Intensive care nurses also perceive that this uncertainty can affect relatives when the question of organ donation is raised, is reveiled in a thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden.
End-of-life care in an intensive care unit (ICU) also includes caring for patients who are brain dead and who by their death become potential organ donors. The thesis investigated attitudes and actions of ICU nurses in the context of organ donation. Information was gathered through both interviews and a questionnaires that went out to 1,100 ICU nurses in Sweden - around half of the total workforce.
The survey showed that less than half – 48 per cent – of ICU nurses perceive that solely clinical neurological examinations can be relied upon for determining that a patient is brain dead. Swedish regulations stipulate that physicians should perform certain clinical tests to establish that the person is deceased. Supplementary contrast x-ray of the brain is only performed in some circumstances, for example when the patient has been affected by medication.
The author of the thesis, Anne Flodén, a registered nurse and researcher at the Institute of Health and Care Sciences, is of the opinion that it is problematic if the nurses’ caring for these patients experience doubts about the reliability of the methods used to establish death. She believes that one explanation for their doubts could be that the concept of brain death challenges most of our preconceptions about death and dying. The deceased patient still has a heartbeat and the body is warm, but is, according to Swedish legislation, deceased.
“If you don’t perceive the patient as deceased it’s not surprising that you don’t see the possibility for organ donation.”
Respecting the wishes of the deceased patient was viewed as vital to the ICU nurses, irrespective of whether organs were to be donated or not. Supporting the family through the process and ensuring that the decision about donation reached by them was genuinely considered and taken of their own free will were also considered important.
“Nothing must go wrong” was an expression that came up time and time again, both in terms of the relation to the family and caring for a potential donor,” says Flodén.The nurses’ own thoughts on the diagnosis of brain death and organ donation were considered to be important, since nurses will act on the basis of their perceptions, consciously or subconsciously, and their perceptions could also affect the family’s attitude to organ donation.
“If a nurse is having doubts, this will be obvious to the family and could also trigger uncertainty in them,” says Flodén.
“The questionnaire also showed that 39 per cent of ICU nurses had been in situations where the question of organ donation had not been raised with close relatives as the situation was considered so emotionally delicate that it was felt to be inappropriate,” says Flodén.She is adamant that the responsibility does not lie with individual ICU nurses, but instead points to a need for a clear and supportive organisation and for guidelines for the entire donation process, particularly the early stages.
“This problem was raised by many of the ICU nurses in several of the studies,” says Flodén. “They were disappointed in the lack of structure and guidelines and are therefore calling for more support from management on these issues.”ORGAN DONATION
According to the Swedish Transplantation Act, the attitude of the deceased to donate organs is paramount. The wish to donate can be expressed through the donor registry, a donor card or verbally. The last expressed wish is valid. Consent is presumed in cases where the attitude of the deceased is unknown. In such cases, families are asked to interpret the wish of the deceased. Next of kin have the right to decline only in cases where the wish of the deceased is not known.
The thesis was successfully defended at 1 pm on Wednesday 8 June 2011 at Wallenbergsalen, Medicinaregatan 20 A, Gothenburg.For more information, please contact:
Doctoral thesis for the degree of PhD (Medicine) at the Institute of Health and Care Sciences, Sahlgrenska Academy.Journal: J Clin Nurs. 2011 May 12. doi: 10.1111/j.1365-2702.2011.03756.x.
New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM
A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
26.04.2017 | Materials Sciences
26.04.2017 | Agricultural and Forestry Science
26.04.2017 | Physics and Astronomy