1.On page 48 of the Forrestal & Cellucci reading, review 3.2 under the For Your Consideration section.  According to the description of the events that took place at this hospital, what guideline or procedure do you think could be drafted that would help to prevent future breaches in patient confidentiality?  According to the ACHE Code of Ethics, what is the healthcare executive’s responsibilities in the event of such a breach?  What ideas will you propose for the guideline?  How are your ideas supported by the ACHE Health Information Confidentiality policy statement?

2.Case Study 3 #Think Before You Post

Katie P. Desiderio

Ella changed the privacy settings on her Facebook account to the most secure option, just as her nursing professor advised. While she understood the importance of being cautious, she thought the nurs­ing faculty members were taking social media privacy to a new level of vigilance, “I’ve had It with lectures on using social media responsibly; seriously, what can really happen?” Ella wondered. Before she could continue venting online to her friend Grayce, her professor interrupted. “Ella, please put your phone away during class, and this request is extended to the rest of the class, too. The obsession with your cell phones has got to stop, people!” Ella rolled her eyes at Professor Cole’s comment and gazed off for the remainder of the class.

At the close of the third quarter of 2015, Facebook reported 1.55 billion active users (Statista 2017). Furthermore, Mark Zuckerberg (2015), founder of Facebook, noted that “for the first time ever [on August 27, 2015], one billion people used Facebook in a single day.” The nursing faculty members at Ella’s nursing school are theoretically aware of the implications pertaining to responsible usage of social media; conversely, many don’t use this medium, so the learning curve is reciprocally influential for both faculty and students. St. Isabelle’s Hospital, the primary partner of the nursing program, has encouraged the college to proactively provide supplementary reading to students on the ethical responsibilities of nursing staff; guidelines for using social media; and, of course, awareness of the Health Insurance Port­ability and Accountability Act of 1996 (HIPAA). The hospital’s stance is that, considering the severity of a breach in patient confidentiality, technology has certainly changed accessibility to patient protected information for anyone working in healthcare. The Office for Civil Rights of the US Department of Health & Human Services (2015) enforces

the HIPAA Privacy Rule, which protects the privacy of individually iden­tifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health Information: the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured pro­tected health Information; and the confidentiality provisions of the Patient Safety Rule, which protect Identifiable information being used to analyze patient safety events and improve patient safety.

As a tenured faculty member and chair of the nursing program, Professor John Cole had never anticipated just how much technology would affect his work. With a new awareness, he became acclimated with the issue by reading the first recommended resource, from The Online Journal of Issues in Nursing’s 2012 publication “Guidelines for Using Electronic and Social Media: The Regulatory Perspective,” before assigning It to students. He was struck by a segment in the first few paragraphs that read, “participating in social media is not a problem as long as nurses always remain cognizant of their professional obli­gations” (Spector and Kappel 2012). Cole read the statement again, reflecting on how it applied to every member of his department, from faculty to staff to students. As he finished the article, he began think­ing about the ways he would integrate its guidance Into his courses.

Cole then searched for definitions of social media. He found that Kaplan and Haenlein (2010, 61) define social media as “a group of Internet-based applications that build on the ideological and technolog­ical foundations of Web 2.0. and that allow the creation and exchange of user-generated content.” For another perspective pertaining specifi­cally to the nursing profession, according to Butman and Schutz (2008), social media is “an outlet where nurses can share workplace experiences, particularly those events that are challenging, [that] can be as invaluable as journaling and reflective practice, which have been iden­tified as effective tools in nursing practice.” To maintain the college’s treasured partnership with St. Isabelle’s Hospital and the overall credibility of the nursing program, Cole realized that explicit educational opportunities surrounding HIPAA and social media consumption must be woven into the curriculum. As he thought about the exciting, and daunting, teaming opportunities, Cole sat back in his chair and enjoyed the glistening of the sun leaving a rainbow across his desk. His calming thoughts were interrupted by an insistent knock on his door. “John, we have a big problem that needs our attention. Now.”

As a senior in the nursing program, Ella was enjoying her clinical rotations and felt eager to begin her career in nursing. She was espe­cially excited about the opportunity to learn more in the obstetrics and gynecology department of St. Isabelle’s, where she had been spend­Ing every Tuesday since the start of the semester. She had never con­sidered the extent of this specialty, nor had she anticipated the wide range of exposure to everything from reproductive cysts to the variety of birthing methods. It was nearly 11:30 a.m., and the patient in room 205 would be arriving soon following recovery from her scheduled cesarean section. Ella decided to use her few minutes of downtime to check Facebook before her day grew busy again. “Oh YAY, this is so exciting.” Ella squealed, forgetting where she was. She quickly “liked” Grayce’s recent post that their favorite professor was expecting a baby in May. “Wow,” Ella thought, “a baby. Professor Lee must be so thrilled!” A smile formed across her face at the thought of her professor as a mom; she couldn’t wait to congratulate her on campus tomorrow!

When Ella left the hospital that evening, she texted Grayce, excited to learn more about Professor Lee’s pregnancy announcement. This text message exchange followed:

Ella: Hey, hey pretty! Saw your FB post about Lee … soooo excited!! 🙂 How did u find out?! What is she having?

Gryce (responded Immediately): I knowww. can u believe it?! She came In today for an ultrasound and seemed as surprised as us. I really hope we can babysit!!

The blood drained from Ella’s face and her excitement dissolved; she felt nauseous. She could hear Professor Cole’s voice In her mind saying. “As aspiring nurses. you must consider how and when to use social media. THINK before you post.” Grayce sent another text, .. “u there?” Ella began typing, but couldn’t formulate her thoughts. She resorted to, “call when u can talk.” Ella’s phone rang moments later.

Back on campus, Cole was frantically gathering Information about the college’s policy for handling such a breach of privacy. He knew he also had to consider the hospital’s policy as noted in its partnership agreement with the nursing program. While he was gratified that his colleague alerted him to Grayce’s Facebook post, he recognized he had more to learn about the privacy, or lack thereof, of social media. He was unaware that liking a post appears on the newsfeed of that friend for anyone to see. His mind was racing with what to do first. In his 20 years in higher education, he never imagined he would be considering expulsion for a student’s misuse of social media. Is expelling Grayce too harsh? Will the nursing program be legally liable for sharing personal patient (and faculty) information without consent? Will Ella face any consequences for liking the post? Does Ella realize that when you like a post, it is shared to your Facebook newsfeed? Does the college have a current social media policy in place? Cole had so many implications to consider. He needed to consult with the college’s provost before making any decisions, but first he had to get in touch with Grayce to have her delete her post. Questions continued to flood his mind.

Discuss your responses as a group to the three questions posed at the end of the case study.

Offer a comprehensive definition of social media.
Will the nursing program be legally liable for sharing personal patient (and faculty) Information without consent?
What is the most important lesson to be learned from this case study?


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