1
|
Avilés L, Kean S, Tocher J. Ambiguous loss in organ donor families: A constructivist grounded theory. J Clin Nurs 2023; 32:6504-6518. [PMID: 36345135 DOI: 10.1111/jocn.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
AIMS AND OBJECTIVES Explore families' experiences when being approached for organ donation authorisation after brainstem death. BACKGROUND The complexities of potential organ donor families' experiences include challenges related to emotional distress, coping with the loss and the organ donation decision-making process, and support needed. A lack of conceptual clarity was found concerning families' experiences when being approached for organ donation authorisation, which guided the study. DESIGN Constructivist grounded theory. METHODS Seventy-one participants, including healthcare professionals and families, were recruited from two large hospitals in Chile between 2017 and 2019. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) were collected and analysed following Charmaz's constructivist grounded theory principles and practices until theoretical saturation was reached. The study is reported using the COREQ checklist. RESULTS A third type of ambiguous loss of bereaved families' experience was developed as a fourfold process: (1) impending loss, (2) confirming loss, (3) ambiguous loss and organ donation decision-making and (4) organ donation as a third type of ambiguous loss. This grounded theory expands the concepts of ambiguous loss by Boss, dying by Glaser and Strauss and grief by Brinkmann, enabling explanation of families' experiences. CONCLUSION Families of potential organ donors develop a highly complex grieving process, which may play a significant role in the organ donation decision-making process. Ambiguity is embedded in how donor families reframe the existence of the donor through the act of giving life. RELEVANCE TO CLINICAL PRACTICE The findings shed light on families' experiences on the organ donation process after brainstem death. The study can be used in nursing practice, education and to inform policy nationally and globally, mainly due to the current focus on quantitative measures and legislative changes fostering individual decision-making. PATIENT OR PUBLIC CONTRIBUTION Families contributed through their first-hand experiences of the organ donation process.
Collapse
Affiliation(s)
- Lissette Avilés
- Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Susanne Kean
- Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Jennifer Tocher
- Old Medical School, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Holthe E, Husby VS. Barriers to Organ Donation: A Qualitative Study of Intensive Care Nurses' Experiences. Dimens Crit Care Nurs 2023; 42:277-285. [PMID: 37523727 DOI: 10.1097/dcc.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND An increasing number of patients affected by organ failure can be treated with organ transplantation. The need for organs available for transplantation is critical and patients die while on the transplant list. Intensive care unit (ICU) nurses are essential in facilitating organ donation through their ceaseless bedside care for potential organ donors and their families. AIMS AND OBJECTIVES The aim of this study was to describe the challenges faced by ICU nurses in the organ donation process. DESIGN A descriptive qualitative study design was used. METHOD Semistructured individual interviews of 9 ICU nurses from 1 university hospital were performed. Data were analyzed using Malterud's systematic text condensation. RESULTS Three themes describe the core of the results: (1) practical tasks, (2) challenging care for the next of kin, and (3) ethical and emotional challenges. CONCLUSIONS Practical tasks represent challenges in the organ donation process that are not previously revealed. Actions to address these challenges should be prioritized to promote organ donation. Simulation-based training may optimize practical aspects of the organ donation process and implementation of simulation-based training should be assessed by future research.
Collapse
|
3
|
Coe D, Newell N, Jones M, Robb M, Clark N, Reaich D, Wroe C. NHS staff awareness, attitudes and actions towards the change in organ donation law in England-results of the #options survey 2020. Arch Public Health 2023; 81:88. [PMID: 37165463 PMCID: PMC10170439 DOI: 10.1186/s13690-023-01099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/28/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND In Spring 2020 there was a change in organ donation legislation in England (UK). Much is known about public opinions to organ donation and the change in legislation, however, there is little evidence about the opinions of the NHS workforce. This study set out to understand the levels of awareness, support and action of NHS staff to this change and explore the impact of respondent demographics, place and type of work on awareness, support and action. METHODS An online survey was offered to all NHS organisations in North Thames and the North East and North Cumbria through the NIHR Clinical Research Network between July and December 2020. Participating organisations were provided with an information package and promoted the survey via email and internal staff communications. Associations were compared univariately using chi-square tests and logistic regression was used for multivariable analysis to compare findings with NHS Blood and Transplant public Kantar survey data. RESULTS A total of 5789 staff participated in the survey. They were more aware, more supportive, more likely to have discussed their organ donation choices with family and more likely to be on the organ donor register than the public. This increased awareness and support was found across minority ethnic and religious groups. Those working in a transplanting centre were most aware and supportive and those working in the ambulance service were most likely to 'opt-in' following the change in legislation. CONCLUSIONS NHS staff in England were well informed about the change in organ donation legislation and levels of support were high. NHS staff were six times more likely than the public to have a conversation with their family about their organ donation choices. The size and ethnic diversity of the NHS workforce offers an opportunity to enable and support NHS staff to be advocates for organ donation and raise awareness of the change in legislation amongst their communities.
