If I saw the picture on social media, my first impression would be, “that is quite a messy trauma room.” My impression would change to a pitiful and angry one if the patient in the room was my loved one. I would pity how he or she had to struggle with the trauma thus making the room very messy. I would also be very angry at the person posting this photo because it is a breach of the patient’s privacy.
Description of the Incident
The incident photo was of a trauma room used to treat a man hit by a New York subway train. The trauma room was scattered and became messy in the process of treating this man and the photo was taken when he was already recovered and left the room. An emergency room nurse, Katie Duke, posted the photo on Instagram with different hashtags including #Manvs6 train, #trauma, #lifesaving, #ER, and #reallife (Ramisetti, 2014). Duke is starring in a reality series, a hospital documentary by ABC called “NY Med.” The news broke when “NY Med” aired an episode of the incident where Duke was fired for posting the photo on Instagram. Duke was fired from New York-Presbyterian Hospital with claims that the photo posted might feel offensive to some people.
The photo of the incident was first posted by an unnamed doctor who is a colleague of the nurse. Duke then reposted the photo on her Instagram account and got fired because of posting an offensive picture. According to a report by New York Daily News, the original post did not have any captions and never captured any attention (Ramisetti, 2014). Thus, if the photo was originally posted with a comment, it would have been classified as offensive as well. The type of comment or caption would also have been a determinant of whether the picture was offensive or not. If the doctor who first posted the photo on Instagram also had an offensive caption, he or she would have been fired. If the original post did not have a caption or the caption was positive, there still would have been no reason to fire the doctor.
Whether the Nurse Should Have Been Fired
I agree that it was only right to fire the nurse for posting the photo on social media. Posting the photo on Instagram was not offensive until Duke included the hashtag #manv6train. This hashtag is offensive because it is ridicule or makes such a life-threatening matter a joke. The hashtag indicates that the man hit by the train was having a fighting match with the train, but he lost. The hashtag is also disrespectful to the patient for suggesting that the patient was playing around when hit by the train.
From a nurse’s practice platform, the hashtag shows a lack of remorse or compassion that a nurse should have towards their patients. In other words, the caption used is offensive in so many ways that other victims of train accidents would feel offended. Duke showed a lack of professionalism by joking about a patient’s traumatic incident (Lachman, 2013). She also would indicate the lack of seriousness about her fellow nurses and doctors especially if she represents them expressing such an opinion.
HIPAA Explanation and/or Violations
The Health Insurance Portability and Accountability Act (HIPAA) was formulated to protect confidential patient information from unwarranted sharing and use. According to the general guidelines, Duke did not violate any HIPPA rules by posting the photo on social media. One of the HIPAA guidelines is that a health institution must ensure the confidentiality, availability, and integrity of all electronically protected health information they create, maintain, receive, or transmit. In Duke’s case, the confidentiality of the information (the photo created) was protected because she did not disclose the patient information. According to Al-Fedaghi (2008), confidentiality is given to personally identifiable information where the patient’s name is mentioned. Based on this guideline, Duke did not mention the patient’s name or any other hospital party names and did not give specific information that would direct the readers to the patient involved. Therefore, Duke did not violate the guideline of keeping the created information confidential, integral, and available.
The second guideline with Duke did not violate is that the patient information should be protected against reasonable potential threats to its integrity or security. The information used by Duke was not specific enough to make it insecure or fail to maintain its integrity. Furthermore, a disclosure that might compromise the information might also require the patient’s consent (Al-Fedaghi, 2008). Duke did not even require patient consent because the information shared was not specific enough to compromise its details. Thus, other than these two guidelines, Duke did not violate any HIPAA guidelines because the shared information lacked specification.
Nursing Social Media Standards
There are several social media nurse standards that Duke might have considered before posting the photo. According to Farrelly (2014a), there are factors within which nurses unintentionally violate the patient’s privacy and confidentially when using social media. One of the factors is when the nurse has a mistaken belief that it is harmless if private patient information is shared where the communication pattern is only accessible to the intended recipient. Duke violated this standard when she posted the photo on social media with expectations that only the patient or her colleagues could understand the situation. The social media users might not have access to the communication used by Duke because only people who have been in this room or have seen the photo after it was taken can understand the message. Although the social media users do not understand this, Duke this factor still violated the patient’s privacy and confidentiality.
Another factor within which Duke acted is believing that it is acceptable to refer or discuss patients without identifying them by name but by referring to them by conditions or diagnosis, room number, nicknames, or other patterns. Duke might not have mentioned the patient’s name in the trauma room but used his condition. In her post, Duke included the hashtag #trauma which in this case describes the patient’s condition. It was easy for social media users to connect the unmentioned patient information by considering the two hashtags, #ManV6tTrain, and #trauma. Therefore, Duke unintentionally violated the confidentiality and privacy of the man hit by the train.
Nursing Professionalism Concepts
Two nursing professionalism concepts that relate to this case are the effectiveness and purpose of nursing. Farrelly (2014b) defines nursing effectiveness as the extent to which a clinical intervention when deployed to a population or patient does what they are expected to do. That is, improve and maintain the greatest possible health gain available from the resource. In this case, Duke did not fully show her nursing effectiveness when she posted the photo on social media. For the intervention employed by the nurse in the trauma room to keep the patient in improved health, Duke should have not revealed the healing process.
When this photo incident was aired by NY Med, the patient might have seen it and relived the traumatic moment. Another element is the purpose of nursing which is to assist sick or well individuals in the function of activities that promote recovery or health (Farrelly, 2014b). When Duke shared the trauma room was not aiding the recovery of the patient because the patient would have relived the trauma incident by just seeing that photo.
Nursing Code of Ethics Concepts
Provision 1 of the nursing code of ethics requires nurses to practice with respect and compassion for the inherent dignity, unique attributes, and worth of every person. Duke violated this code because posting the photo with the #ManVtrain hashtag, disrespected the dignity of the patient. Duke also violated provision 6 which demands nurses develop and maintain an ethical environment that is conducive and safe for quality health (American nurses association code of ethics for nurses, 2019). Duke created an unethical environment whereby nurses can joke about patient health conditions. Indeed, she mentions that she and her fellow nurse talk about things they do not mean about patient conditions.
Thoughts about the Incident
This incident helps me think about the need to thoroughly control what I post on social media as a nurse. Nursing practice is not limited to when I am in the clinical rooms or environment. Social media platforms when used for education and health promotion purposes are excellent but bring negative effects to nurses when used to violate nursing rules. Thus, as a nurse, it is important to examine what I want to post on social media before posting it.
Al-Fedaghi, S. (2008). Scrutinizing the rule: Privacy realization in HIPAA. International Journal of Healthcare Information Systems and Informatics (IJHISI), 3(2), 32-47. Web.
American nurses association code of ethics for nurses. (2019). Web.
Farrelly, R. (2014a). Nurses and social media. British Journal of Nursing (Mark Allen Publishing), 23(6), 343-343. Web.
Farrelly, R. (2014b). Nurses elements: What are they? British Journal of Nursing, 23(17) 965-966. Web.
Lachman, V. D. (2013). Social media: Managing the ethical issues. Medsurg Nursing, 22(5), 326-330. Web.
Ramisetti, K. (2014). ‘NY Med’ star Katie Duke speaks out on getting fired from NYC hospital for posting an Instagram photo of the trauma room. New York Daily News. Web.