Ethical Implications in Nursing

The books of Genesis and Acts in the Bible hold passages that Jehovah’s Witnesses feel are key in their beliefs on not receiving blood transfusions (Ethics, 2009). For the medical community this is a difficult issue to deal with and relate to. Saving lives is what healthcare is about and blood transfusions assist in that. For some, however, blood transfusions are not an option. Although denial of life saving measures such as blood transfusions may not be ideal for members of healthcare, it is an important ethical issue and belief for some.

With that being said, it is important as a leader in healthcare to have a better understanding of this in order to advocate for the patient, communicate the patients views, and provide excellent patient care. There are over one million Jehovah’s Witnesses in the United States (Watchtower, 2012). Ethics and values play an important role in their life. Refusal of blood transfusions is an important belief. They relate their refusal of blood products to Bible passages and feel that to go against God’s word is a sin.

Jehovah’s witnesses believe that eternal life in God’s kingdom is dependent on obedience upon strict laws (jehovah’switness. org, 2012). Going against Bible passages related to blood would ultimately go against God’s word, resulting in not entering his kingdom. Ethics, values, beliefs, and religion is what molds people into who they are as a unique person. Not everyone believes the same things or in the same ways. As leaders in healthcare it is important to first realize that not everyone believes the same things or in the same ways. What is important to one person isn’t necessarily important to another.

Also it is essential to be open- minded and be the patient advocate and insure they receive care that does not compromise their beliefs or values. The role of the healthcare leader is simple, educate the staff and encourage them to reach beyond their cultural comfort seat. Also, support the patient in their decisions and open the door to available alternatives. Open a line of communication between the physician and unit staff that explores outside the proverbial box into an area of expanded knowledge. Many times prejudices made against people are often due to lack of knowledge about that person’s eliefs or views.

This is where the leader comes into play. According to the book Quantum Leadership, Advancing Innovation, Transforming Healthcare, the leader’s first job is to act as the facilitator which means giving parties involved a voice. Listen to their concerns and their perception of the issue at hand (Tim Porter-O’Grady, 2012). Many times in current healthcare settings, the patient may lose blood which results in a drop in their hemoglobin and hematocrit. Just because the patients lab values decrease to a critical value in some cases, doesn’t necessarily mean they are in need of a blood transfusion.

Is the patient symptomatic? Do they get light headed when they ambulate? What are their vital signs? Are they compensating on their own for the decreased lab values? If they are handling the critical lab value, then what is the need for the transfusion? According to The Journal of Trauma Injury, Infection and Critical Care, transfusion requirements are often overestimated. Increased morbidity and mortality is rarely observed in patients with a hemoglobin concentration >7 g/dL, and the acute hemoglobin threshold for cardiovascular collapse may be as low as 3 g/dL to 5 g/dL (Hughes, Ullery, & Barie, 2012).

If the patient is tolerating the levels then what’s the need for a transfusion. In this instance the leader can communicate with the staff regarding the patient’s status thus relaying it to the physician and exploring alternatives to blood transfusions such as iron replacement therapy. Issues such as refusal of blood transfusions among certain groups pose possible threats to their health that medical staff find hard to deal with. As medical professionals, saving lives are the number one goal. One way to save lives is blood transfusions.

Unfortunately, not everyone is willing to receive blood products. Just because they refuse, does not mean they are non-compliant. Many people have ethical principles that guide their daily decisions regarding their everyday life as well as their health. It is the responsibility of the healthcare leader to adapt to the patients way of thinking and familiarize themselves and their staff with the views the patient holds important. It is not necessary to agree with the patient’s views but to be respectful of them and not compromise their values.

In Jehovah’s witnesses, to compromise their beliefs regarding blood transfusions is one that in their eyes results in defying their God which is unacceptable. Many feel that to defy God in order to live only results in eternal damnation. Although it may be difficult to accept, the role of the nursing leader is to not agree with the patient’s decisions but to ensure that they are met. Not everyone thinks or functions the same way. That is what makes people different. A willingness to accept each other’s differences is what makes us exemplar.

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