Collapse
Affiliation(s)
- Dorothy Coe
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Natalie Clark
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - David Reaich
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Caroline Wroe
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| |
Collapse
|
4
|
Facial Allograft Donation: An Interpretative Phenomenological Analysis of the Experiences of Family Members. J Craniofac Surg 2023; 34:942-948. [PMID: 36744885 DOI: 10.1097/scs.0000000000009156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/24/2022] [Indexed: 02/07/2023] Open
Abstract
Facial allograft transplantation can be regarded as a particular and complex type of donation because of its perceptibility and the importance of the face as an identity characteristic. As research on this topic is currently lacking, the objective of this study is to explore the experiences of the family members of the donor in facial allograft donation. In-depth, semi-structured interviews were conducted separately with the donor's family members and analyzed using interpretative phenomenological analysis. Six themes were identified: (1) Contrasting facial donation to that of more commonly donated organs; (2) Consenting to facial donation; (3) Expectations towards the recipient of the facial graft; (4) Expectations and consequences of restoration of the donor's face; (5) Relationship with the medical team during the process; and (6) Media attention. The findings of our study help to better support donor families through the facial donation process and to improve facial transplantation procedures.
Collapse
|
5
|
Bjelland S, Jones K. A Systematic Review on Improving the Family Experience After Consent for Deceased Organ Donation. Prog Transplant 2022; 32:152-166. [DOI: 10.1177/15269248221087429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The demand for transplanted organs outweighs the supply and intensifies the need to improve care for donor families. Studies have shown inadequate care by hospital staff can increase posttraumatic stress disorder and complicated grief in these families but putting solutions into practice remains slow. Objective This systematic review identified factors that relieve or contribute to distress for deceased organ donor families in the time since the decision to donate. Additionally, it provides insights into potential improvements at public health, educational, and health system levels to address these deficiencies. Methods Search terms included organ don*, famil* or relati*, family-centered, grief, and experience*. The search covered original research articles, published in English, from 2014 to July 2021. Results Four key themes emerged among the studies. (a) Understanding factors that affect the emotional aftermath can help staff prevent posttraumatic stress disorder and complicated grief. (b) Improving communication by hospital staff includes: avoiding medical jargon, providing adequate audio and visual explanations, and understanding that the next of kin is struggling to comprehend the tragedy and the information they are being told. (c) End-of-life care such as memory making, bringing in palliative care resources, and parting ceremonies can assist with familial coping as well as staff interactions. (d) Families want more support in the months and years after the donation decision. Discussion Changes at multiple levels can improve the quality of care for families whose relative gave the gift of life, but more research and translation into practice are needed.
Collapse
Affiliation(s)
- Sonja Bjelland
- University of Illinois at Chicago College of Nursing, Urbana, IL, USA
| | - Krista Jones
- Department of Population Health Nursing Science, University of Illinois at Chicago College of Nursing, Urbana, IL, USA
| |
Collapse
|
6
|
Ma J, Zeng L, Li T, Tian X, Wang L. Experiences of Families Following Organ Donation Consent: A Qualitative Systematic Review. Transplant Proc 2021; 53:501-512. [PMID: 33483168 DOI: 10.1016/j.transproceed.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This systematic review synthesizes qualitative evidence on the experiences of donor families after consent to organ donation. METHODS This robust, qualitative systematic review included an exhaustive search of electronic databases, including PubMed, Scopus, EBSCO PsycINFO, and CINAHL Complete. Manual searches of reference lists and gray literature were conducted to achieve a comprehensive identification of all relevant research. A qualitative study design served to capture the experiences of donor families after organ donation consent. RESULTS A total of 6 articles that met the eligibility criteria were identified and included in this review. Three key themes emerged from the primary research: 1. family members were ambivalent about consent due to the ambiguity of brain death; 2. conversations about donation requirements proved uncomfortable; and 3. support is needed after donation. CONCLUSIONS Family members demonstrated ongoing ambivalence and distress that lasted for weeks after organ donation due to the ambiguity of brain death. Some family members were unhappy with having been approached for a conversation about organ donation. Donor families were not always able to deal with the difficulties they faced after their decision about organ donation. Health care professionals should provide ongoing care and updated information to family members. This review helped to identify family members' needs for both psychological and financial assistance.
