Jehovah's Witness and Blood Refusal in OR

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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. I was told to have 2 units of PRBCs on hand in the fridge by the surgeon. I pointed out to my co-circulator that the patient was a Jehovah's Witness and had a signed blood refusal and showed it to him. I asked him if we should show it to the surgeon as a reminder. He said not to show it and told me to have them brought up anyway because when the patient is on the table it falls to the surgeon to make the call between saving a life and letting the patient bleed out. I thought that this was wrong but did what I was told and had the blood sent up. Thankfully we didn't need it, but I want to know for next time how to handle the situation.

Specializes in Education.
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.

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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...

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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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I'm sorry but as a former JW I know first hand they will not receive that care. JWs are SHUNNED by their friends and family once they are disfellowhsipped. I don't think that hits home with people because it is so strange but many are kicked out of their homes, left for homeless, family won't talk to them. It is a rare exception for them to be cared for and all I am saying is as nurses we need to protect our patients and care for them as we see fit. Yes patient autonomy is important but have you been in a double bind before? Their options are to accept blood and be kicked out of their community or to possibly die. That is manipulative and not a decision. I think nurses are ignorant of cults but people in them don't always seem irrational. Some are educated but that organization holds them emotionally hostage by threatening to take their community away. That's why I feel so strongly that if a JW patient wants blood we should work hard to keep it confidential, not allow visitors from the church, keep their elders out of it.

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Specializes in Education.

1. Everything Jehovah's Witnesses believe is based on the bible. And yes, the Bible says, "abstain from blood" Acts 15:20, so they do not take blood transfusions. Members are not automatically disfellowshipped, disfellowshipping is done when members unrepentantly make a practice of breaking the Bible's commands.

2. Definition of Cult-a small group of people having religious beliefs or practices regarded by others as sinister. Disfellowshipping is based on Bible principles 1 Cor 5:13, and there are over 8 million Jehovah's Witnesses.

3. Members are not left homeless. My father-in-law was disfellowshipped and needed care and my sister-in-law took him in. When someone is disfellowshipped members of the congregation do not SOCIALIZE with them, this is in accord with the Bible's teachings, this doesn't mean they don't take care of family members who can not take care of themselves.

4. If a patient decides to receive blood, that is their decision, and as a nurse, we need to be the patient's advocate.

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Specializes in OR.

We can argue points 1, 2 and 3 all day because they can be held up as matters of opinion, interpretation and personal experience. Number 4 is the big one. If a patient/family signs a DNR or a WOC (or says "do everything" even though we know darn well it's futile") we do it because it is honoring their wishes and it is the patients right. i think this falls under the same thing. (I know DNRs are suspended in surgery so let's not chase that bunny trail)

When a Jehovah's Witness asks for my opinion on the blood issue I will give it to them. That has not happened yet and i don't expect it to. I will however respect their right to an opinion and the choice. i advocate for my patient not for my own personal beliefs.

holds them emotionally hostage by threatening to take their community away. That's why I feel so strongly that if a JW patient wants blood we should work hard to keep it confidential, not allow visitors from the church, keep their elders out of it.

This may be true but by doing something like this you are doing exactly what you are accusing the church of doing. IE: controlling......just saying...

If this is what the patient asks then fine but there should be no prodding from me, such as "we can do this but they don't have to know."

Above all....and i've said it before, our job is to advocate for the patient, not agree with their choices. If you are my patient and you don't want blood, you don't get blood. i will not sneak around behind anyone's back. If you choose to accept it and you want it kept from family for whatever reason, i will respect that too. But overall, you are my patient and so long as you understand the impact of your choices (and it does not involve copious amount of narcotics...haha) i will do everything in my power to honor them. Period.

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Specializes in Pedi.
That's why I feel so strongly that if a JW patient wants blood we should work hard to keep it confidential, not allow visitors from the church, keep their elders out of it.

A blood transfusion takes a matter of hours. If the patient is alert enough to consent to a transfusion, it seems to me like it would be easy enough to schedule this transfusion after visiting hours have ended. There is no reason any medical professional would need to involve church members or elders in blood transfusions of any patient, JW or not. If I, an atheist, needed a blood transfusion and was alert and stable enough to consent to it, I wouldn't expect that information to be shared with anyone in my personal life, even though no one would care.

I did once have a pediatric oncology patient whose parents were JW and they consented to blood products for him but did not want Grandma to know that they had consented. That kid would have gotten transfusions either way because, as I pointed out earlier, if the parents refuse to consent, the hospital simply gets a court order to administer blood products over their objections. I don't know if the Grandma thought there was a court order or if staff just administered the transfusions when she wasn't around.

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A blood transfusion takes a matter of hours. If the patient is alert enough to consent to a transfusion, it seems to me like it would be easy enough to schedule this transfusion after visiting hours have ended. There is no reason any medical professional would need to involve church members or elders in blood transfusions of any patient, JW or not. If I, an atheist, needed a blood transfusion and was alert and stable enough to consent to it, I wouldn't expect that information to be shared with anyone in my personal life, even though no one would care.

I did once have a pediatric oncology patient whose parents were JW and they consented to blood products for him but did not want Grandma to know that they had consented. That kid would have gotten transfusions either way because, as I pointed out earlier, if the parents refuse to consent, the hospital simply gets a court order to administer blood products over their objections. I don't know if the Grandma thought there was a court order or if staff just administered the transfusions when she wasn't around.

I'm not sure if you're a nurse in the OR, but in my experience when we transfuse in the OR, it is done over a matter of minutes, or in the event of a massive transfusion using s Belmont faster.... the consents are done preoperatively, sometimes the day of surgery when family may be at the bedside. We should always ask if it's ok to talk with them in the room, but in a teaching hospital where residents are sometimes the ones obtaining consent, this may not be something they think about even though it should be.

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Specializes in OR, Nursing Professional Development.
A blood transfusion takes a matter of hours.

I've never seen a blood transfusion in the OR last more than 10 minutes. Additionally, as mentioned previously, if there is any expectation of a need for blood during surgery, all consents and type and cross or screen are done prior to the actual surgery.

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Specializes in Pedi.
I'm not sure if you're a nurse in the OR, but in my experience when we transfuse in the OR, it is done over a matter of minutes, or in the event of a massive transfusion using s Belmont faster.... the consents are done preoperatively, sometimes the day of surgery when family may be at the bedside. We should always ask if it's ok to talk with them in the room, but in a teaching hospital where residents are sometimes the ones obtaining consent, this may not be something they think about even though it should be.

I don't work in the OR nor have I ever. And I definitely understand about Residents. I once had a Resident have a mother sign a surgical consent form for an 18 year old (who was alert, oriented, cognitively intact and her own legal guardian) and then didn't understand when I told him it wasn't valid.

In the pediatric hospital I currently liaise at, the surgeons will not operate on the child of a Jehovah's Witness parent who refuses to consent to blood products until/unless they have a court order. I had a patient last year whose cardiac surgery was delayed for that reason.

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