Doctor Asked For A "Kind" Nurse - page 4

Let me preface this thread by stating a few things: 1. I'm not posting this thread to bash certain religions, I'm posting to vent, gain understanding, and get a variety of views. 2. Whatever... Read More

  1. by   Disablednurse
    Fab4, thanks for the link. I have a clearer understanding now. just never knew where their belief came from.l
  2. by   P_RN
    Several of our orthopods have done many total joints on people of this faith without use of blood. Some would agree to cell-saver and autologous retransfusion, but some did not. The lowest hgb I recall was 5 something.

    On another note we lost a friend last year whose family member was of this faith but he was not. The family member refused any blood products.
  3. by   kids
    Originally posted by Flynurse
    I was just thinking....this would really really bite if this teenager was 17...and just months of making his own decisions!
    My question is:

    At what point, if parents are witholding treatment can a child/teen say "I don't want to die?"

    What happens if the a child/teen makes this statement?
  4. by   cna on her way
    I have to say that I don't understand this either. I could not stand by and watch my child die when there was something that I could have done about it. If a child is under the age of 18 and you bring them to a hospital for treatment, then we should be allowed to do just that. Just as a christian can believe "spare the rod, spoil the child" would it not be child abuse to hit a child with a rod? Children are not our property and we should not be able to decide if they live or die. This is just my opinion and I am not trying to put down anyones faith. I just don't see how allowing a minor child to die if blood would've saved their life can be justified.
  5. by   ShandyLynnRN
    I cannot understand it either, but then again, I have friends of different faiths than me, and they don't agree with many of my beliefs either. We have actually gotten into some heated debates before we agreed to disagree.

    I think the point is, is that the JW faith, those that refuse blood and blood products, obviously feel very strongly about their faith. Otherwise they wouldn't put their lives in jeopardy.

    I was also under the impression that if the patient is a minor, that the hospital is able to take the case before a judge to get the proper treatment for the child.

    Even as much as I agree with supporting all faiths, etc, I could never in good conscience not atleast attempt to have family services or a judge or whatever to intervene to get a child proper treatment.

    Then again, as a Christian who believes in the gifts of the spirit and divine intervention, I suppose people could argue that I should just be able to lay my hands on the child and heal him.

    I don't understand it. Most ppl not of the JW faith don't understand it. But I do commend them for being so strong in their faith. I am not sure that I would be so strong when it came to the life of my child.
  6. by   caroladybelle
    Originally posted by 3rdShiftGuy
    Couldn't the patient at least have an EGD and maybe find the source of the bleed?

    5.8 is not too horribly low for an 18 year old to recover from, unless he continues to bleed profusely. There's a few other options for him. But stopping the source is paramount.
    As far as an EGD is concerned, many Gastroenterologists refuse to scope anyone with platelets less than 60 to 75 - a platelet count of 14 would definitely fall well below acceptable parameters, especially when you know that transfusions (in case of a perforation) are not an option. The 5.8 hemoglobin would also be worrisome for the sedation involved.

    I frequently have onc patients that need scoping for major bleeds and the GI's refuse until acceptable blood counts are achieved - it seems not to matter that you can't get a good count until the bleeding stops.

    If the 5.8 hemoglobin occurs slowly, there is generally a better recovery. However, if it occurs rapidly, recovery is much more difficult. I've had elderly ladies that drove themselves to the MDs office, feeling "a little tired" with hemes of 3.7, and had youngsters fainting w/heme of 8.5.

    Fab4fan - is Neumega (increases platelet production) or Procrit (increases red cell production) considered acceptable. Other options - vitamin K and amicar(?) to increase clotting in absence of adequate blood clotting components - iron supplements (IV/IM/PO) - Tagamet/Pepcid/Zantac to decrease upper GI bleed - some places use iced gastric lavage, do not know the success rates of that.

    Studies have shown that hospitals draw way too much blood from critical low patients and that pedi tubes could easily be used on adults with little loss of accuracy. We frequently use them for checking JW patients to minimize blood loss.

    Vegas, inform that gluteus maximus of an MD that 95% of the people that work in nursing these days are "Kind" nurses. Nobody else but a "kind" person could do this job.
    Last edit by caroladybelle on Mar 25, '03
  7. by   Spidey's mom
    Hey Fab 4 - misconceptions run amok . . . I see what you mean.

    " spare the rod and spoil the child" by cna

    I've always heard that was comparing raising our children to sheparding sheep . . . . the shepard guides the sheep with the rod. They don't hit them with the rod.