Collapse
Affiliation(s)
- Juanjuan Ma
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Li Zeng
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China.
| | - Tingjun Li
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Xiaofei Tian
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Wang
- Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| |
Collapse
|
7
|
Kerstis B, Widarsson M. When Life Ceases-Relatives' Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor-A Literature Review. SAGE Open Nurs 2021; 6:2377960820922031. [PMID: 33415278 PMCID: PMC7774436 DOI: 10.1177/2377960820922031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/26/2020] [Accepted: 04/04/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Most healthcare professionals rarely experience situations of a request for organ donation being made to the patient's family and need to have knowledge and understanding of the relatives' experiences. Objective To describe relatives' experiences when a family member is confirmed brain dead and becomes a potential organ donor. Methods A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019. Results The overarching theme When life ceases emerged as a description of relatives' experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss. Conclusion Caring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives' processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.
Collapse
Affiliation(s)
- Birgitta Kerstis
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Margareta Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| |
Collapse
|
8
|
Chan HY. Remapping the organ donation ethical climate: a care ethics consideration. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:295-308. [PMID: 31811525 DOI: 10.1007/s11019-019-09934-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.
Collapse
|
9
|
Cignarella A, Redley B, Bucknall T. Organ donation within the intensive care unit: A retrospective audit. Aust Crit Care 2020; 33:167-174. [DOI: 10.1016/j.aucc.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022] Open
|
10
|
Simonsson J, Keijzer K, Södereld T, Forsberg A. Intensive critical care nurses' with limited experience: Experiences of caring for an organ donor during the donation process. J Clin Nurs 2020; 29:1614-1622. [PMID: 31971283 DOI: 10.1111/jocn.15195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/28/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe how intensive critical care nurses, whose experience is limited, experience caring for an organ donor during the donation process. BACKGROUND Intensive critical care nurses are involved in the care of organ donors and their relatives. This may be challenging and evoke a sense of providing an inhumane care. Few studies have explored how intensive critical care nurses whose experience is limited experience caring for an organ donor during the donation process. DESIGN An interview study with an inductive qualitative approach was conducted. The study was reported according to COREQ guidelines. METHODS This study was performed during 2019. Participants were intensive critical care nurses (n = 7) from different hospitals (n = 4) with <3 years of experience and involvement in the donation process at least once but no more than three times. Data were analysed using qualitative content analysis. FINDINGS Five categories emerged: the donation process is emotionally challenging; supporting relatives is an essential but demanding task; a complex and multifaceted process involving a high level of responsibility; needing appropriate prerequisites in the form of education and collegial support; and providing a dignified care based on respect for the organ donor. CONCLUSIONS Having limited experience as an intensive critical care nurse may not automatically mean that caring for an organ donor is experienced as more challenging than it is for a more-experienced colleague. However, certain intensive critical care nurses whose experience caring for an organ donor is limited found it to be highly demanding due to its complexity, specifically in regard to informing relatives of the loss of their loved one and providing them with support. RELEVANCE TO CLINICAL PRACTICE Our study revealed a need for further education. This need could be met by simulation tasks during the specialist education in intensive critical care nursing, where primarily ethical aspects and strategies for meeting with and supporting relatives should be examined and practiced.
Collapse
Affiliation(s)
- Johan Simonsson
- Intensive Care Unit, Karolinska Institutet, Stockholm, Sweden
| | - Karl Keijzer
- Intensive Care Unit, Östersund Hospital, Östersund, Sweden
| | - Theres Södereld
- Intensive Care Unit, Sunderby Hospital, Luleå, Sweden.,Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Angelica Forsberg
- Intensive Care Unit, Sunderby Hospital, Luleå, Sweden.,Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| |
Collapse
|
11
|
Dicks SG, Burkolter N, Jackson LC, Northam HL, Boer DP, van Haren FM. Grief, Stress, Trauma, and Support During the Organ Donation Process. Transplant Direct 2020; 6:e512. [PMID: 32047840 PMCID: PMC6964929 DOI: 10.1097/txd.0000000000000957] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022] Open
Abstract
The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.
