Pts abusing "cultural/religious" practices to manipulate RNs

nurse_clown · Dec 4, 2006

i would ask this patient how she plans to care for her child upon discharge. if she cannot provide an adequate answer such as 1. having a plan in place for the care of the child on the sabbath. 2. adequate supports for the family on the sabbath. i would refer her to "social work" and the mandated child welfare agency to assist her with her delema. because regardless of what the "religious" implications are, i doubt seriously that god would would condone a mother "grossly and purposely neglecting" her child. there are no excuses for not feeding, clothing and protecting your child.

you could say she's abusing "cultural/religious" practices but more seriously, she is abusing her child. i wouldn't let that child go home with her until she provides definate proof that she's willing and able to care for this life. i'm pretty offended that she would use the cultural religious excuse - as a mother who belongs to a "culture". that's just plain stupidity on her part. and i can express my opinions as a child welfare authority for three years.

BSNtobe2009 · Dec 4, 2006

i would ask this patient how she plans to care for her child upon discharge. if she cannot provide an adequate answer such as 1. having a plan in place for the care of the child on the sabbath. 2. adequate supports for the family on the sabbath. i would refer her to "social work" and the mandated child welfare agency to assist her with her delema. because regardless of what the "religious" implications are, i doubt seriously that god would would condone a mother "grossly and purposely neglecting" her child. there are no excuses for not feeding, clothing and protecting your child.
you could say she's abusing "cultural/religious" practices but more seriously, she is abusing her child. i wouldn't let that child go home with her until she provides definate proof that she's willing and able to care for this life. i'm pretty offended that she would use the cultural religious excuse - as a mother who belongs to a "culture". that's just plain stupidity on her part. and i can express my opinions as a child welfare authority for three years.

i completely agree, if she thinks taking care of her baby is work and refuses to care of the baby on the weekends, then she definitely needs to be reported to dss.

i know a tons of jewish people and i am very familiar with their religion, and that is the nuttiest thing i have ever heard of. the us supreme court has ruled many, many times over that the right to religious freedom is not absolute and you cannot harm a child while practicing your religion.

HvnSntRN · Dec 4, 2006

i doubt seriously that god would would condone a mother "grossly and purposely neglecting" her child. there are no excuses for not feeding, clothing and protecting your child.
you could say she's abusing "cultural/religious" practices but more seriously, she is abusing her child. i wouldn't let that child go home with her until she provides definate proof that she's willing and able to care for this life.

that's what i find totally ridiculous about the situation: they do plan to feed their baby on the sabbath when they are at home, because it's not against the rules of the sabbath to eat, or to do what is necessary to sustain life. the "sabbath" thing was just a convenient way to suck our staff into keeping the baby in the nursery overnight and do all the feedings so she could sleep. we still provide respite visits to the nursery like this for patients, without them needing some kind of religious trump card to throw down. to lie about it on top of that is even more stupid.

i'm pretty offended that she would use the cultural religious excuse - as a mother who belongs to a "culture". that's just plain stupidity on her part.

or a cop-out. i don't know. to me, it seems very manipulative and exploitive and offensive, when you know that nurses in general are very sensitive to cultural issues and try to go the extra mile in accommodating people who are of different cultures and faiths. to abuse that quality doesn't help establish trust between nurses and patients.

nurse_clown · Dec 4, 2006

i noticed that you are from ontario, canada. have you checked out the new legistlature on the child welfare act? i heard there's a number of "interesting" changes to the act. also, toronto has a "mandated" jewish child welfare agency that you can ask them questions and if the family lives in toronto, a referral would be of benefit to the child.

i'll be attending an "information session" this friday regarding the changes. i'm from niagara and represent the aboriginal community at this forum. anyway, good luck to you and i think it's very good that you were concerned.

HvnSntRN · Dec 4, 2006

I'm in Eastern Ontario, not in Toronto, so the Jewish Child Welfare agency would be outside our jurisdiction.

I'd be very interested in hearing about anything you learn at your information session on Friday as it pertains to the situation I described!

I'll check out the new legislation and pass the information on to my colleagues. Thanks for the info.

TrudyRN · Dec 4, 2006

It sounds like she is depressed and overwhelmed right now. She should receive a psych eval, maybe needs medication and/or counseling, probably could really use some help in the home, and I think she might also need to reevaluate her commitment to her religion.

