NR 361 Discussion Use of Personal Communication Devices in Patient Care Settings
NR 361 Discussion Use of Personal Communication Devices in Patient Care Settings
Nurses using their cell phone at work can both positively and negatively affect patient care. A nurse using their cell phone for personal reasons can be a distraction, therefore leading to delay in patient care. On the other hand, I have used my cell phone for work-related reasons and it has positively affected patient care. Many of times as an ER nurse have I done home medication histories from patients using their pills in unmarked containers (such as a pill organizer). I have an app on my cell phone from “Drugs.com” that has a helpful function called “Pill Identifier”.
The ethical and legal implications of the use of personal devices are all centered around preserving patient confidentiality. The debate is, can a nurse use their personal device without interfering with patient confidentiality. I do believe that if a nurse violates a patient’s rights, they should face legal repercussions.
The article, Calling on smartphones to enhance patient care, states that the greatest benefit of nurses using their personal devices at work was improved communication by members of the healthcare team (VanDusen, 2017). At my hospital, we use an Android mobile device as our work phone. We are able to send physicians text messages of the situation or the patient’s needs, and they call us and give us verbal orders. I believe our messages are being conveyed more efficiently since the physician can read our message and call to clarify and give orders.
VanDusen, Krista A. BSN, RN Calling on smartphones to enhance patient care, Nursing: November 2017 – Volume 47 – Issue 11 – p 1-2 doi: 10.1097/01.NURSE.0000525993.44109.f9
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The use of personal communication devices can impact the nursing practice in positive and negative ways. Distraction can be a negative impact of nurse’s personal communication device. When a nurse is distracted it can cause errors and mistakes. Distractions also decrease the quality of care that a nurse gives the patients. On the positive side nurse’s personal communication devices can help get important patient information to the correct people in a timely manner and it is an easy way to look up something you are not familiar with quickly. Using the device in this matter will improve quality care and decrease delays in treatment. “Bedside technologies continue to grow; they interface with smart phones and other devices to improve communication and, ultimately, patient care” (Hebda, Hunter, & Czar, 2019 p.218).
The patient is the nurse’s first prior. The use of personal devices can cause challenges ethically and legally. “These challenges are personal (distraction), negative patient perception (interference), and potential delays (disruption) in providing care” (Conant, et al., 2020). We as nurses have ethical guidelines that we are supposed to follow. One of the nursing ethical guiding principles is “nonmaleficence: the obligation for doing no intentional harm” (Hebda, Hunter, & Czar, 2019). If the nurse was distracted by a personal communication device and the patient experiences a negative outcome, the nurse did not follow ethical guidelines which may result in legal consequences.
There are several generations of nurses. Older nurses tend to not need to use personal communication devices as much as younger nurses. Nurses have personal communication devices at work is now normal. There is a time and a place for everything. Nurses have a life outside of work should still have access to it while at work but not allow it to cause a distraction. It is important that all nurses be mindful of their agency policy in reference to these devices. “ Policies concerning the use of personal communication devices need to provide the ability for the nurse to remain connected to his/her personal life yet not inhibit the provision of care” (Conant, et al., 2020). If these devices are being used it important to have clear and concise guidelines to follow to ensure patient’s safety as well as the patient’s rights.
Conant, J., Elmore, R., Moore, A., Blake, S., Peacock, A., & Ward-Smith, P. (2020). Use of Personal Communication Devices in Clinical Settings. JONA: The Journal of Nursing Administration, 50(4), 192-197. doi:10.1097/nna.0000000000000867 https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142534847&site=eds-live&scope=siteLinks to an external site.
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.
It is very disappointing that nurses may feel or need to use their personal devices to contact people or retrieve information. I work in two different specialties. As a detox nurse I have access to a mobile laptop, cell phone, and computer. The computer we sit at when we are not actually on the unit. The phone is carried everywhere with the nurse and the laptop is used when on the actually unit. There is internet access on all these devices as well as contact information for all health professionals needed for patient care. We have these tools in place to ensure that we don’t use our personal devices. This doesn’t stop people from using them but we do have policies in place to avoid distractions. My other job I am a nurse consultant for developmentally disabled individuals. I have my own company laptop and cell phone that I can access all information needed. The cell phone that I carry has a hot spot feature which allows me to gain access to the internet through my computer if I am in a place outside of the company. I never have to use my personal devices to contact people or look for information. Nurses already have many responsibilities, using our personal devices to manage workflow is not one of them.
