I'm going to probably open a can of worms here, but I want your opinion

elthia · May 19, 2006

Everywhere I have worked has had on the admission packet the question(in one form or another) "are there any religious/moral/dietary restrictions that we need to be aware of in providing you care." If they say no, then in my opinion, it is not negligent for a nurse to administer a medication derived from pork.

brattyone · May 20, 2006

I'm in complete agreement with fotograf. It is our professional duty to disclose and correctly inform the patient. The patient's cultural, spiritual and personal beliefs should NEVER be ignored. It is our duty to incorporate these things into their care. America has a diverse population and to impose our own belief system on others is unethical. Would you give blood products to a Jehovah's Witness? Cultural ignorance is no excuse. All the information you need to know is readily available, ask the patient or the patient's family members. Takes a few minutes out of our already over taxed time, but it has been proven to avoid misunderstandings and increases patient satisfaction. Studies have recently been released : patient's that have been deemed difficult i.e. demanding, angry, rude etc. by staff members have been found that they are acting out because their belief system was ignored. It makes more sense to me to take the extra few minutes upon receiving a pt. to explore and incorporate their needs, initiate a careplan or make an addition to an existing one. Than to spend the extended time it takes in problematic resolutions. Of course there are always going to be difficult, demanding and outright annoying pts.. The ones that can,in one shift, make you start asking yourself why did I chose nursing? What the (BLANK!) was I THINKING?????!!!!

kaur2004 · May 21, 2006

you need to tell your patients about the medicine especially if you know about their religion and what is prohibited.......as a nurse we are the patients advocate and remember verbal consent, patients right, .....its the patients body and the patient if a muslim or a jew knows best if they should take it or not for a lot of people religion is a big part of their life. when i go to discharge a patient i always try to educate them about medication because if they know about the medication just briefly they know how important it is to take

JeanettePNP, MSN, RN, NP · May 22, 2006

you need to tell your patients about the medicine especially if you know about their religion and what is prohibited.......as a nurse we are the patients advocate and remember verbal consent, patients right, .....its the patients body and the patient if a muslim or a jew knows best if they should take it or not for a lot of people religion is a big part of their life. when i go to discharge a patient i always try to educate them about medication because if they know about the medication just briefly they know how important it is to take

See, this is the point. It's not so simple. You can't assume to know what's forbidden in another person's religion. The laws can get complicated and it's not so straightforward that if it has pork in it, it's forbidden. Depends on how sick the person is, how essential the med is, if alternatives are available, if it's eaten (tasted) or not, the amount of the non-kosher ingredient, if the non-kosher ingredient underwent chemical change.....

I'm speaking only from an orthodox Jewish perspective here, and I don't know what the rules are for Muslim/hindu/vegetarian/etc. Personally, I would prefer not to be told that the med has pork in it. Imagine the scene: I'm sick in the hospital, and the nurse comes to tell me that my med has pork. Do I want to take it. What do I do now? Put in a frantic call to my rabbi? So my rabbi tells me that it's OK, take the med because you need it. Or he goes into a consultation with the doctor, to find out what the med is for, and if there are any alternatives. Then I'm told the med is OK, but in the meantime I'm agitated. And even if I take the med, I'm thinking, oh great, I'm getting injected with pork. It's completely psychological, but the fact is that the well-meaning nurse basically dropped a little bombshell here and put a sick patient under mental strain which she did not need. What if the patient is stubborn and refuses to take the med even after the rabbi says it's ok? People can be irrational about religious matters (you can argue that all of religion is irrational but we'll save that for another time.) Jewish law is clear that in case of danger to life, you do what needs to be done, NO QUESTIONS ASKED. You don't run and ask the rabbi first to find out if you can break shabbat, or give the needed medication with the non=kosher ingredient. Also, you don't do anything to needlessly agitate a sick patient. This is not analogous to eating a non-kosher meal, because usually you can get kosher food and it's just as healthy and nutritious as the non-. (Eating a non-kosher meal would also be allowed if the situation were dire enough, say they were hospitalized in a place where absolutely no kosher food was available)

