Ethical and Legal Considerations in Telenursing and Digital Health Care

Ethical and Legal Considerations in Telenursing and Digital Health Care

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  ETHICAL & LEGAL ISSUESIN TELENURSING AND DIGITAL HEALTH Presented by Altaf M Nadaf
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  Telenursing and digitalhealth, we can use………..
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  “When nurses protectprivacy and data ethically, patient trust rises. When ethics fall, trust falls.” “ Ethics is the foundation on which patient trust grows.
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  माझ्यापासून सुरुवात करा
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  “What is anABHA card and how does it help patients?” ABHA card is a digital health ID for storing medical records
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  How ABHA CardHelps • Helps patients maintain all medical records in one place • Improves continuity of care by sharing health history with doctors • Saves time and paperwork during hospital visits • Reduces duplicate tests and errors • Supports better diagnosis and treatment planning • Useful during emergencies for quick access to health information
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  We are goingto deal with Patient privacy data security informed consent professional accountability
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  Telenursing: Nursing careprovided using digital communication technologies. Digital Health: Use of electronic systems, apps, telemedicine, and health records for care. Ethics: Moral principles guiding right and wrong actions. Confidentiality: Duty to protect patient information. Informed Consent: Patient’s voluntary agreement after understanding care and risks. Accountability: Being responsible and answerable for professional actions.
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  1. Patient privacy Patientprivacy means the patient has control over who hears, sees, or accesses their health information, including during video calls.
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  Elements 1. Environmental Privacy •Ensure patient is in a private place • Ask: Is anyone else with you? • Suggest headphones or moving to another room 2. Visibility of Participants • Identify all people on screen • Get patient approval for trainees or IT staff
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  Privacy breach :Sharing a patient’s information without permission
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  Correct Practice • Nurseconfirms privacy first • Asks permission for others present Research Evidence • Studies show privacy concerns are a major barrier to telehealth use (NIH, 2020).
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  2. Data security Datasecurity means protecting health data from loss, theft, or unauthorized access.
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  Elements 1.Cyber Hygiene Strong passwords Multi-factor authentication(MFA) Regular software updates 2. Encryption Data encrypted at rest(stored) Data encrypted in transit(sent) 3. Access Control Role-based access Staff see only what they need
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  Real Example (Global) ChangeHealthcare breach (2024) 100 million records affected Cause: Lack of MFA (Multi-Factor Authentication.) Something you know – Password or PIN Something you have – OTP on phone, smart card, security key Something you are – Fingerprint, face ID, iris scan
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  Nurse uses personalphone without lock Phone stolen → patient data leaked
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  Best Practice Hospital-approved apps Password+ OTP + device lock
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  3. INFORMED CONSENT Indigital health, informed consent means the patient understands: The care being given • The technology risks • Their right to refuse digital care
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  TYPES OF CONSENT 1.Implicit Consent • Given automatically by the patient’s action Occurs when the patient initiates the teleconsultation Example: Patient calls the nurse through a telehealth platform for advice ✅ Implies agreement to receive care 2. Explicit Consent • Clearly expressed consent (verbal, written, or digital) • Mandatory in telenursing and digital health for: First- time teleconsultation Use of patient data for research or education • Example: Patient clicks “I Agree” or gives verbal consent before a video consultation
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  Informed Consent • Thenurse must clearly explain:The nature and purpose • How care will be provided • Possible benefits and limitations • Potential risks, including data breaches or technical failures • Consent is given only after the patient understands this information. Voluntary Consent • Consent must be given freely, without pressure or coercion. • The patient has the right to refuse or withdraw consent at any time without affecting future care
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  Electronic Consent (eConsent) •eConsent refers to the method used to obtain consent, which can take various forms. It includes: • Digital Signatures: Using tools like DocuSign to sign, or using a "photo signature" • Interactive Web Applications: include quizzes or video modules to ensure the patient has read and understood the information before signing. • Chatbots/AI: Using AI-driven tools to guide patients through the consent process Granular Consent • Allows the patient to pick and choose which aspects of their digital health data they are willing to share or what services they agree to. • Example: A patient consents to their data being used for care delivery, but opts out of having their data used for research purposes.
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  What Must BeExplained Possible technical failures • Risk of data breach Capacity Assessment • Nurse must assess patient’s ability to understand • If patient lacks capacity → proxy consent (Proxy consent is consent given by a legally authorized representative when the patient cannot give consent themselves.)
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  Example Telepsychiatry patient withdementia • Consent must be taken from legal guardian Research Evidence • Studies show proper consent improves patient satisfaction and trust (SAGE Journals, 2024).
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  4. PROFESSIONALACCOUNTABILITY Professional accountability means nurses arelegally and ethically responsible for digital care.
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  KEY RESPONSIBILITIES Legal Compliance Follow HIPAA / GDPR ( law globally—USA/ EUROPE)  Follow national digital health rules (India) Eg. Ayushman Bharat Digital Mission (ABDM) Digital Personal Data Protection Act (DPDP Act), 2023 National Health Digital Standards (NDHS) Documentation  All emails, messages, teleconsult notes  Must be part of medical record Professional Conduct  No personal WhatsApp or social media for routine care  Maintain professional boundaries
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  HOW?
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  KEY TAKE-HOME MESSAGES Digitalcare needs extra ethical care Privacy, security, consent, and accountability are connected Nurses play a central role in patient trust Ethical telenursing = safe + legal + respectful care
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  RESEARCH-BASED ISSUES Domain Issue Evidence Source Ethical Informedconsent challenges Solimini et al., 2021 Ethical Patient privacy & confidentiality Ritunga et al., 2025 Legal Data protection & liability Nittari et al., 2020 Ethical Professional–patient relationship Keenan et al., 2021 Ethical/Legal Equity & access Solimini et al., 2021
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  Key Research Conclusions ✔Tele-nursing and telemedicine both face ethical issues in consent, autonomy, and confidentiality that need structured guidelines. Legal protections and cyber-security safeguards are ✔ essential to protect patient data and ensure. compliance with laws such as HIPAA/GDPR. Ethical integrity of digital care depends on trust, ✔ privacy, equitable access, and accountability of providers.