Nursing: An Ethical Dilemma

Define a critical thinking task that your staff does frequently (Examples: treat high blood sugar, address low blood pressure, pain management, treating fever etc.). Create a concept map or flow chart of the critical thinking process nurses should take to determining the correct intervention. Include how much autonomy a nurse should have to apply personal wisdom to the process. If the critical thinking process was automated list two instances where a nurse may use “wisdom” to override the automated outcome suggested. Note the risks and benefits of using clinical decision making systems.

A critical thinking task that staff on our unit are frequently challenged with is treating low blood glucose levels, which are considered to be a blood glucose level less than 80 mg/dl. The flow chart that follows is what our diabetic educators would like to see being done by nurses to address low blood glucose levels.

Although the flow chart is straight forward and easy to follow, nurses often use nursing wisdom, which is based on their knowledge and experience (McGonigle & Mastrian, 2012). For example, rather than giving orange juice or one tube of glucose gel and rechecking a patient’s blood glucose in 15 minutes, nurses may wait for a breakfast tray to arrive and recheck a patient’s blood glucose after breakfast. Possible risks include a patient not eating his or her breakfast and their blood sugar continuing to drop. Possible benefits are a patient eats his or her breakfast and his or her blood sugar returns to normal. However, there are applications in the computer where a diabetic educator is able to view when a patient had a low blood sugar and it was not rechecked in a timely manner to ensure that the blood glucose returned to normal. Managers are often being talked to by diabetic educators, because nursing staff at times decide to use their own judgment when treating low blood sugars rather than following the hospital protocol and then nurses are forced to explain their decisions. Thus, the importance of documenting and ensuring a patient’s blood glucose has returned to normal, even though the flow chart was not implemented is often emphasized.

Discussion B

Describe an ethical dilemma that could occur in your organization. Apply the ethical decision making model. Using the detailed analysis of alternative actions (Chapter 5, Table 5-1) create a table analyzing potential alternative solutions for your dilemma.