Pts abusing "cultural/religious" practices to manipulate RNs

[HvnSntRN]

This has been bugging me for a while.

A few weeks ago, we had a postpartum patient who is Jewish (Orthodox), which means that they won't do "work" on their Sabbath (sundown on Friday until sundown on Saturday). No problem. The nurse looking after her planned with her to check in every hour to see if she needed something.

I later found out that the patient sent the baby to the nursery to be bottle fed by the staff overnight, even though she was breastfeeding.

I also found out that not only did she do this on Friday-Saturday, but also Saturday-Sunday, and Sunday-Monday. She had a different RN working with her each shift and pulled the "no work on the Sabbath" routine, expecting that the nurse wouldn't be familiar with the differences between the Christian and Jewish observances of the Sabbath.

I guess I just have a hard time respecting people who misinform regarding their beliefs and cultural practices with the aim of getting what they want from other people. I mean, why not just say (like other people do) "I'm really tired from breastfeeding and I'd rather let you give the baby a bottle overnight", instead of trying to manipulate us with phony information about religious beliefs and practices? I'm pretty sure that Jewish people eat on the Sabbath; do they plan to not feed their babies on the Sabbath once they're discharged from the hospital? If that's the case, then we should be calling CPS, right?

I'm all for being culturally sensitive and respecting other peoples' belief systems. What I don't appreciate is when my colleagues get manipulated on that basis by people being deceptive about their beliefs and practices - it shows a distinct lack of respect for us and an abuse of our efforts at being culturally sensitive.

How do other RNs handle situations like this?

[NursShar1]

The reaction of feeling manipulated by this patient is natural and justified. However, it seems that being personally offended may be interfering with the nurse looking at the entire picture. I am not Jewish, but have worked in a heavily populated Jewish area and am somewhat familiar with the culture. I do not think that feeding a child is against the Sabbath practice, and if someone sat down with this woman and had a heart to heart talk, I am sure that she may admit it eventually as well. What needs to be done, is to look beyond the feelings of manipulation, and see what is at the heart of it all. If it is a first child, she may feel overwhelmed and need some time. Is it a 3rd or 4th or 5th? She may just want the rest that she knows she will not get when she goes home. This is no reason to call child services. People are entitled to feel overwhelmed or need some rest. Is she being pressured into breast feeding by a family member? If so, she may be using this as an excuse or justification to the family for not breast feeding, and then perhaps say "the baby won't take to the breast - they bottle fed her in the hospital...". What ever the reason, of course this patient is not going to come clean and and give the real reason up front. IT is easier and less embarassing for her to hide behind an excuse.

Remember what we all learned in nursing school however many years ago, and do not take things personally, and especially do not let it interfere with looking at the big picture. Yes, this person probably manipulated the nurse by using a cultural practice excuse, but it does not excuse us from digging deeper.

[GardenDove]

I wouldn't feel manipulated by a pt who made up a fib to get me to take care of her baby so she could sleep. I would maybe think that she was not too smart to make up one like this, since Orthodox Jews don't neglect and starve their children just because it's the Sabbath, it's totally obvious it's a fib.

I can't believe people think she needs therapy and intervention because she made up a fake excuse to get the nursing staff to let her rest. Are OB nurses that judgemental? Hey, this is coming from me, the original Earth Mama, I'm very in favor of breast feeding. I also, however, believe strongly in pt rights, which include them choosing how to manage their own health.

I also think that the OP's OB dept needs to wonder why pts feel like they need to lie to get taken care of. Are they too domineering with these women? People are very vulnerable when they give birth, they need to be totally defered to and given control over their own healthcare. If they want things a certain way, within reason, they should be made to feel unjudged and safe. Asking for a nights unbroken sleep after giving birth is entirely reasonable.

[caroladybelle, BSN, RN]

If This Little Girl Thinks That Holding A Newborn Infant And Breast Feeding It Is Work She Has A Real Awakening Coming To Her.it's Possible That Her Husband Treats Her Like A Princess

I disagree. If you know much about Orthodox Jewish women, you know that culturally that they work VERY hard, to maintain their household according to kosher law. That is not easy, and much more difficult to do than handling a nonkosher household. And as Kosher (Kashrut) is involved in all aspects of the Orthodox life - from cleaning house, cooking and raising children - it is substantially more onerous than what I see in Christian households.

There is a derogatory stereotype - Jewish American Princess - used to describe very privileged and self absorbed Jewish women. I have never met a Hasidim or an Orthodox female that fell into a "princess" category. They work to hard.

Though all wives of all religions deserve to be treated as "princesses".

And why do you refer to her as a "little girl"? There was no age mentioned. While Orthodox do often marry young, this could have been a later pregnancy in a much older woman.

[Retired R.N.]

So why should any nurse get upset if a patient asks that her baby be fed in the nursery? Has anyone considered that perhaps this patient has been brow-beaten into saying that she will breast feed, but she really doesn't want to? If she knows that she will be going home to trying to keep a kosher household, she knows that she has her work already cut out for her. If she fears will have no support for not wanting to breastfeed when she gets home, why can't you graciously allow the woman a few nights of uninterrupted sleep so she can rest and regain some strength?

[MomNRN, BSN, RN]

Warning - thread hijack alert:

I learned alot from reading this thread. We have very few Orthodox Jewish people in our area (if any). I had no idea of their beliefs.