Shaquita good post! I agree it is very disappointing that nurses feel the need to use their own personal devices for their job in any instance. Unfortunately, I find myself in this very position. I have field nurses that use their own cell phones for business and am hopeful that they are following HIPAA at all times. You had mentioned using cell phones for “hot spots” to access on line which is great idea and that is the current situation with my employer. We are trying to get our company to purchase “company owned” cell phones for our part-time staff who do not have a company cell phone to be able to have a hot spot to access the internet for documenting in their I-pads while out in the field. I am hopeful that in the near future this company purchases the cell phones as we move forward into a new computer system and keep up with technology to provide the best care possible in the a timely fashion. On the other hand, you discussed distractions and it made me thing of how I am in the office distracted not only by staff coming to the office and that are in the office, telephone calls but also my work cell with texts and calls throughout the day. I was recently advised that I need to add emails to my work cell phone and since then the phone dings everytime an email is sent to me which is at least 5 to 10 times a day. I cannot imagine working in the hospital with a cell phone that constantly rings or dings, I hope this not the case for hospital nurses however, I can see the importance of being contacted with testing updates for example a critical lab or test as soon as possible. I believe we just went full circle right back to our recent discussion of sensory overload. Too many devices being used at once to listen to and for responses. Thanks for sharing.
You provided good information in your post. My only concern is the work-home life balance and utilization of personal devicesduring work hours. My experience with fellow employees has been the personal device does take precedence. Shift report the personel device is pulled out to speak to fellow employees with home life and placing the patient care second and is not our position to care for the patient? Policy within the organization tells employees to keep cell phone in lockers and may be utilized on breaks. This does not happen. I will admit to pulling my cell phone to show family pictures but i do try to complete this during downtimes. As presented by Gill et al, (2012), logo labeled organizational provided devices have preinstalled job-specific functions and apps work better than personal devices. The organizational device would have all the security hardware, blocks websites with low security and regulates the use of apps, keeping the safety of patient information. This would minimize the distractions that occur with own personal devices.
Gill, P. S., Kamath, A., & Gill, T. S. (2012). Distraction: an assessment of smartphone usage in health care work settings. Risk management and healthcare policy, 5, 105–114. https://doi.org/10.2147/RMHP.S34813, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/Links to an external site.
Thank you for sharing your views. I completely agree with all your points particularly the concept of “nonmaleficence” that you introduced in your discussion. It is a great point for reflection that either intentionally or unintentionally if a nurse’s use of PCD is distracting her from her duty then she is breaking this rule of nonmaleficence and she should be accountable for her actions. Also, I liked that you mentioned the fact that older nurses tend to avoid PCDs at the workplace as compared to younger nurses. This forms a communication barrier, specifically in this digital world. So, if a nurse is taking good care of her patient then there is no harm in bringing a PCD to work.
How can the use of the nurse’s personal communication device(s) impact patient care positively and/or negatively?
The topic of communication devices would be an interesting discussion at any period however the current COVID 19 situation we find ourselves in can support the pros for this technology more than ever. At my facility, we make great efforts to minimize patient contact with positive COVID 19 patients. Nurses are primary care providers as we act like all the ancillary disciplines. We are lab techs, housekeeping, and respiratory therapists to just name a few. We do our best to be a liaison for the family, many times communicating and updating on patient’s personal cell phones. When contact is necessary for other healthcare professionals like the physicians and or consultations, we have an iPad available in each isolation room. This is very helpful in situations like translation, informed consent, and even delicate discussions involving code status changes. It is up to the nurses, especially now to be the patient advocate and initiating these conversations while sometimes we are the only direct contacts these patients have. As stated by Tsigrogianni and Tarnanas, “There are winners and losers with any change; and it is incumbent on health service workers (including researchers, providers, administrators, and decision- and policy-makers) to ensure that care recipients and informal caregivers continue to be on the winning side” (2007). As far as the use of healthcare professionals’ personal devices, the pros have a lot to do with education. I can use my own device to access information from the web quickly when needed to educate myself or review a topic prior to introducing the information to patients and family. Although I do have the same access to this info on my work devices, it is many times faster to access from my personal phone’s internet. Although it is convenient for the nurses it may be negatively impactful when a patient or family member sees a healthcare professional on their phone not understanding the reasons.
What are the ethical and legal implications of the use of personal devices?
Information can fall into the wrong hands if it is not handled with the most caution to protect the confidentiality of our patients. Therefore, when I use my PCD I will only search for generic topics like disease processes and not information with specific identifiers. I know some nurses will friend patients on social media, but I fear that a simple casual conversation on this media could cross confidentiality lines and result in HIPPA violations. This is a no-go zone for me. As mentioned in Hebda, “Threats to information and system security and confidentiality come from a variety of sources, including system penetration by thieves, hackers, unauthorized use, denial of service and terrorist attacks, cybercrime, errors and disasters, sabotage, viruses, and human error” (2019). These are many reasons why we should not use a PCD to access anything involving personal identifying information. My facility provides a safe way of accessing information online that is protected by firewalls and encryption if it involves the use of confidential information. Therefore, there is no need for me to put myself or my patients at risk.
What does professional literature say about how communication devices can support safe nursing practice?
Using communication devices can support the safe nursing practice by providing documentation, reimbursement, and efficient use of valuable time. Saving time is especially helpful when urgent situations arise. As Hebda explains, Database searches of professional journals and credible evidence-based practice (EBP) Web sites significantly reduce the time and effort one might expend investigating a clinical question (2019). Although this technology is always evolving, we must keep up. As Hebda also explains, the process of accreditation has direct implications for how documentation and information systems are structured (2019). One example impressing upon us the importance of accreditation.
