Nursing Paper on Approach to Patients Who Decline Blood Transfusion


Nursing students are supposed to work jointly with others to uphold and enhance the wellbeing and benefit of the patients, their family members, carers, and every stakeholder. Furthermore, the professional values for nursing learners and professionals demand them to be open and ingenuous, promote integrity, and support the status of the career. The professional principles affirm that the decisions and health of the patients ought to be valued and safeguarded. Nonetheless, when such rights involve patients’ refusal of possible lifesaving care, serious concerns develop. On this note, every patient has a right to decline blood transfusion, surgical practice, or a form of care that they consider inappropriate regardless of whether others find it suitable. If a nurse in any health facility decides to offer care or carry out a medical procedure devoid of the consent or agreement by the patient, he/she could face battery charges. However, the implication of blood transfusion in saving the life of patients can in no way be undervalued.


Approach to Patients Who Decline Blood Transfusion

Various reasons lead to patients refusing blood transfusion; some refuse because of their culture, religion, and fear of blood borne infections (Binder et al., 2014). The most evident cause is from a certain group of believers called Jehovah’s Witnesses, whereby blood transfusion refusal lies on their religious beliefs thus intimidating blood transfusion practices. Patients may turn down blood transfusion on reasons outside spiritual or individual context. Various patients have rejected blood transfusion due to fear of being found out by family members, followers of a religious group, or because of experience with a life-intimidating blood transfusion response. The approach to such patients should differ from the encounter with individuals who refuse blood for ethnic or other bases. A comprehension of the patient’s psychological history, together with a cautious explanation of the dangers and advantages of blood transfusion in particular to their condition may determine the fear of undergoing blood transfusion.

Comparison and Contrast

As a nursing student, my professional values encompass ensuring that caring for patients is my first concern and always uphold their dignity. In this regard, students are anticipated to provide sufficient information and advice to patients in a comprehensible manner to allow them to choose the best approach to care. Nursing students ought to work in collaboration with others to safeguard and enhance the healthiness and welfare of the patients, their family members, caregivers, and all stakeholders (Pattakos et al., 2012). Moreover, the professional values for nursing students expect them to be open and truthful, operate with integrity, and promote the reputation of the career. The professional values affirm that the rights of the patients ought to be respected and safeguarded. Nevertheless, if such rights entail patients’ rejection of possible lifesaving treatment, serious concerns come into play.

Similar to the students’ professional values, the values of the health institution in which I work affirm that all adult patients of sound mind ought to be allowed to make decisions regarding their bodies. In this regard, such patients have a right to refuse blood transfusion, surgical procedure, or a form of treatment that they consider improper regardless of whether others find it lifesaving (Garraud, 2014). This essential value, which is entrenched in the legal principle, acts as the cornerstone of the policy of informed consent. In line with such values, no nurse or doctor in the organization can force a medical process or surgical operation to a patient devoid of their consent. The vision of the organization is to become progressively better in satisfying the needs of the society with care, concern, and expertise. Patients have to be informed of the name, procedure, and possible outcomes of the intended treatment with the aim of their knowledgeably determining what ought to be done. In this regard, if a nurse in the organization decides to administer treatment or carry out a medical process devoid of the knowledge or permission of the patient, he/she could be charged with battery (attributable to the nonconsensual meddling with the body of the patient). Medical operations on the body of a patient are considered trespass or battery except when the doctor or nurse in-charge first seeks consent, irrespective of the benefit of the process or care entailed in undertaking the practice.

The president of the organization and the nurse manager belong to the Jehovah’s Witnesses religious group. This religion is against the practice of blood transfusion, and this may play a significant role in the occurrence of the issue. Blood transfusion is a practice that is highly employed across the globe in saving life, particularly after excessive bleeding. Most health professionals consider the process to be of great importance in the profession. Nevertheless, the president and nurse manager in the organization consider that God, the giver of life, intends blood to be sacred and is not supposed to be utilized in transfusion practices, irrespective of the condition of the patient. They cite numerous verses from the Bible in support of their stand. If they are attending to a patient who requests blood transfusion, they do not administer it but call upon a different health professional to undertake the process. Though the Bible does not prohibit blood transfusion directly but disallows eating blood, they understand this in terms of intravenous and oral consumption (Pattakos et al., 2012).

