Vote and discuss.

Regardless of your belief, you should always be open, understanding, and respectful of other cultures.  Everyone has a right to believe as they choose....it is not for us to determine if it is right or wrong. 

I believe that we can always practice cultural sensitivity.  We can even voice our objections and be respectful about it, if it's something that we believe is morally or ethically wrong.  Many times, I've felt that something was ethically over the top, and I have discussed it as even toned, without raising my voice.  My co-workers tell me, that they love working with me, because very little rattles me.  I just laugh, because sometimes it does rattle me, but I have learned how not to show it.  It's a technique that all in healthcare should learn.  The healthcare enviroment, is often very emotionally charged, people learning difficult diagnosis, dealing with loss of limb and life.  It should be our job to guide, educate, and listen without feeding into the chaos.

Honor killings are illegal.   When we talk about cultural differences, I would expect that since most of us work in some type of medical facility we are talking about legal practices that are performed LEGALLY in the United States. 

I have respectfully disagreed with Jehovahs who refused blood transfusions, but still honored the request.

As for jehovah's witnesses.. If  I am duing the case and there could be HUGE amounts of blood loss... well I tell them they may DIE.. most will even refuse cell saver....

OK.. so what if the parents wont  let the KID have blood... for the sake of argument.. the kid is 17 and also refuses bacuase they wnat to go to heaven....Is that OK?

I do not need a order to transfuse blood, insert an epidrual etc..

Suppose YOU were the CRNA and you could give the blood to the 16 year old and it would save his life.... and neither the parents nor the patient would know.. would you give it?

They would know when it shows up on the bill or they review a copy of the chart.  We had a motorcycle trauma in Tucson one night, head trauma, multiple fractures ruptured spleen.  he was impaled on a saguaro cactus if you know what that is.  Anway we gave him blood and platlets and when his parents got there about 3 hours after we admitted him they told us he was a Jehovas witness, The 17 year old had no id about religious pref on him at admission.  He was unconscious for a week and his parents thanked us for saving him but when he awoke and found out we gave him blood he was devestated since he would forever be separate from God.  he remained angry and inconsolable throughout his hospital stay.  I don't know if he recovered from having had trasfusions.  So Nope I would call the ethics committee and let them sort out the blood no blood with parents and a 17 year old. If the 17 yr old and the parents don't want the blood, vaya con dios.  I will give expanders if possible, sometimes they allow Albumin, but Inshallah.

Epidural when the pregnant patient wants it and the macho SOB male partner doesn't ,, she gets it, she is competent and she is my patient.

Kittyrn says ...

I am not a CRNA, nor do I have any desire to be a CRNA.  I am very happy doing what I enjoy doing. 

 

It was a HYPOTHETICAL situation.... no one was suggesting you desired to.. or could even become a CRNA.

I've encountered some middle eastern cultures, where the husband needs to consent.  But in every instance that I've encountered the women were afraid of their husbands and would not have dissented.  We had pre-operative women that by our law/legal standard needed to sign consents, but by their culture the husband had to sign.  We were instructed to have the husband sign the consent first (thereby conforming with their culture) , and then have the wife sign it (satisfy our legal requirements).  Sadly, every time the wife could do no more then scratch an X because they were also kept illiterate.  It's not a perfect world.  But in every instance, if you want to keep your nursing license, you need to conform to both hospital policy and legal advise on how to follow state guidelines.  If you ever feel that something is morally or ethically wrong, almost all institutions have some sort of chain of command with legal council for you to follow.  You also have to remember that on a rare occasion you will be told to do something that is in the best interest of the hospital, but is not neccessarily in YOUR best interest as a licensed nurse.

RE administering blood as a CRNA to SEVO;

I am not a CRNA, and I am not familiar with the legal guidelines that you follow.  But, I can assure you that the choice I made would be the one that protected my nursing license.

I can give you 2 examples of blood transfusions, and pt consent that both went badly.  These both happened at a hospital that I worked at, and both had an effect on our hospital policy, and how we subsequently did blood transfusion consents. 

Postpartum pt, begins to bleed excessively, with continued drop in h/h.  She and her husband were 'devout' Jehovah's.  OB/GYN wanted to give her a blood transfusion and pt refused, this continued over a 48hr period, and the pt was spoken to on several occasions by MD that this was serious and potentially life threatening.  Pt died.  Husband filed a lawsuit, that said they would have accepted the transfusion if they had realized the seriousness of it.

In the second instance, an operative pt had no consent on record for blood transfusion, and told the surgeon prior to surgery that he did NOT want a blood transfusion.  Excessive bleeding during surgery resulted in either the CRNA or the anesthesiologist administering prbc.  When the pt recovered and found out he had a blood transfusion he sued.