Collapse
Affiliation(s)
- Sean G. Dicks
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
| | | | | | - Holly L. Northam
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Douglas P. Boer
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Frank M.P. van Haren
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
- School of Medicine, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
12
|
Drexler S, Kugler C, Farin E. Care of (potentially) brain-dead patients: A qualitative study protocol. J Adv Nurs 2019; 75:3105-3110. [PMID: 31236999 DOI: 10.1111/jan.14139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022]
Abstract
AIM Aim of this study was to describe the experiences of intensive care unit (ICU) nurses, physicians and relatives of (potentially) brain dead patients; and to develop recommendations to optimize the workflows on ICUs. BACKGROUND Limited published information on caring for brain dead patients suggest it to be a burden for the nursing staff. It also remains unclear how physicians and relatives of (potentially) brain dead patients perceive these experiences. DESIGN Interpretive phenomenology according to Benner. METHODS Medical caregivers (nurses' und physicians) from multiple wards in a German University Medical Center and relatives of (potentially) brain dead patients will be interviewed. Data collection will include episodic interviews with participants' experiences in care of (potentially) brain dead patients. The study is funded by the Ministry of Science, Research and the Arts, Baden-Württemberg (1 February 2016). DISCUSSION Gaining insights into caring for (potentially) brain dead patients and its associated burden will lead to the development of better recommendations to assist all people involved. IMPACT Expand the understanding of the experience of healthcare professionals in the care for (potentially) brain dead patients. Understand the experience of relatives of (potentially) brain dead patients. Findings from this study will support the development of recommendations for action by a multi-professional expert group consisting of nurses, physicians, healthcare managers and patient advocates. TRIAL REGISTRATION Protocol version. German Register for Clinical Studies (Registration No. DRKS00010420) Database of Health Services Research Germany (Project Nr. VfD_16_003710).
Collapse
Affiliation(s)
- Sabine Drexler
- Section of Health Care Research and Rehabilitation Research, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.,Department for Nursing Science, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Christiane Kugler
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
13
|
Poppe C, Akum S, Crombez G, Rogiers X, Hoste E. Evaluation of the quality of the communication and emotional support during the donation procedure: The use of the donor family questionnaire (DFQ). J Crit Care 2019; 53:198-206. [PMID: 31271955 DOI: 10.1016/j.jcrc.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/26/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE A multi-centric study in Intensive Care units (ICU) and Emergency departments (ED) was designed to evaluate whether the provided communication and emotional support to the family in the context of organ donation met the international recommendations of the European Donor Hospital Education Program (EDHEP). MATERIALS AND METHODS Using a participatory approach and focus groups, a questionnaire was constructed: Donor Family questionnaire (DFQ). The questionnaire was distributed to 203 families. The data were analysed on item level. RESULTS Sixty-four families participated, and 89% considered the communication as tactful. Only 24.1% had a separate conversation about passing and donation, which is the recommendation. 88.5% reported they could count on emotional support in the first phase on the ICU/ED. This dropped during the parting phase and the aftercare. The physician is perceived as the most active caregiver in the emotional support during the entire procedure. CONCLUSIONS The DFQ is a useful instrument to evaluate the donor procedure. The physician is important in the first phases of the donor procedure for the medical explanation. Other disciplines could be more involved in the following phases to assure enough emotional support, but this issue requires further exploration.
Collapse
Affiliation(s)
- Carine Poppe
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium.
| | - Sandra Akum
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium
| | - Geert Crombez
- Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Xavier Rogiers
- Department of Hepato-billiary surgery, Ghent University, Belgium
| | - Eric Hoste
- Departement of Intensive care Medicine, Belgium and Research Foundation-Flanders, Ghent University, Brussels, Belgium
| |
Collapse
|
14
|
Smith Z. Perioperative nurses' experiences of caring for donation after cardiac death organ donors and their family within the operating room. J Perioper Pract 2019; 30:69-78. [PMID: 31081736 DOI: 10.1177/1750458919850729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Worldwide, operating rooms have seen the re-emergence of donation after cardiac death organ donors to increase the number of available organs. There is limited information on the issues perioperative nurses encounter when caring for donor patients after cardiac death who proceed to organ procurement surgery. Objectives The purpose of this paper is to report a subset of findings derived from a larger study highlighting the difficulties experienced by perioperative nurses when encountering donation after cardiac death organ donors and their family within the operating room during organ procurement surgery from an Australian perspective. Methods A qualitative grounded theory method was used to explore perioperative nurses’ (n = 35) experiences of participating in multi-organ procurement surgery. Results This paper reports a subset of findings of the perioperative nurses’ experiences directly related to donation after cardiac death procedures drawn from a larger grounded theory study. Participants revealed four aspects conceptualised as: ‘witnessing the death of the donation after cardiac death donor’; ‘exposure to family’; ‘witnessing family grief’ and ‘stepping into the family’s role by default’. Conclusion Perioperative nurses’ experiences with donation after cardiac death procedures are complex, challenging and demanding. Targeted support, education and training will enhance the perioperative nurses’ capabilities and experiences of caring for the donation after cardiac death donor and their family with the operating room context.
