Question

A 6 year old has come to the attention of the child welfare department as a possible victim of sexual abuse.The child lives in a very rural part of a western state. Rather than have the child travel a distance to experts, she was taken to the nearest clinic with assault nurse examiners and a knowledgeable pediatrician skilled in sexual abuse examinations. At the time of the examination, pictures ere taken of the child’s body, including the genital area. These pictures are crucial if charges are filed. To ensure that an accurate diagnosis is made, local experts wish to have a second opinion because the results of the physical examination were not believed to be completely definitive. The experts for the second opinion were linked via the internet and internet videoconferencing equipment so that the two teams could talk and view deidentified (because the information was going across unsecured Internet channels) photos. Within 15 minutes, it was determined that the hymen was intact and no penetration had occurred. Other markers indicated that there was evidence of chid abuse, but none that supported a claim of sexual assault. This case used an EMR, digitized photos, and internet consultation to arrive at a diagnosis that had both medical and legal implications.

1. Discuss the impact of the use of these methods in the case on the nurse-patient relationship and on patient confidentiality including HIPAA requirements.

2. How else might this technology be used?

3.What is your opinion of the human, caring part of the care process in relation to this case description?

Answer 1

1.The EHR is a safer technique which can be used for transfer of data and images.It complies under HIPAA.It is highly maintained as a confidential matter.It can impact a relationship between a nurse and patient as a concern of autonomy ,though the patient is a child the privacy has to be maintained ,decision shoukd be mqde on the basis of beneficience.It can morally impact the feeling of a child by capturing image of the private area for investigative process.The chance of cyber crime has also increased to a greater extent irrespective of any security system laid ,so the threat of hack is possible via internet.

2.Instead of using an internet video conferencing a mobile app which are secured can be used .The usage of Personal Health Information under Privacy rule act could have been used to interchange images.This method used is an unsecured one ,so the healthcare professionals can be charged against it for not protecting patient personal information.

3.This ideology of taking an image of the private area for investigative purpose is though legally acceptable but not morally acceptable by any one.The physician was using the most unsecured system making the privacy of the child a question mark.Hence it seems to be an ineffective care process though the pediatrician is knowledgeable and skilled in handling these cases.