Doctor Asked For A "Kind" Nurse

[LasVegasRN]

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 your belief, please respect the beliefs of others.

That said, I admit to not understanding how parents can stand by and watch their child bleed to death.

Teenager, throwing up blood for 2 days, H & H 6.1 and 17.0. Platelets 14. WBC 1.0. Pancytopenia. A religion that does not allow blood products or transfusions. Essentially we will be watching this patient die. As the majority of us know, some fresh frozen plasma, units of packed cells, the ability to SAFELY do an EGD and the patient would be discharged home in about 2 days.

Instead, in 4 hours when the next CBC was done, the Hgb was down to 5.8.

I overheard the attending doc asking the charge nurse to assign a "kind" nurse as this was a "difficult" case. I felt that was unnecessary, because as hard as it is for all of us to watch this, we still treat the patient and family with compassion.

My main point: I'm hoping someone could explain to me, how in the world can you stand by and allow your child to die?

Harsh question, and I'm sure an age-old question, but I do not and can not understand it.

[disher]

Thank you for starting this thread LasVegas. Fab4 & Marysusan your posts speak volumes of your compassion and wisdom in this matter. I have saved your links and feel better informed for having read this thread.

[roxannekkb]

When I worked in the NICU, the doctors automatically got a court order to administer blood. If the parents wanted to fight it, it was up to them to try to reverse it. None ever did, to my knowledge. And in my own personal experience, the majority of JW parents that I dealt with in this situation seemed a little relieved that the decision was taken out of their hands. They didn't want their baby to get transfused, but a preemie is going to die without it. So it was a choice that they had no say in. There was only one case that I recall where the parents abandoned the baby, saying that she had been tainted from the blood. The baby was put up for adoption, and adopted.

When it comes to adults, I firmly believe everyone has the right to decide on their care, and decline care even if it puts their life at stake. With children it is a very sticky issue. Many questions arise--how old is the child? Does the child believe in their parents religion? Does the child want the treatment--especially in the case of a teenager? Do parents have the right to decide whether or not a 16 year old should have treatment withheld? Where do parental rights end?

It goes way beyond a blood transfusion, as there have been cases where Christian Scientists refused antibiotics for children with meningitis, parents have refused cancer therapies (and a few cases where teens have run away to avoid chemotherapy and get alternative treatments), and so on. I don't know what the answer is, especially when dealing with an infant.

But it will be a rich source of debate for years to come!

[fab4fan]

PLEASE, please let me say that the parents who abandoned their child because it was "tainted"...that does NOT represent how JW feel at all. That may have been their individual decision, but an action like that could actually result in being disfellowshipped. NEVER, would you abandon your child because it had been transfused.

[roxannekkb]

I was just recounting an experience, that's all. I imagine other issues may have been going on, but that was the what they told us. All other JW families that I dealt with in this situation were fine, and did not abandon the babies we transfused. And as I said, many seemed relieved that the decision was no longer theirs to make, and to my knowledge, none ever tried to overturn a court order.

[susanmary]

OK nurses, imagine for one moment that you admit a direct admission tomorrow -- she is a pre-op patient. She identifies herself as a JW, and states that she refuses blood/products. The MD orders usual pre-op lab work, including a type & screen. What would you do? What questions would you ask? Who would you contact? What policies/protocals does your facility have?

Sue

[LasVegasRN]

Interesting question, Sue.

Talked to the DON at my facility today about this case. She said our JW liason did an inservice about 2 years ago to the medical staff and it was poorly received. The physicians were not receptive to learning about bloodless treatments at ALL. The only protocol I know of is that when we have a case where ethics are involved (which not everyone knows to contact the ethics committee in cases such as this one) the ethics committee contacts the JW liason. The JW liason is under the same confidentiality and HIPPA rules for privacy as all hospital employees.

In this case, the JW liason has been EXTREMELY helpful in locating a hematologist and hospital nearby that specialize in bloodless treatments for this patient and getting local support from JW members for this family.

Upon further discussion in the DON's office, a lot of the house supervisors didn't even know we had a JW liason as a resource!

Currently when a patient states they are JW, they have to sign a medical release of liability. Some physicians have them complete a partial DNR which just states no blood/blood products.

Court orders are automatically obtained for neonates/preemies.

It's just amazing what I have learned over this week. At our next staff meeting, I'm going to present the case so the other case managers know.

[hollybear]

susanmary I personally would have no problem drawing a type and screen or type and cross on a patient that originally refused blood products. you never know if they will change there minds. but i would have a real problem if asked to give blood product to patient who had not given consent!

to answer an earlier question, yes plasma is a blood product, and as far as autologous transfussions or cell saver transfussions it depends on the particular sect of JW concerned. having several JW in my close family. i can tell you from experience it varies. but the sect my relatives belong to autologous or cell saver transfussions are not allowed niether is plasma, albumin or any other blood derived product.

each person has a right to believe what they believe:)

I find it troubling that the doc had to ask for a "kind " nurse. shouldn't we all be kind and compassionate?

[Nurse Ratched, RN]

I feel like we should all be getting CEU's for this thread :).

Great information. Thanks to all who shared. And kudos to Vegas for being such a great patient advocate. Aren't we lucky to have this resource?

[Furball]

I also have to thank LV for getting me away from those gut wrenching war threads for a bit. Thanks!!

[susanmary]

I have questioned physician's orders regarding drawing a type & screen -- in every instance, the doc was simply ordering standard pre-op orders. I have never drawn a type & screen on a JW who stated they did not want blood/products. Labs -- yes, using pedi tubes. HCT/Hgb -- yes, again using pedi tubes -- and often not every day. Judicious bloodwork and support for my patients are my goals -- whether they are JW or not -- receive take blood products or not.

On another note, I have NEVER had a JW try to "convert" me in a hospital setting. Not once. I wear a small cross, and have been asked about it -- I simply state that I am a practicing Catholic. That's it.

Again, this is such a great thread & I'm appreciative of all the posts -- it's important to get accurate information out there. This is a challening topic -- the more we educate ourselves, the better. Fab4fan -- thanks for the insightful information. This post, to me, is the board at it's best. Thanks LasVegasRN for initiating it -- I love educational/insightful posts. We all have much to offer this board.

[zambezi, BSN, RN]

thanks fab and hollybear (and anyone else...) who answered my question regarding autologous transfusions and albumin...so true that when in comes to this is can be a very individual choice...it dosent come up too often but when it does, i know that i will be glad to be aware of the correct information... often, when i first see the patient they are still intubated, it would be a shame to go against someones wishes because i didn't have correct info...thanks again...

[LasVegasRN]

Update today: Hgb 2.9, Hct 8.1. Platelets 8.