Congress Abstracts 2004

167

RESPECTING SPIRITUAL BELIEFS: MANAGING A JEHOVAH’S WITNESS PATIENT WITHOUT BLOOD PRODUCT SUPPORT. Suzanne Carroll, RN, MS, OCN^®, AOCN^®, Wake Forest University Baptist Medical Center Comprehensive Cancer Center, Winston Salem, NC.

Research suggests there is an increased sense of spirituality among patients with cancer. Spirituality refers to the dimension of being human that motivates self-transcendence. Spirituality assists patients to make sense of their universe. Religiosity is an extension of spirituality. Religion, through rituals, observances, and sacred practices serves to represent and express ones spirituality. Oncology nurses facilitate patient spirituality.

A religious practice followed by Jehovah’s Witnesses includes the refusal of blood products. Jehovah’s Witnesses believe that all hope of eternal life will be forfeited if transfusion is accepted. Instead of transfusions, Jehovah’s Witnesses promote blood conservation and transfusion alternatives. Recently, many medicolegal and ethical issues arose when we treated a Jehovah’s Witness patient with induction chemotherapy for acute lymphocytic leukemia (ALL). The purpose of this poster is to describe this patient care experience with an emphasis on the spiritual issues encountered.

As blood counts fell to dangerously low levels, oncology nurses needed to utilize clinical interventions that were respectful and sensitive to the religious beliefs of the patient. Nursing interventions were aimed at minimizing blood loss by consolidating blood draws and using the least amount of blood; administering long acting agents such as Neulasta, Aranesp, and Neumega instead of shorter acting agents; controlling symptoms to prevent nausea/vomiting/constipation, all of which could initiate a bleeding episode and loss of blood; providing nutritional support and administering vitamin supplements; and optimizing oxygen delivery and reducing oxygen consumption. An advanced directive was reviewed and communicated among nursing and medical staff to ensure that blood products would not be administered in the event of a bleeding episode, adverse reaction, or medical emergency.

Treating this patient without the use of blood products was a departure from the norm and created some tense and anxious moments among the nursing staff. This departure, however, also allowed for some creative nursing interventions and demonstrated that patients can be treated successfully without the use of supportive blood products.

This patient care scenario exemplified the importance of recognizing and respecting patients’ spiritual beliefs and will serve as an example for other patients with unique spiritual needs.