Caring for Jehovah's witnesses

danissa, LPN, LVN · Jan 30, 2008

Just reading the whole of this thread from the start should offer you some insight, from many points of view.

tophthegoph · Jan 30, 2008

I don't get a chance to talk to too many fellow Jehovah's Witnesses who are RN's. I am curious to know how you deal with the issue of blood transfusions.
Some in our religion would give the blood transfusion as a matter of conscience feeling they are simply following a doctor's order. Others (as in my case) ask the RN they are checking the blood with to start the transfusion, and they monitor the infusion from there. Either is acceptable. So I am just curious.

Hey Meg. I too am one of Jehovah's Witnesses, however I'm just now finishing up my pre-reqs and applying to a nursing program. I was actually searching this forum to see if I could find the answer to the exact question you just asked! I am interested in going into emergency nursing, so I know this will definitely be an issue. You already clarified one question that I had, which was if a nurse can administer blood transfusions, and if so, under a doctor's direction or on their own. My friend's father has been the head ED nurse at his hospital for some fifteen odd years, and according to my friend, he just asks another nurse to perform the transfusion. I've never actually gotten to talk to him personally, so I don't know if he does something similar to what you do, or has the other nurse do everything. By the way, what's involved in monitoring the infusion once it is given?

Thanks for your help, Chris

rnwaller · Jan 30, 2008

Hello again,

You mention this patient had chronic anemia. Is she getting the full follow up? Does she have a hematologist, is she getting Epogen? Iron?

May be this is all true but I do sometimes find that a patient will refuse a transfusion, then no aggressive follow up is made.

She is in my prayers.

Michelle

LiverpoolJane · Jan 30, 2008

Hey Meg. I too am one of Jehovah's Witnesses, however I'm just now finishing up my pre-reqs and applying to a nursing program. I was actually searching this forum to see if I could find the answer to the exact question you just asked! I am interested in going into emergency nursing, so I know this will definitely be an issue. You already clarified one question that I had, which was if a nurse can administer blood transfusions, and if so, under a doctor's direction or on their own. My friend's father has been the head ED nurse at his hospital for some fifteen odd years, and according to my friend, he just asks another nurse to perform the transfusion. I've never actually gotten to talk to him personally, so I don't know if he does something similar to what you do, or has the other nurse do everything. By the way, what's involved in monitoring the infusion once it is given?
Thanks for your help, Chris

As a Jehovahs Witness and a RN I do not like having to be involved in administering blood but sometimes there is nobody else to do it. All of my colleagues know I am a Witness and are understanding if I ask them if they would start that transfusion etc. Thankfully I work in Renal and our Consultants are used to correcting anaemia without blood because of the impliations of compromising a patients chances of a kidney transplant if they build up antibodies.

When I am in the situation where I have to be involved in the transfusion I aware of the precident set in the bible in Daniel - I won't go into any further detail as I don't think it is appropriate in a public forum, but just to say that it involves three young men who had to serve food having blood in it although they wouldn't partake themselves.

Likewise in work as long as patients are fully aware of the risks etc - and I believe in the US you have to sign a consent form for a BT - then although it is not something I would want I understand that it is part of my role as a nurse.

Hope this helps

rnwaller · Jan 30, 2008

I am agreeing with Liverpool Jane, as an RN and a JW I try to avoid hanging blood. In the US it is always two nurses who hang blood (so I am never doing it 'solo'), and after the blood is hanging it is my job to monitor the patient (as nurses do all the time.)

The Bible also states that free will is a choice (not always the right choice) so if the patient with his/her physician has consented to have blood, it is not my place to impose my religious beliefs on them.

I hope this helps. - Michelle

tophthegoph · Jan 31, 2008

That does help Michelle, thanks. Just one more quick question, when you say you monitor the patient afterwards, I'm assuming this means you are just making sure they don't have a bad reaction to the blood, right? Or do you have to sometimes alter the amount of blood being transfused or something along those lines? Not that it matters, I'm just curious.

Chris

psychnurse1998 · Feb 4, 2008

I am pursuing my BSN. As part of my current class I am researching the difficulties of caring for patients with the Jehovah's witness' beliefs. If anyone has an experience that he/she can share with me about your personal feelings in caring for a Jehovah's witness, I would greatly appreciate it. I am new to the discussion board and look forward to hearing from you.

I go along with respecting others patients belliefs and cultures. If because of one persons beliefs, medicines gets to learn the outcomes of not having blood transfusions even when current knowledge recommends it, I think there might be a good outcome. And no one had to volunteer as a guinea pig to test it out, saving people money.

I dont view children as property of parents, so I dont think they should control their care or put their health at risk. I believe Christian science, believes in withholding medical care that has resulted in children dying. but i guess thats another topic. I guess one could compare the cases of those that have died from reactions to blood trasnsufions to those that have refused them. I dont know if that has been studied. If my brain is starving for oxygen, please send as many packed cells to it as soon as possible. I dont think its the function of plasma expanders to carry oxygen, I am glad JW's at least come to hospital for care.

Just please make sure you get the right blood type.

rnwaller · Feb 21, 2008

I continue to monitor the patient (which would include transfusion reaction) just as if I hung any other medication. That is, in essence, a nurses job.