Literature Search

Disparities taking place between patients and medical attendants on the decision of treatment stands to be a rampant challenge in the recent medication at the facility. Some of these conflicts often end up straining the vital health attendants and patient relationship. A number of differences have drawn a lot of attention in the medicinal, legal, and community spheres as the rejection of blood transfusion becomes the most abundant. Relating with patients who do not acknowledge blood transfusion in conjunction with their relatives, it takes a nurse to move an extra mile in the creation of unusual time and even application of more energy, which may not be available in  circumstances of emergency. However, in the healthcare sector in Minnesota, the United States, and all over the world, nurses are required to give their best administration possible, factoring the period required to evaluate the precise preferences of patients and their relatives. Getting informed of permission towards blood transfusion needs an approval of both benefits and hazards (Pattakos et al., 2012).

The figure of Jehovah’s Witness is increasing globally, while they continue with their belief of not going through blood transfusion (Shander et al., 2014). Treating a patient who does not recognize blood transfusion is stuffed with a couple of challenges. In order to treat a patient who does not allow blood transfusion, a health attendant should engage moral and legal affairs in regard to the need for preparation and implementation of his/her required performance rate. In a situation where an individual is in a life-severe condition and declines a blood transfusion, he/she is in an extremely critical state that calls for an alternative quality care by a health attendant. Failure to take action may lead to illegal charges of abandonment, and when the patient dies, the health attendant could be in critical scenario. In this regard, health professionals should do everything possible to offer blood transfusion to patients who need it seriously without coercing them.

McAuley, a patient in Selly Oak hospital in England aged fifteen years, was found to have rejected blood transfusion as advised by the health professionals, a choice that the family members maintained. The boy had been taken to the hospital after a vehicle had knocked him against a wall as he was going on with the task of preaching to people at a shopping center in Smethwick. He had numerous injuries on his body, particularly his legs and the abdominal part, after being trapped against the wall. Following the accident, the boy was quickly airlifted to the health institution in an effort of saving his life. Nonetheless, despite the attempts by the caregivers to offer alternatives to blood transfusion, the boy passed away just before six o’clock in the evening. A nurse from the hospital proclaimed that there is no approach or regulation concerning the best approach to blood transfusion (Shander et al., 2014). This gap is also extant in research as there is no discovered instant right to overrule the wishes of the patient or the parents in case of a minor. This presents an exceedingly critical issue that must be approached on a situation by situation basis.

In the United States, there are many situations where health professionals have been compelled to go to court in search of a permit of conducting blood transfusion to critically ill children contrary to the demands of the parents, which mainly emanate from religious belief. Nevertheless, if the health professionals deem a child competent to make a strong decision, they obey his/her wishes, which can only be altered by the stand of the parents, the court of law, or other persons who have parental authority. In situations where children are found not lawfully fit to make a decision, permission ought to be sought from the parent, guardian, or any other person with parental accountability, except in emergency situations. Emergency cases may be handled devoid of seeking consent in a bid to prevent death or detrimental worsening in the health of children or minors (Kitahama, Smith, Rosencrantz, & Patterson, 2013).