Thanks!

[dragonflyRN]

Regardless of beliefs in whatever faith, things have changed. When I had my first, the nurses wanted him. I had my second....they offered to take him. I had my third and I didn't have a choice. I had him with me all of the time. This is where I would have appreciated a little help.

[Yuliya3]

I think you meant Jehovah's Witness. There is no prohibition for SDAs against taking transfusions. Individuals may choose that, probably, but nothing in the corporate faith. My church has blood drives!

No intent to hijack here...just wanted to clarify. I am an SDA and we get confused with other faiths all the time.

I did mean Jehovah's Witness. I was just typing too fast to think. We did have a lot of SDA patients, that's probably how it got into my head. Sorry.:)

[SmilingBluEyes]

I do not think it is reasonable to give a mom a whole night's sleep without interruption, esp if she is breastfeeding. PART OF MY JOB is to ensure mom and baby are bonding and the parents are able and ready to care for the newborn when they go home. I have to document on these things in my nurses' notes, especially if things are not going well or normally. And believe me, if issues come up later, a nurse CAN be subpeona'd to court to give depositions as to mom/baby relations in the hospital, in extreme cases. How do I know? Cause it happened to me in a case of extreme neglect, and my notes along with those of the other nurses, were used and we were questioned by attorneys in the courthouse in this case.

So it's not about being judgemental, but about doing my job. And if I feel a social service visit is warranted and I don't follow up, I can be called on the carpet for this later on. And rightfully so!

So yes, it's important new parents be given a break when we can, but we have a short time to help them assume care and to observe how they do taking over the care of their newborn babies. Our priority is not to give uninterrupted sleep to new parents in the hospital if they are well, and their babies are also. It is not our job to entirely defer to their demands, if they are unreasonable. It IS our job to ensure to the best of our ability, they are able to care for themselves and babies and/or have good support networks when they go home.

[Josifek]

Give the poor woman a break! She's tired and has paid a lot of money to have the baby in your hospital and would like to use your services of keeping the baby in the nursery overnight. Maybe it's these "call CPS at the drop of a hat" attitudes that keep her from coming out and saying "I'm tired, please take the baby for a while". Instead she exaggerates her religious practices hoping you will be a bit more sympathetic than if she just came out and admitted she's not super mom. Put down your stones and place yourself in her shoes for a moment. Do you want to be reported to CPS when you get tired as well?

[SmilingBluEyes]

It was not about "please take my baby for a while" that concerned many of us. Refusal to care for a baby, even to feed the child, is a cause for concern and investigation. Not necessarily a CPS call and hold, but at the least, a good and thorough assessment by the nurses responsible for their care and if needed, yes, a referral to social services personnel, if a problem is truly suspected.

Since none of us was there, it's hard to say what ALL the social dynamics were in the situation, but frankly, it would have me a bit concerned, based on what I read here.

[SuperFlyRN]

I do not think it is reasonable to give a mom a whole night's sleep without interruption, esp if she is breastfeeding. PART OF MY JOB is to ensure mom and baby are bonding and the parents are able and ready to care for the newborn when they go home. I have to document on these things in my nurses' notes, especially if things are not going well or normally. And believe me, if issues come up later, a nurse CAN be subpeona'd to court to give depositions as to mom/baby relations in the hospital, in extreme cases. How do I know? Cause it happened to me in a case of extreme neglect, and my notes along with those of the other nurses, were used and we were questioned by attorneys in the courthouse in this case.

So it's not about being judgemental, but about doing my job. And if I feel a social service visit is warranted and I don't follow up, I can be called on the carpet for this later on. And rightfully so!

So yes, it's important new parents be given a break when we can, but we have a short time to help them assume care and to observe how they do taking over the care of their newborn babies. Our priority is not to give uninterrupted sleep to new parents in the hospital if they are well, and their babies are also. It is not our job to entirely defer to their demands, if they are unreasonable. It IS our job to ensure to the best of our ability, they are able to care for themselves and babies and/or have good support networks when they go home.

I totally agree. Part of my job is to help teach the new parents. In our facility we do not even HAVE a nursery. Every baby rooms-in and total care is taken by the new parents. When they are given their pre-natal tours they are explained that it is expected that a support person stay (pref. Dad) to assist the new mom. We have had babies that were taken out for the night and they are literally left at the desk (as long as a nurse is there we can do this, but with our current shortage it is hard-emergency bell goes off and someone has to stay behind with the baby so we try to discourage this) and then the mom wants to go home and she is asking a million and one questions that had her baby been in her care she would have picked up on some of those "cues". My "normal" PP assignment when I work PP is 4-5 moms and 4-5 babies. If I take even one of those babies and I am tied up with a patient, someone at the desk (that has a very similiar assignment) is left to care for "my" baby. It just does not work in our facility unfortunately. We have had patients request to baby be removed from the room and mom and dad or mom and grandma are both staying, I don't see the logic in this.

They are with us such a short time-24 hours for NSVD and 60-72 hours for c/s-that every precious moment counts.

We have not had a nursery in our hospital in six years.

[dragonflyRN]

Regardless of faith, did anyone stop to think on how the units have changed over the years? 11 years ago, the nurses got my babe at night. They wanted him....they wanted me to rest. Now? Pop the kid out and take care of it on your own.