Experience of nurses in the process of donation of organs and tissues for transplant

Barriers to Organ Donation: A Qualitative Study of Intensive Care Nurses' Experiences

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.

Nurses' Perspectives and Experiences Regarding Organ Transplantation in Turkey: A Qualitative Study

As professionals, nurses are often required to provide care for patients from different cultural and religious backgrounds during an organ transplantation process. It is therefore important to understand the views and experiences of nurses regarding the organ transplantation process. The aim of this study was to explore nurses' perspectives and experiences in providing care to donors and transplant recipients. In this descriptive qualitative study, semistructured in-depth interviews were conducted with 17 nurses in Turkey. The qualitative interviews were analyzed using thematic analysis. At the end of the study, four themes were represented: nurses' characteristics, nurses' roles and responsibilities, nurses' views on organ transplantation, and nurses' experiences with providing care. The results of the study revealed that nurses have positive and negative attitudes about organ transplantation, and they need education on this topic. In addition, considering the cultural factors and religious beliefs that prevent organ donation, cooperation between health professionals and religious authorities is necessary. Furthermore, support systems should be developed to reduce the problems that nurses face. The relevant authorities should collaborate to increase the number of donors by informing the public that the religious view is favorable to organ donation.

Edgework emotion management: A constructivist grounded theory of organ donation nurses' experiences and practices

AIMS AND OBJECTIVES

To explore nurses' experiences when approaching families for organ donation authorisation to guide nursing practice.

BACKGROUND

Organ donation after brainstem death implies that bereaved families are approached to discuss organ donation authorisation, and in many countries, specialist nurses do this approach. The literature describes the social, psychological and emotional challenges of health professionals in this role. However, lack of conceptual clarity regarding nurses' experiences on approaching families to guide nursing practice was found.

DESIGN

Constructivist grounded theory.

METHODS

Between October 2017 and July 2019, seven months of observations were conducted across two large public hospitals in Chile. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) with 71 participants (51 healthcare professionals and 20 bereaved families) were included. Data collection and analysis followed the principles and practices of Charmaz' constructivist grounded theory. The COREQ checklist was followed in reporting the study.

RESULTS

Edgework emotion management of organ donation nurses was developed as a threefold process: 1) being present to recognise inner and family emotions, 2) being on an emotional edge when approaching families and 3) extending the emotional edge to make sense of their experiences. The grounded theory was conceptualised using edgework emotion management by Lois (2003), which allowed to elucidate organ donation nurses' experiences and practices on managing their emotions.

CONCLUSIONS

Organ donation nurses develop a sophisticated and complex emotional regulation process to approach and care for families when negotiating organ donation authorisation for transplantation.

RELEVANCE TO CLINICAL PRACTICE

The experiences of specialist organ donation nurses entail a sophisticated emotion management process, which may explain the complexities of a critical role within healthcare institutions. Findings can be locally and internationally used to understand, educate and guide nursing practice, in an area of increasing specialisation and staffing shortages such as organ donation and transplantation.

Assessment of safety culture in organ donation

OBJECTIVES

To evaluate the perception of safety culture by health professionals who work with organ and tissue donation.

METHODS

A quantitative, descriptive study developed with 185 health professionals who act directly and indirectly with organ and tissue donation from two hospitals in the South of Brazil. The data collection was performed between January and July 2017 by using the Safety Attitudes Questionnaire. The analysis took place through descriptive statistics.

RESULTS

The mean score of the domains evaluated ranged from 41.6, for Perception of management of the unit, and 80.9 for Job satisfaction. Positive perception of safety culture in this study was evidenced only for Job satisfaction with a score higher than 75.

CONCLUSIONS

Of the six domains evaluated, only one had a positive score, evidencing the need to elaborate effective strategies for implanting safety culture in these institutions.

Grief, Stress, Trauma, and Support During the Organ Donation Process

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.

The impact of multi-organ procurement surgery in the nursing team: An Italian qualitative study

The removal of organs and tissues is characterized by a high level of stress and can be very traumatic for the nursing team. This study was informed by a grounded theory approach and was based on data drawn from two focus groups with 15 nurses. Main themes centered on factors that modulate the level of stress (first experiences, children donors, doubts about death, organizational factors), and coping strategies (including nurses' attitudes toward organ donation and training needs). There is a need to implement training for the stress management of the operating nurses and to provide supportive interventions.

Organ and Tissue Donations for Transplants in the Macroregional North of Paraná, Brazil

BACKGROUND

Few studies have analyzed the results of the organ and tissue donation process for transplants.

OBJECTIVES

To analyze donations of organs and tissues for transplants in the Macroregional North of Paraná.

MATERIAL AND METHODS

Cross-sectional and retrospective study, using data from 7383 death certificates of eligible donors notified in 2015 by 16 hospitals accredited to the Organ Procurement Organization. The data were analyzed using the prevalence ratio (PR) and the Wald test.

RESULTS

Among the 934 eligible donors, the prevalence of effective donations was 23.4% (219) Among the 582 organs and tissues donated, corneas were predominant. Organs became available for donation from younger individuals (PR = 0.992), due to brain death (PR = 2.482), notified by the type III Intra-Hospital Organ and Tissue Donation Commissions for Transplants (PR = 2.016), which took place in intensive care units (PR = 1.471). The relatives interviewed were the partners and/or children (PR = 0.469), and the interviews were held by the nurse (PR = 1.324).

