YouTube Patient Advocacy Discussion

You were asked a couple posts ago to view this video:
http://www.youtube.com/watch?v=zfS3q0v4U4E

Now that we have reviewed patient rights and basic medical ethic principles. What did you notice in the scenario where the patient did not want the blood transfusion? Initially the two nurses discussing her case stated that she was confused, and nurse A stated that since she was "out of it" they should give her the blood transfusion since she would not realize what they had done anyway and it would be a life saving measure. Nurse B stated that from her previous admissions she had not wanted nor had she consented to any previous blood transfusions and that they should honor her wishes. Who is correct? Well, first you do need informed consent prior to transfusing blood. The patient has to understand that there are potential risks in blood transfusions and the risks and benefits should be discussed; ideally this should be done by the physician and nursing staff can reinforce the information given by the physician. So who do you go for consent if the patient is unable to sign for themselves? Patient's may have appointed a health care agent within documents such as the Health Care Proxy or Living Will, or patient's next of kin may be able to give consent if the patient did not appoint anyone in case of such a scenario. It is important to note that in the case the patient had an established behavior of refusing blood transfusions (and contrary to the family wishes, they wanted her to have the transfusion) so sometimes what a family may verbalize may not necessarily be what the patient would have wanted, these situations can get very complicated if the patient did not make any official documentation of what there wishes were. Going back to the scenario the patient was able to answer all of Nurse B's questions to determine her level of orientation, and she was oriented and capable of making her own decisions and thus refused the transfusion. It is not our place to pass our beliefs on to that of the patient (Nurse A felt she should have the transfusion) our job is to respect and follow the wishes of the patient regarding their treatment and care. It is in the Patient Bill of Rights that patients have the right to decisions regarding their medical care. Reflect further on this scenario and tomorrow we will discuss what ethical principles were upheld or potentially violated in this scenario.