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
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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