Situation E.M., a 47-yr-old Mexican American woman living with type 2 diabetes mellitus, comes to the clinic to have her blood glucose measured. It has been 12 months since her last visit. At that time, the nurse asked that she bring along her glucometer and strips to show how she checks her blood glucose because her glucose values were high at her previous visits. When you check E.M.’s equipment and glucose strips, you find that the strips are for a different machine and they expired more than 2 years ago. When you inquire about the situation, E.M. explains that she cannot afford to come to the clinic or to buy new equipment and supplies to check her blood glucose level. During the day, E.M. cares for her 3 grandchildren so her daughter can work. E.M. spends most of her income on food for her family, so she has little money left for her health care. Ethical/Legal Points for Consideration • Ethnic minorities and other vulnerable or disadvantaged groups experience certain chronic illnesses at higher rates. Limited access to high-quality, accessible, and affordable health care services is associated with an increased incidence of illness and complications, as well as a reduced life span. • People with certain health problems such as diabetes may have difficulty obtaining health care insurance. Consider these issues in the broader context of social justice. • In many states, the legal definition of the role of the professional nurse includes patient advocacy. Advocacy includes the obligation to provide adequate follow-up care for all patients, especially those who are experiencing health care disparities. • A nurse who observes disparities must consider the possibility of discrimination and abuse. Professional nurses are legally and ethically responsible for patient advocacy. The nurse may incur legal liability if failure to fulfill this obligation results in patient harm. Discussion Questions 1. How would you work with E.M. to help her obtain the necessary resources and knowledge to care for her diabetes? 2. What can you do to begin working on the problems of health disparities in your community?
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