Confidentiality Considerations of Treatment of Diabetes Patients in the Healthcare System

Running head: CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 1

Confidentiality Considerations of Treatment of Diabetes Patients in the Healthcare System –

Future of Nursing

Following the American Psychological Association Style Guide

Professor CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 2

Introduction

This essay will consider diabetes prevalence, quality outcome framework, and discuss the state of diabetes on the American with a protection of the trust and confidentiality of patients

(NMC, 2017).

Patient Description

This particular patient identified as Patient C for confidentiality reasons developed diabetes later in life around the age of 60 years old. She is slender and has Type 2 diabetes. The treatment of diabetes began with the consuming of medications in order to help the diabetes. The diabetic situation progressed and now Patient C is injecting herself with insulin. Patient C will be turning 100 years old in October of this year. Patient C has been able to prolong her life by eating a diet based on Mediterranean cuisine; exercising by walking daily either on her treadmill in cold weather, or through her neighbourhood when weather is warming. She walks for a minimum of 30 minutes daily. As well, Patient C reduces any level of stress from her life and also has a very good family and strong family support. She speaks with many of her family members on a daily basis, if not on a weekly basis with other members. She takes care of her great grandchildren and watches only programs on television that make her laugh, plus listens to music at home that enjoys. Due to her age, she does not go out to as many social functions as she even did 10 years ago, however she does entertain at home often where her all of her children, grandchildren and great children help to prepare the meals and clean the home. Patient C need not do anything that would result in any stress for her.

The second case study of another patient is named Patient A with diabetes and leg wounds. I would need to do a care plan about his treatment that his a Type 2 diabetic patient and CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 3 what insulin he is on and why. The patient name has been changed to John to adhere to Nursing

Midwifery Council NMC, code of conduct which is a standard five confidentiality (NMC, 2017).

John is a 55 year old man who was diagnosed with Type 2 diabetes 13 years ago. When he was first diagnosed he was started on Metformin tablets for three years but because of poor management of his diabetes and bad diet, he developed diabetic foot ulcers. Due to his diabetes not being well controlled he had his right foot toes amputated. After John had his surgery his medication was changed from metformin and was now started on insulin. John has been on insulin for while he takes Humulin one once a day at night and Humulin S three times a day.

John was still having problems with his diabetes it was still not well controlled, his Blood

Glucose readings were also high there where from 20 to 30. John was not managing his diabetes well, he was on a very dad diet having a lot of sweet stuff, not an attending his diabetes appointments with the dietician and the diabetic nurse and doctors, his living conditions were very bad. John has now being admitted in hospital again after developing painful left foot and leg pain, black discolouration on the big toe plantar surface and also on the small toe base at the lateral surface and also ulcer on the right shin area. On examination by the surgeons they were not unable to feel the dorsal pedal artery nor the TIB post artery, leg was tender and red no improvement with antibiotics. The plan for John was to go to theatre again for amputation. His recent HbA1c was 82.

Literature Review

Anywhere hospital recently experienced negative publicity in the local community because of some unethical actions taken by a few of its employees concerning PHI. According to

HIPAA.com (2017) Protected Health Information is PHI. The hospital subsequently took disciplinary action against the employees. The hospital Administration has asked me to address CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 4

“Ethical Issues” in the workplace. The work product I produce will be used to prevent recurrence of these unethical actions by implementing a Policy/Procedure and education to employees. The following questions will be answered for this essay: if the hospital has a code of ethics/conduct, are employees aware of it? If the hospital does not have a code, should one be developed and implemented? Does the hospital have a compliance program? Are the employees aware of laws, rules, regulations, policies that govern a compliance program? Do the employees understand the consequences of their actions in not adhering to the compliance program? Do the employees understand the benefit from adhering to the compliance program? Does the hospital train employees on not only the theories associated with their program, code of ethics, confidentiality, etc. but on their application of such? Do the hospital’s procedures align with compliance program? Is the issue of ethics interwoven into all hospital policy/procedures? Are employees appraised on questions of ethics? Is there a mechanism for positive reinforcement of ethical behavior? Is there a mechanism to detect unethical behavior at the time of its occurrence or immediately thereafter? Is there a mechanism to deal with unethical behavior as a personnel matter, as a licensing/credentialing matter, and a public relations matter? Is there a mechanism in place to review and learn from past mistakes involving ethics?

