Caring for Jehovah's witnesses

Nurses Safety

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I am pursuing my BSN. As part of my current class I am researching the difficulties of caring for patients with the Jehovah's witness' beliefs. If anyone has an experience that he/she can share with me about your personal feelings in caring for a Jehovah's witness, I would greatly appreciate it. I am new to the discussion board and look forward to hearing from you.

Specializes in psych..
As a Jehovahs Witness and a RN I do not like having to be involved in administering blood but sometimes there is nobody else to do it. All of my colleagues know I am a Witness and are understanding if I ask them if they would start that transfusion etc. Thankfully I work in Renal and our Consultants are used to correcting anaemia without blood because of the impliations of compromising a patients chances of a kidney transplant if they build up antibodies.

When I am in the situation where I have to be involved in the transfusion I aware of the precident set in the bible in Daniel - I won't go into any further detail as I don't think it is appropriate in a public forum, but just to say that it involves three young men who had to serve food having blood in it although they wouldn't partake themselves.

Likewise in work as long as patients are fully aware of the risks etc - and I believe in the US you have to sign a consent form for a BT - then although it is not something I would want I understand that it is part of my role as a nurse.

Hope this helps

With so many areas in nursing where you probably would never have to give a blood transfusion, why would a JW pick ER or surgery? It does not compute. I dont know If I would be to comfortable doing a transfusion for someone else unless they were going to do part of my assignment in return. That would also mean, I would be at risk for making a med error, on the transfusion. I wouldnt be a happy camper if I lost my job, taking care of someone elses patient.

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A while back we had a married couple of Jehovah Witnesses. They wanted to have their first child the “old fashion way”, and they did work for it!

They decided to deliver in their home with a mid-wife present. There were complication and the mother started to bleed.

We received her in the ICU still bleeding. Over several hours of saline and volume expanders, she continued to deteriorate. Her husband was with her most of the time. It was like watching a textbook death as her HGB dropped below 4. First came the arrhythmias, and then the chest pain because of poor perfusion. Her pressure continued to drop and the SOB increased. The cyanosis crept through her body. She became decreasingly coherent.

With each new worsening her husband would go to the phone and call his leader in the church and then come back and tell her the same thing, It is in God’s hands, and they continued the refusal of blood products and intubation. (I firmly believe that since she was the one dying that she would have accepted the blood, but with her husband continuously there she would not.)

The situation continued downhill. We had not seen our MD for and hour or so, he came back in and requested a transfer to a local burn center.

The couple came back about six months later (without infant) to say “Thank You”.

What had happened was the burn center had a new hyperbaric chamber. They had used the pressure/oxygen to super-saturate the HGB with oxygen. Shad had stayed in that hospital 3 months.

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Specializes in psych..
A while back we had a married couple of Jehovah Witnesses. They wanted to have their first child the "old fashion way", and they did work for it!

They decided to deliver in their home with a mid-wife present. There were complication and the mother started to bleed.

We received her in the ICU still bleeding. Over several hours of saline and volume expanders, she continued to deteriorate. Her husband was with her most of the time. It was like watching a textbook death as her HGB dropped below 4. First came the arrhythmias, and then the chest pain because of poor perfusion. Her pressure continued to drop and the SOB increased. The cyanosis crept through her body. She became decreasingly coherent.

With each new worsening her husband would go to the phone and call his leader in the church and then come back and tell her the same thing, It is in God's hands, and they continued the refusal of blood products and intubation. (I firmly believe that since she was the one dying that she would have accepted the blood, but with her husband continuously there she would not.)

The situation continued downhill. We had not seen our MD for and hour or so, he came back in and requested a transfer to a local burn center.

The couple came back about six months later (without infant) to say "Thank You".

What had happened was the burn center had a new hyperbaric chamber. They had used the pressure/oxygen to super-saturate the HGB with oxygen. Shad had stayed in that hospital 3 months.

I guess we can come to our own conclusions. Should all hospitals have hyperbaric chambers? Perhaps. One thing I thought about before..was that necessity forces us to use whatever is at hand to save life. It would seem that life is more important than any dogma. I know, to survive..I would do like the survivors of the andes plane crash, and turn to cannibalism. I think anytime you put dogma before life..you are in danger of doing the absurd. I think, it wont be long, where science will create a suitable blood substitute, just like it was able to create synthetic rubber. I go further, It wont be long when science will create man or woman, ..Which will put all religions in position to reassess their beliefs.

Its hard to discuss such a topic without thinking about religion. As I understand, JW's long term goal is to establish a theocracy here on earth.

