Chapter 37: Decision-making

Jon is a third-year student on the 8th week of a community placement. As he has been doing so well he is asked to go and see an elderly woman, Dorothy, who was discharged home the previous week following a fall. She had suffered a deep gash on her arm and needs her stitches removing. The nurse tells Jon that Dorothy is also complaining about her foot and it is likely that she hurt it in the fall so to check it if he has time.

Jon removes Dorothy’s stitches and then asks if he should look at her foot. Dorothy looks at him and says ‘no, I am sure it will be fine’ and looks away. Her response worries him so he tells her he has plenty of time and asks again if he can look at it. He removes her socks and finds a small ulcer on one of her toes which is very black. Jon is aware that Dorothy is a diabetic and knows that ulcers are common in people with diabetes and so he asks if he can check her blood sugar which he finds is higher than normal. He asks her if she has been taking her tablets for her diabetes and she says yes, she is very careful to ensure she takes her tablets every day.

Questions

  • What types of decisions has Jon made in the above scenario and what other decisions must he now make?
  • What factors may have influenced his decision-making?

Answers

Jon has made three decisions:

  • Assessment – Jon has assessed Dorothy’s toe visually and then taken her blood sugar to assess her blood sugar level.
  • Diagnosis – based on the site of the ulcer, her diagnosis of diabetes and high blood sugar Jon makes a diagnosis of diabetic foot ulcer.
  • Experiential, understanding or hermeneutic – he used Dorothy’s non-verbal cues to inform him that she was worried and that needed investigating.

His next decisions are:

  • Referral – as Dorothy will need treatment for her foot ulcer and also a review of her diabetes management.
  • Information seeking – Jon rings his mentor to ask her advice about referring Dorothy and how he should dress her ulcer in the meantime.
  • Communicating with Dorothy what he intends to do and the need for further treatment.

Factors which influenced Jon are likely to be:

  • Knowledge of diabetes from lessons in university
  • Previous experience in caring for people with diabetes in previous placements.
  • Self-confidence based on knowledge and experience in using the above to make the key decisions.