Ethical theory and decision making in practice
Ethical theory and decision making in practice
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. Gravol 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 antiemetic, do not give insulin. I informed the in-charge nurse about those orders and that I disagree with them. It was about 3 o’clock, 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 doctor’s 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 patient’s 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 doctor’s orders. Of course I did not give that insulin. I paged the internist at 6 o’clock without any response....