Hello, my Name is Nurse Udogwu Felix, and I would like to tell you my story. It was the year "1992", I had attended the State School of Nursing Warri, and was of the Class of 1991. As a student nurse, in my second year clinical posting to central hospital Warri, I encounter a case which I am sharing now, please feel free to advice.
The day started off like this...
A patient was brought into the female medical ward for admission after seeing the doctor on duty. I as a student nurse was with the Senior Nursing officer at the Nursing table when this happened.
My senior colleague requested that I carry out the admission process of the said patient while she monitors, I obliged her immediately, after reading the case file that accompanied the patient to the ward, which clearly indicated “ADMIT FEMALE MEDICAL”.
I remember clearly that I was very happy as a young, enthusiastic upcoming nurse who wanted to partake in all new cases that came along my way. I took the history of patient, (let's call her "Miss FX" for now) and the following was recorded and handed to the senior Nursing officer who was closely observing and monitoring me.
The complete objective data I cannot actually remember now, after 25 years.
Subjective Data that I can remember few from the picture I can still see.
I took the case file to an unoccupied bed (Admission bed) close to a window in the middle of the ward which also had a fan close to the bed. After this my superior asked that i administer a dose of Analgen Injection I.M to the patient, which I did and the patient was quite after some minutes, I was happy that the Nursing care is working.
Later in the day, the Doctors came for their rounds and as a young Nurse, I was following them, listening to what was being said about my patient, and the result of the P.C.V.
They recommended blood transfusion for the patient and moved on. Now after the ward rounds, I went to ask the senior Nursing officer who was my direct supervisor when we were going to start the transfusion to give the patient the blood that was recommended.
To my surprise she bluntly told me that I wasn't observant at all in any way and that I did not know my patient. I was shocked, because at that moment I could tell the name of the patient, her age, also her Blood pressure ,respiration, temperature, pulse at that time without having to look at the case file of the patient.
I remember laughing and saying "Ma, there is noting that I cannot tell about the patient...", She just stretched out her hand and opened the case file which I had filled during the admission process and pointed to the section where I had written Religion: Christian and in bracket (Jehovah witness).
I still did not still get the message, so she asked me to go confirm with the patient if she would accept a blood transfusion. The girl was aged 19 then, and was qualified to take decision for herself i believed. So I quickly went to meet her because I had established what i believed to be an effective nurse/patient relationship by accomodating the patients needs when she was complaining of not breathing well, though then I did not know the reason, the best I could do at that time was to make sure that air from the fan gets to her.
I was shocked and a bit shaken when my patient said "NO". No to an action that would save her life... Just "NO"
I tried to council her on the importance of the blood transfusion, but she still said "NO".
I turned to one side and saw her mother by the window looking back at us, while her daughter was in tears from the pain, this time with tears rolling out of her eyes, moving and squirming from one side of the bed to the other.
I left her side and went to the mum, before I opened my mouth to say madam, she said I should not go there, that they do not accept or donate blood.
At this point, i was clearly disappointed, but as the ethics of this noble profession and the respect for patients right to accept or refuse treatment, with the recognition for respect for patient religion, culture and rights I stepped away but went back to my patient and reminded her that since she was 19 years old, she was free to make her own decision in view of saving her life by signing the consent form to recieve the needed blood transfusion.
But she just looked away from me and kept quiet while rivulets of tears kept flowing down the sides of her face, as she twisted around in pains. When I noticed the distress from the patient, I quickly called out and notified my superior, who then assessed and requested for the Doctor on duty, they came, took her blood pressure, did the little that they could, got her a bit comfortable but in the end she died.
My next assignment was to do the last office after the Doctor had confirmed her dead and called the time of death.
Learning from incidence (L.M.I)
1. What is your take in this case, my dear colleagues in the Nursing profession?
2. What should Government do in this kind of situation? Or does the Government even have a say?
3. What are the rules and regulations governing government hospital in this kind of situations?
4. What are the Nursing ethics that the Nurse should follow in cases such as this?
5. What alternative treatment can be given in this type of case If any?
6. Should the doctor ask the patient to sign against medical advice and discharge her?
7. To what extent can the nurse council the patient?
8. Do you think we did all we could have done in that circumstance, what else would we have done to save the life of Miss FX.
9. What type of legislation can be instituted to balance this type of cases?
10. Should a Jehovah’s Witness doctor be allowed to treat cases of this type without going against the Hippocratic Oath they took?
11. Should a Jehovah’s Witness nurse be sent to managed such a case, if yes, why, if no why.
12. If the case is the other way round, a sickle cell anemia patient is the one that a Jehovah’s Witness Doctor is required to treat, and the only option left is blood transfusion, what should he do? And what should he not do. (Please with all due respect to the religion, I am not judging, but let us all be practical with our calling and the Hippocratic Oath taken: do no harm, do your best to help,etc
Remember, based on the ICN CODE OF ETHICS FOR NURSES A Nurses and people. The nurse’s primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.
Did we do the right thing then, please I personally need your response on Nursworldnigeria for all to learn
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