Keep up the great work everbody.

lorilou22RN · Feb 21, 2008

This is probably gonna get some heated comments, but here goes. I have taken care of numerous JW, and it truly represents a challenge for health care workers. The Jehovahs, I have cared for tho, truly need PRBC's, not albumin, hespan, etc. Typically they have been GIB's, This last lady, nearly died H & H 5 and 17 BP's low, truly attempting to continue to perfuse her brain and her kidneys, of course she developed ATN and had to be treated for this as well. She ended up with a colectomy 2/2 her GIB, trached, you know the works. Her family steadfastly refused blood, and while I respect that right, It puts those of us who are not JW's and are nurses/doctors in a horrible position. You are constantly chasing your tail, and making little headway. I think she ended up in a acute-care vent facility. The other guy did die, He actually had a CV surgeon perform a MVR, and triple vessel cabg. He just bled out, during the code, the CCP drew the code blood femorally, and it was like water. No RBC's, just plasma. This is going to sound a bit prejudiced, but it is not meant that way at all. I really think that JW's should be treated by JW's, docs, nurses, etc. There should be a facility that treats only witnesses. That way it would be completely understood, and you all could still get the care you may need, the way you want it. If you can refuse to hang blood, based on your beliefs, shouldn't those of us who aren't JW's reserve the right to not be put into the position of caring for someone who wants care, and wants to be a full code, yet we can't do the one thing that could help save you? Ethically, it can really back us in a corner of wanting to do the right thing (medically), yet unable to because of religious beliefs.

Please if anyone has an answer or input please divulge. And for those that are JW's, truly no offense, this is just my dillemma, and my :twocents:

psychnurse1998 · Feb 21, 2008

This is probably gonna get some heated comments, but here goes. I have taken care of numerous JW, and it truly represents a challenge for health care workers. The Jehovahs, I have cared for tho, truly need PRBC's, not albumin, hespan, etc. Typically they have been GIB's, This last lady, nearly died H & H 5 and 17 BP's low, truly attempting to continue to perfuse her brain and her kidneys, of course she developed ATN and had to be treated for this as well. She ended up with a colectomy 2/2 her GIB, trached, you know the works. Her family steadfastly refused blood, and while I respect that right, It puts those of us who are not JW's and are nurses/doctors in a horrible position. You are constantly chasing your tail, and making little headway. I think she ended up in a acute-care vent facility. The other guy did die, He actually had a CV surgeon perform a MVR, and triple vessel cabg. He just bled out, during the code, the CCP drew the code blood femorally, and it was like water. No RBC's, just plasma. This is going to sound a bit prejudiced, but it is not meant that way at all. I really think that JW's should be treated by JW's, docs, nurses, etc. There should be a facility that treats only witnesses. That way it would be completely understood, and you all could still get the care you may need, the way you want it. If you can refuse to hang blood, based on your beliefs, shouldn't those of us who aren't JW's reserve the right to not be put into the position of caring for someone who wants care, and wants to be a full code, yet we can't do the one thing that could help save you? Ethically, it can really back us in a corner of wanting to do the right thing (medically), yet unable to because of religious beliefs.
Please if anyone has an answer or input please divulge. And for those that are JW's, truly no offense, this is just my dillemma, and my

I am having a hard time understanding some of the abbreviations, so I dont know if I understood some of what you are saying. I have been both a nurse and an auto mechanic. I have not however been in a situation with caring for a JW. So all I can draw on is my auto mechanic experience. Sometimes, we would recommend to a customer to have repairs done. Repairs we may feel would lead to costlier repairs or possibly endanger the customer. Often times, the customer would refuse. All we could do is document it on the work order.

I think, JW's have given this a lot of thought. If they want to take that risk

And they are adults, not asking one of their children to take the risk, I have no problem with it.

You do raise a good point. I was a seventh day adventist. They own a medical school and hospital, Loma Linda University. I think if they wanted too, JW's, could build their own hospitals, but dont know if the Govt would allow them. I think there would probably be a lot of legal obstacles. I dont know if you can open a hospital and deny non JW's care. Like those that request Blood. What isa GIB anyway?

elkpark · Feb 21, 2008

The Seventh Day Adventist church has a whole system of excellent hospitals and healthcare teaching institutions across the country (and internationally, I believe), but they don't only treat SDAs (they don't even employ only SDAs -- I and plenty of others here have worked for them). They were never intended as a system to provide care for SDAs; they were intended from the beginning as a medical ministry to the world.

Sure, it can be frustrating to treat people with values different from our own (been there!! :)), but that's sorta what we signed up for when we went into healthcare. We live and work in a country and healthcare system that respects (with a few, specific limitations) the individual's right to self-determination. All healthcare clients, not just JWs, always (again, except for a few specific, legally defined situations) have the right to make the final decisions about their care, and refuse any treatment they choose, whether it makes sense to "us" or not, and whether the refusal is based on strong religious convictions, their personal "risk vs. benefit" analysis of the situation, or just something crazy they read in the newspaper last week ...

We don't get to impose our values on those we care for in healthcare settings, just like we wouldn't want to have someone else's values imposed on us. :)

basict · Feb 21, 2008

I posted already but it didn't show up. I just wanted to know if anyone knew if CRNA's order/tranfuse blood. And what other JW's thought about persuing a CRNA career.