EDUCATION AND COLLABORATION 1

Education and Collaboration

Ashley Redinger

James Madison University

Introduction

For patients with diabetes, education and collaboration are vital in the maintenance and

control of the condition. This education includes evaluation of the patient’s diet and knowledge

of diabetes, nutrition plans, and education about the disease (Malaguti-Boyle, 2016). If this

education is not available or not provided, the patient could suffer irreversable damage to their

body. Along with education, interprofessional collaboration with other health care professionals

is also necessary. Collaborative care uses the skills, knowledge, and experience of health care

providers across different professions to work together to provide the highest quality of patient

care (American Nurses Association, 2016). It is important for nurses and nutritionists to

collaborate when caring for a diabetic patient. If this collabortion does not occur, the patient

will not receive the necessary education and care needed to prevent future complications

(Malaguti-Boyle, 2016). Since education and collaboration are vital to diabetes management, it

is important to look at situations where this did not occur and what can be done about it.

Background

Sometimes, there are ethically difficult situations that we experience in the healthcare

field. While in clinical, I was involved in a situation where a nurse did not provide a patient

access to available resources. The patient was newly diagnosed with type 2 diabetes, and had

been admitted to the hospital due to a diabetic ulcer and resulting infection. Before being

discharged, the patient asked the RN if he could meet with a nutritionist before being

discharged later that day. He stated that he had many questions regarding what foods he could

and could not eat with diabetes, and would like assistance in planning healthy meals. Instead of

connecting the patient with a nutritionist, the RN stated, “Just don’t eat junk food or sugar and

you will be fine. Eat healthy and you will be able to control your blood sugar. Eat things like

broccoli and grilled chicken, okay?” Once the RN left, the patient expressed to me that he knew

he was supposed to eat healthy, he just didn’t know how to. I responded to this by helping the
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patient to find online resources he could use to help plan diabetic friendly meals. I also provided

education on why eating healthy helps to control blood sugars, and the possible consequences

of uncontrolled diabetes. In addition to this response, I could also have gone to my clinical

instructor and asked if we could help connect the patient with a nutritionist, since the RN did

not want to.

This particular situation caused me moral distress. I knew how important proper

nutrition and tight control of blood sugars is for patients with diabetes. I also knew that the

patient had a right to request available resources. This put me in a difficult position because I

knew that the right thing to do was call for a nutritionist, but I felt that questioning the RN’s

decision may come across and disrespectful and questioning her authority.

Methods/Findings

To analyze this situation further, I will be using the JMU 8 key questions. These

questions are designed to aid in making decisions regarding ethical challenges (“Madison

Collaborative”). The questions cover many areas including, outcomes of decisions, rights and

responsibilies, empathy, and authority. These key questions take into account, the positions of

all parties involved, and can be used across different cultures and languages.

One of the first key questions asks to consider the possible short and long-term

outcomes of the decision (“Madison Collaborative”). In my situation, the short-term outcome of

not providing the patient with education on proper nutrition for diabetes would lead to chronic

high glucose levels. In the long-term, high glucose levels can cause many complications

including peripheral neuopathy, ulcers and wounds, eye sight problems. These complications

could lead to permanent damage and cause the patient to be readmitted to the hospital. Another

two questions involve liberty and rights. This patient has the freedom to explore all available

treatment options and select the one that they believe best fits their needs. He also has the legal

right to healthcare and the necessary resources available for his diabetes, including a meeting
EDUCATION AND COLLABORATION 4

with a nutritionist. It is a nurse’s responsibility and duty to connect this patient with these

requested resources, regardless of personal opinions or judgements. Another key question

discusses fairness and if the decision balances the interests of all parties. In this case, the nurse

denied the patient access to a nutritionist, while other patients are able to freely meet with one.

He was not provided the same nutritional education, thus the needs of the patient were not

balanced, making this an unfair decision. In addition, the hospital expects that all patients

receive all things necessary to provide the highest quality of care. The nurse did not abide by

the rules set forth by her employer, meaning that she did not follow the expectations of a

higher authority. The last two of the 8 key questions involves empathy and character. These

ask if the decision reflects your ideal self, and how you would feel if you cared about those

involved. In my situation, the nurse’s decision would not reflect my ideal self. For me, I would

want my loved one to have all available resources, ensuring they have all of the info needed to

stay healthy and not end up in the hospital again. As a nurse, I would understand that the

patient needs further education and schedule a meeting with a nutritionist.

Another resource available for ethical challenges, is the American Nurses Association

(ANA) code of ethics, which outlines the roles and responsibilities expected of nurses (ANA,

2015). Provision 2.1 is especially important in this situation. This provision discusses the

importance of patients’ interests and the expectation that the nurse will involve the patient in

planning their treatment. This provision could have helped reinforce that the nurse has the

responsibility to recognize the request and involve the patient in making decisions about their

care.

Conclusion

There have been many valuable lessons learned from this situation. Often times, nurses

think that they know what the patient needs based on experience in caring for similar patients.

While this may be the case, the patients themselves have valuable input about their needs and
EDUCATION AND COLLABORATION 5

plan of care. I learned that it is important to listen to the patient fully and allow them to ask

whatever questions they may have about their care. If there are some questions that I am

unable to answer, I would collaborate with an expert in the topic. I also learned that it is

important to ask the patients questions regarding their knowledge about their condition and

care for the future once discharged. Nurses are expected to provide patient education in an

effort to decrease the risk of another hospital stay. Patients also have a right to all available

resources and treatment options, regardless of the personal opinions of those providing care.

If I was the nurse in this situation, I would have done things differently. In a discussion,

the nurse could ask the patient more about why he felt the need to speak with a nutritionist.

Using this additional information from the patient, the nurse could then re-evaluate her

decision. If the nurse did contact a nutritionist in the hospital and they were unavailable, the

nurse has other options to fulfill the patient’s request. First, the nurse can set up an

appointment with a nutritionist outside of the hospital for later in the week. Next, the nurse

could provide some patient education about a diabetes friendly diet. Although this may not be

as extensive as a nutritionist can provide, this is still valuable information. There are also many

reliable resources online that the patient could refer to until meeting with the nutritionist.

As a nursing student, I should have asked the nurse why she did not think a nutritionist

was necessary, outside of the patient’s room. I could have presented her with the questions the

patient had for the nutritionist and reminded her of the consequences of uncontrolled diabetes.

Although I am only a nursing student, I can still provide input on the situation and explain

why I think he should see a nutritionist. By having another individual express that the patient

should see a nutritionist, the nurse may have changed her mind and realized the importance of

the meeting.
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References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.

Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-

Nurses.html

American Nurses Association. (2016). Collaborative health care: How nurses work in team-

based settings. Retrieved from http://nursingworld.org/Content/Resources/Collaborative-

Health-Care-How-Nurses-Work-in -Team-Based-Settings.html

James Madison University. (n.d.). The madison collaborative: Ethical reasoning in action.

Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml

Malaguti-Boyle, M. (2016). Evidence for the effectiveness of clinical nutrition therapy in

diabetes mellitus type 2. Journal of the Australian Traditional-Medicine Society, 22(2),

74-82.