In the United Kingdom, a youthful Jehovah’s Witness patient passed away shortly after she had given birth. Before her death, the patient had signed a form rejecting blood transfusion, and her family members supported her decision. Why did the health professionals not intervene compellingly? If such a situation had taken place, the nurses and physicians involved might have been charged with a crime devoid of saving the life of the patient. The United Kingdom, just like the US and other regions around the world, has strong weight on respecting the religious beliefs of patients (Kitahama et al., 2013). Health professionals can only try other alternatives in cases where a patient rejects blood transfusion or other medical practices; this is a thing that medics have no choice but to abide by the status quo; another option would be to advocate for the amendment to the existing regulation. It is vital that human beings have the right to make independent choices devoid of decisions being dictated by religious groups or other associations. In an unforgettable occurrence in the UK, a court permitted blood transfusion to be conducted on a Jehovah’s Witness patient aged twenty years old after suffering a fatal accident in 1992. This ended up saving the patient’s life. Health professionals should seek the intervention of the court in a situation that they feel that blood transfusion is in dire need.

A Realistic Solution

A Jehovah’s Witness who obtains blood transfusion secretly without the knowledge of anyone will not be discovered if not confessing the truth. In a certain situation, a patient could speak out a desire to obtain blood transfusion in covert. A nurse should acquire whatever measures necessary to ensure complete privacy regarding this point. With respect to patient secrecy, relatives, companions, and infirmary personnel are required to maintain a high level of confidentiality in order to uphold patient’s rapport. Preferably, the nurse should verify the treatment platform with the patient secrecy (Kitahama et al., 2013). In any case, there is the possibility of an exception that may result in a healthcare personnel with whom the patient could consider contented with. Several individuals might be willing to admit blood transfusion in extremis, and this likelihood must be carefully discovered early during the patient’s sanatorium stay, earlier before the level hemoglobin falls to the point that thinking develops into obscurity.

There is an important emotional hazard to a nurse when watching the sick dying from a simply avoidable death (Kitahama et al., 2013). Those accountable for the sick should regard as their own responses to this likelihood and transfer care if suitable, or else prepare to look for emotional support if required. Jehovah’s Witnesses as a group is not litigious, however, their family members who do not observe Jehovah’s Witnesses beliefs may have sturdy emotions about witnessing a treasured one dying after rejecting blood transfusion. In a case where family members or allies sturdily differ with the patient’s verdict to admit or decline blood transfusion, the nurse may be required to give a supplementary explanation. For such cases, the medical center’s morals committee, legal unit, and hazard management group should be involved in turn to stabilize the need linking and defending privacy and giving useful communication of the treatment platform and its rationale.

The patient’s desires should be documented in a progressed health care card; Jehovah’s Witnesses are persuaded to have it on their own. The attending nurses should assess the written order together with the patient and ensure that a duplicate is put in the health record. The accord between patient and the nurse is complex and must be detailed apparently in the medical record, including any contingency contraventions as noted down. Some sanatoriums give a form precisely for this purpose to note down the agreement. When there is any qualm in a nurse’s decision regarding to the desires of a patient or even what is legally suitable, the wise course would be to treat him/her in regard to the recognized standards of care. There should be no consideration of special needs of parents on behalf of their children or relatives on behalf of debilitated adults while awaiting dependable legal credentials to be availed. All in all, nurses should advice patients to look at their preferences in the light of likely unfavorable health effects (Kitahama et al., 2013).

A Plan of Action

As outlined by the nursing core values, patients have authority over their bodies and ought to be allowed to reject the medical practice they dislike, irrespective of the rationale behind their rejection, on condition that the refusal does not put others at risk (for instance, refusing treatment for greatly communicable and fatal illnesses). It does not matter whether the cause of refusing a medical procedure such as blood transfusion is cautious deliberation of the merits and drawbacks of the process, personal conviction, or religious belief, but the treatment of adult patients against their approval is a profound infringement of their rights. In this regard, the health profession initiated the process of risk/benefit analysis with the purpose of making it easy for caregivers to assist in the avoidance of blood transfusion in case a patient rejects it. Through this process, health professionals weigh aspects such as the side effects of a given drug or drawbacks of a surgical procedure and the anticipated gains. Medical professionals are in the best position of identifying such factors as one’s spiritual and psychological capacity, family financial ability, impact on the family, and personal morals (Narita et al., 2014).

