General clinical nursing had been my major focus. My career refocus began when, as head nurse in a skilled nursing facility, I had encountered a patient who presented with an elevated blood glucose and sporting a full spica cast. Her primary care plan focused on learning to climb stairs unaided, completing daily back-strengthening exercises, and improving her diabetes self-management. Stress filled the air the day I entered the patient’s room. She burst into tears, saying, “I don’t understand why everyone wants me stair climbing. I don’t have stairs at home. I can’t even get to a bathroom on my own! I’m so frustrated, and angry. No one will listen to me!” Clearly, the team had reverse-focused on hospital goals, not person-centered self-care goals.
In that moment, my career journey took a 180° turn. We had missed an opportunity to tailor this patient’s care plan to meet her immediate needs, had not fully explored what was important to her, and likely caused her additional stress, resulting in elevated blood glucose levels.
Her care plan was immediately reviewed, refocused, and revised. The team helped devise a more useful urine collection receptacle (working around the spica cast challenge, ie, a handled liquid soap bottle), researched alternate urine testing methods (BGM was not an accepted practice quite yet), utilized OT services to improve her limited dexterity, and yes, cancelled the stair climbing goal. A reasonable discharge date was established, her blood glucoses were managed to target, and she and her family were armed with skills and resources for potential situations at home. Lesson learned.
This event led to improved assessments, refocusing on self-care, situational problem solving, and Diabetes Care and Education Specialist certification. Fifty years later, I’m still a registered nurse clinician by profession and an educator by choice.
Carolé Mensing, RN, MA, CDCES, FDCES, was the original editor of The Art and Science of Diabetes Education: A Reference Guide.