The nurse is caring for a client who is a Jehovah’s Witness and is scheduled for hip replacement surgery. The client refuses to sign consent for blood due to religious reasons. The client’s daughter has the power of attorney in case the client is unable to state his wishes regarding health care. The daughter tells the nurse, “I’m afraid if something goes wrong, dad might need blood. I want to sign a blood consent form since I’m his power of attorney.” The daughter is not a Jehovah’s Witness. Which action by the nurse is the best in this situation?

  1. notify the charge nurse so that she can ask the night shift nurse to handle the situation
  2. go and get a blood consent form for the daughter to sign, noting that she has power of attorney over the client
  3. notify the surgeon that the client’s daughter has power of attorney and will be signing a blood consent form so that an order may be obtained for a type and cross
  4. remind the daughter that the client clearly does not wish to receive blood, and that a power of attorney cannot override client wishes that have been clearly stated when he was able to give or refuse consent
Number 4 is correct.
Rationale: The client has made his wishes known to the nurse by refusing to sign the consent for blood. Upon admission to the facility, all clients are asked about special religious beliefs that affect care. A power of attorney completed before the client arrives at the facility allows the client to personalize what he does not wish to have done, so he may refuse blood on the power of attorney and allow his daughter to make choices regarding artificial hydration or food, for example. The nurse has an ethical duty based on the principle of client autonomy to not knowingly act against client wishes, even if she does not agree with them. Notifying the charge nurse to let the night shift nurse address the issue does not solve the problem and is irresponsible. Getting a consent for the daughter to sign goes against client wishes, which were recorded upon admission. There is no need to notify the surgeon or to order a type and cross. To give blood to the client against his wishes is considered assault and battery and may result in legal action involving the health care providers, including the surgeon, nurse, and facility. Although the client presents himself as a Jehovah’s Witness, the nurse should still ask questions regarding transfusions, preferably out of the presence of friends or family members who may influence the client’s true wishes. HIPAA allows the nurse to ask others to leave the room during the questioning process if the client is able to communicate, thereby preserving his privacy.