CONCLUSION

Effective donations were able to take place through proper organizational structure and trained human resources, highlighting the role of the nurse in the optimization of the organ and tissue donation process for transplants.

Family Interview to Enable Donation of Organs for Transplantation: Evidence-based Practice

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.

Efetividade do processo de doação de órgãos para transplantes

Resumo Objetivo: Verificar a efetividade do processo de doação de órgãos para transplantes no Estado do Paraná. Métodos: Estudo transversal realizado com dados disponibilizados pelo Sistema Estadual de Transplantes do Paraná referentes ao processo de doação de órgãos, no período de 2011 a 2016. Das 3.872 notificações de potenciais doadores em morte encefálica, 2.600 foram incluídas neste estudo por se constituírem em doadores elegíveis de órgãos. Avaliou-se os desfechos dos protocolos e variáveis relacionadas aos doadores elegíveis, aos centros notificantes e às notificações. Os dados foram analisados descritivamente por frequências absolutas e relativas, e calculou-se odds ratio verificando-se a associação pelo teste de Qui-Quadrado de Wald, em que considerou-se p<0,05 como significância estatística. Resultados: Entre os 2.600 doadores elegíveis, 1.267 (48,7%) tornaram-se doadores efetivos de órgãos. Como principais obstáculos do processo destacaram-se a parada cardiorrespiratória, a sepse e a recusa familiar. As chances de efetivação da doação foram significativamente maiores nos indivíduos com menos de 60 anos (p<0,001), do sexo masculino (p=0,001) e notificados pelas Macrorregionais Leste e Oeste do Estado (p<0,001). O percentual de doações de órgãos aumentou de 38,8% para 66,5% no período estudado. Conclusão: O Paraná apresentou crescimento expressivo no número de notificações e doações de órgãos nos últimos seis anos. As fragilidades identificadas no processo se referiram às questões clínicas e culturais, que indicam a necessidade de intervenções gerenciais de capacitação dos profissionais de saúde na identificação e manutenção do potencial doador, bem como na sensibilização da sociedade quanto a importância do consentimento à doação.

Prototype of a computerized scale for the active search for potential organ donors

Objective:

to develop a prototype of a computerized scale for the active search for potential organ and tissue donors.

Method:

methodological study, with the analysis of 377 electronic medical records of patients who died due to encephalic death or cardiorespiratory arrest in the intensive care units of a tertiary hospital. Among the deaths due to cardiorespiratory arrest, the study aimed to identify factors indicating underreported encephalic death cases. The Acute Physiology and Chronic Health Evaluation II and Sepsis Related Organ Failure Assessment severity indexes were applied in the protocols. Based on this, a scale was built and sent to five experts for assessment of the scale content, and subsequently, it was computerized by using a prototyping model.

Results:

34 underreported encephalic death cases were identified in the medical records of patients with cardiorespiratory arrest. Statistically significant differences were found in the Wilcoxon test between the scores of hospital admissions in the intensive care unit and the opening of the encephalic death protocol for both severity indexes.

Conclusion:

the prototype was effective for identifying potential organ donors, as well as for the identification of the degree of organ dysfunction in patients with encephalic death.

Aproximación fenomenológica al significado e impacto de la donación de órganos en la familia

La donación de órganos es un acontecimiento crítico tras la pérdida de un ser querido. España, a pesar de ser el país del mundo con mayor tasa de donantes, todavía mantiene una negativa familiar del 15,56 % . Objetivos: conocer y analizar el impacto de la donación de órganos a través de los significados que tiene para la familia en el contexto español. Materiales y método: estudio cualitativo fenomenológico según el marco conceptual y método de Giorgi. Luego de respetar, al menos, tres años de duelo desde la pérdida de un ser querido, se entrevistaron en profundidad a once familias que donaron órganos en el Hospital La Fe en Valencia. Resultados: tras el análisis de los resultados, se describieron veintisiete unidades de significado que fueron clasificadas en relativos a la pérdida y relativos a la donación de órganos y, posteriormente, correlacionadas. Conclusiones: la donación aparece como mecanismo de alivio o compensación del fallecimiento del familiar.

Experiências e expectativas de enfermeiros no cuidado ao doador de órgãos e à sua família

RESUMO Objetivo Compreender as experiências e expectativas dos enfermeiros de unidades de terapia intensiva no cuidado ao doador de órgãos para transplantes e à sua família. Método Pesquisa qualitativa, com abordagem da Fenomenologia Social realizada em 2013, com 20 enfermeiros. Resultados As experiências dos enfermeiros com as famílias dos doadores foram representadas pelas categorias: obstáculos vivenciados e intervenções realizadas no cuidado às famílias dos doadores. As expectativas desses profissionais na assistência às famílias e aos doadores de órgãos foram descritas pela categoria: cuidar para salvar vidas. Conclusão O estudo mostrou que o cotidiano dos enfermeiros de terapia intensiva no cuidado às famílias e aos doadores de órgãos é permeado por obstáculos que interferem no processo de doação. Diante desse cenário têm como expectativas oferecer uma assistência intensiva ao doador falecido e um cuidado humanizado às famílias, intencionando possibilitar a aceitação da doação de órgãos pelos familiares e viabilizar órgãos para transplantes.