Deceased donor organ donation: The critical care nurse's role

Experiences of Intensive Care Unit Nurses in Caring for Brain-Dead Donors

Organ donation after brain death is an alternative to living organ donation, which has various risks and is a means of addressing organ supply shortages. In South Korea, primarily, the organ donation decision is made by the brain-dead donor's family under the guidance of medical staff. Intensive care unit nurses, who are consistently present with patients, can significantly influence families' decision-making process. Hence, nurses' experiences of caring for brain-dead donors should be explored to obtain detailed explanations of the related complex social phenomena. This qualitative study aimed to understand the structure and nature of nurses' experiences using Colaizzi's phenomenological method. Data were collected from 10 intensive care unit nurses from a hospital-based organ procurement organization between June 27 and September 10, 2022. Twelve themes and 5 components were identified from participants' interviews, including "nursing with regret," "enduring agony from repeatedly caring for deceased organ donors," "lack of a support system," "deep emotional pain and scarring left after care," and "balancing emotions." It is necessary to clarify the required nursing interventions and role of nurses in intensive care units who care for brain-dead donors and develop specific guidelines to assist them in their work.

The effectiveness of video training in improving intensive care nurses' knowledge about brain death identification

BACKGROUND

Because patients diagnosed with brain death in intensive care units constitute a potential cadaveric donor group for organ transplantation, intensive care units are potential donor sources. Nurses who closely monitor the patient collaborate with medical personnel in the recognition and early diagnosis of brain death. Nurses also have an important role in supporting the patient's family. Therefore, it is very important for nurses to know the diagnostic criteria for brain death.

AIM

The aim of this study was to compare the effectiveness of theoretical education and video-assisted education in equipping intensive care nurses to recognize brain death.

STUDY DESIGN

A randomized, experimental study was conducted between February and May 2020 with a total of 50 intensive care nurses, split into 25 in the video-assisted training group and 25 in the theoretical training group. In study, intensive care nurses were given a theoretical training and video-assisted training on brain death criteria. One group was trained theoretically and the other group used a video showing criteria for brainstem reflexes (pupil assessment, spontaneous breathing, corneal reflex, retching and coughing assessments) and deep tendon reflexes in a simulated patient, supported by animation. The data were collected before, immediately after and 3 months after the training using the Brain Death Criteria Knowledge Test, the Brain Death Case Test, and the Training Effectiveness Evaluation Form. The independent samples t-test, Mann-Whitney U test, Friedman test, Wilcoxon test, and Chi-square test were used for statistical analysis of data.

RESULTS

It was found that the knowledge scores of both groups immediately after training and 3 months after training were higher than before the training (p < .001). However, the post-training knowledge scores of the video-assisted training group were significantly higher than those of the theoretical training group (p = .011).

CONCLUSIONS

To enable intensive care nurses to identify brain death, video-assisted training with a simulated patient is recommended, as is repeating the training at regular intervals.

RELEVANCE TO CLINICAL PRACTICE

The simulated patient video-assisted training method can be used for in-service training to provide intensive care nurses with the ability to identify brain death. The training may be repeated at regular intervals (e.g., every 3 months) to increase nurse recall.

Intensive critical care nurses' with limited experience: Experiences of caring for an organ donor during the donation process

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.