Identify and discuss at least two potential ethical issues that could be of concern for nurses with telehealth-delivered care.
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Ethical Issues in Telehealth-Delivered Care for Nurses
Telehealth, the delivery of healthcare services using digital communication technologies, has become an integral part of modern healthcare. Its utilization surged during the COVID-19 pandemic, facilitating remote patient consultations and increasing access to care. Despite its advantages, telehealth presents several ethical challenges that nurses must navigate to ensure quality care and uphold professional standards. Two prominent ethical concerns for nurses delivering telehealth care are patient privacy and confidentiality, and maintaining the quality of care in virtual interactions.
1. Patient Privacy and Confidentiality
A primary ethical concern in telehealth is the protection of patient privacy and confidentiality. Nurses are bound by the Health Insurance Portability and Accountability Act (HIPAA) to maintain the privacy of patient information, whether care is delivered in-person or remotely. Telehealth complicates this obligation because digital platforms introduce potential security vulnerabilities. Sensitive patient data may be exposed to unauthorized individuals through hacking, data breaches, or unsecured networks.
Telehealth often requires patients to access care from their homes, which can be a less controlled environment compared to clinical settings. Family members, friends, or others may inadvertently overhear confidential discussions, particularly when patients lack private spaces for their virtual consultations. Nurses are responsible for ensuring that their telehealth platforms comply with HIPAA regulations, using encryption, secure logins, and two-factor authentication to safeguard patient data (Papanagnou et al., 2021). However, technical issues, such as patients using public or unsecured Wi-Fi networks, can also put information at risk. It is essential for nurses to educate patients about securing their home networks and finding private locations to maintain confidentiality during telehealth sessions.
Beyond the technical aspects, another dimension of privacy in telehealth is the appropriate storage and handling of patient records. With electronic health records (EHRs) becoming the norm, nurses must be vigilant in ensuring that only authorized personnel access patient information and that records are stored in compliance with HIPAA standards. Telehealth platforms should also have clear policies for data retention and disposal to prevent unauthorized access after the termination of services.
2. Quality of Care and Nurse-Patient Relationships
Another ethical concern in telehealth-delivered care is the potential impact on the quality of care and nurse-patient relationships. Telehealth limits physical assessments, which are often critical for comprehensive care, especially for conditions that require tactile evaluation, such as skin conditions, wound care, or respiratory issues. Nurses may miss important non-verbal cues or subtle signs of distress that would be more apparent in face-to-face interactions. This raises the ethical question of whether patients are receiving the same standard of care remotely as they would in person.
Telehealth consultations may also lead to a reduction in the depth of nurse-patient relationships. The therapeutic relationship between a nurse and patient is built on trust, communication, and empathy, all of which can be challenged in a virtual environment. Nurses may struggle to establish rapport or convey empathy through a screen, which can impact patient satisfaction and engagement in their care. According to Shaw et al. (2020), the lack of in-person interaction can create emotional distance, making patients feel less connected to their healthcare providers. This disconnect may reduce the likelihood of patients adhering to treatment plans, which raises ethical concerns about the efficacy of care.
Moreover, nurses must navigate ethical dilemmas related to informed consent in telehealth. Ensuring that patients fully understand the limitations of telehealth, including the possibility of diagnostic errors due to the lack of physical examination, is crucial. Patients may not be aware of the risks associated with virtual care or may not be fully informed about how telehealth differs from in-person visits. Nurses have an ethical obligation to explain these limitations clearly and ensure that patients give informed consent before proceeding with telehealth services.
Conclusion
Telehealth presents nurses with unique ethical challenges that require careful consideration and proactive management. Protecting patient privacy and confidentiality in the digital realm is paramount, as is ensuring that the quality of care delivered remotely meets professional standards. Nurses must be diligent in using secure telehealth platforms, educating patients about protecting their privacy, and maintaining strong nurse-patient relationships despite the limitations of virtual communication. As telehealth continues to evolve, ongoing education and adaptation to emerging ethical issues will be essential for nurses to provide ethical and effective care.
References
Papanagnou, D., Santavicca, M., Randazzo, M., & Matthews, L. (2021). Telehealth, HIPAA, and COVID-19: Effective security methods for health care delivery and public health. Journal of Health and Medical Informatics, 12(2), 1-8. https://doi.org/10.35248/2157-7420.21.12.392
Shaw, S. E., Seuren, L. M., Wherton, J., Cameron, D., A’Court, C., Vijayaraghavan, S., … & Greenhalgh, T. (2020). Video consultations between patients and clinicians in diabetes, cancer, and heart failure services: A linguistic ethnographic study of video-mediated interaction. Journal of Medical Internet Research, 22(5), e18378. https://doi.org/10.2196/18378