Critical Incident AnalysisStacy Centeno
Content
Critical Incident Analysis GNUR 460
Stacy Centeno
A memorable nurse-client experience was with a pregnant woman who had gestational diabetes. She came in with her husband for a consult to learn about managing her condition. I had been working as a diabetes educator for 14 years. She was a 22 year old, 33 weeks gestation and I will refer to her as “Martha.” They spoke of their excitement about having their first child. She already had a session with the dietician two days prior. After having her sign a patient accountability contract, I instructed them about gestational diabetes, its risks, how to self-blood glucose monitor and ketone test. She was able to return demonstrate blood glucose testing which revealed an elevated glucose. I reviewed her food log and the potential cause of the elevation. After finishing the session, I scheduled follow up appointments. Martha was given glucose and ketone testing goals and asked to notify any abnormalities. She was required to bring her meter to all future appointments. Both verbalized understanding. At our follow up meeting, her records indicated that her written blood glucoses were mainly within goal ranges. She stated that she had no problem with the diet or testing. I asked her to return demonstrate the meter, which she did without difficulty. I downloaded the data from her meter. It uncovered conflicting results and minimal testing. Nearly every result was highly elevated. I confronted the patient about the discrepancies. She and her spouse offered no explanation or excuse. I discussed the patients need for insulin to control her glucoses. She refused to take medications or do further monitoring. After reemphasizing maternal and fetal risks of high glucoses and the importance of frankness, I brought the inconsistent records to the physician for review. After considering the alarmingly high readings and her refusal to selfmanage her diabetes, he scheduled a stat ultrasound and induction for the patient for the following week. The patient was lost to follow up after that. I have reflected upon this situation
a great deal and have used it as a primary focus of my MSN training. I have discovered that theory application, research, ethical dilemmas, and mainly cultural competency have allowed me to have a new insight unto this case. In reflection, I competently implemented protocols of patient/provider contracts and assessed the patient closely; however, if I were posed with a similar case in the future, I would discuss cultural views regarding glucose monitoring, pregnancy, and medications. I also learned from this experience, the importance of protocol and policy development to ensure that standards of care are met and applications for less than optimal outcomes are considered for both the protection of the patient(s) and providers. I do not know if any change would have occurred, but it has driven me as a nurse and future FNP to want to overcome or minimally better understand barriers such as this for improved outcomes and to provide the best care that I can as a professional.
Stacy Centeno
A memorable nurse-client experience was with a pregnant woman who had gestational diabetes. She came in with her husband for a consult to learn about managing her condition. I had been working as a diabetes educator for 14 years. She was a 22 year old, 33 weeks gestation and I will refer to her as “Martha.” They spoke of their excitement about having their first child. She already had a session with the dietician two days prior. After having her sign a patient accountability contract, I instructed them about gestational diabetes, its risks, how to self-blood glucose monitor and ketone test. She was able to return demonstrate blood glucose testing which revealed an elevated glucose. I reviewed her food log and the potential cause of the elevation. After finishing the session, I scheduled follow up appointments. Martha was given glucose and ketone testing goals and asked to notify any abnormalities. She was required to bring her meter to all future appointments. Both verbalized understanding. At our follow up meeting, her records indicated that her written blood glucoses were mainly within goal ranges. She stated that she had no problem with the diet or testing. I asked her to return demonstrate the meter, which she did without difficulty. I downloaded the data from her meter. It uncovered conflicting results and minimal testing. Nearly every result was highly elevated. I confronted the patient about the discrepancies. She and her spouse offered no explanation or excuse. I discussed the patients need for insulin to control her glucoses. She refused to take medications or do further monitoring. After reemphasizing maternal and fetal risks of high glucoses and the importance of frankness, I brought the inconsistent records to the physician for review. After considering the alarmingly high readings and her refusal to selfmanage her diabetes, he scheduled a stat ultrasound and induction for the patient for the following week. The patient was lost to follow up after that. I have reflected upon this situation
a great deal and have used it as a primary focus of my MSN training. I have discovered that theory application, research, ethical dilemmas, and mainly cultural competency have allowed me to have a new insight unto this case. In reflection, I competently implemented protocols of patient/provider contracts and assessed the patient closely; however, if I were posed with a similar case in the future, I would discuss cultural views regarding glucose monitoring, pregnancy, and medications. I also learned from this experience, the importance of protocol and policy development to ensure that standards of care are met and applications for less than optimal outcomes are considered for both the protection of the patient(s) and providers. I do not know if any change would have occurred, but it has driven me as a nurse and future FNP to want to overcome or minimally better understand barriers such as this for improved outcomes and to provide the best care that I can as a professional.
