Professor Tubog and class,
Both religion and spirituality can be powerful coping mechanisms when a person faces acute medical situations, chronic disease management, and end-of-life situations (Weber & Kelley, XXXXXXXXXXUnfortunately, many clinicians overlook the importance of spirituality when considering the health of their patients and even themselves (VanderWeele, Balboni, & Koh, XXXXXXXXXXThis is why assessing someone’s religious beliefs and spirituality is such an important part of our nursing health assessment. However, to assess this effectively, nurses must be aware of their own religious beliefs and spirituality to recognize their own biases. As a Jehovah’s Witness, I have seen this from both points of view, as the patient and the nurse. As a patient, I make it clear to all my providers that due to my religious beliefs I have made the informed decision not to accept blood transfusions. Then, I provide them with a copy of my medical directive to place in my chart which is a legal document that clearly states my wishes. This position is easier for me to handle, because I know I have done everything I can to ensure that my wishes about not receiving a blood transfusion is honored. However, when I had to give blood for the first time to a patient as a new RN, I found it to be more of a challenge and this is why I chose option #3 to discuss. This situation posed an internal struggle and forced me to examine my feelings and biases in order to realize the effect they had on my decision making.
My patient was a young woman who had just had a baby and lost enough blood that according to current standards a blood transfusion was indicated. This young woman was hesitant about accepting blood and even asked about getting Aids from blood transfusions, but the doctor offered her a great deal of reassurances, and then, he and the patient’s mother proceeded to convince her. After, a lengthy conversation the young woman agreed to the blood transfusion. Now as a Jehovah’s Witness, I know why I do not take blood, but as a nurse I know I have to honor my patient’s wishes. However, the biggest problem I had with this situation is the doctor gave her no other options to consider. Jehovah’s Witnesses are educated on alternative treatments and even have a resource for clinicians on our website that provides them with alternative medical treatment options and guidance on how to provide us with care without the use of blood. She was given no other options. The challenge I faced was if I were to speak up and inform her that there are other options or remind the doctor that there are, would I be doing this out of my own biases toward not taking blood? Or would I be advocating for my patient who seemed very hesitant about the blood transfusions initially? The doctor I was working with was well aware of my religious beliefs, so I wondered how he would perceive my voicing my concern? Would he disregard it and contribute it to my personal beliefs, or would he take my concerns about the patient’s initial reaction into consideration? Or was I reading into the patient’s reaction, seeing what I wanted to see so that I would not have to give her blood? In that moment, I truly had to examine my feelings, remember that I was her nurse that had to honor her wishes, and then, to calm my nerves, I turned to my source of calm, prayer. Then, I proceeded to go back into the patient’s room to explain the procedure for the blood transfusion. As I proceeded to explain, the patient told me she was really scared and did not really want to take blood but wanted to listen to the doctor and her mother. As I listened to her, all I could think in my mind was please do not ask me what I would do, but of course she did. She asked if I would take the blood, which proceeded to make my heart pound out of my chest. I could not lie to her, so I took a deep breath and I explained my beliefs to her. However, I informed her that ultimately the decision was hers not mine or the doctor’s or her mother’s and that she should speak to her doctor to get all the answers to her questions so that she could make an informed decision. The patient asked to speak to the doctor again which meant I had to go and explain the situation to him. In this moment, I truly understood the saying “Dead man walking.” I thought the doctor would be very upset and blame me and my beliefs. I had my defense speech ready, prayed that I would say the right things, and not get angry in return. However, to my surprise, he actually understood and acknowledged that she was very hesitant in the first place, so he went to speak to her again. He presented her with other options. She agreed to one of the alternative treatments and ended up taking no blood. She and her baby went home healthy and happy a few days later. This situation caused me not to be the best advocate for my patient and to doubt my nurse’s instinct. I observed the situation but was afraid to speak due to fear of it being construed as me projecting my beliefs on to the patient. And I also doubted what I observed, because essentially for the same reason. Instead of trusting what I observed, I thought it could have been possible that my perception was skewed because of my beliefs. Also, I knew if she would have been unsure about any other treatment or medication, I would not have hesitated to speak up. So, this situation gave me a lot to think about and helped me figure out what type of nurse I wanted to be.
Looking back on this situation, I would have handled it differently. I would have advocated for my patient to the doctor as soon as possible, discussed how hesitant she was about accepting blood, and suggested to him we explore other alternatives. In the end, the situation worked out and the patient thanked me for my honesty, but I remembered never wanting to be put in that situation again. Therefore, I made the decision to work in healthcare settings that did not involve giving blood. I made this decision not to escape my internal battle, but so I would never be put in a situation where I could not trust my instinct and would cause me to hesitate to advocate for my patient. Some might not agree with that decision, but I felt it was what was best for both me and the patients I would care for.
April
References
VanderWeele, T., Balboni, T., & Koh, H XXXXXXXXXXHealth and spirituality.Jama, 318(6), XXXXXXXXXX.
Weber, J.R. & Kelley, J.H XXXXXXXXXXHealth Assessments in Nursing (6th ed.). Philadelphia, PA:
Wolters Kluwer.