The significance of blood transfusion in saving life cannot be underestimated (Narita et al., 2014). In early 2015, Brandon got the chance to meet with about forty individuals that had assisted in saving his life by donating blood at Ronald Reagan University of California Medical Center. He nearly lost his life after suffering a motorcycle accident and in endeavors of ensuring that he recuperates successfully, nurses and doctors at the health facility did all they could. When he met the donors, Brandon expressed his immense joy while sharing his experience with them. At one point, he warmly told them that a section of each of them is in him, something that has enabled him to live again. Perhaps Brandon would not be alive had he not receive blood from the donors. This evidence will assist in supporting my plan or confidential discussions with patients alone to offer the greatest influence in convincing even the followers of Jehovah’s Witnesses to undergo blood transfusion. This could be necessitated by the high rate of death for critically ill Jehovah’s Witnesses’ patients requiring blood transfusion when judged against other comparable patients at the organization.

A Jehovah’s Witness who undergoes a transfusion in secret (that is, devoid of the knowledge of the members of the family, pals, and other followers of the religion) cannot be assessed, or probable of being found out if he/she does not openly admit the occurrence. In this regard, I would convince the nurse manager in private to allow the nurses discuss the issue of blood transfusion secretly and if the patients insist on not permitting the process then an alternative procedure could be sought. In cases where patients allow transfusion, issues of religion or other reasons for initially refusing ought not to be revisited, and the nurse should go ahead and undertake the process. The health professional should do everything possible to uphold confidentiality, particularly if the patient insists so. Respecting the confidentiality of the patients will call for privacy from members of the family, friends, and other clinicians not directly involved in the process, especially the president and nurse manager at the organization. If achievable, the caregiver should privately check the treatment plan together with the patient (Narita et al., 2014).


Different reasons could result in a patient refusing blood transfusion. Some patients may refuse a medical process because of their ethnicity, religion, and dread of blood-borne infections. Amid the most evident cause of blood transfusion rejection are beliefs by a religion such as Jehovah’s Witnesses, where refusal intimidates the significance of such medical practices. Nonetheless, there is a negative emotional hazard to nurse as they watch the sick die from a simply preventable cause. As delineated by the nursing core values, patients have a right over decisions concerning their bodies and ought to be permitted to decline the medical practice they abhor, no matter the rationale behind their rejection, if the refusal does not put anyone at risk.



Binder, R. K., Barbanti, M., Ye, J., Toggweiler, S., Tan, J., Freeman, M. & Webb, J. G. (2014). Blood loss and transfusion rates associated with transcatheter aortic valve replacement: Recommendations for patients who refuse blood transfusion. Catheterization and Cardiovascular Interventions, 83(6), 221-226.

Garraud, O. (2014). Jehovah’s Witnesses and blood transfusion refusal: What next? Blood Transfusion, 12(1), 402.

Kitahama, S., Smith, M. D., Rosencrantz, D. R. & Patterson, E. J. (2013). Is bariatric surgery safe in patients who refuse blood transfusion? Surgery for Obesity and Related Diseases, 9(3), 390-394.

Narita, T., Hamano, I., Kusaka, A., Murasawa, H., Tokui, N., Imanishi, K. & Yoneyama, T. (2014). Surgery without blood transfusion for giant paraganglioma in a Jehovah’s Witness patient. Case reports in oncology, 7(1), 233-238.

Pattakos, G., Koch, C. G., Brizzio, M. E., Batizy, L. H., Sabik, J. F., Blackstone, E. H. & Lauer, M. S. (2012). Outcome of patients who refuse transfusion after cardiac surgery: A natural experiment with severe blood conservation. Archives of internal medicine, 172(15), 1154-1160.

Shander, A., Javidroozi, M., Naqvi, S., Aregbeyen, O., Çaylan, M., Demir, S. & Juhl, A. (2014). An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME). Transfusion, 54(10), 2688-2695.