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Most members of the Jehovah's Witness community refuse blood transfusions, and there are variations in what alternatives they will accept depending on their personal decisions. To provide culturally competent care, healthcare providers need to be knowledgeable about substitutions for blood administration as well as the risks and benefits of available alternatives so that they can inform their patients. It has been recognized in the literature that preoperative optimization of hemoglobin levels with alternative treatment modalities through a multidisciplinary approach can improve clinical outcomes in patients who refuse blood products. The purpose of this article is to illuminate the current beliefs of Jehovah's Witnesses regarding receiving blood products, discuss ethical and legal considerations for the nurse anesthetist, discuss the risks of blood transfusions, and examine transfusion alternatives. Finally, this article considers a multidisciplinary approach to the optimization of preoperative hemoglobin levels.
Keywords: Bloodless surgery, elective surgery, Jehovah's Witnesses, transfusion alternatives.
Jehovah's Witnesses are a vulnerable patient population that presents unique ethical and legal dilemmas for anesthesia professionals. Comprising approximately 1.2 million of the US population, Jehovah's Witnesses have religious beliefs that deter them from receiving blood transfusions, which can lead to adverse reactions from the refusal of treatment.1 Surgical procedures that have the potential for large amounts of blood loss for any patient can be challenging for the nurse anesthetist, but when combined with the patient who refuses to receive blood products, the intraoperative fluid hemodynamic management strategies can become critical. Regardless of the patient's reasons for declining blood products, healthcare providers should provide culturally competent care and therefore must be knowledgeable about substitutions for blood product administration as well as the risks and benefits of such treatments.
Inconsistencies exist in what alternatives a Jehovah's Witness patient will accept, depending on his or her religious sect. The responsibility of the nurse anesthetist is to ensure that this unique patient population makes informed decisions established on evidence-based transfusion alternatives, as such treatments relate to their religious practices. Furthermore, failure to optimize hemoglobin (Flgb) status and provide culturally competent patient education on transfusion alternatives before the day of surgery could have financial implications for the institution and may result in cancellation or delay of the surgery.
A multidisciplinary approach to the care of the Jehovah's Witness...