I've had too many experiences of people doing what they thought was a public service and alerting everyone to a kosher problem that no one thought about before, and the ensuing hysteria. Just as an example: One thing we're careful about is not to eat any insects. That means that we wash lettuce very carefully and check for bugs, among other things. So, a year or two ago, some wiseguy decided to check tapwater under a microscope and guess what! There were little bugs (copepods) floating in it! So it became a whole panic and some rabbis ruled that all water must be filtered before drinking. Other rabbis said don't worry about it, so depending on who your rabbi is, you either filter your water or you don't. But what if you go visit someone's house and they don't filter the water? What if you're hospitalized and the water isn't filtered? I leave it to your imagination, but basically whoever "discovered" the bugs in the water should have left it alone. That's how I feel about the pork in heparin. If I need the heparin, I'll take the heparin, but I'm not going to agonize over it, and knowing that there's pork in it does not benefit me in the least.

As I've said before on the thread, a nurse is NOT doing anything unethical by giving a needed medication to a patient, regardless of the ingredients, unless the patient explicitly asks about the formulation.

darius000 · May 22, 2006

I am working in ED Perth Western Australia. All our Heparin is of the porcine version. To be honest it had never really occured to me to mention this to Muslim/Jewish patients. One of my co-workers is Muslim from Singapore so I discussed this with her. Her opinion was that because this is a medical intervention, there should be no problem. In fact a cousin of hers required cardiac surgery (not sure exactly what for) but it involved pig products. The family discussed this with their religious leaders and they also came to the conclusion that because this was a medical intervention, there was no problems.

I guess it is a matter of informing the patient and family to the best of your knowledge. But I certainly don't enquire as to my patients religion and I definately do not know every ingrediant/process used in the production of pharmaceuticals.

Patrick

hafsa44 · May 23, 2006

Hi I'm a muslim and a nurse. When it comes to things that will save your life it really doesn't matter what the product is made of. In the religion of Al-Islam we know that life preservation is important. Most muslim would not make a big deal out of that.

Furoffire · May 24, 2006

great can of worms

i am a kosher vegetarian and the thought of insulin and heparin out of beef or pork freaks me out :nono: is there an alternative? i find most patients don't have a clue. kitten

fotografe · May 24, 2006

The point is here that it was DISCUSSED. THe patient was able to make an informed decision before the procedure. Some Muslims would only undergo a procedure/use a medication of porcine origin if there were no other alternatives. How would you feel if you were the patient, who had no idea they were reciving porcine valves, woke up, then was told there now beats the heart of a pig in your chest? I don't know that any convincing form anyone at that point would make them feel better. They would feel violated. Having the information beforehand and being allowed to make the CHOICE is the important element.

I am working in ED Perth Western Australia. All our Heparin is of the porcine version. To be honest it had never really occured to me to mention this to Muslim/Jewish patients. One of my co-workers is Muslim from Singapore so I discussed this with her. Her opinion was that because this is a medical intervention, there should be no problem. In fact a cousin of hers required cardiac surgery (not sure exactly what for) but it involved pig products. The family discussed this with their religious leaders and they also came to the conclusion that because this was a medical intervention, there was no problems.
I guess it is a matter of informing the patient and family to the best of your knowledge. But I certainly don't enquire as to my patients religion and I definately do not know every ingrediant/process used in the production of pharmaceuticals.
Patrick

caroladybelle, BSN, RN · May 24, 2006

I believe that Darius's case, there is a cultural difference.

We (in America) discuss things in religious (and racial, and gender terms) differently than many individuals of other countries.

In Europe, despite historical issues, rarely did anyone point out my Judaism, rarely did overwhelming Christianity show up in classrooms. Did nativity scenes show up....certainly but you did notice or choose to be offended unless, it was over the line or enforced on one. Most people carry their religion discreetly, and it is not that common to know the religion of your coworkers. Religion is not debated among individuals to the extent that it is here.

As such, if I required certain accomodations due to religion, I would have written in report, or a note on the front of the chart or on my door. I would not expect that someone would automatically have researched my chart and mystically know my "rules". Nor would I expect them to acknowledge such unless I voiced my restrictions.

I believe that you will find that most Australians (much like many Europeans)do not discuss "religious" differences and while they will consider requests, do not automatically feel the need to know the patient's religion, and they expect the patient to notify them if this will be an issue to be accomodated.