According to Flite & Harman (2013) the code of ethics at many hospitals and healthcare facilities in America have been revised over many decades, close to centuries in some situations not researched in this particular article. Although efforts are made by the Hospital

Administration to educate their staff on the complete understandings regarding code of ethics procedures as they relate to PHI, many employees of hospitals and healthcare facilities simply do not understand the extent and the severity of their actions when they breach the code of ethics protocol (Flite & Harman, 2013). As well, there are many employees at health facilities, CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 5 healthcare centers and hospitals who do not even understand the legal definitions without any legal backgrounds of the code of ethics protocol within their hospitals despite the efforts of

Healthcare Administration to clarify the wording of the legislation that is involved with code of ethics and PHI (Flite & Harman, 2013):

The code of ethics for a professional association incorporates values, principles,

and professional standards. A review and comparative analysis of a 1934 pledge

and codes of ethics from 1957, 1977, 1988, 1998, 2004, and 2011 for a health

information management association was conducted. Highlights of some changes

in the healthcare delivery system are identified as a general context for the codes

of ethics. The codes of ethics are examined in terms of professional values and

changes in the language used to express the principles of the various codes (Flite

& Harman, 2013).

Methodology

Limentani (1999) does understand that a code of ethics at healthcare facility can sometimes and even often conflict with a personal and/or individual moral code of ethics.

However, Limentani (1999) does offer this in explanation of whether or not hospitals without a code of ethics should have one:

An ethical code cannot provide the answer to specific ethical problems. Rather

than dictating particular actions a code should describe the ethical environment

for the delivery of health care and reflect its character and general approach. An

ethical code should not try to make subjective aspects of care more objective or

separate value from practical situations: it is in the nature of the work of

professions that there remains individual responsibility for ethical practice. If CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 6

challenged, ethical codes cannot explain why moral judgments should be made or

give a firm justification for making those judgments; considered, individual moral

judgments themselves are more basic and require no more profound reference.

Ethical codes can give shape and structure to our moral environment and

summarise our ethical position while leaving ethical responsibility with the

individual practitioner. Looked at in this way, individual variation and personal

issues can be taken into account. An ethical code can facilitate the discussion of

ethical issues in difficult cases, and distinctive ethical positions can be established

and argued, leading to broader and more secure moral conclusions. An ethical

code can describe the ethical attitudes that are shared by healthcare workers, and

in this it can be immensely valuable and influential. But what it cannot do is

provide the certain answers for the many ethical problems encountered in the

course of medical practice (Limentani, 1999).

Expected Results/Conclusions

Mayberry, Nicewander, Qin & Ballard (2006, April) contribute to this discussion regarding PHI that hospitals and healthcare facilities do require compliance programs for the benefit of the consumers who use the healthcare system:

The health care quality chasm is better described as a gulf for certain segments of

the population, such as racial and ethnic minority groups, given the gap between

actual care received and ideal or best care quality. The landmark Institute of

Medicine report Crossing the Quality Chasm: A New Health System for the 21st

Century challenges all health care organizations to pursue six major aims of CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 7

health care improvement: safety, timeliness, effectiveness, efficiency, equity, and

patient-centeredness (Mayberry, Nicewander, Qin & Ballard, 2006, April).

Laws and Rules that Govern a Compliance Program

Since about 1970, several major business and government excesses were seen in

the United States to generate subsequent legal, public and political reaction.

The Foreign Corrupt Practices Act is perhaps the legislation with the most

significant impact and influence in the development of ethics and compliance

programs; similar ideas are encoded in the Committee of Sponsoring

Organizations, and the Federal Sentencing Guidelines (Bemporad & Campbell,

2006).

Consequence of Violating PHI

According to Ulrich, Taylor, Soeken, O’Donnell, Farrar, Danis & Grady (2010) this research focuses on the ethical stress associated with being a nurse in hospitals of this time. The results of the research were:

A total of 422 questionnaires were used in the analysis. The five most frequently-

occurring and most stressful ethical and patient care issues were protecting

patients' rights; autonomy and informed consent to treatment; staffing patterns;

advanced care planning; and surrogate decision-making. Other common

occurrences were unethical practices of healthcare professionals; breaches of

patient confidentiality or right to privacy; and end-of-life decision-making.

