Need expereinced RN advice please

[The Purple Smurf]

Today I was in a community health rotation and I saw something I feel very uncomfortable with an need some advice. I am a BSN student and and 6 months from graduating (just background on knowledge level). We were assessing homeless people in a free clinic. A woman came in and her blood sugar was found to be 328. When she was told that is was very high, she got upset and started crying with her head in her hands saying, "oh my god, oh my god, I have diabetes". The student nurse who told her that her blood sugar level was high tried to console her and said you don't necessarily have diabetes. What she said next is what bothers me. She said, "these numbers don't mean anything." Knowing full well that yes, these number do have meaning, I feel uncomfortable with her lying to the patient. I feel that although we are not qualified to diagnose patients, we need to inform people properly of the severity or possible severity of their health honestly, within the scope of our knowledge. They turn to us here to see if they need to seek further care, I think taking this responsibility lightly is not only wrong, but unethical. Am I wrong here? Am I overreacting? Any thoughts? (BTW: We have only 1 instructor and she is spread so thin over so many students, we're lucky to find her at any particular time.)

PS: she did advise her to see a doctor, it's just that i think acting like it's really not that big a deal is doing the patient a real disservice.

[The Purple Smurf]

forgot to state that according to the patient she hadn't eaten since the morning and this was around 530 pm

[nursej22, MSN, RN]

It seems to me that your clinical group may not have been adequately prepared on how to deliver abnormal test results to clients. I mean, its easy to tell someone their readings are normal, but delivering bad news takes tact, skill and practice. And specific to this client, you don't know that she may have been told previously that she had diabetes or metabolic syndrome, but she had been denying it. In my experience, most non-diabetics would not know that a 328 BG is elevated.

So perhaps your classmate could have handled this better by pointing out that this was a random reading and isn't a diagnosis, that DM is treatable and catching it early can prevent many of the complications. Or asking the client to express why this was so upsetting and letting her vent her feelings.

This could be a good topic of discussion in class, perhaps play-acting on how to deliver test results, especially the abnormals to clients and families.

Good for you for your concern about delivering accurate information to your clients. And I wouldn't be too hard on your classmate, she may have been caught off-guard and felt stressed by the client's reaction.

[Whispera, MSN, RN]

Another big thing....advising a homeless person to see a doctor... Isn't the clinic there for health needs? Is there no doctor or NP there who can follow up? It's difficult for homeless people to get in to see doctors (transportation, paying for the visit, being willing to go see another provider when they have just seen one).