The unconscious J.W. Patient!

haywoodm · #1 (**permalink**) 11-14-2005, 05:50 AM

What would you do if there was an unconsious J.W. patient who had no medical directive on them and the family could not find it, but the relatives said the patient is a J.W! The patient needs emergancy surgery and you known they could die on the table due to massive bloodloss and intra-op Cell Salvage was not avaliable???

MThomasRN · #2 (**permalink**) 11-14-2005, 08:26 AM

In that scenario, the 'next of kin' would be the one making decisions and consenting for procedures so the patient would be treated as that person directed.

Jan B. Wade · #3 (**permalink**) 11-14-2005, 08:42 AM

Also I would vote for two things if I could. We would contact risk management AND follow the direction of the next of kin.

There is a caveat in this...If the next of kin said the JW patient was not a JW and directed us to give blood we would.

This shows the importance of carrying an advance directive.

Jo Valenti, RN · #4 (**permalink**) 11-14-2005, 08:42 AM

....except for pediatric patients, of course

Jan B. Wade · #5 (**permalink**) 11-14-2005, 03:02 PM

absolutely :-)

haywoodm · #6 (**permalink**) 11-15-2005, 03:48 AM

This was a real case that I had to deal with!

MThomasRN · #7 (**permalink**) 11-15-2005, 06:22 AM

Quote:

Originally Posted by haywoodm

This was a real case that I had to deal with!

Been there many times, it is very frustrating. Still so many don't have their directives completed.

I'm curious, for those who selected "call the lawyers" why would you have to do that if you had next of kin?

Jo Valenti, RN · #8 (**permalink**) 11-15-2005, 08:08 AM

Having worked for over 7 years in a hospital with a state designated trauma service and dealing with severely injured patients, I can attest to the fact that many many people do not have their directives in order or worse yet, do not carry one. Being there to represent and advocate for patients who are many times extremely difficult to manage from a clinical perpesective, it is sorely frustrating when they make it even harder by not complying with their responsibility to have properly executed directives. Especially when the family do not support their decision. Especially when no one knows what personal choice opitions they would allow. Especially when decisions on what to do means life and death.
People just think it will never happen to them or whatever. I've heard every excuse you can imagine. No wonder many physicians and hospital administrators have developed bad attitudes on working with patients!

E. Crum, RN · #9 (**permalink**) 11-15-2005, 01:45 PM

Like Jan, I would listen to the next-of-kin, document carefully, and call Risk Management. I think most hospitals would want to know this is going on. Joining the soapbox, many Jehovah's Witnesses who DO carry their DPA select 'C' - saying in effect, "You have to talk to me before you give me anything..." Do those who select 'C' realize we can't give them anything that involves a conscience matter until they or their proxy agrees? Do they realize the luxury of time is not always available in a true emergency? At best they are left with making decisions under a lot of pressure with no time to study or pray about their choices. And that is only the Witnesses population! Non-JW refusers have no idea about any alternatives. We have to educate them from scratch in an emergency! Very frustrating!

ybunch · #10 (**permalink**) 11-16-2005, 09:56 AM

The public need to understand when there is no advance directive, and you are unconscious, it becomes implied consent. Regarding the J.W. Healthcare Power of Attorney, I wrote a letter to Watchtower outlining the good points and bad points. The 'C" part on that document basically lets the patient say, "I am not going to make a decision right now about..." Very dangerous. I agree with Liz. It is very frustrating!

View Poll Results: You have an unconsious J.W patent having emergancy surgery with no medical directive?
Take the families word that they are a J.W?	77	58.78%
Give the patient blood if you need to?	7	5.34%
Call the hospital legal team?	39	29.77%
Don't know?	8	6.11%
Voters: 131. You may not vote on this poll

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The unconscious J.W. Patient!

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