Case Study

Louise is a registered nurse working on medical ward in the local hospital. She is caring for Sam, an 18 year old, who has been admitted with unstable blood sugar levels. Sam has a history of type 1 Diabetes Mellitus, which he was diagnosed with at the age of 5.

At 5pm Louise takes Sam his insulin to administer just prior to his dinner. Sam however, refuses to take the insulin and tells Louise he is not hungry and is sick of being in this stupid hospital. Louise tells Sam he must take his insulin but he tells her to get lost. Upset by Sam's comments, Louise leaves the room and does not come back to see Sam for the rest of the shift. Louise hands over to the night shift that Sam is non-compliant and aggressive.

The next day Louise comes in for day shift and is called to the Nurse Unit Manager's (NUM) office. The NUM informs Louise that Sam has been transferred to the Intensive Care Unit (ICU) overnight with a diagnosis of diabetic ketoacidosis (DKA) and is very unwell. The NUM asks Louise why Sam was not given his evening does of insulin. When Louise gets home from work that afternoon she is upset and makes a post to her Facebook page. Whilst Louise has not mentioned any names in her post, many of her Facebook friends know where Louise works and are colleagues of hers.

Louise Smith Can't believe I got called into the office today because my stupid patient refused their insulin & ended up in ICU.

How is that my fault?

1. What are the legal issues in this case?

- If legal action is taken by Sam or his family is it likely that Louise will be found to be negligent? Consider the four (4) actions that must be met to be considered negligent.

- Is Louise's post on Facebook a breach of Sam's privacy? Consider the legislation, hospital policy and the NMBA codes and guidelines in your response.

2. Are Louise's actions ethical?
- Define the bioethical principles commonly utilized in healthcare and use these to argue for or against Louise's actions.

3. What should Louise have done differently in this scenario?
- In your response outline the fundamental patterns of knowing in nursing and explain how she could improve her knowledge on EACH of these to improve her actions.

- Justify you response with supportive evidence including reference to the NMBA codes and guidelines.

Headings to be used:

- Introduction
- 1. Legal Issues
- 2. Bioethical Principles
- 3. Recommendation
- Conclusion

All of the above are to be supported with reputable resources/references. The focus of this assessment is NOT on the medical diagnosis of Diabetes Mellitus or DKA.

- Consider the importance of types of knowledge and knowing in nursing
- Outline the patterns of knowledge in nursing
- Identify ways of raising ethical issues and how ethical principles can assist in
- decision making in health care
- Explain 'duty of care' in the context of nursing practice
- Demonstrate an understanding of the legal issues in the context of health care
- Consider approaches to understand and resolve tensions and overlap between
- the legal and ethical issues in health care.