I can just see myself waking up in ER, wanting whole blood, and being told..sorry buddy...the JW state does not permit that. Most of the people that think like myself , would probably be in an overcrowded prison..reading Watchtower tracts. I can just see the JW guards, going cell to cell, knocking.

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.

I don't work in ER or surgery - I work in Renal medicine / dialysis. We work as a team so it is not a case of you do this for me and I'll do that for you. When a transfusion is started two nurses check it but only one needs to spike the bag and attach the blood. When a pt is receiving a BT it is still my responsibility to monitor obs and carry out other care for that pt, you make it sound like I have abandoned my responsibility to that pt? I do give BTs when I have to, but I don't really like it - but there are other things I don't like doing that are part of my job. I'm sure there are things about your job you don't particulary like - but accept? In reality we do not carry out that many BTs and it doesn't fill me with dread if it just so happens someone has to have a BT, it's no big deal, I don't panic and stress about it.

I hope this puts things into perspective for you.

Jane

With so many areas in nursing where you probably would never have to give a blood transfusion, why would a JW pick ER or surgery? It does not compute. I dont know If I would be to comfortable doing a transfusion for someone else unless they were going to do part of my assignment in return. That would also mean, I would be at risk for making a med error, on the transfusion. I wouldnt be a happy camper if I lost my job, taking care of someone elses patient.
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Specializes in psych..
I don't work in ER or surgery - I work in Renal medicine / dialysis. We work as a team so it is not a case of you do this for me and I'll do that for you. When a transfusion is started two nurses check it but only one needs to spike the bag and attach the blood. When a pt is receiving a BT it is still my responsibility to monitor obs and carry out other care for that pt, you make it sound like I have abandoned my responsibility to that pt? I do give BTs when I have to, but I don't really like it - but there are other things I don't like doing that are part of my job. I'm sure there are things about your job you don't particulary like - but accept? In reality we do not carry out that many BTs and it doesn't fill me with dread if it just so happens someone has to have a BT, it's no big deal, I don't panic and stress about it.

I hope this puts things into perspective for you.

Jane

Jane , I admire the stand JW's take on war. I was a Seventh day advenstist. We were concientious objectors. We did everything but shoot the gun. JW's would have nothing at all to do with war. I sense an inconsistency..you hand the whole blood, or bullet to someone else to do it for you.

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.

Hi,

I would just like to clarify that I am a JW as well as a RN and I cannot refuse to give a blood transfusion.

I would also like to say that I have seen a few people exsanguinate despite having massive blood transfusions. So is it really possible to say a person died because they didn't have a BT when even those that do still die?

As regards JW only hospitals - a better idea is something that you already have in the US - bloodless hospitals that treat anyone who would would rather not have a BT. I would recommend you have a look at some of the websites as it is really interesting and I'm sure most people if asked would say they would prefare not to have a BT if possible? The technology available these days is enabling all of us to have a safer alternative to blood transfusions.

Several hospitals local to me have accepted equipment donated by JWs that are being used for the benefit of all it's patients and reducing the need for transfusions. The surgeons have been receptive to new techniques and are more confident in treating more and more people without transfusions and now treating JWs is not something they fear.

This is probably gonna get some heated comments, but here goes. I have taken care of numerous JW, and it truly represents a challenge for health care workers. The Jehovahs, I have cared for tho, truly need PRBC's, not albumin, hespan, etc. Typically they have been GIB's, This last lady, nearly died H & H 5 and 17 BP's low, truly attempting to continue to perfuse her brain and her kidneys, of course she developed ATN and had to be treated for this as well. She ended up with a colectomy 2/2 her GIB, trached, you know the works. Her family steadfastly refused blood, and while I respect that right, It puts those of us who are not JW's and are nurses/doctors in a horrible position. You are constantly chasing your tail, and making little headway. I think she ended up in a acute-care vent facility. The other guy did die, He actually had a CV surgeon perform a MVR, and triple vessel cabg. He just bled out, during the code, the CCP drew the code blood femorally, and it was like water. No RBC's, just plasma. This is going to sound a bit prejudiced, but it is not meant that way at all. I really think that JW's should be treated by JW's, docs, nurses, etc. There should be a facility that treats only witnesses. That way it would be completely understood, and you all could still get the care you may need, the way you want it. If you can refuse to hang blood, based on your beliefs, shouldn't those of us who aren't JW's reserve the right to not be put into the position of caring for someone who wants care, and wants to be a full code, yet we can't do the one thing that could help save you? Ethically, it can really back us in a corner of wanting to do the right thing (medically), yet unable to because of religious beliefs.

Please if anyone has an answer or input please divulge. And for those that are JW's, truly no offense, this is just my dillemma, and my :twocents:

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.

