Every day, nurses come to work providing care for patients requiring multiple levels of skilled nursing care ranging from basic to complex. Some patients may require vasoactive or vasopressor drugs to reduce or increase a patient’s blood pressure and other devices, such as a ventilator, intra-aortic balloon pump, or continuous renal replacement therapy, just to name a few, in order to preserve a patient’s life. In addition to caring for patients, nurses also have to make sure the patients’ family members understand the different aspects of the patient’s plan of care, such as the medications’ indication, side effects, and expected outcomes, as well as blood tests and diagnostic tests.
On a daily basis, nurses deal with the various level of stress caring for their patients and family members. These stressors could be the workload, time management, difficult patients and/or family members, discharges, admissions, and cardiac or respiratory arrest events. While nurses set goals to provide quality care that leads to better patient outcomes, nurses have the tendency to neglect themselves while working for the welfare of their patients by occasionally taking shorter meal breaks.
The big question is: who cares for nurses so they can continue to provide quality care every day to achieve positive outcomes? I see myself as a guardian angel for nurses whom I work with every day. Driving to work, I talk to God and ask him to help me make a positive difference, whether it is a soft touch of my hands, my soft-spoken voice, or my tight hugs. I believe that nurses should be cared for similarly to the way we take care of our patients and their families. Therefore, I look for a bible verse that would facilitate me making a difference in the lives of others. The bible verse I read is Proverb 3:6, which reads: “In all thy ways acknowledge him, and he shall direct thy paths.” The reason for this particular verse is that I need God’s guidance so I can be a blessing to others. The way I believe that I am a blessing to others is demonstrated by monthly birthday cards and luncheons for coworkers who are born in a particular month as well as greeting cards and gift cards for expecting mothers and fathers or weddings. I also recognize coworkers if they have achieved any type of certification or graduated from college.
Sometimes, I make and bring in desserts and have food delivered for lunch. On our unit, we are a melting pot of people. Every year in August, we celebrate International Culture Day where the staff brings an entrée from their culture and shares a little bit of history and its meaning. Additionally, I show concern about them as a whole and will ask them how they are feeling, what is going on with their children, dogs and/or cats, and their commute to work. The admiration of taking care of nurses and others as extended family members at work gives me great joy and pleasure that leaves my heart full of exhilaration every day.
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.
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