Younger nurses and those with fewer years of experience encountered ethical

issues more frequently and reported higher levels of stress. Nurses from different CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 8

regions also experienced specific types of ethical problems more commonly

(Ulrich, Taylor, Soeken, O’Donnell, Farrar, Danis & Grady, 2010).

Benefits of Compliance

Again, according to the research of Ulrich, Taylor, Soeken, O’Donnell, Farrar, Danis &

Grady (2010), their conclusions support that more hospital staff would benefit from complying to the codes of ethics protocol in hospitals and healthcare facilities: “Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed (Ulrich, Taylor,

Soeken, O’Donnell, Farrar, Danis & Grady, 2010).

Good Training of a Beneficial Code of Ethics and Compliance Program

A strong code of ethics plan contains the following:

 Effectiveness describes the quality of a program along two dimensions: design

effectiveness and operational effectiveness

 The concept of efficiency captures the cost of the process or system – not simply

financial efficiency, the amount of money spent but also the cost of human capital

expended.

 Responsiveness should be looked at on two dimensions — the system's ability to

operate quickly and flexibly in response to changing circumstances (OCEG.org,

2017).

Future Recommendations

In conclusion, according to Epstein & Turner (2015) “to practice competently and with integrity, today's nurses must have in place several key elements that guide the profession, such CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 9 as an accreditation process for education, a rigorous system for licensure and certification, and a relevant code of ethics.” The same is true of everyone in a hospital, healthcare facility and health center who is a member of staff from as high up as the Hospital Administration and/or CEO to the janitor or delivery person.

Forms of Treatment and the Future of Nursing

This formal paper focuses on the future of nursing and how it relates to the Robert Wood

Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health”

(Campaignforaction.org, 2015). The paper also deals with the importance of the IOM “Future of

Nursing” report related to nursing practice, nursing education and nursing workforce development (Campaignforaction.org, 2015). Also, the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action will be discussed

(Campaignforaction.org, 2015). Keeping in mind the State of New York where I live, the following questions will also be answered in this formal paper: in what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers? First, I will discuss the Robert

Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of

Medicine research that led to the IOM report mentioned earlier.

IOM Report and Robert Wood Johnson Foundation

This campaign sees a history where all Americans have access to “high-quality healthcare” (Campaignforaction.org, 2015). Eighteen member experts over a two year period studied the issues around healthcare and nursing in America and came up with recommendations CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 10 towards the future of nursing in America (Campaignforaction.org, 2015). The key factors that were concluded from the findings of the IOM report are:

 “Nurses should practice to the full extent of their education and training.

 Nurses should achieve higher levels of education and training through an improved

education system that promotes seamless academic progression.

 Nurses should be full partners with physicians and other healthcare professionals, in

redesigning healthcare in the United States.

 Effective workforce planning and policy-making require better data collection and

improved information infrastructure” (Campaignforaction.org, 2015).

The key goals of the campaign’s continuation rely on the following goals:

 “Leveraging Nursing Leadership.

 Removing Barriers to Practice and Care.

 Promoting Diversity.

 Bolstering Workforce Data, and

 Fostering ‘Interprofessional’ Collaboration” (Campaignforaction.org, 2015).

Next, the role of state-based action coalitions and how do they promote the goals of the Future of

Nursing: Campaign for Action will be discussed (Campaignforaction.org, 2015).

State-Based Action Coalitions CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 11

Recently with the Great State Fair of New York they raised $5,000 for the Nursing

Action-Coalition in New York State. The New York State Action Coalition or (NYSAC) has the following mandate:

“The New York State Action Coalition (NYSAC) is composed of a diverse array

of stakeholders that are charged with leveraging nurses to transform health care in

New York by implementing the recommendations of the Institute of Medicine

(IOM) report, ‘The Future of Nursing: Leading Change, Advancing Health’”

(NYSAC, 2015).

The aims of the NYAC include the following:

“Remove scope-of-practice barriers so that advanced practice nurses can practice

to the full extent of their education and training.

