Nurses Advocating for Patients

People of different age, gender, and race may have similar values, beliefs, and faith as their family and caregiver. What would you do if a patient’s values and faith are different from one’s family and/or caregiver?

Six years ago, I found myself in an unfortunate situation that resulted in an ethical dilemma. A 48-year-old single female and mother of three (children ages ten, eleven, and thirteen) who had an emergency coronary bypass surgery without needing a blood transfusion. Initially, she was extubated in twelve hours with no obvious signs of any complications. All invasive lines, epicardial pacing wires, and mediastinal chest tubes were removed. A complete medical history was obtained, which consists of: Hypothyroidism, Hyperlipidemia, and Type II Diabetes, one pack a day smoker, occasion alcohol consumption with meals, and two living siblings.

The patient asked her nurse how long and what operation procedure was done. The nurse explained the surgery in details to the patient and said you are fortunate that you did not need any blood products during or after surgery. At that time, the patient informed the nurse that she does not receive blood transfusions because she is a Jehovah's Witness. Her medical record was updated to "no blood products; patient’s Jehovah Witness." Post op day two, the patient developed respiratory failure related to hypoxia and was reintubated. Post op day six, the patient’s condition further deteriorated by developing a clotting disorder that caused the patient to bleed profusely that would require multiple blood products transfusion in an effort to save her life. The patient’s family was notified of her condition, the need for blood transfusion, and her religious faith (Jehovah's Witness). The nurse explained the seriousness of her condition and she could probable die without receiving a blood transfusion. In talking with the family, it was discovered that the patient’s two siblings were not of the same faith and they agreed to the blood transfusions. The primary nurse obtained written consent from the family for blood transfusion.

In this situation, what should the nurse do to avoid this ethical dilemma? The nurse understood the complexity of the patient’s condition, which had been complicated by a clotting disorder. In addition, she realizes that she is the patient’s advocate regardless of patient’s ability or inability to make her wishes made known. What should the medical staff do? Should they disregard that the patient is a Jehovah's Witness and give her multiple blood transfusions to save her life because they received permission from the patient’s family or should the patient’s religious belief be respected and honored? Doctors and nurses face ethical decision every day where their values, beliefs, and faith may be the same or different from their patients. The nurse should continue to be the patient’s advocate even if it does not align with what could be a desirable outcome for the patient. Nurses have an obligation to be the voices for their patients even if they do not agree with a person's religious preference. In addition, the ethical principles of autonomy, beneficence to do good, and nonmaleficence to cause no impairment or damage should be integrated into nurses' daily practices. Unfortunately, the patient cardiac arrested due to inadequate circulating blood volume leading to effortless resuscitation, three children without a mother, and moral distress for doctors and nurses.