Jehovah's Witness and Blood Refusal in OR - page 3

Hey! Last week I circulated with another nurse (I am still on orientation). We had a patient who was a Jehovah's Witness, so along with a signed surgical consent there was a signed refusal for blood.... Read More

  1. by   thenursemandy
    Quote from IftheShoeFits
    as an almost new nurse entering the field, this discussion has been very helpful.

    It is the hardest thing as a healthcare worker, hardwired to save lives with resources available, to not use those resources.

    See it from the pts point of view. They believe that their ETERNAL LIFE is in danger if they disobey Gods command to abstain from blood. It is not up to the surgeon or nurse to decide for them. Taking in blood is NOT negotiable to a JW. Its our right.
  2. by   mom4kids
    Hi Shaunta,

    I am a JW too and also graduating as an LPN in a few weeks. I just wanted to say "hi" and that I thought what you said here was right on.
  3. by   shodobe
    Not all JWs abide by their beliefs because I have had a few over the years who sign the refusal but also state that if it was the difference between living and dying, give me the blood! So this is an issue that should be resolved BEFORE surgery and yes the surgeon isn't always right.

    PS this has only been a few over 37 years in the OR kind of like Holiday Catholics or Jack Mormons
  4. by   madi.sand
    There is also controversy that many consider Jehovah's Witnesses a cult because if they accept a blood transfusion willingly they are shunned by their family and community so knowing that some may want a transfusion but be too afraid to accept one.
  5. by   offlabel
    I'm always very clear and specific about exactly what the patient will and won't accept, ie, albumin, ffp, cell saver etc. It does vary from time to time. What I'm also very clear about is that death isn't the only consequence of not enough red blood cells.

    Irreversible brain damage and / or heart or kidney damage leading to permanent disability and the need for long term care/dialysis is more probable than death.

    I will say that at least in part, their reluctance to receive blood has lead to the realization that we transfused way too much blood in the past. Transfusion triggers have been revised drastically in the last 20 years.
  6. by   offlabel
    Quote from madi.sand
    There is also controversy that many consider Jehovah's Witnesses a cult because if they accept a blood transfusion willingly they are shunned by their family and community so knowing that some may want a transfusion but be too afraid to accept one.
    They're going to need that community after they've had their stroke. But that's their call. The best we can do is be very sure they understand the consequences.
  7. by   madi.sand
    Right I agree but also I think it is important for nurses/HCPs to understand that these patients are in a double bind and acknowledge that they understand the consequences of accepting blood for them and if they choose to do so they will keep it confidential and be careful with those who visit (because other JWs are required to report on those not compliant with doctrine). That way they can feel that if they do choose blood they can do so without the loss of community .
  8. by   catsmeow1972
    The overwhelming majority of the JW patients that i have done pre-op anything for, for elective surgery have toted in with them, a folder with signed paperwork that states something to the effect of "i am one of Jehovah's Witnesses and then goes on to delineate what fractions/blood products what have you that they will/won't accept. I have seen some that are okay with cell saver, in a closed circuit and some that are not. As above poster stated, it falls to the individual's conscience as to the specific stance.
    Whatever my patient documents as their wish, I am going to abide by it. Once the patient has been educated on what may happen if they decline blood products, my job is done. I am there to speak for them at a time when they cannot and it is my responsibility to honor the patient's decisions, never mind whether I agree with them or not. My opinion regarding what faiths are/are not "cults" is inappropriate and irrelevant in this setting.
  9. by   offlabel
    Quote from madi.sand
    That way they can feel that if they do choose blood they can do so without the loss of community .

    There is no keeping secret the fact that a JW received blood. That would be a reassurance I would be very hesitant to give. If they say they don't want it and they're a mature, informed adult, they don't get blood from me.
  10. by   RobtheORNurse
    In the OR, you, the RN Circulator, are the patient's advocate and have the responsibility to speak for the patient when they cannot speak for themselves. It is highly likely that the surgeon did not know about the patient's religious practices or had forgotten, especially if it is a big case. You must inform the surgeon of this before they order blood.
  11. by   DeLynn
    Quote from offlabel
    They're going to need that community after they've had their stroke. But that's their call. The best we can do is be very sure they understand the consequences.
    They will still receive the help and care they need from family members even if they are disfellowshipped. As nurses it is our ethicial duty to be the patient's advocate.
  12. by   Soida
    I'm a JW and I work in the OR. I'm not sure how it works everywhere, but when I am doing an Open Heart case, the Dr has standing orders for things like ABX, beta blocker, blood etc. The pre-op nurse might have just went along with the order to get a type and screen and type and cross because they were just following orders.
    Also, our blood tubes are pink and blood bands are blue with stickers on them and honestly, with all the pre-op labs being drawn, ECG, being performed, Cath lab tests, etc, a little pink tube can get lost in the mix of everything that is going on. Every hospital is different, so it's not like there can be a blanket statement of "beware of pink/red/blood tubes being drawn". There is enough stress of the surgery itself, added to by the stress of our belief not being honored while we are under anesthesia. I don't always fault the pt for not knowing, especially since they signed the refusal on the blood consent.
    I can see why the pre-op nurse would follow the order though. As stated before, even if the pt is a JW, they can change their mind and decide to accept.
    I love the fact that so many here are true advocates for their pt's, even if they don't agree with our stand on blood. I applaud and thank you all..
    If in fact you sign a refusal and are given blood, that opens the door for malpractice and/or battery.
    In the case of children, I agree with the statement about court orders...
  13. by   labsally
    This is an interesting thread. I am a phlebotomist going to nursing school. I work in a very small and somewhat sleepy hospital. I remember pretty clearly two years ago when I was called to draw and band for a type and cross a pregnant woman who needed an emergency c-section. I saw (and I don't remember now exactly where) that she had asked for no blood products. When I ran back to the lab with the blood I asked my manager about this. The lab manager told me that the surgeon is allowed to order a type and cross for the patient and to order the blood. If the order has been signed for no blood products, of course, they cannot be given. However, the surgeon is allowed to have them on hand in case there is a last minute life or death mind change.

    Fortunately, this woman went through surgery fine and both she and her babies were healthy.

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