Discuss the impact of the use of these methods in the case on the nurse–patient relationship and on patient confidentiality, including HIPAA requirements.

A 6-year-old has come to the attention of the child welfare department as a possible victim of sexual abuse. The child’s school nurse reported the situation as required by law.
The child lives in a very rural part of a western state. Rather than have the child travel a distance to experts, she was taken to the nearest clinic with sexual assault nurse examiners and a knowledgeable pediatrician skilled in sexual abuse examinations. At the time of the examination, pictures were taken of the child’s body, including the genital area. These pictures were crucial if charges were to be filed. To ensure that an accurate diagnosis was made, local experts sought a second opinion because the results of the physical examination were not believed to be completely definitive. The experts for the second opinion were linked via the Internet and Internet videoconferencing equipment so that the two teams could talk and view de-identified (because the information was going across unsecure Internet channels) photos.