It tends to be the US that has the major religion debates, and thusly the increased "sensitivity" on these issues. We also have JCAHO that tends to overregulate on some issues like cultural sensitivity, yet neglects to address a greater issue of staffing issues.

As far as a Jew or a Muslim having a problem with a "pig" heart, I believe that it is pig valves, not hearts that are used. And these are clearly permitted in both religions as lifesaving measures, as noted by the posters of those religions.

Also in Judaism, as we cannot control what occurs to our bodies at a time of mental disability (coma, anesthesia, etal.), we are exempted from blame from an act in which we could not control, or the caregiver is providing in good faith the appropriate lifesaving care.

hairas · Feb 29, 2008

My Father was a muslim and very strong in his belief. It's why he had a muslim doctor, he made sure that he understood that he was not to get any pork products. You have to understand someone who doesn't eat pork for over 40 years and you give them a morsel of pork bacon will vomit for days. Can you imagine what this pork heparin can do running through the blood of a muslim or a jew. My Father is not here anymore to continue the anger he had when he found out the muslim doctor knew he was getting pork heparin when there was a beef heparin.

Vikingkitten · Apr 29, 2008

This is assuming that you know the origin of the med and assuming that you know this med might present a religious problem for the patient. But IMO this is a lot of assuming for a nurse to do. If a patient knows s/he might have a religious issue with a med or treatment it's their job to disclose that information and not rely on the nurse's knowlege of halacha or sharia.
As an Orthodox Jew I don't have a problem with an injectible drug. Drugs that are injested are a problem according to some rabbis (for example gelatin capsules) but then the issue depends on the availability of other brands, how critical the patient is, etc. But I wouldn't consider it the nurse's job to tell me "this pill might contain gelatin, do you have a problem with it?" Rather, it would be my job to let the nurse know that I have an issue with gelatin capsules. I wouldn't want a nurse to hold back from giving me a medication I needed based on her faulty knowledge of my religious practices.

OK, I get that we are, these days, more socially aware of our patients religious/cultural backrounds and the implications of them. Being an Army medic, we were always well-trained in the local religion/ culture ....etc. I have to ask; do you ask everyone if they are a vegetarian, as many of our meds and etc. are animal-based. Do you ask if they are native-american, as they have many taboos as other cultures do? What about the Buddhists? Maybe that darker-skinned patient is Hindu............... I think our first duty is to take care of our patient; the rest can come later or if we have the time and it isn't critical. I'll get off my soapbox. "And now, for something completely different"!:bowingpur:saint:

edmia, BSN, RN · Apr 30, 2008

Fotografe wrote: it's called INFORMED CONSENT -- which is required as the result of what the NAZIs did in WWII. This international law was borne of the Nuremburg trials.
administeriing even a placebo -- which is harmless in every way -- requires informed consent.
violating informed consent constitutes criminal negligence. it's a slam dunk! and a fast track to court.

I'm sorry, but this is ridiculous. It is up to the patient to inform the staff if they have a specific dietary concern. We are not expected to know the restrictions and intricacies of every religion out there. We are expected to make every effort to respect these things if we are informed of them.

As a Jewish person, it is up to me to figure out what I want to ingest. There are many different degrees of observance in many religions, so assuming that I won't eat pork because I'm Jewish is just that, assuming. You don't know what my rabbi and I have discussed about medication. You don't know what decisions I may have already made. You assume I'm an ignorant Jewish person that should be told there's pork in a medication? You give me no credit? C'mon.

Informed consent is not for medication administration. Patients agree to a General Treatment Consent for this purpose and it is their job as a consumer to ask questions. I will tell them, this xyz medication was prescribed by your MD for xyz condition. Do you have any questions about the medication? and that's it.

On admission I don't ask what foods you eat. If you're vegan, tell me if you really care. If you don't want blood products, tell me if you really care. Otherwise, I can't read your mind nor would I expect anyone to read my mind. If I'm a patient and something is important to me, like no mercury in a vaccine, I speak out, I ask for what I need, and I make every effort possible to fulfill my personal beliefs. But, it is up to me.