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.
Observing the cell's protein factories during self-assembly
15.06.2018 | Charité - Universitätsmedizin Berlin
Scientists unravel molecular mechanisms of Parkinson's disease
13.06.2018 | The Francis Crick Institute
Moving into its fourth decade, AchemAsia is setting out for new horizons: The International Expo and Innovation Forum for Sustainable Chemical Production will take place from 21-23 May 2019 in Shanghai, China. With an updated event profile, the eleventh edition focusses on topics that are especially relevant for the Chinese process industry, putting a strong emphasis on sustainability and innovation.
Founded in 1989 as a spin-off of ACHEMA to cater to the needs of China’s then developing industry, AchemAsia has since grown into a platform where the latest...
The BMBF-funded OWICELLS project was successfully completed with a final presentation at the BMW plant in Munich. The presentation demonstrated a Li-Fi communication with a mobile robot, while the robot carried out usual production processes (welding, moving and testing parts) in a 5x5m² production cell. The robust, optical wireless transmission is based on spatial diversity; in other words, data is sent and received simultaneously by several LEDs and several photodiodes. The system can transmit data at more than 100 Mbit/s and five milliseconds latency.
Modern production technologies in the automobile industry must become more flexible in order to fulfil individual customer requirements.
An international team of scientists has discovered a new way to transfer image information through multimodal fibers with almost no distortion - even if the fiber is bent. The results of the study, to which scientist from the Leibniz-Institute of Photonic Technology Jena (Leibniz IPHT) contributed, were published on 6thJune in the highly-cited journal Physical Review Letters.
Endoscopes allow doctors to see into a patient’s body like through a keyhole. Typically, the images are transmitted via a bundle of several hundreds of optical...
Light detection and control lies at the heart of many modern device applications, such as smartphone cameras. Using graphene as a light-sensitive material for...
Water molecules exist in two different forms with almost identical physical properties. For the first time, researchers have succeeded in separating the two forms to show that they can exhibit different chemical reactivities. These results were reported by researchers from the University of Basel and their colleagues in Hamburg in the scientific journal Nature Communications.
From a chemical perspective, water is a molecule in which a single oxygen atom is linked to two hydrogen atoms. It is less well known that water exists in two...
13.06.2018 | Event News
08.06.2018 | Event News
05.06.2018 | Event News
18.06.2018 | Earth Sciences
18.06.2018 | Process Engineering
18.06.2018 | Life Sciences