Collapse
Affiliation(s)
- Zaneta Smith
- Faculty of Medicine & Health, School of Health, University of New England, Armidale, Australia
| |
Collapse
|
15
|
Jensen AMB, Larsen JB. The public debate on organ donation and presumed consent in Denmark: Are the right issues being addressed? Scand J Public Health 2019; 48:480-485. [PMID: 30973069 DOI: 10.1177/1403494819833797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The legal framework for organ donation in Denmark is informed consent. But due to the unsatisfactory number of organ donors, Denmark is considering changing legislation to presumed consent. This article discusses the public debate on organ donation and presumed consent in Denmark, and asks whether the right issues are being addressed in the quest towards more available organs and better donor rates? Basing our considerations on the various arguments in the debate and on scientific findings, we question the potential benefits of presumed consent and challenge some of the assumptions and rationalizations that characterize the discussions in Denmark regarding public support, public trust and the role of the family in donation decisions.
Collapse
Affiliation(s)
- Anja M B Jensen
- Centre for Medical Science and Technology Studies, University of Copenhagen, Denmark
| | - Johanne Bjørg Larsen
- Centre for Medical Science and Technology Studies, University of Copenhagen, Denmark
| |
Collapse
|
16
|
Tatterton MJ, Summers R, Brennan CY. A qualitative descriptive analysis of nurses' perceptions of hospice care for deceased children following organ donation in hospice cool rooms. Int J Palliat Nurs 2019; 25:166-175. [PMID: 31013194 DOI: 10.12968/ijpn.2019.25.4.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Following organ donation, bodies of children are generally cared for in hospital mortuaries or by funeral directors, and their families are offered little routine bereavement support. A partnership between an organ donation nursing team and regional children's hospice trialled an initiative where families were offered bereavement support from the hospice, and their child's body was cared for in a 'cool room' after death. Hospice services are usually restricted to children with life-limiting conditions, and their families. OBJECTIVE To explore the perceptions and experience of nursing staff who are involved in supporting families of children and young people who have been cared for in children's hospice cool rooms after death, following organ donation. DESIGN A qualitative exploratory study consisting of a focus group interview with registered nurses from the children's hospice and organ donation teams. METHOD A purposeful sample of nurses was recruited. Data were collected in a digitally-recorded focus group interview during March 2018. The interview was transcribed and analysed using a qualitative content approach. RESULTS Six nurses participated in the focus group. Analysis revealed five themes that characterised the perceptions of nurses: (i) barriers to care, (ii) bereavement care for families, (iii) impact on families and staff, (iv) influencers and enablers of change, and (v) sustainability of new practices. CONCLUSION Nurses perceived the long-term, responsive and family-centred approach to bereavement support as a strength of the hospice model, reducing the experience of moral distress in organ donation nurses.
Collapse
Affiliation(s)
- Michael J Tatterton
- Consultant Nurse/Head of Nursing, Martin House Children's Hospice, Wetherby, UK
| | - Rachel Summers
- Specialist Nurse Organ Donation, Yorkshire Organ Donation Services Team, NHS Blood and Transplant, Leeds, UK
| | | |
Collapse
|
17
|
A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation. Can J Anaesth 2019; 66:686-695. [PMID: 30809778 DOI: 10.1007/s12630-019-01332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/23/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Rates of organ donation vary between otherwise comparable intensive care units (ICUs) suggesting that the process of donation must vary between ICUs. The purpose of this study was to describe the process of organ donation from the perspective of ICU staff, identify important drivers of successful donation, and develop strategies to improve the process of donation. METHODS We conducted qualitative interviews with 32 ICU staff, including physicians, nurses, and respiratory therapists, using an interview guide developed from previous studies on organ donation. Using a qualitative descriptive approach, we coded interviews using qualitative content analysis. We integrated findings from the interviews in a mixed-methods analysis with previously published data from a document analysis and cross-sectional survey to identify practices that may enhance organ donation in the ICU. RESULTS Five major themes important to the organ donation process emerged from the interviews: i) staff relationship with organ donation coordinators; ii) standardized processes; iii) ICU staff beliefs; iv) integration of donation and high quality end-of-life care; v) feedback and staff support. In the mixed-methods analysis, we identified 22 actionable practices to enhance the process of organ donation in the ICU. CONCLUSION Incorporating the perspectives of ICU staff, we were able to identify 22 practice changes that may have a significant cumulative impact on donation outcomes. Future research is required to evaluate whether these findings account for the variability of donation rates between otherwise comparable ICUs.
