Arizona Board of Nursing Edition 30 : Page 10
<<< continued from mindful of employer policies, relevant state and federal laws, and professional standards regarding patient privacy and conﬁdentiality and its application to social and electronic media. By being careful and conscientious, nurses may ENJOY THE PERSONAL AND PROFESSIONAL beneﬁts of social and electronic media without violating patient privacy and conﬁdentiality. of using a personal device to take a patient’s photo; and that conﬁdential information should not be disclosed to persons no longer involved in the care of a patient. SCENARIO 2 Sally, a nurse employed at a large long-term care facility arrived at work one morning and found a strange email on her laptop. She could not tell the source of the email, only that it was sent during Illustrative Cases the previous nightshift. Attached to the The following cases, based on events email was a photo of what appeared to reported to BONs, depict inappropriate be an elderly female wearing a gown uses of social and electronic media. The with an exposed backside bending over OUTCOMES WILL VARY FROM JURISDICTION TO near her bed. Sally asked the other JURISDICTION�e; dayshift staff about the email/photo and some conﬁrmed they had received the SCENARIO 1 same photo on their ofﬁce computers. Bob, a licensed practical/vocational Nobody knew anything about the source (LPN/VN) nurse with 20 years of of the email or the identity of the woman, experience used his personal cell phone although the background appeared to to take photos of a resident in the group be a resident’s room at the facility. In home where he worked. Prior to taking the an effort to ﬁnd out whether any of the photo, Bob asked the resident’s brother if staff knew anything about the email, it was okay for him to take the photo. Sally forwarded it to the computers and The brother agreed. The resident was cell phones of several staff members unable to give consent due to her mental who said they had not received it. Some and physical condition. That evening, staff discussed the photo with an air of Bob saw a former employee of the group concern, but others were laughing about home at a local bar and showed him the it as they found it amusing. Somebody photo. Bob also discussed the resident’s on staff started an ofﬁce betting pool to condition with the former coworker. guess the identity of the resident. At least The administrator of the group home one staff member posted the photo on learned of Bob’s actions and terminated her blog. his employment. The matter was also Although no staff member had reported to the BON. Bob told the BON bothered to bring it to the attention of he thought it was acceptable for him to a supervisor, by midday, the director take the resident’s photo because he of nursing and facility management had the consent of a family member. He had become aware of the photo and also thought it was acceptable for him to began an investigation as they were very discuss the resident’s condition because concerned about the patient’s rights. The the former employee was now employed local media also became aware of the at another facility within the company matter and law enforcement was called to and had worked with the resident. The investigate whether any crimes involving nurse acknowledged he had no legitimate sexual exploitation had been committed. purpose for taking or showing the photo While the county prosecutor, after or discussing the resident’s condition. reviewing the police report, declined to The BON imposed disciplinary action on prosecute, the story was heavily covered Bob’s license requiring him to complete by local media and even made the national continuing education on patient news. The facility’s management placed privacy and conﬁdentiality, ethics and several staff members on administrative professional boundaries. leave while they looked into violations of This case demonstrates the need facility rules that emphasize patient rights, to obtain valid consent before taking dignity and protection. Management photographs of patients; the impropriety reported the matter to the BON, which 10 opened investigations to determine whether state or federal regulations against “exploitation of vulnerable adults” were violated. Although the originator of the photo was never discovered, nursing staff also faced potential liability for their willingness to electronically share the photo within and outside the facility, thus exacerbating the patient privacy violations, while at the same time, failing to bring it to management’s attention in accordance with facility policies and procedures. The patient in the photo was ultimately identiﬁed and her family threatened to sue the facility and all the staff involved. The BON’s complaint is pending and this matter was referred to the agency that oversees long-term care agencies. This scenario shows how important it is for nurses to carefully consider their actions. The nurses had a duty to immediately report the incident to their supervisor to protect patient privacy and maintain professionalism. Instead, the situation escalated to involving the BON, the county prosecutor and even the national media. Since the patient was ultimately identiﬁed, the family was embarrassed and the organization faced possible legal consequences. The organization was also embarrassed because of the national media focus. !
�d;YEAR�d;OLD JUNIOR NURSING STUDENT�c; Emily, was excited to be in her pediatrics rotation. She had always wanted to be a pediatric nurse. Emily was caring for 4OMMY�c;ATHREE�d;YEAR�d;OLDPATIENTINAMAJOR academic medical center’s pediatric unit. Tommy was receiving chemotherapy for leukemia. He was a happy little guy who WAS DOING QUITE WELL AND %MILY ENJOYED caring for him. Emily knew he would likely be going home soon, so when his mom went to the cafeteria for a cup of coffee, Emily asked him if he minded if she took his picture. Tommy, a little “ham,” consented immediately. Emily took his picture with her cell phone as she wheeled him into his room because she wanted to remember his room number. When Emily got home that day she excitedly posted Tommy’s photo on her Facebook page so her fellow nursing students could see how lucky she was to be caring for such a cute little patient. Along with the photo, she commented, arizona STATE BOARD OF NURSING REGULATORY JOURNAL