Doctor Asked For A "Kind" Nurse

fab4fan · Mar 30, 2003

Originally posted by lgflamini
Wrong. They prefer to use it because it's more effective.

Actually:

1. Bank blood does not have O2 carrying capability for 24h, so essentially, you are just replacing volume.

2. Doctors tend to use blood first because that is what is familiar. When they cannot use blood it forces them to be even more aggressive in tying off smaller bleeders that they could ordinarily let go if the pt was getting blood. It also forces them to utilize other lesser known (yet very effective) non-blood alternatives.

frannybee · Mar 30, 2003

Deneen, I'm sorry to hear how rough this has become for you. I'm thinking of you often. (((((Vegas)))))

LasVegasRN · Mar 30, 2003

Originally posted by caroladybelle
Vegas - Why is pt a full code (crash cart at door)?

I'm sorry, I thought I mentioned they made her a medical code only - we won't call a code, no CPR, no cardioversion, compressions or defib, no intubation.

Thank you, everyone, for your support and good wishes. I'll give an update tomorrow.

-jt · Mar 30, 2003

We once had an unconscious teenager minor who's parents religion did not allow blood transfusions, which the child needed, but the parents were refusing based on their religion. He didnt have a life threatening illness or nothing that couldnt be fixed, so our doctors went to court to treat the kid and won. The ruling basically was that since the child was a minor, he had no choice on the religion his parents assigned to him, and there was no way to know that he would have chosen the religion for himself. So he got a court order allowing him to be transfused over his parents religious objections - because they were his parents religious objections and not necessarily his own.

Whole other ethical debate there too.

MPHkatie · Mar 30, 2003

Involve court orders for kids in these cases. They are clearly documented in Medical Ethics books. Usually the child gets the treatment. I will always respect an adults wishes in regards to treatment, but Children have the right to grow up into adults who can then make a choice.

Diana in Sweden · Mar 31, 2003

I have enjoyed this thread very much, thank you for starting it.

fab4fan I want to thank you for your valuable information, here in Sweden they routinely put JW children that need blood or blood products under the custody of the state ( during the transfusion or treatment, then they are immediately placed back in their parents care) and I have always wondered what those children will later be taught by their parents. It is a great comfort to me to hear that they are taught that that is not their fault and that God will see them as blameless, which makes sense as they and their parents had no choice in the matter.

Aussienurse2 · Mar 31, 2003

Sometimes you just have to go home, look your kids in the eye and tell them how much you love them.

I would want everything available to continue my life drugs, blood, vodka...But sometimes I have to take a step back, breath a little and then keep going. Working in aged care is very different to acute care. We deal with death a lot more and sometimes even wish for it. Nursing is a continual learning curve, just look at the stuff we have learned here, but sometimes there just isn't a "right" answer, no matter how hard we look, how much we know. Sometimes people die because of what they believe, they "know" that it is worth dying for. Just look at how many people have and are dying in Iraq at the moment because it is worth dying for, freedom, faith, love of country. I think that we need to let people die with impunity if it is important to them not to accept certain medical interventions. ( Not children I agree!!)

I really do fell so bad for you Deneen, but guess what? Emmas mum would move mountains for her and that (IMHO) is the most inportant thing to remember at times like this.

NurseGirlKaren · Apr 2, 2003

Any update, LV?

Gabbybird · Apr 4, 2003

Wow, what a hot topic. What did the teenager want to happen? I do know that at certain ages, teens can petition a judge to be in control of their own futures and decisions. Of course, that would involve social services and legal aid, and a lot of work. I just know that when I was a teenager, I would have wanted to live no matter what the consequences, and hope that God would forgive me later.

-jt · Apr 5, 2003

Englewood Hospital in NJ is the leader in bloodless program medicine. People, including JWs, from all over the world are transferred there for this kind of management. Heres one pts story (hgb 1.7 when he got there - supposedly incompatible with life):

http://www.time.com/time/reports/heroes/bloodless.html

More about the hospital & its bloodless program:

http://www.bloodlessmed.com/

-jt · Apr 5, 2003

She would have already signed a refusal to consent to blood products on admission and would be wearing a lavender-colored ID wrist band identifying her as a pt in the bloodless program. She'd have a 6 page detailed advanced directives form from the bloodless program signed by her in each section, explaining exactly what she will and will not accept as far as blood products, derivatives, and meds, & it would already be on her chart by the time she got to her room. A sign would be posted in her room and on her chart stating No Blood Products. And all her labs would be drawn in pediatric tubes. She'd have an order for iron & epogen. She would be visited daily by the JWs that serve as consultants to the hospitals program. But these consultants are not allowed to view the pts chart and are given no right to know about the pts treatment and decisions. They are there merely to support the pt with her decision to refuse blood, answer her questions, pray, and basically just visit. Pt confidentiality is maintained. Anyone can choose the bloodless surgery program - not just JWs - and all of the above applies to them too.

If the pt came in emergently and mentioned that she did not want to accept blood products or was a JW, we just note it, notify the doctor & admitting office, have the ID band changed to a lavender one, have the signs posted, & call the bloodless program consultant to take it from there. The RNs are not responsible for all the paperwork or consents.

It seems like every active massive, emergent, symptomatic, life threatening GI bleed we get in my ICU is a JW refusing blood and practically crashing. You look at them and think "now what are we supposed to do with this?"

We have a big bloodless program but some of the JW pts have changed their minds on their own or at their familys request while in our ICU, & decided to accept transfusions at the last moment, but want/need to keep it confidential from their religious community. They have the right to change their mind about treatment and to keep it their own business, but those who did so feared being ostracized by their community if their secret decision was known. In those cases, we have had to take extra precautions to maintain their privacy and transfuse them in a private, curtained, closed door room - after visiting hours. And file the transfusion records, consent, and notes in a temporary folder kept separate from their chart during their length of stay.

We once had a JW who was symptomatic & asked to be transfused but had such a revolving door of community visitors that she was frantic about repercussions. She was finally transferred to the OR just to be transfused without anyone she knew walking in unannounced & seeing it.

NurseDennie, BSN, RN · Apr 5, 2003

Taken out because it wasn't really about the thread topic.

Sorry!

Love

Dennie