# A nurse is caring for a competent adult patient who is refusing a blood transfusion due to religious beliefs, despite having a critically low hemoglobin level of 5.2 g/dL. The patient's family is pressuring the nurse to "do something" to save their loved one. What is the nurse's most appropriate action?

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> language: ko  
> subject: Critical Care

## 문제

A nurse is caring for a competent adult patient who is refusing a blood transfusion due to religious beliefs, despite having a critically low hemoglobin level of 5.2 g/dL. The patient's family is pressuring the nurse to "do something" to save their loved one. What is the nurse's most appropriate action?

## 보기

1. Respect the patient's autonomous decision and provide supportive care while documenting the refusal **✔ 정답**
2. Convince the patient to reconsider by explaining the serious medical consequences of refusing treatment
3. Consult with the family to override the patient's decision since they have the patient's best interests in mind
4. Contact the hospital ethics committee to make the decision for the patient

**정답: 1**

## 해설

Patient autonomy must be respected for competent adults making informed decisions, even if refusal leads to harm. Supportive care and documentation are key, while family pressure does not override patient rights.

## 심화 해설

Correct Answer: 1

The most appropriate nursing action is to respect the patient's autonomous decision and provide supportive care while documenting the refusal.

Rationale

This clinical scenario tests your understanding of ethical principles and legal obligations when a competent adult patient refuses life-saving treatment. The core issue here is the principle of autonomy, which is a foundational element of transcultural nursing and patient-centered care. A competent adult has the legal and ethical right to refuse any medical treatment, even if that refusal may result in death.

The provided research by Domaradzki et al. (2024) specifically examines the attitudes of future nurses toward the refusal of blood transfusions by Jehovah's Witnesses [1]. This study highlights that caring for patients who refuse blood products based on their religious beliefs is a classic and high-stakes transcultural nursing dilemma. The research underscores that quality care requires recognizing the significance of a patient's cultural and religious background, which directly informs their healthcare decisions [1].

In this situation, the patient's critically low hemoglobin of 5.2 g/dL creates a medical emergency, but it does not negate the patient's right to self-determination. The nurse's role is not to convince or coerce the patient, as this would violate the ethical principle of autonomy and could constitute battery if treatment were forced. Similarly, consulting with the family to override the patient's decision is legally and ethically incorrect. The patient, not the family, is the decision-maker. Contacting the ethics committee is a valid step for consultation in complex dilemmas, but its role is advisory, not to "make the decision for the patient." The immediate and most appropriate nursing action is to honor the competent patient's informed refusal, continue to provide supportive care that does not violate their religious beliefs, and meticulously document the refusal and the nurse's actions [1]. This approach aligns with the legal and ethical standards for professional nursing practice.References (research sources)

- [1]Cultural competences among future nurses and midwives: a case of attitudes toward Jehovah's witnesses' stance on blood transfusion.Case reportDomaradzki J, Głodowska K, Doron E, Markwitz-Grzyb N, Jabkowski P. (2024) · DOI: 10.1186/s12909-024-05646-1

## 임상 시나리오

Managing Life-Saving Treatment RefusalRespecting Autonomy in a Medical Emergency
The core principle is patient autonomy. A competent adult has the absolute right to refuse any treatment, even if the refusal leads to death. The nurse's primary role is to advocate for this right.

Immediate nursing actions include verifying the patient's decision-making capacity, ensuring they understand the risks (e.g., a hemoglobin of 5.2 g/dL is critically low), and confirming the refusal is voluntary. This is an informed refusal.

Documentation is critical. Record the patient's stated reason for refusal, the specific treatment refused, that education on risks and alternatives was provided, and the patient's continued competence. Have the patient sign an Against Medical Advice (AMA) form if applicable.

CautionNever coerce, pressure, or deceive the patient to change their mind. Administering blood against a competent patient's explicit refusal is battery and a serious legal violation. Family wishes do not override the patient's decision.

## 핵심 개념

- **Patient Autonomy** — The ethical and legal right of a competent adult to make their own decisions about medical treatment, including refusal, even if it results in death.
- **Informed Refusal** — A competent patient's decision to decline recommended medical treatment after being informed of the risks, benefits, and alternatives.
- **Battery** — Intentional and wrongful physical contact with a person without their consent; administering treatment against a patient's will constitutes battery.
- **Competence** — A patient's legal and clinical ability to understand relevant information, appreciate the situation and consequences, and communicate a choice.
- **Transcultural Nursing** — A nursing specialty focused on providing culturally congruent care that respects patients' cultural and religious beliefs, values, and lifeways.

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