Phase 1 A 5 year old is brought to her pediatrician for an annual routine checkup. Her grandparents, who are also the legal guardians, are with her. The child has not seen her pediatrician in a year. The child recently had a visit to the urgent care center and was treated for strep throat. The grandparents are concerned about the child’s weight gain. They state no matter how much she eats she cannot gain weight and is hungry all of the time. Phase 2 The primary care office does not have a glucometer available, so the provider orders a urinalysis dip stick test. The urinalysis shows a glucose of over 500mg/dl with blood, leukocytes, and ketones. The results are shared with the grandparents along with the potential diagnosis and complications. The child’s grandparents are visibly upset and start asking the nurse questions about their grandchild. Below are several responses the nurse can make to the child’s grandparents. Drag and drop the nurse’s responses to the child’s grandparents to either ‘therapeutic” or “nontherapeutic” based on how you would best categorize the responses.

Therapeutic Responses: “By administering IV insulin and IV fluids, we can help your grandchild feel better.” This response is informative and reassuring without giving false hope. It focuses on the next steps in care and shows confidence in the treatment plan. “It is important that you understand that this is not something you could have prevented.” This reduces feelings of guilt or blame, which is important when dealing with families learning about a chronic diagnosis. “I understand all of this can be overwhelming, but we are here to support you through this new diagnosis.” This validates the caregivers’ feelings and offers emotional support, which is crucial in pediatric care. Nontherapeutic Responses: “There is no need to worry, this diagnosis is common in children.” This dismisses the caregivers’ valid emotions. While Type 1 diabetes is relatively common, minimizing their concern is not supportive. “Yes, you could have attributed to this problem by not limiting the amount of sugar your grandchild eats.” This is blaming and factually incorrect, as Type 1 diabetes is an autoimmune condition and not caused by sugar intake.