Biomedical subjects

Judith A Erlen

Publications and source records attributed to Judith A Erlen.

24 records · Page 2Linked to original sources

PubMedDate not supplied

HIPAA--clinical and ethical considerations for nurses.

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to protect patients' basic rights to privacy and their control over the disclosure of their personal health information. Advances in and the more widespread use of communication technology were increasing the public's concerns over the ease with which their health information could be transmitted, how protected that information was during such transmissions, and their lack of approval for the use of that information by known and unknown third parties. This article, the first of two papers focusing on HIPAA, discusses HIPAA from the clinical perspective and focuses primarily on the HIPAA Privacy Rule. Under what circumstances can a covered entity disclose protected health information? What are the ethical issues inherent in HIPAA? What does HIPAA require of covered entities? What are the implications of HIPAA for professional nurses? The goal of HIPAA is to ensure the protection of confidential health information through having appropriate security systems to guard against unintentional disclosure of that information.

Access to Information↗

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HIPAA--Implications for research.

Privacy, anonymity, and informed consent are the hallmarks of current research conduct. How do the Health Insurance Portability and Accountability Act regulations regarding individually identified health information and protected health information affect research? The purpose of this article is to discuss ways that the Health Insurance Portability and Accountability Act is influencing the conduct of research, including the implications for institutional review boards, recruitment of subjects, obtaining consent, access to data, de-identification of data, authorization to disclose data, and the processing, transmission, and storage of collected data.

Access to Information↗

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When patients and families disagree.

Advance care planning is meant to safeguard the patient's autonomy when that individual is unable to make his or her own healthcare decisions. Yet, families do not always agree with the specific wishes of their family member when there is a need to make critical decisions, such as continuing treatment because of some new research protocol or providing comfort through palliative care. When there are patient-family disagreements, the decision-making process is even more complicated if the patient is fully able to participate because competent patients have the right to make their own healthcare decisions. In addition, family members may not agree with each other. Thus, even though healthcare providers want to respect their patients' wishes, they are uncertain about the most appropriate course of action. This article discusses why families and patients may disagree, describes relevant ethical perspectives for understanding the issues, and identifies possible strategies to help nurses address these ethical dilemmas. Valuing the patient as a person, the vulnerability of the patient, whose interests should prevail, and quality of life are pertinent and overlapping ethical issues in this case. Possible strategies that nurses can implement to address the "thorny" issues raised by patient-family disagreements include helping the patient to remain in control, facilitating responsible decision making, requesting an ethics consultation, and requesting a palliative care consultation.

Advance Directives↗

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Who speaks for the vulnerable?

Feeling vulnerable is a common human experience; everyone has probably felt powerless or unable to exert personal control in various situations. Lacking information, feeling stigmatized, being unable to control what is happening, or lacking access to services may lead people to have a heightened sense of vulnerability. They may wonder what rights they have, whether they have been stripped of their rights, or whether anyone cares about their situation. Although a more consumer-oriented approach is being used in many healthcare facilities, patients do not know how to get the help they need or to whom to turn for help. Therefore, the purposes of this article are to explore the concept of vulnerability, discuss advocacy as an ethical response for nurses, and offer recommendations for creating an ethical environment that supports efforts of nurses to act as advocates and uphold the rights of patients and families.

Attitude to Health↗

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Genetic testing and counseling: selected ethical issues.

As science and technology in genetics continue to expand, complex ethical questions arise that require difficult decisions for all concerned. Rather than having ready-made answers, there may be only more challenging questions for patients, families, and healthcare professionals. These complicated questions may have no straightforward, correct answers, thus creating an ethical quandary. This article discusses some selected ethical issues that occur when patients are considering undergoing genetic testing and counseling, including respecting autonomy and the patient's right to decide, establishing patient-healthcare provider trust, and disclosing private information to others. Several strategies are presented that nurses can use as they assist patients and their families who are facing these challenging ethical dilemmas.

Communication↗

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Adherence to antiretroviral therapy among women with HIV infection.

OBJECTIVE: The overall objective of this secondary analysis was to examine self-reported adherence to antiretroviral therapy in a sample of women with HIV. DESIGN: The primary study used survey methodology. SETTING: The setting included a university-based HIV/AIDS clinic in southwestern Pennsylvania and a community-based HIV/AIDS clinic in eastern Pennsylvania. PARTICIPANTS: Sixty-one women infected with HIV who were taking protease inhibitors. MAIN OUTCOME MEASURE: Self-reported adherence was based on responses to two questions: whether the person had missed a dose of her medications within the past 24 hours, and how many pills the person had taken on time as scheduled (none, very few, a few, about half, most, nearly all, all of them). RESULTS: Adherence ranged from 60% to 75%. Two thirds (65.6%) of the sample thought that their medications were helping them; three fifths (57.4%) thought that it was dangerous to miss a dose of their medications. CONCLUSIONS: Adherence in this sample was less than perfect, suggesting the need to develop, implement, and test interventions to promote better adherence to antiretroviral medication regimens among women with HIV.

Adult↗