Things you've learned about patient's religions and care?

donsterRN, ASN, BSN · Apr 19, 2011

Only once. A Muslim woman requested a female nurse. No biggie.

LPNweezy · Apr 19, 2011

Once, a muslim patient i had wanted to be turned east so they could pray 5 times a day.

psu_213, BSN, RN · Apr 19, 2011

Had a pt who was a Jehovah's Witness. Most of us know that those of that faith cannot receive blood products (at least that is the similified view of it...). Anyway, had a pt whose H/H was low. Could not give her blood. With future blood draws the MD ordered that only 'pedi' tubes be used.

msjellybean · Apr 19, 2011

Had a patient on our floor a while back who was Jehovah's Witness & was diagnosed with AML. For some reason, she went ahead with induction chemotherapy. No supportive therapy via PRBCs & platelets and she ended up bleeding out.

NurseStephRN · Apr 19, 2011

Had a pt who was a Jehovah's Witness. Most of us know that those of that faith cannot receive blood products (at least that is the similified view of it...). Anyway, had a pt whose H/H was low. Could not give her blood. With future blood draws the MD ordered that only 'pedi' tubes be used.

We've also done that on my unit. Pre-op we have started them on Aranesp and PO Iron supplements.

caroladybelle, BSN, RN · Apr 19, 2011

Had a patient on our floor a while back who was Jehovah's Witness & was diagnosed with AML. For some reason, she went ahead with induction chemotherapy. No supportive therapy via PRBCs & platelets and she ended up bleeding out.

I can't even imagine that there is a successful induction without being able to transfuse, except maybe M3 (APL). Since epogen and iron would not really be any help, I would think it an extremely risky chance to take.

caroladybelle, BSN, RN · Apr 19, 2011

In our area, we have large numbers of Orthodox Jews. And despite the fact, that the cancer center was part of a donation by Jewish patrons, there are no Sabbath elevators. Trying to remember that the visitors cannot touch buttons on Friday to Saturday night, and they are often reluctant to ask assistance. We have staffers that initially do not realize that the kosher meals need to be heated inside the sealed package - microwaves are not kosher.

As I am Jewish but not Orthodox, I can help explain rules, but usually cannot physically work with them on the Sabbath/ Holy days. Because while I may not feel that it is wrong to help them on the Sabbath and consider it a Mitzvah, they cannot knowingly ask another, even one not as observant as they are, to assist them. And as some are my neighbors, they often know.

Recognizing that many of their Holy days are clustered. Negotiating procedure around the Yom Kippur, Rosh Hashanah, and Sukkat in fall can be complicated.

(some rules may make little sense to outsiders. Once during Yom Kippur, a Rabbi was in my care and desperately ill - needing a CT. As an acutely ill pt, many Sabbath prohibitions are null, permitting the extraordinary care in those circumstances. However, as most acutely ill Orthodox, he was accompanied by a young family member to help translate/ keep watch over his care. The pt needed to go to CT on ground floor and we were on tenth. I explained about the Sabbath elevator in that facility, but he said he was not permitted even to use it on the Yom Kippur evening and instead took the stairs up and down. I would consider that more obvious "work" than the use of elevator, but thus is that sect's rules.)

noahsmama · Apr 19, 2011

I had a pt whose parents were Jehovah's witnesses. Brought him into the ED for bloody diarrhea and lethargy. Turned out to have a hemolytic infection and Hgb of 2.x. Parents were almost talked into transfusion despite their religion but balked at the last minute. CPS was called and court order obtained to transfuse him anyway. Parents were cooperative with the court order -- they actually seemed somewhat relieved to have the decision taken out of their hands.

The transfusion raised his Hgb to 7.x. It gradually fell over the course of the next week or so despite daily epogen and ferrous sulfate, but finally turned around after bottoming out at 5.0. Doctors were prepared to transfuse again if his Hgb had fallen below 5.0.

For a child whose family was not Jehovah's Witnesses they would have done another transfusion long before the Hgb got that low, but this number was considered to be the threshold below which the value would be considered life-threatening. I heard some of the docs debating the use of this cutoff value, since of course the real health effects of low Hgb fall on a continuum, but thankfully the pt's Hgb and his general health took a big turn for the better before this became an issue.

linearthinker, DNP, RN · Apr 19, 2011

I did not know that microwaves were not kosher. Fascinating.

Had a JW die once b/c refusing an transfusion. I don't have any feelings about it, people die for a lot of reasons that make no sense to me.

iNurseUK, RN · Apr 19, 2011

Not strictly religious but years ago we had a child with 60% burns on the Unit. Some of the burns were inhalation injuries from smoke and so on. The child could not eat in the normal manner.

Parents were strict vegans. We tried to set up NG feeds but the parents refused to allow this as some of the constituents were animal-derived. In desperation we next suggested TPN. No go. Some proteins were animal-based.

My hospital took the case to court and won. It is one thing making these decisions for yourself as a competent adult, quite another to endanger your child's life because of some deeply entrenched belief.

carolmaccas66, BSN, RN · Apr 20, 2011

Yes. My family members are Jehovah's Witnesses (JWs). They would literally die rather than have blood transfused.

If you're asking re dilmemmas, with the JWs here in Oz at least, an urgent court order can be obtained to transfuse blood into either a very confused/psychotic patient or with children. JWs here are not allowed to dictate their children's care here when it comes to life saving procedures. The doctors can and will override parents wishes - I've seen it happen.

With muslim patients, saw one get very upset when given ham - they're Halal so don't eat it. He didn't eat it, his wife just spotted that it was ham. We had to fill out incident reports, ring down to the kitchen, report to the NM in charge that night - what a carry on. We didn't really have time for it TBH. I don't know why they are Halal - and I don't want to get into any religious arguments etc - but it we wasted so much time with this man and his wife over this, when we had other, sicker people to care for. It was all blown out of proportion and was ridiculous.

I've known a staff member (years ago) who didn't call a dying patients priest or confessor (can't remember their title/religion now) and got sacked because the dying patient never saw their priest before they died. Mind you, the staff member was probably very busy - funny how no-one takes that into account.