As a result, in all instances where a blood transfusion might be required and a pt refused, we had a large RED refusal form to be signed by the pt, the MD, and the anesthesiologist. The MD and the anesthesiologist (or a second MD in the case of an OB/GYN pt) were required to make a note on the chart documenting conversation and pt objections.

I am not a CRNA, and I am not familiar with the legal guidelines that you follow.  But, I can assure you that the choice I made would be the one that protected my nursing license.

So you would protect your nursing license above saving the life of the patient?

Interesting.

Nurse_John says ...

I am assuming that you are in the US, where if the patient is of sound mind has the legal right to decided about her own treatment. If the woman wants it, I would respect her and give it to her.

 

OK ,you give her the epidural against the will of the husband. The woman is now in danger of being beaten or worse when she is discharged....

Why is the most tolerent country on earth willing to accept the intolerent actions of other cultures? Why are we told to be understanding of barbaic practices?

We should not be accepting of such behavior, and more importantly, why is multiculturalism being pushed?

When I lived in other countries it was drilled into us..( Iran, Lebanon, etc.)  you are a guest you will abide by the customs and mores of the guest country.... that should apply to visitors to THIS country also... Mulitcultural sensitivity is the opposite of cultural assimilation... and that is a BAD thing.

We are a diverse country.  We have Muslims, Jews, Jehovahs, Catholics, and they are all still Americans.  If I want to be the best bedside nurse that I can be,  I have to be culturally sensitive.  Most of medicine is NOT life and death situations.  But real people with dietary restrictions (JEWs Muslims, NO PORK), Jehovah's No blood etc etc.  If we are not making any attempt at cultural sensitivity then they either choose not go to a hospital, or to another hospital with a staff that is willing to accomodate them.

BTW, in answer to your question, my first obligation is practice within the scope of my license, and follow all laws of my state.  I would not administer a blood transfusion unless it fell within those legal parameters (even if it meant the pt died)

SEVOFLURANE says ...

Nurse_John says ...

I am assuming that you are in the US, where if the patient is of sound mind has the legal right to decided about her own treatment. If the woman wants it, I would respect her and give it to her.

 

OK ,you give her the epidural against the will of the husband. The woman is now in danger of being beaten or worse when she is discharged....

Why is the most tolerent country on earth willing to accept the intolerent actions of other cultures? Why are we told to be understanding of barbaic practices?

We should not be accepting of such behavior, and more importantly, why is multiculturalism being pushed?

When I lived in other countries it was drilled into us..( Iran, Lebanon, etc.)  you are a guest you will abide by the customs and mores of the guest country.... that should apply to visitors to THIS country also... Mulitcultural sensitivity is the opposite of cultural assimilation... and that is a BAD thing.

I would not be giving her the epidural against the will of the husband, I would be giving it at the request of the patient who has the legal right to determine her own care. 

mrbrownrn49 says ...

As I need my nursing license to work as a nurse, I would agree in principle with Kitty on this part. I worked 17 years in ER. Ft. Bliss, which is in El Paso now, has contingents from all friendly Arab countries training there (on YOUR tax dollars). The active duty foreign soldier receives their care at William Beaumont Army Medical center (on YOUR tax dollar) but their dependents must receive care at non-military facilities (guess? Again on YOUR tax dollar).

It seemed to be an early morning routine at the beginning of day shift: The arrival of women, always accompanied by their sullen husbands, from the United Arab Emirates. These women had on little blinders (for lack of a better decriptive word) made of gold. It kept them from looking anywhere but straight ahead. The dark veil they also wore kept anyone from being able to make eye contact with her.

Ask her what the problem is that broguth her to ER and the husband pipes u immediately that she MUST be seen and talked to only by other females.

Too bad, so sad. All there is on duty this day are male nurses and a male doctor. Perhaps you would rather go to another facility? At times they did, other times the husband wanted her to remain there. BUT he would have to answer any questions, approve of any staff including the doctor and the exam may not include any "seeing" of her undressed.

Go away. Just go away.

I did work in an arabic country( Kuwait) and indeed only women nurses must attend to their women and male nurses to men. The older and the very religious younger women did cover their faces in public . Some arabic countries are more stricter than others and the very religious people prefer to bend the law than to upset ALAH. It is more difficult to accomodate these type of patients here but it shouldn't be impossible.

When I worked in Kuwait I was pleasantly impressed with their medical care and technology. One nurse attended to only 3 patients and most of them had their own private nurse too. I had a very good life and nursing experience there.