Identify the ethical Dilemma
For this assignment, my assigned case scenario is
about the diabetes patient who ate a piece of cheese cake while he is on DM
diet. He has craving for it and he had it as his birthday celebration. Even
though he is on strict IO, I decided to help Mr David and did not document on
the chart. Because of it, his blood sugar level went high and doctor has been
ordered 10units of insulin. Sadly, he is not on insulin before. So, when staff
nurse supervised me to give insulin injection to patient, my dilemma comes in.
Should I inform the staff nurse about Mr David or should not? In this case, if
I tell the staff nurse about it, she will go and tell the patient. Then, the
relationship between me and patient will be disrupted. Patient will upset me
and he is not going to trust me anymore. The reason to inform the staff nurse
is because I am a nurse. As a nurse, we only want patients to get better from
their diseases and do not want to harm them. We want to provide the
comprehensive care for them. Not documenting patient IO is too much already. If
I still keep quite about that, it is true that the client nurse relationship
will remain intact but it will harm the patient and myself.
To explore more, there are many reasons why I should
not inform the staff nurse. It is correct that patient blood glucose level go
up to 18.8mmol/L. Normally, an acceptable blood sugar level of diabetic patient
2 hours after meal is 11.1mmol/L. (1. Citation). If it is significantly high
more than 11mmol/L, it is hyperglycemia and patient need immediate medical
interventions. (2. citation) Since the staff nurse has informed the doctor and
doctor has prescribed insulin, the immediate action was taken for patient. Insulin
is the most effective medication at lowering glycemia and it is very beneficial
for patient with poor glycemic controls (3. Citation). So, patient will go back
to normal in a short time. The patient also did not even complain about
hyperglycemia such as headache or blurred vision. It is difficult to say whether
he hide it purposefully or he did not really experience at all. Anyway, patient
is still fine and no any other issues except he got injection. In this article
(4. citation), mild or transient elevated blood glucose level may not need
medical treatment. So, I think that if I do not inform the staff nurse also, it
However, it is not right to remain silent because at
least the staff nurse in charge of Mr David need to know all conditions about
him to arrange the better plan of care. Although high blood sugar level did not
harm the patient for now, patient is going to get injected. First of all,
patient will get pain from injection already. On and on, patient may become
incompliance to the dietary control of DM. Diet is a first line treatment for
type 2 DM. If the patient failed to control DM by changing life style such as
diet or exercise, he will require medicine such as insulin (5. citation) like
for now. No medication is better than normal body mechanism. Then, patient may
become poorly control of DM. In this article (4. citation), prolonged or poorly
controlled hyperglycemia may lead to serious complication such as heart
disease, kidney disease and eye disease. So as a nurse, I should prevent this
kind of condition.
If I choose not to tell the staff nurse, it means
that I respects the patient own decision and self determination. Although he
knowns that he cannot have this kind of food, he decided to have it at least
once. So, we must respect his decision and he has his own autonomy. As loon as
the patient has no harm, we can let it be for the time being. So that, we can
maintain the trusted relationship with the patient. Patient will trust me more
and will share his information. From there, I will be able to know more about
patient and can provide better plan of care.
Despite that, if I inform the staff nurse also, I am
not wrong. The staff nurse will be able to explain the patient not to do this
again. She will educate the patient more about the disease process such as the
risks. So the staff nurse able to utilize the ethical principle of and
veracity. I also know that if patient not stick to the diet plan, he will get a
lots of complication. I am trying to prevent patient form getting worse of the
disease and consequences. I am doing good for the patient which is beneficence.
I am using my own knowledge to help the patient and it is paternalism. I am
trying to keep a commitment as a nurse which is fidelity.
Instead of choosing one out of two options, what can
I do not to get scold by the patient and to do good for him? There are many solutions
for that. (1) Inform the staff nurse about Mr David after giving the injection but
I educate the patient myself not to do this again by taking advice from the
staff. (2) Inform the staff and we only access and observe the patient. (3) Not
inform the staff, I observe the patient myself and I just tell patient not to
break the diet plan again. (4) Just neglect that this case happen since I am
going back to school after this clinical attachment. (5) Ask the staff nurse to
manage the case because I want to avoid the patient. (6) inform the family
members, ask them to explain the patient not to do it again.
Among these solution, I think that it is the best to
inform the staff nurse about the patient but I educate the patient by myself.
After giving the injection, I will wait until the staff nurse is relax and feel
free to listen to me. Then I will tell the staff nurse that I failed to
document patient intake and output. I will also explain that this is what
patient want and I hide it for him. So that, she will be able to know the cause
of sudden high blood sugar level of the patient. Then, she will be able to do
something for patient and for me. I will request the staff to explain and educate
the patient by myself but with her advice and it will help me to prevent
misunderstanding with patient. I may have to write the reflection or incident
report. At least I did the right thing as a nurse. So worth it.
By choosing this solution, I may breach the principle
of respect and autonomy. But, I will be able to maintain the principle of the beneficence,
veracity and fidelity. I will be able to utilize the paternalism principle also.
The relationship between the patient and the nurse could be improved and remain
intact because I will not let the patient know that I informed the staff nurse
although I did. According to dilemma that I choose, SNB value statement 3 is
breached. Actually, I must maintain the confidentiality of patient information.
Patient trusted me and want me to keep the information but I did inform and I breached
the duty. However, value statement 5 was practiced in this case. I did make
sure that Mr David get an effective and risk-free care by receiving accurate
information from the professionals. Moreover, I also applied the value
statement 7 regarding to the dilemma. I fulfilled the patient’s wish and promote
his interest by recognizing his need. Even though I inform the staff nurse, he
may not know that I have done. At least he met his needs.