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). New York, NY: Pearson.
Tsigrogianni KG, Tarnanas IA. Patients, Caregivers, and Telehome-Based Care Systems: A Case Study. Journal of Cases on Information Technology. 2007 Jul;9(3):71-90.
You made a good point about our current situation and its relationship to potential positives for the use of communication devices. I noted you did not specifically include ‘personal’ ones.
I appreciate you for sharing your thoughts with us, including both the positive and negative aspects of using PCDs. Nurses need to find a balance between positive ways of using smartphones, setting alarms to remember critical tasks for example, and the negative consequences of the potential distraction of using it.
I don’t think the responsibility lies with the nurse alone. Facilities admit patients in vulnerable states to provide assistance, diagnostic, treatment, recuperative, etc., and share the responsibility for providing safe, quality, secure care to them.
- They can do this with effective hiring, good policy creation/enforcement, and budgeting that reflects the needs of their customers, our patients.
- Both policy and budgeting concerns must take into account the potential benefits and risks from integrating technology into healthcare in a proactive manner by providing resources like secure devices and effective firewalls/encryption to promote ethical HIPAA-compliant behavior to reach positive outcomes.
- Policies without enforcement are worse than not having the policies in the first place.
- Consequences may be necessary and I will again share a reference that addresses accountability that includes the need for consequences (Rachel, 2012).
Rachel, M. (2012). Accountability: A concept worth revisiting. American Nurse Today, 7(3). Retrieved from https://www.americannursetoday.com/accountability-a-concept-worth-revisiting/ (Links to an external site.)Links to an external site.
The nurse’s personal communication device (PCD) meets dynamic patient care needs in a positive way to educate patients and provide access to evidence-based information at the bedside through the apps (Giles-Smith et al, 2017). The Institute of Medicine has proposed transforming the way care is delivered consistently and accountability to advance the quality of health care in the United States. A mobile device can provide nurses with better and faster access to promote communication among healthcare providers and increase system efficiency (Komusky et al, 2018). In a negative way, some nurses who use PCD are interested in accessing personal conveniences and social media which reduces the amount of time to provide the care of patients and team efforts. This must be addressed in order to realize the benefits of patient-centered care. Intentional misuse of data is unethical and could lead to civil action (Hebda, Hunter, & Czar, 2019). We must practice self-awareness into our daily routine and reflect on ways to enhance and improve our performance (Stephens, 2017). According to the White Paper (NCSBN, 2011): A nurse’s guide to the use of social media, Social media can benefit health care in a variety of ways including fostering professional connections, promoting timely communication among healthcare professionals. Without practicing professional ethics, these benefits may result in nurses disclosing too much information and violating patient privacy and confidentiality. Another concern with the misuse of social media is affecting on unit-based patient care. Online comments by a nurse to nurse incivility, lateral violence that includes disruptive behaviors and bullying, which is a leading cause of burnout in nurses and other healthcare professionals. Misuse of the personal communication device and negative work attitude may affect the quality and safety of patient care. Nurses should keep in mind of employer policies, relevant state and federal laws, and professional standards regarding patient privacy and confidentiality (NCSBN, 2011).
Giles-Smith, L., Spencer, A., Shaw, C., Porter, C., & Lobchuk, M. (2017). A Study of the impact of an educational intervention on nurse attitudes and behaviors toward mobile device and application use in hospital settings. Journal of the Canadian health libraries association (JCHLA). 38 (1).
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.
Komusky, J. ( 2018). Technology: Using to Improve Patient Care. CINAHL Nursing Guide, EBSCO Publishing, evidence care sheet.
National Council of State Boards of Nursing. (2011). White paper: A nurse’s guide to the use of social media.https://www.ncsbn.org/Social_Media.pdfLinks to an external site.
Stephans, T. (2017). Situational awareness and the Nursing Code of Ethics. American Nurse Today (12 ).11
Thank you for your response. I apologize if I was not clear regarding personal devices. It was my intent to address this issue when I commented about how I use my personal device to review information prior to educating a patient or family. if I need to familiarize myself with new material or if I just need to review it. The statement regarding the internet on my phone is faster for me than using the access provided by the facility example of how it is another pro for my personal device. I can see how this is not ideal but right or wrong, for many of us, this is reality. I also made a comparison to how the personal phone could be seen by patients or families and might be concerning or confusing. It would be easy to confuse whether a nurse is on their personal phone or a work phone these days they look similar. I see and completely understand your point regarding policies and accountability. I was trying to be transparent with my discussion.
I live in a small city and I have patients that try to friend me on social media. This always makes me uncomfortable, because I cannot accept them, but they feel offended most of the time. I used to see my patients every 4-6 months and talk to them every 2 months which made it difficult when some take social media very seriously. I have my page set to private and they cannot see my posts but they can still find my name. I really understand this area and that it could definitely lead to a violation of HIPPA. I wish we have some kind of flyer to give our patients regarding social media so that patients can fully understand why we have to ignore their request. Thank you for pointing this area out.