Example research essay topic: Blood Sugar Patient Care - 1,122 words

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The night shift on the surgical ward began as usually with report without any interruption. There were 12 patients on the floor and 2 nurses including me and in-charge nurse. It was about 2 am when one of my patients, 32 year old woman, diabetic, approximately 12 hours postoperative reconstructive foot surgery became nauseated and had small emesis. She was on PCA Morphine, drowsy and responded appropriately to questions. Her pain was on 3 / 5 scale, her nausea persisted, capillary blood sugar was 20. 6.

The orders stated to start the usual insulin in AM, a dose in which she was previously at home. Gravel 12 mg IV every 8 hours and last dose was given at 2300 hours by evening staff. I called the on-sight physician, the only doctor in the small hospital, told him about patient condition, high blood sugar and that patient is still nauseated. I received orders by phone and: monitor patient, do not give more anti emetic, do not give insulin. I informed the in-charge nurse about those orders and that I disagree with them. It was about 3 oclock, my patient was still nauseated and still had small emesis, and blood sugar was 21. 6.

Patient was unable to tell me how high blood sugar she could tolerate. I called on-sight physician again and asked him to assess the patient. The doctor came, assessed the patient, he cosigned previous orders and stated that patient must be assessed in the morning by internist. Then he told me that he can stay any longer and he left the floor.

I updated in-charge nurse about the doctors visit, and we were very surprised with his orders. Condition of my patient did not change, she was still nauseated and still vomiting small amounts, she was tired, exhausted and unable to settle. There was no orders which I could use to make her more comfortable. At five am my patients condition was still the same, blood sugar was 21. 2.

I called the on-sight again, he comes and writes the entry in the progress notes, and he told me that he cannot do anything for this patient. My in-charge was getting upset and telling me to give the morning dose of insulin in spite of recent doctors orders. Of course I did not give that insulin. I paged the internist at 6 oclock without any response. At 6: 40 resident came and stated that the ortho-surgery is on the way to do the dressing. A nurse who prepared the patient for this surgery came in before 7 oclock and together with the in-charge stated that I shall give this patient the insulin now.

I responded to in-charge that I am not giving this insulin and if she feels that I am not giving appropriate care for this patient she can take this patient over. Her response was Im not doing your work and I am too busy with my assignment. The ortho-surgeon came at 7: 00 am, he tells me to wait for the internist to come as he does not want to intervene in patients medical problems. The interest came at 7: 25 am, I described everything what happened until now with this patient, when there was no response from him I asked him for the insulin order. Finally I administered the usual dose of insulin at 7: 32 am. Two above mentioned nurses decided to have a conversation with me after the shift was over.

In their opinion I shall give the insulin much earlier. Also they implied that I could loose my license if this patient would progress into coma. I was about to leave the floor when my Patient Care Leader asked me why I was still there. I described what happened during the night with my patient and I addressed the problem with getting appropriate orders as well as mentioned about disagreement with in-charge nurse. My Patient Care Leader stated that there were some nursing concerns about this doctor previously and she assured me that my actions were consistent and the patient condition did not get worse.

I was very frustrated in the end of my shift. My feeling was due to a fact that my patient did not receive appropriate care. My primary goal as per Code of Ethnics for Registered Nurses is to promote health and well-being. Failure to do so influenced significant suffering for me and mainly for my patient. Cindy Hylton Rushton in an article about Ethical issues in critical care addressed suffering as described by Reich as an anguish experiences as a threat to our composure, our integrity, and the fulfillment of our intentions, and more deeply as frustration to the concrete meaning that we had found in our personal experience.

It is the anguish over the injury or threat of the injury to the self and thus to the meaning of the self that is at the core of suffering. There is no doubt that I have encountered ethical nursing problem. To understand the nature of the problem and the decision which had to be made, I find very helpful an article Values, Moral Reasoning and Ethics, written by Anna Over. The patient was my priority so identified principles as autonomy, beneficence, non maleficence and justice will help my to analyze the problem and comment on my choices and decisions made on the mentioned night shift.

Finally I will comment on contributing factors and I will evaluate my practice. Autonomy in the literature stress that every individual has independent value and worth. For me it means choice. Thinking about my patient I realize that her right to exercise her autonomy in the hospital setting were limited. She was unable to express and communicate with others mainly because she was tired, exhausted and in pain. Being in private room and on the bed rest limited her access to other people.

I was her voice outside the room, her advocate and her only connection with others. I tried to get appropriate orders to relief her symptoms and promote her rest. My choices were also limited as the on-sight physician was the only doctor in the hospital. In practice we never involved other doctors during night shift, even we have had there was no response from them. Being a nurse I do need a doctors order before administering medication.

It is my biggest limitation and restriction in this case. I had no choice in doctor or my coworker neither my patient had a choice to nurse. Beficience means doing good for others. My responsibility and obligation as a nurse was to make this patient comfortable. Frequent mouth care, cold compresses were just a little things and far form reaching this goal. Check...

Research essay sample on Blood Sugar Patient Care