Collapse
|
18
|
Gyllström Krekula L, Forinder U, Tibell A. What do people agree to when stating willingness to donate? On the medical interventions enabling organ donation after death. PLoS One 2018; 13:e0202544. [PMID: 30142168 PMCID: PMC6108459 DOI: 10.1371/journal.pone.0202544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/06/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose of the study The purpose of this study is to explore donor relatives’ experiences of the medical interventions enabling organ donation, as well as to examine the donor relatives’ attitudes towards donating their own organs, and whether or not their experiences have influenced their own inclination to donate. Methods The experiences of donor relatives were explored via in-depth interviews. The interviews covered every step from the deceased family member being struck by a severe bleeding in the brain till after the organ recovery, including the medical interventions enabling organ donation. The interviews were analysed through qualitative and quantitative content analysis. Results Brain death and organ donation proved to be hard to understand for many donor relatives. The prolonged interventions provided after death in order to enable organ donation misled some relatives to believe that their family member still was alive. In general, the understanding for what treatment aimed at saving the family member and what interventions aimed at maintaining organ viability was low. However, most donor relatives were either inspired to, or reinforced in their willingness to, donate their own organs after having experienced the loss of a family member who donated organs. Conclusions There is a need for greater transparency regarding the whole chain of events during the donation process. Yet, having experienced the donation process closely did not discourage the donor relatives from donating their own organs–but rather inspired a willingness to donate. This indicates an acceptance of the medical procedures necessary in order to enable organ donation after death.
Collapse
Affiliation(s)
- Linda Gyllström Krekula
- Function area—Social Work in Health Care, Karolinska University Hospital, Stockholm, Sweden, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Ulla Forinder
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; University of Gävle, Department of Social Work and Psychology, Gävle, Sweden
| | - Annika Tibell
- Program Management Office (PMO), New Karolinska, Karolinska University Hospital, Stockholm, Sweden, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Roque R, Rodríguez-Villar C, Ruíz A, Paredes D, Gelpi R, Rodríguez S, García FJ, Adalia R. Relatives' Perception After Tissue Donation Experience: Results of a Postdonation Phone Survey. Transplant Proc 2018; 49:2296-2298. [PMID: 29198664 DOI: 10.1016/j.transproceed.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postmortem tissue donation (TD) requires the establishment of strategies for family approach to clearly explain the characteristics of multi-tissue donation. In a tertiary university hospital with a long tradition of tissue generation, we designed a survey to be applied to tissue donor families to evaluate global hospital care, care from Transplant Coordinators (TC), quality and content of information given about TD, experience, and motivations after TD process. METHODOLOGY A prospective phone survey of 10 multiple-choice items was conducted to all TD relatives that agreed to donate one or more tissues. RESULTS From the 166 calls made to TD relatives, 75 (45%) were answered: 50 were cornea donors and 25 were multiple-tissues donors. None of the relatives denied participating, the rest were not found. No statistical differences in demographical variables were found between both types of TD. The hospital and TC care perception, the quality of the given information about the processes of TD, the postdonation experiences in terms of procedures, and the impression about body appearance for relatives regardless of the type of donation, corneas or multiple tissues, were evaluated as good or very good for most of the TD relatives. Our study showed that 83% of the family members would agree to donate again; 40% of the relatives were surprised to be offered the option to donate; 10% did not know if they would donate again. Solidarity was the leading reason for TD. CONCLUSION The relatives' perception of care is a critical component of the quality evaluation of the TD process. The global evaluation results support our strategies for family approach.