Increase the proportion of nurses with a baccalaureate degree to 80 percent by

Increase the diversity of students to create a workforce prepared to meet the

demands of diverse populations across the lifespan.

Prepare and enable nurses to lead change to advance health by assuming

leadership positions across all levels of public, private and governmental

programs” (NYAC, 2015).

Now keeping mind that I am a nurse in New York State, I will discuss how the initiatives of the

NYAC and the Campaign for Action advance the nursing profession.

“Nurses should practice to the full extent of their education and training,”

(Campaignforaction.org, 2015). New York State has fantastic world-class schools that can CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 12 produce some of the best and brightest nurses in the United States. “Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression,” (Campaignforaction.org). Again, New York State due its superb school system offers a myriad of opportunities for nurses to not only receive their required undergraduate training to become a nurse, but even to continue with their schooling by seeking out graduate work at the master’s and doctoral level, as well as specialized certifications to nurse in environments such as mental health or oncology as just two examples.

“Nurses should be full partners with physicians and other healthcare professionals, in redesigning healthcare in the United States,” (Campaignforaction.org, 2015). Coupled with higher education levels, an example of a nurse who has her PhD, or doctorate in nursing is a good companion ally to work with physicians and other healthcare professionals in redesigning the healthcare system in the United States. Through certifications and the certification process as well, nurses can work alongside other healthcare professionals in specialty areas and have the same or similar knowledge or skill sets on the healthcare issue at hand so it leads to more teamwork in the healthcare system in the United States. In terms of the goals of the NYAC

(2015), the Campaignforaction.org goal of “effective workforce planning and policy-making require better data collection and improved information infrastructure,” (2015) leads to improvements in hospital administration – and the State of New York also has some of the best hospitals in the world. These future visions for nursing and healthcare will simply make New

York State even better than it is. Next I will discuss the following issues and respond to the following questions: what barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers? CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 13

Barriers to Advancement

I will discuss the issue and respond to the question of barriers to advancement currently existing in New York State. With many foreign-trained nurses in New York, the focus of the barriers will focus on this issue.

According to Foster & Wheeler (2013) there are barriers between internationally educated nurses (IENs) and registered nurses (RNs). In Foster & Wheeler’s study (2013), they found that the participation of nurses in hospital government lead to empowerment. Their study focused on methodology of semi-structured interviews with 82 nurses in two urban hospitals.

With a study such as this, the hospitals could have been in one of the many urban environments of New York State, being a state with a high concentration of urban metropolises. In this same study 40 nurses were interviewed to follow up on themes (U.S. National Library of Medicine,

2015). The results of this research found that IENs and RNs share similar perspectives on the barriers to professional advancement in nursing. Both of the sample nursing sets from the RNS and the IENs felt that they lacked guidance of how to participate in hospital administration, were not encouraged to advance and preferred to be at the bedside of their patients. The conclusions support the initiatives of the NYAC (2015), as well as the Campaignforaction.org (2015). Next I will also conclude this paper.

Conclusion

This essay will consider diabetes prevalence, quality outcome framework, and discuss the state of diabetes on the American with a protection of the trust and confidentiality of patients

(NMC, 2017). CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 14

In conclusion, according to Epstein & Turner (2015) “to practice competently and with integrity, today's nurses must have in place several key elements that guide the profession, such as an accreditation process for education, a rigorous system for licensure and certification, and a relevant code of ethics.” The same is true of everyone in a hospital, healthcare facility and health center who is a member of staff from as high up as the Hospital Administration and/or CEO to the janitor or delivery person.

This formal paper focused on the future of nursing and how it relates to the Robert Wood

Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health”

(Campaignforaction.org, 2015). The paper also dealt with the importance of the IOM “Future of

Nursing” report related to nursing practice, nursing education and nursing workforce development (Campaignforaction.org, 2015). Also, the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action was discussed

(Campaignforaction.org, 2015). Keeping in mind the State of New York where I live, the following questions were answered in this formal paper: in what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?

CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 15

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CONFIDENTIALITY CONSIDERATIONS OF TREATMENT OF DIABETES PATIENTS IN THE HEALTHCARE SYSTEM – FUTURE OF NURSING 17