that the industrialized world has
only recently entered—is that of technological permeation in which technology gets integrated into everyday human activities. In the
1990s, Donald Gotterbarn became a strong
advocate for viewing computer ethics as a
branch of professional ethics, and of developing standards of practice and codes of conduct for computing professionals. As a result,
Gotterbarn and others have been involved in a
number of related activities, such as coauthoring the third version of the American Computing Machines (ACM) Code of Ethics and Professional Conduct∗ and working to establish
∗ The
Board of ACM adopted this Code in 1992, and it
is binding on all ACM members. For a full rendition of
this Code, augmented by the extremely helpful guidelines
included, please visit ACM’s Web site at
licensing standards for software engineers.8,9
The code, consisting of 24 imperatives formulated as statements of personal responsibility, identifies the elements of each commitment. It contains many, but not all, issues
professionals are likely to face, outlines fundamental ethical considerations, and addresses
additional, more specific considerations of
professional conduct. The code and its supplemented guidelines are intended to serve as
a basis for ethical decision making in the conduct of professional work. Secondarily, they
may serve as a basis for judging the merit of
a formal complaint pertaining to violation of
professional ethical standards.
Health services involve some of the most
substantial information about matters that are
unquestionably personal and highly significant to all, and to each who receives healthcare at some point in his or her life—and that
is just about all of us. Its collection, accuracy,
and distribution is essential to both continuity
in our personal healthcare and research into
health and illness in populations. The information contained in these databases also offers
enormous opportunities for prejudice and financial gain.
Applied ethics is an area of inquiry that developed over the millennia, primarily to protect people from those who hold power. It
deals primarily with helping people decide
what is the right thing to do in a given situation, based on general concepts of good
and bad—and on the values of individuals and
the societies in which they live, breathe and
have their being. Often, what people believe
to be “right” ends up translated into laws designed to protect the “right,” which is what
happened in this case (note the privacy safeguards built into the Health Information Portability and Accountability Act).
The information revolution places unprecedented power in the hands of anyone with
access to a computer—many of whom are
ill-prepared to assume the responsibilities of
such power. Hacking, malicious destruction
(computer viruses), identity theft, sale of private information amply attest to both the
power of the medium and the puerile (and
occasionally villainous) uses to which it is fartoo-often put. And whole new areas of law and
law enforcement are quickly developing.
The mathematicians, engineers, and scientists who developed the hardware and
software—the very “engines”of the computer
revolution—are rapidly forging a new profession, one dedicated to personal development
and public protection (thus, the standards and
ethics). Healthcare informatics, by its very nature, intersects all 3—healthcare, ethics, and
informatics—and its practitioners must, for
the public’s good, be bound by additional ethical, moral, and legal responsibilities.
1. Kenneth G. Ethics, Computing and Medicine.
Melbourne, Australia: Cambridge University Press;
2. Carl W. Morals and Ethics. Glenview, Ill: Scott, Foresman Co.; 1975:317.
3. Bronowski J. The Identity of Man. Garden City, NY:
The Natural History Press; 1965:23.
4. Edmund P. The Health Care Professional as Friend
and Healer. Washington, DC: Georgetown University
Press; 2000:32.
5. Walter M. Unique ethical problems in information
technology. The London Times. June 9, 1995:137–
152. In: Bynum and Rogerson, eds. “Cyberspace:
The Ethical Frontier,” Times Higher Education
6. Johnson DG. Computer ethics in the 21st century.
Spinello RA, Herman TT, eds. Readings in CyberEthics. Jones & Bartlett; 2001. A keynote address at
the ETHICOMP99 Conference, Rome, Italy, October
7. Moor JH. Towards a theory of privacy in the information age. Comput Soc. 1997;27(3):27–32.
8. Donald G, Miller K, Rogerson S. Software engineering
code of ethics. Inf Soc. 1997;40(11):110–118.
9. Ronald A, Johnson D, Gotterbarn D, Perrolle J. Using the New ACM Code of Ethics in Decision Making.
Commun ACM. 1993;36:98–107.
JDMXXX10.1177/8756479314530509Journal of Diagnostic Medical SonographyBagley et al.