Collapse
Affiliation(s)
- R Roque
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain.
| | - C Rodríguez-Villar
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Ruíz
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - D Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - R Gelpi
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - S Rodríguez
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - F J García
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - R Adalia
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Organ donation in the ICU: A document analysis of institutional policies, protocols, and order sets. Intensive Crit Care Nurs 2018; 45:58-65. [DOI: 10.1016/j.iccn.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/07/2017] [Accepted: 12/17/2017] [Indexed: 11/20/2022]
|
21
|
de Moraes EL, Dos Santos MJ, de Barros E Silva LB, de Lima Pilan LAS, de Lima EAA, de Santana AC, Martins MS. Family Interview to Enable Donation of Organs for Transplantation: Evidence-based Practice. Transplant Proc 2018; 50:705-710. [PMID: 29571742 DOI: 10.1016/j.transproceed.2018.02.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In this study we propose a theoretical and practical basis for the best practices for interviewing relatives of brain-dead eligible organ donors. METHODS This investigation was a reflective study of the methodologic factors of the family interview that affect their decision regarding the donation of a deceased patient's organs for transplantation. The articles that formed the empirical basis of the trial were obtained from PubMed, which is a free-access tool of the MEDLINE database of the United States National Library of Medicine. Published articles that allowed us to reflect on evidence-based family interview practice were selected. RESULTS Thirty-six scientific articles were used to guide our assessment the family interview, providing evidence for its adequate execution in view of the following prerequisites: When should the family interview be performed? Where should it be done? How many and which people should participate in the interview? Who should perform it? How should it be done? CONCLUSION Scientific studies offer evidence to donation and transplantation specialists that can help them in their daily work regarding their interactions with relatives in the process of decisionmaking and family consent.
Collapse
Affiliation(s)
- E L de Moraes
- Department of Professional Orientation, Nursing School, University of São Paulo, São Paulo, Brazil.
| | - M J Dos Santos
- Department of Professional Orientation, Nursing School, University of São Paulo, São Paulo, Brazil
| | - L B de Barros E Silva
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - L A S de Lima Pilan
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - E A A de Lima
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - A C de Santana
- Organ Procurement Organization, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M S Martins
- Adventist University Center, São Paulo, Brazil
| |
Collapse
|
22
|
Bereaved donor families' experiences of organ and tissue donation, and perceived influences on their decision making. J Crit Care 2018; 45:82-89. [PMID: 29413728 DOI: 10.1016/j.jcrc.2018.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To elicit bereaved families' experiences of organ and tissue donation. A specific objective was to determine families' perceptions of how their experiences influenced donation decision-making. METHODS Retrospective, qualitative interviews were undertaken with 43 participants of 31 donor families to generate rich, informative data. Participant recruitment was via 10 National Health Service Trusts, representative of five regional organ donation services in the UK. Twelve families agreed to DBD, 18 agreed to DCD, 1 unknown. Participants' responses were contextualised using a temporal framework of 'The Past', which represented families' prior knowledge, experience, attitudes, beliefs, and intentions toward organ donation; 'The Present', which incorporated the moment in time when families experienced the potential for donation; and 'The Future', which corresponded to expectations and outcomes arising from the donation decision. RESULTS Temporally interwoven experiences appeared to influence families' decisions to donate the organs of their deceased relative for transplantation. CONCLUSIONS The influence of temporality on donation-decision making is worthy of consideration in the planning of future education, policy, practice, and research for improved rates of family consent to donation.
Collapse
|
23
|
Dicks SG, Ranse K, Northam H, van Haren FMP, Boer DP. A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study. Health Psychol Open 2018; 5:2055102917753706. [PMID: 29399367 PMCID: PMC5788101 DOI: 10.1177/2055102917753706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of 'communication' between researchers contributes to information being 'lost' and then later 'rediscovered'. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.
Collapse
Affiliation(s)
| | | | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University, Australia
| | | |
Collapse
|
24
|
Dicks SG, Ranse K, Northam H, Boer DP, van Haren FM. The development of a narrative describing the bereavement of families of potential organ donors: A systematic review. Health Psychol Open 2017; 4:2055102917742918. [PMID: 29379629 PMCID: PMC5779939 DOI: 10.1177/2055102917742918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.