Orthodox women are expected to be very fruitful and multiply. Families of 10 and more children are not uncommon. This is not good for every woman. Many probably resent it and feel tremendously burdened, although they likely love their children very much. Guilt, exhaustion, money trouble, work, work, work, one pregnancy after the next - it can be very painful.

Judaism does not teach at all that feeding a baby is work. It is not prohibited on the Sabbath. This woman is just in need of help.

Do not be angry with her, though. Try to understand and get her the help she needs. You'll be helping her, her children, her husband.

TrudyRN · Dec 4, 2006

I completely agree, if she thinks taking care of her baby is work and refuses to care of the baby on the weekends, then she definitely needs to be reported to DSS.
Before involving DSS, why not just talk with the patient openly. She can say it is disturbing and confusing and that she is concerned. I wish people didint' get angry or offended so easily. This woman's doctor should be involved, too, and her husband, perhaps her mother or a sister if the pt likes. She needs care and rest, she is exhausted. Reporting can be done later if warranted after these other avenues are spent.
Maybe a public health nurse can visit her and/or her doc can order home health visits for a while to eval the home and situation.

sunnyjohn · Dec 4, 2006

It sounds like she is depressed and overwhelmed right now. She should receive a psych eval, maybe needs medication and/or counseling, probably could really use some help in the home,......
Orthodox women are expected to be very fruitful and multiply. Families of 10 and more children are not uncommon. This is not good for every woman. Many probably resent it and feel tremendously burdened, although they likely love their children very much. Guilt, exhaustion, money trouble, work, work, work, one pregnancy after the next - it can be very painful.
........

I was thinking the same thing. The first thing that popped in my head was, "this sounds like a brewing case of post partum depression"

SmilingBluEyes · Dec 4, 2006

I think evaluation by social services/child welfare personnel is in order.

caroladybelle, BSN, RN · Dec 5, 2006

This has been bugging me for a while.
A few weeks ago, we had a postpartum patient who is Jewish (Orthodox), which means that they won't do "work" on their Sabbath (sundown on Friday until sundown on Saturday). No problem. The nurse looking after her planned with her to check in every hour to see if she needed something.
I later found out that the patient sent the baby to the nursery to be bottle fed by the staff overnight, even though she was breastfeeding.
I also found out that not only did she do this on Friday-Saturday, but also Saturday-Sunday, and Sunday-Monday. She had a different RN working with her each shift and pulled the "no work on the Sabbath" routine, expecting that the nurse wouldn't be familiar with the differences between the Christian and Jewish observances of the Sabbath.

First, even Orthodox Jewish eat on the Sabbath and feed their children. While some might employ gentiles in some capacity, they prep everything ahead of time, so that they are not actively preparing the food on the Sabbath. Therefore, there should be no prohibition against breastfeeding then. Why she sent the baby back for bottle feeding (which requires someone prep something) - I have no clue.

However, as far as Sabbath restrictions, remember that Orthodox groups often also mark religious holidays much more strictly than other Jews. I recently made the mistake, of thinking Sabbath restrictions were over for my Orthodox patient, forgetting that we were now on Sukkot...and that Orthodox mark Sukkot as a longer period than those of us more nominally Jewish. I was caring for my patient over several days, in which the restrictions against using call buttons, turning on and off lights, and writing/signing anything were active. So even if Sabbath were over, other Holy Days might have been the issue, and Conservative/Reform Jews may not mark them as strictly as Orthodox.

That still does not explain why she did not breastfeed the baby.

subee, MSN, CRNA · Dec 5, 2006

i would ask this patient how she plans to care for her child upon discharge. if she cannot provide an adequate answer such as 1. having a plan in place for the care of the child on the sabbath. 2. adequate supports for the family on the sabbath. i would refer her to "social work" and the mandated child welfare agency to assist her with her delema. because regardless of what the "religious" implications are, i doubt seriously that god would would condone a mother "grossly and purposely neglecting" her child. there are no excuses for not feeding, clothing and protecting your child.

you could say she's abusing "cultural/religious" practices but more seriously, she is abusing her child. i wouldn't let that child go home with her until she provides definate proof that she's willing and able to care for this life. i'm pretty offended that she would use the cultural religious excuse - as a mother who belongs to a "culture". that's just plain stupidity on her part. and i can express my opinions as a child welfare authority for three years.

she's not simply a schnorrer - she's neglecting her little baby. its nothing to do with religion - she's just creative in expressing her lack of maternalism. hope someone's following up at home.