I don't see the two as the same. When it comes to blood transfusions I use the precident from the Bible when it tells us about three of Gods servants who were the kings court officials. They would serve the kings delacacies but wouldn't eat them themselves because they contained blood. I would not have a BT myself but if I have to "serve the kings delacacies" to those who choose to, I would as part of my job. I wouldn't apply for a job in the blood transfusion service but I accept that on occasions I may have to look after a pt having a BT. I wouldn't smoke - or apply for a job at a cigarette factory - but if I worked in certain establisments I might have to serve somebody with cigarettes.

I don't gamble but may work in a hotel which had slot machines or a casino.

I can see you may not understand this explanation but at the end of the day I have a clear conscience about this - again I will say I would rather not have to but - that's life!

Jane

Jane , I admire the stand JW's take on war. I was a Seventh day advenstist. We were concientious objectors. We did everything but shoot the gun. JW's would have nothing at all to do with war. I sense an inconsistency..you hand the whole blood, or bullet to someone else to do it for you.
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Specializes in psych..
Hi,

I would just like to clarify that I am a JW as well as a RN and I cannot refuse to give a blood transfusion.

I would also like to say that I have seen a few people exsanguinate despite having massive blood transfusions. So is it really possible to say a person died because they didn't have a BT when even those that do still die?

As regards JW only hospitals - a better idea is something that you already have in the US - bloodless hospitals that treat anyone who would would rather not have a BT. I would recommend you have a look at some of the websites as it is really interesting and I'm sure most people if asked would say they would prefare not to have a BT if possible? The technology available these days is enabling all of us to have a safer alternative to blood transfusions.

Several hospitals local to me have accepted equipment donated by JWs that are being used for the benefit of all it's patients and reducing the need for transfusions. The surgeons have been receptive to new techniques and are more confident in treating more and more people without transfusions and now treating JWs is not something they fear.

you raise a good point, I believe statistics show most people die from med errors than any other single cause. with or without blood.. someone might argue do 2 med errors make a right..

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Specializes in critical care.

as I stated before I respect the rights to not receive Transfusions, yet I personally do not like taking care of JW's because of the limitations in care. It is all well and good to have facilities that are going to more alternatives vs giving blood, but those places are few and far between. Definately not at my facility. If those places are available well...JW's need to go there, not back me in a corner during care.

PS that tidbit about hyperbaric chamber was very interesting.

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Specializes in psych..
I don't see the two as the same. When it comes to blood transfusions I use the precident from the Bible when it tells us about three of Gods servants who were the kings court officials. They would serve the kings delacacies but wouldn't eat them themselves because they contained blood. I would not have a BT myself but if I have to "serve the kings delacacies" to those who choose to, I would as part of my job. I wouldn't apply for a job in the blood transfusion service but I accept that on occasions I may have to look after a pt having a BT. I wouldn't smoke - or apply for a job at a cigarette factory - but if I worked in certain establisments I might have to serve somebody with cigarettes.

I don't gamble but may work in a hotel which had slot machines or a casino.

I can see you may not understand this explanation but at the end of the day I have a clear conscience about this - again I will say I would rather not have to but - that's life!

Jane

"Gods servants who were the kings court officials. They would serve the kings delacacies but wouldn't eat them themselves because they contained blood"....My king James says Daniel would not eat "MEAT", he prefered a "pulse" diet..i take that as vegetarian...but I guess we dont want to get into theology here.But King James does not mention BLOOD..it mentions MEAT.. you come to your own conclusions.

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My worse experience with a JW patient was a mother of 5 children, all under the age of 7, who came in bleeding from an ectopic pregnancy and had to have surgery. Her hematocrit dropped to 6 and she refused any blood products. She was with us for over 3 weeks, lying in bed, getting total care since she was too weak to do anything on her own. When her crit got to over 12, we send her home with her family and I hope she did well. The staff, although having trouble understanding why she would risk leaving her children, were very supportive of her choice and faith and worked hard to help her survive. I can't fault someone who has that much faith and conviction.

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Specializes in CNA, EMT.
"Gods servants who were the kings court officials. They would serve the kings delacacies but wouldn't eat them themselves because they contained blood"....My king James says Daniel would not eat "MEAT", he prefered a "pulse" diet..i take that as vegetarian...but I guess we dont want to get into theology here.But King James does not mention BLOOD..it mentions MEAT.. you come to your own conclusions.

By "blood" they definitely mean meat/ pusle diet, which is Jewish practice. I don't think that was important in this exerpt, though, but the lesson behind the story: Do your job the way you were taught. Allow them their choice, but don't jeopardize your own faith. It's about religious tolerance, I think?

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