Collapse
Affiliation(s)
| | | | | | | | - Frank Mp van Haren
- University of Canberra, Australia.,Australian National University, Australia
| |
Collapse
|
25
|
Syversen TB, Sørensen DW, Foss S, Andersen MH. Donation after circulatory death - an expanded opportunity for donation appreciated by families. J Crit Care 2017; 43:306-311. [PMID: 28968526 DOI: 10.1016/j.jcrc.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Torgunn Bø Syversen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Dag Wendelbo Sørensen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Stein Foss
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Marit Helen Andersen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| |
Collapse
|
26
|
Fernandes MEN, Bittencourt ZZLDC, Boin IDFSF. Experiencing organ donation: feelings of relatives after consent. Rev Lat Am Enfermagem 2017; 23:895-901. [PMID: 26487140 PMCID: PMC4660412 DOI: 10.1590/0104-1169.0486.2629] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 04/11/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: to identify experiences and feelings on the organ donation process, from the
perspective of a relative of an organ donor in a transplant unit. Method: this was exploratory research using a qualitative approach, performed with seven
family members of different organ donors, selected by a lottery. Sociodemographic
data and the experiences regarding the donation process were collected through
semi-structured interviews. The language material was transcribed and submitted to
content analysis. Results: poor sensitivity of the medical staff communicating the relative's brain death -
the potential donor - and the lack of socio-emotional support prior to the
situation experienced by the family was highlighted by participants. Conclusions: the study identified the need to provide social-emotional support for families
facing the experience of the organ donation process. From these findings, other
care and management practices in health must be discussed to impact the
strengthening of the family ties, post-donation, as well as the organ procurement
indexes.
Collapse
|
27
|
Ahmadian S, Rahimi A, Khaleghi E. Outcomes of organ donation in brain-dead patient's families: Ethical perspective. Nurs Ethics 2017; 26:256-269. [DOI: 10.1177/0969733017703696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. Objective: The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. Methods: This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. Findings: The main category of the data was “Decision to organ donation: a challenge from conflict to transcendence.” This main category consisted of 10 subcategories and 3 general categories. The general categories were “challenging outcomes,” “reassuring outcomes,” and “transcending outcomes.” Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Conclusion: Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.
Collapse
|
28
|
Marck CH, Neate SL, Skinner M, Dwyer B, Hickey BB, Radford ST, Weiland TJ, Jelinek GA. Potential donor families' experiences of organ and tissue donation-related communication, processes and outcome. Anaesth Intensive Care 2016; 44:99-106. [PMID: 26673595 DOI: 10.1177/0310057x1604400115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to describe the experiences of families of potential organ and tissue donors eligible for donation after circulatory death or brain death. Forty-nine family members of potential donors from four Melbourne hospitals were interviewed to assess their experiences of communication, processes and the outcomes of donation. Interviews were recorded, transcribed verbatim and analysed thematically. Families expressed a range of perspectives on themes of communication, hospital processes and care, the processes of consent and donation and reflected on decisions and outcomes. They expressed satisfaction overall with communication when receiving bad news, discussing death and donation. Honest and frank communication and being kept up-to-date and prepared for potential outcomes were important aspects for families, especially those of post circulatory death donors. Participants reported high levels of trust in healthcare professionals and satisfaction with the level of care received. Many donor families indicated the process was lengthy and stressful, but not significantly enough to adversely affect their satisfaction with the outcome. Both the decision itself and knowing others' lives had been saved provided them with consolation. No consenting families, and only some non-consenting families, regretted their decisions. Many expressed they would benefit from a follow-up opportunity to ask questions and clarify possible misunderstandings. Overall, while experiences varied, Australian families valued frank communication, trusted health professionals, were satisfied with the care their family member received and with donation processes, despite some apparent difficulties. Family satisfaction, infrequently assessed, is an important outcome and these findings may assist education for Australian organ donation professionals.
Collapse
Affiliation(s)
- C H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| | - S L Neate
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria
| | - M Skinner
- DonateLife Victoria, Melbourne, Victoria
| | - B Dwyer
- Organ and Tissue Authority, Canberra, Australian Capital Territory
| | - B B Hickey
- Intensive Care unit, St Vincent's Hospital, Melbourne, Victoria
| | - S T Radford
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria
| | - T J Weiland
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| | - G A Jelinek
- Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| |
Collapse
|
29
|
Mills L, Koulouglioti C. How can nurses support relatives of a dying patient with the organ donation option? Nurs Crit Care 2015; 21:214-24. [DOI: 10.1111/nicc.12183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/16/2015] [Accepted: 03/27/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Leanne Mills
- Goring Hall Hospital - BMI Healthcare; Worthing UK
| | - Christina Koulouglioti
- Research and Innovation Department; Western Sussex Hospitals NHS Foundation Trust; Worthing UK
| |
Collapse
|