Tameka Jones is a 37-year-old, Black woman with a diagnosis of Type II diabetes who comes to the Emergency Room (ER) with a 4-day history of nausea, vomiting, polydipsia, and polyuria. She was diagnosed with Type II diabetes three years ago and was started on oral hyperglycemic agents. Ms. Jones wears a device which continually monitors her blood sugar levels. However, Ms. Jones often misses doses of her medications. The ER doctor orders blood work and urine analysis. Ms. Jones’ laboratory results show an anion gap, hyperglycemia, and metabolic acidosis. She is admitted to the Intensive Care Unit (ICU) unit for diabetic ketoacidosis. You are her nurse and start to treat her with intravenous fluids and insulin-glucose infusion. You need to check Ms. Jones’ blood sugar level every hour to titrate the amount of insulin Ms. Jones receives accordingly. As the ICU is a very busy environment, you did not have the time to explain to Ms. Jones the reasons for the frequent blood glucose checks you are performing.
Ms. Jones is starting to become uncomfortable with being pricked every hour. Ms. Jones asks you, “Why can’t you use my blood sugar monitor?”. My friend, who was admitted to the ICU last week for a similar issue was allowed to use her blood sugar monitor and share the readings with the nurses and doctor.”
You respond that you need to follow the hospital policies and that you must use the hospital’s blood glucometer to ensure the accuracy of the readings as you are not familiar with Ms. Jones’ device. As well, the value obtained by the hospital blood glucometer is automatically transmitted into the computerized charting system to be accessed by other healthcare providers involved in Ms. Jones’ care. Ms. Jones states, “I feel like you are hurting me for no reason. It is clear that hospital policies are set differently for each patient as my friend was allowed to do this on this same unit.” You respond that you will investigate this situation and address the patient’s concerns before the end of your shift.
Upon reflection, sitting at the nursing station, you realize that Ms. Jones has not been provided with enough information about the procedure at the beginning. You also are aware that some of your colleagues do not always follow hospital protocols, policies, and best practices. You decide to consult with the nursing educator on the unit about how to best proceed with the patient.
The next hour, when you enter the room again to check her blood sugar, Ms. Jones refuses and states that her fingers are too sore to be pricked again. You pull up a chair beside Ms. Jones’s bed and sit down to have a conversation with her. You take the time to explain the hospital policies, share a pamphlet with her on the care protocol the healthcare team needs to follow for a patient with diabetic ketoacidosis and acknowledge that this is the most evidence-based way to provide treatment for a patient with such a clinical presentation. Ms. Jones thanks you for the time you spent communicating this information with her and proceeds to give consent for the continuation of the hourly blood glucose monitoring using the hospital-grade device.
Case Study Expert Reviewer: Dr. Nadia Prendergast