Identify and discuss at least two potential ethical issues that could be of concern for nurses with telehealth delivered care. 
The use of telehealth has made its way into common vocabulary of the healthcare field. In the past, it was seen as an addition to care but now it is becoming its own avenue of medicine. Telehealth delivered care uses telephone, computer, texts, video conferencing and phone applications to provide provider-patient encounters. “These appointments via telehealth were examined and found to be as effective as standard face-to-face visits held in a providers office or clinic” (Nelson, 2014, p.149). But with every great thing comes potential issues. Two ethical issues that could be a concern for uses of telehealth would be privacy and practicality for all patients. 
A key to telehealth success is healthcare providers access to patients health records at the time of the telehealth encounter just as in-person” (Nelson, 2014, p.136). This means that to ensure HIPAA standards there needs to be secure storage system of data. Workplaces, as well as higher education facilities, should then provide our healthcare workers with the skills to use telehealth appropriately in order to successfully respect the patient experience. When using telehealth through video chat it’s critical to provide privacy just as one would receive in person. This mean not having anyone around, but not in view of the camera, to hear conversations that are not directly involved in the patients care. 
The other concern for nurses with telehealth delivered care is acknowledging that patients differ dramatically, and some may not be able to use telehealth to the best of its ability. What may work for one family, may not work for another. The older population may not understand how to use a phone app to log on for a live visit, others may prefer phone calls over texts, some may not have a computer or smart phone to log onto for services. The same situation could affect a household within a health disparity group.  These differences in access to technology may exacerbate existing health care access and equity issues related to demographics and socioeconomic status (Mehta, 2014). Productive telehealth would need to user appropriate and friendly. If this is the case, health professionals would need to alter what is expected of patients to meet their needs. This could mean a  simple phone call for some or text messaging for those who are hard of hearing. There is a home health company in Florida that has the nurses drop off a smart phone or an iPad at the door of patients, walk away to perform a video call and when the call is finished the nurse goes and collects the device again at the door. This ensures that households that do not have the technology are still able to benefit from telehealth in a safe and social distanced manner.  
References  
Mehta, S. J., (2014) Telemedicines Potential Ethical Pitfalls. AMA Journal of Ethics 16(12). Retrieved from https://journalofethics.ama-assn.org/article/telemedicines-potential-ethical-pitfalls/2014-12 (Links to an external site.) 
Nelson, R., & Staggers, N. (2014). Health Informatics: An Interprofessional Approach (2nd ed.). Elsevier. 
Edited by Wood, Carmen on Sep 1 at 12:35

REPLY 2
 Ethical Issues
Advancement of technology, especially the information technology (IT) has increased the use of telehealth services in the treatment of patients and provision of nursing care (Langarizadeh, Moghbeli, & Aliabadi, 2017). The use of telehealth in the clinical practice has increased ethical issues, especially in a culturally diverse society. The World Health Organization (WHO) has defined telenursing as the provision of online health care services when there is some geographical distances between the provider and the patient (Langarizadeh et al., 2017).  Ethical issues in telehealth implies to consideration of individual patients loss or benefit when receiving telehealth services. Patients have the right to choose appropriate therapeutic method and react to any unsatisfactory services based on their healthcare needs. 
Telenursing is a component of telehealth that involves the use technology to provide nursing care and conduct nursing practice based on patients individual health needs.  The use of technology like telenursing has changed the delivery of quality, safe, holistic, and patient-centered care, but is associated with various ethical issues in the healthcare setting. The scope of practice and nursing process do not change with the application of telenursing as a component of telehealth (Langarizadeh et al., 2017).   
Ethics related to security and confidentiality are becoming common with the use of telehealth in the provision of patient care in the healthcare setting. The use of telehealth services may threaten patients confidentiality and information security. Nurses and other health care providers should focus on promoting confidentiality of patients electronic data when receiving, sharing, and storing the data in the electronic health records (EHR) system. Nursing staff should be responsible for the confidentiality and security of patients electronic data (Schlachta-Fairchild, Elfrink, & Deickman, 2008). Another cause of ethical issues with the use of telehealth services is caregiver-patient relationship. This is considered as the main ethical issue with the uses of telehealth services in the clinical setting. 
The three components that define caregiver-patient relationship are: a patient is someone who is sick and needs help from the provider, and health care provider feels responsible for helping the patient, and medical action/application of medical science. A patient is required to voluntarily refer to a provider whom he/she trusts. Clinical decision-making should be a mutual action involving both patients and providers decisions (Schlachta-Fairchild et al., 2008). On the other hand, the health care provider is expected to respect patients autonomy and decisions. In this case, both the patient and nurse should mutually communicate in an open manner to ensure the application of appropriate therapeutic process. The patient should respect nurses comments and caregivers should respect individual patients choice of therapy or care in order to maintain a good caregiver-patient relationship and prevent ethical issues in the healthcare setting (Schlachta-Fairchild et al., 2008).  
Patients informed consent may also result to ethical issues when using telehealth services in the provision of nursing care. Failing to obtain patients informed consent results to ethical issues (Schlachta-Fairchild et al., 2008). Nurses should focus on obtaining patients informed consent. Patients informed consent is obtained by ensuring full description of the therapeutic procedures, a full description of positive issues that are expected in the provision of care, and providing a clarification on a medical procedure that can be canceled by the patient upon his/her choice. 
References
Langarizadeh, M., Moghbeli, F., & Aliabadi, A. (2017). Application of ethics for providing telemedicine services and information technology. Medical Archives, 71(5), 351. doi: 10.5455/medarh.2017.71.351-355
Schlachta-Fairchild, L., Elfrink, V., & Deickman, A. (2008). Chapter 48 patient safety, telenursing, and telehealth. Patient safety and quality: an evidence-based handbook for nurses. Agency for Healthcare Research and Quality, Rockville (https: //www. ncbi. nlm. nih. gov/books/NBK2687/). https://www.ncbi.nlm.nih.gov/books/NBK2687
All replies must be constructive and use literature where possible.