Original Article
Health Care Students Who Frequently
Use Facebook Are Unaware of the
Risks for Violating HIPAA Standards:
A Pilot Study
Journal of Diagnostic Medical Sonography
2014, Vol. 30(3) 114­–120
© The Author(s) 2014
Reprints and permissions:
DOI: 10.1177/8756479314530509
Jennifer E. Bagley, MPH, RDMS, RVT1, Dora DiGiacinto, MEd, RDMS, RDCS1,
Jaclyn Lawyer, BSMIRS, RDCS1, and Michael P. Anderson, PhD1
Social networking creates easy opportunities to violate HIPAA (Health Insurance Portability and Accountability Act).
The purpose of this study is to determine if students who frequently update their Facebook statuses have the ability
to identify certain Facebook postings as HIPAA violations. An anonymous survey was distributed to students on
a university campus of a health sciences center, containing questions related to how often Facebook was used or
accessed, how often students updated their Facebook statuses, and whether they could identify if specific online postings
constituted HIPAA violations. Students’ HIPAA scenario responses were compared to their frequency of Facebook
status updates, and students who frequently updated their information were more likely to incorrectly identify a
HIPAA violation—namely, photos of patients posted to Facebook, even those devoid of identifying information. No
other HIPAA violation scenarios demonstrated an association with frequencies of use or status updates. Further
research needs to be conducted to see what traits or behaviors put students at risk for violating HIPAA through social
networking sites.
Health Insurance Portability and Accountability Act, HIPAA, violation, social media, professionalism, online
Facebook has evolved from a social media site for high
school and college students to a globally used and recognized social networking forum that includes more than 1
billion people.1 Facebook has created a forum in which
individuals, businesses, schools, and other professions
are able to connect with one another, share information,
and express opinions across a wide network of users. The
literature is unclear how personal use overlaps with professional use or if individuals identify the difference. The
information that health care workers post online not only
affects others’ opinions of them and the reputations of
their employers but also creates the potential to violate
patients’ privacy and trust. As a result, the medical field is
beginning to define best practices for maintaining both a
professional and a personal online persona. The goal of
this study is to determine if students who frequently versus infrequently update their Facebook status information
can correctly identify updates that are in violation of laws
per the Health Insurance Portability and Accountability
Act (HIPAA).
Problems With Social Media in the
Health Care Setting
Pew Internet Research2 released a survey in 2010 that
explained how American adults interact on social networking sites. The Pew sample found that 92% of the 975
respondents participating in social networking sites have
a Facebook account and that 52% of these individuals
stated that they interact on Facebook on a daily basis. The
survey noted that Facebook users are more likely to comment on others’ Facebook posts, statuses, and photos than
The University of Oklahoma Health Sciences Center, Tulsa, OK,
Corresponding Author:
Dora DiGiacinto, MEd, RDMS, RDCS, Associate Professor,
Department of Medical Imaging and Radiation Sciences, College of
Allied Health, The University of Oklahoma Health Sciences Center,
1200 North Stonewall, Oklahoma City, OK 73126, USA.
Email: [email protected]
Bagley et al.
to update their own Facebook statuses on a daily basis.
Women are more likely than men to interact on Facebook,
and the younger the user is, the more likely that he or she
will comment on others’ posts at least once per day. The
survey also demonstrated how social networking platforms have changed social interactions. The average
American adult feels more connected to other people
when interacting on Facebook and claims to have closer
social circles in which to confide and discuss daily events.
Thompson et al3 conducted a study in 2008 to assess
501 medical students’ and 312 residents’ use of Facebook
and their professionalism (or lack thereof) present in their
digital profiles. The researchers found that 44.5% of participants had Facebook accounts and that the further students progress in school, the less active they became on
the site. Only 12.8% of the residents had Facebook
accounts, while 64.3% of medical students each had one.
The study demonstrated that only 37.5% of medical students and residents had private Facebook profiles, while
the remaining students left their Facebook profiles public
and did not implement any additional privacy settings.
MacDonald et al4 conducted a study that examined the
use of social networking sites and content posted, as well
as the use of privacy settings by doctors who graduated
from a university in New Zealand between 2006 and
2007. Their retrospective study assessed 338 newly graduated physician Facebook profiles for availability of content to other Facebook users who belonged to the same
network. They found that 65% of newly graduated doctors had Facebook accounts, that 66% of the these doctors
frequently accessed their Facebook profiles, and that
63% of the profiles had activated privacy settings. A
number of users provided their personal age, friends, and
associated groups, including groups with obscene names
containing profanity or degrading to the medical profession. The mean number of photographs displayed per
Facebook account was 85.8, and approximately half the
photos portrayed unhealthy, unprofessional, or obs …
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