    And now, off to work.
  8. by   Tweety
    Originally posted by caroladybelle
    As far as an EGD is concerned, many Gastroenterologists refuse to scope anyone with platelets less than 60 to 75 - a platelet count of 14 would definitely fall well below acceptable parameters, especially when you know that transfusions (in case of a perforation) are not an option. The 5.8 hemoglobin would also be worrisome for the sedation involved.

    I frequently have onc patients that need scoping for major bleeds and the GI's refuse until acceptable blood counts are achieved - it seems not to matter that you can't get a good count until the bleeding stops.

    If the 5.8 hemoglobin occurs slowly, there is generally a better recovery. However, if it occurs rapidly, recovery is much more difficult. I've had elderly ladies that drove themselves to the MDs office, feeling "a little tired" with hemes of 3.7, and had youngsters fainting w/heme of 8.5.

    Fab4fan - is Neumega (increases platelet production) or Procrit (increases red cell production) considered acceptable. Other options - vitamin K and amicar(?) to increase clotting in absence of adequate blood clotting components - iron supplements (IV/IM/PO) - Tagamet/Pepcid/Zantac to decrease upper GI bleed - some places use iced gastric lavage, do not know the success rates of that.

    Studies have shown that hospitals draw way too much blood from critical low patients and that pedi tubes could easily be used on adults with little loss of accuracy. We frequently use them for checking JW patients to minimize blood loss.

    Vegas, inform that gluteus maximus of an MD that 95% of the people that work in nursing these days are "Kind" nurses. Nobody else but a "kind" person could do this job.

    Excellent points, I didn't consider the low platelet count. Thanks for pointing that out.

    Not to answer for Fab4, but the neuro case I mention the family allowed procrit.
  9. by   ayemmeff
    Thanks for the insight Terri.
  10. by   911fltrn
    As an 18yr old the patient has the right to make this decision. Its my belief however that if this was a minor the doctor should transfuse the child and involve child health and welfare services.
  11. by   sjoe
    "What was said about JW was inaccurate."

    There are several "branches" of JW (like every other religion in the world), each one thinks it has the "correct" message. What was said about JW IS accurate for some of these branches, inaccurate for others.

    BTW, I hadn't noticed that Vegas has later posted that the patient was 18 years old, which removes my argument about parents/minors/children/etc. If this patient had wanted blood products, etc. then specific advance directives would have been in order (ANOTHER reason to complete these directives at the earliest possible age, unless one wishes next-of-kin to make the decisions).

    fab writes: "Care of minors presents the greatest concern, often resulting in legal action against parents under child-neglect statutes. But such actions are questioned by many physicians and attorneys familiar with Witness cases, who believe that Witness parents seek good medical care for their children. Not desirous of shirking their parental responsibility or of shifting it to a judge or other third party"

    Who cares whether "many" physicians and attorneys...question such actions? Other physicians and attorneys do NOT question such legal actions. It is up to a judge and/or a jury to decide in these cases.

    Regardless, the hospital has some serious legal exposure by not contacting the authorities in a timely manner in this case, as do those employees who knew about the situation and did not do so themselves.

    Ask Nevada's BON and its attorney general, if you think I am mistaken. (Not about JW, of course, but about legal obligations and remedies.) We don't want Vegas to be posting from inside the slammer in the future.
    Last edit by sjoe on Mar 25, '03
  12. by   fab4fan
    There are many alternatives that are acceptable. Procrit and Epogen are among the newer drugs used, very successfully, for that matter. There are other things that can be done, such as hypothermia, hyberbaric O2, and others. I was glad to see someone mention something that should be obvious, but often gets overlooked: microsampling when labs are needed.

    As far as a situation in which a minor child would request a transfusion...I honestly don't know. I suppose this would be one of those situations that could lead to a court decision. No one has ever asked me that before, so I don't know, but I will try to find out.

    I know that it seems harsh, but bear in mind that this is one aspect of care that is being refused, not all care. Even in a case of massive blood loss d/t trauma, it's the lack of volume that is the initial problem, not blood itself. Medical personnel frequently deal with pts. who have other issues that force them to modify the initial tx. plan, e.g. pre-exisiting conditions, medication allergies, etc.

    Parents make very personal decisions for minor children all the time. I think some people (and I'm saying this in general, not people on the BB here specifically) think that parents in this situation have some sort of cool detachment...that is not the case. Witness parents consider children to be a blessing from God, so clearly they would want what is best for the child. But they also have to think about the child's spiritual life as well.

    I hope some of this info clarifies things. BTW, the comments about a child being "shunned" and put out by his parents...not true.

    Thanks for bearing w/ me on this...got a little hot under the collar last night.
  13. by   fab4fan
    sjoe: There are no "other branches" of JW...any people that have separated and formed variations of the faith are considered apostate.

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