The European Donor Hospital Education Programme (EDHEP): addressing the training needs of doctors and nurses who break bad news, care for the bereaved, and request donation

The competence of critical care staff when it comes to death and organ donation can make the difference between a family's agreeing to or refusing the latter. Doctors and nurses often feel uncomfortable approaching relatives about donation and attribute this to a lack of training. Bereaved relatives express dissatisfaction with inappropriate communication and support when brain death is announced and thereafter when a request for donation is made. The European Donor Hospital Education Programme (EDHEP) was designed to meet the training needs of critical care staff in breaking bad news, caring for the bereaved, and requesting donation. EDHEP is a two-part educational package consisting of a presentation about the donor shortage followed by a one-day workshop. The implementation of EDHEP throughout the world has been facilitated through effective national working groups and standardised “train the trainer” courses. Several countries anecdotally report increases in donation following implementation. Controlled evaluation of the effect(s) of EDHEP, which started at the end of 1995, focuses on the satisfaction of the participants with EDHEP, on the competence of the participants in breaking bad news and requesting donation, on the teamwork regarding death and donation, on the satisfaction of bereaved relatives, and on organ donation rates. Received: 5 June 1998 Received after revision: 1 December 1998 Accepted: 18 December 1998     

Participants' judgements of the European Donor Hospital Education Programme (EDHEP): an international comparison

The European Donor Hospital Education Programme (EDHEP) is a one-day workshop, aimed at providing guidelines for breaking the news of the death of a relative and for raising the issue of organ donation with bereaved relatives. Participants' judgements of the workshop in the Netherlands and in the United Kingdom were compared to determine whether EDHEP meets doctors' and nurses' training needs in breaking bad news and requesting organ donation. In both countries EDHEP appears to be greatly appreciated by intensive care medical and nursing staff; the judgements are more positive in the United Kingdom than in the Netherlands. It seems that, irrespective of their professional experience, intensive care staff consider EDHEP a valuable teaching programme that increases confidence in communicating with bereaved relatives about death and organ donation. Received: 5 June 1998 Received after revision: 1 December 1998 Accepted: 22 December 1998     

Sex differences in executive functioning and latent herpesvirus reactivation among bereaved and nonbereaved individuals

The death of a spouse is a highly stressful event. Better executive functioning has been shown to benefit men to a greater degree than women during stress. We evaluated potential sex differences in stress and immune dysregulation among control and bereaved participants who completed a self‐report measure of perceived stress, neuropsychological measures of inhibition and updating/monitoring of information in working memory, and a blood draw to measure Epstein–Barr virus (EBV) antibody titres. Moderation analyses were conducted to test the hypothesis that better inhibition would be associated with less stress and immune dysregulation among male bereaved participants compared with female bereaved participants. Bereaved females demonstrated greater EBV antibody titres than bereaved males. Male bereaved participants benefited from better inhibition, as evidenced by fewer EBV antibody titres, whereas bereaved female participants did not. In the control group, males with high inhibition reported lower stress than males with low inhibition. Present study results are an important step towards identifying those at greatest risk of stress and poor health.     

The effect of traumatic bereavement on tsunami‐exposed survivors

Fourteen months after the 2004 tsunami, mental health outcome was assessed in 187 bereaved relatives, 308 bereaved friends, and in 3,020 nonbereaved Swedish survivors. Of the bereaved relatives, 41% reported posttraumatic stress reactions and 62% reported impaired general mental health. Having been caught or chased by the tsunami in combination with bereavement was associated with increased posttraumatic stress reactions. Complicated grief reactions among relatives were almost as frequent as posttraumatic stress reactions. The highest levels of psychological distress were found among those who had lost children. Traumatic bereavement, in combination with exposure to life danger, is probably a risk factor for mental health sequelae after a natural disaster.     

肿瘤科护理人员安心卡工作坊死亡教育培训实践

目的探讨安心卡工作坊在肿瘤科护理人员死亡教育培训中的应用效果,为护士死亡教育培训提供参考。方法选取185名肿瘤科护士体验安心卡工作坊,首先采用中文版死亡态度描绘量表(修订版)调查护士的死亡态度;参加安心卡工作坊后评价结果。结果共开展安心卡工作坊23次。实施安心卡工作坊前后护士死亡恐惧、自然接受、逃离接受得分比较,差异有统计学意义(P<0.05,P<0.01)。90.27%护士认为安心卡工作坊有助于提升死亡教育能力,84.86%护士愿意推广安心卡,81.08%护士会尝试与患者谈论死亡相关议题。结论安心卡工作坊的开展有助于引导护士思考死亡与人生的价值,是一种有效的死亡教育模式。     

Traumatic Memories of Relatives Regarding Brain Death, Request for Organ Donation and Interactions with Professionals in the ICU

Little is known about the memories of relatives after they have been confronted with the brain death of a loved one and the request for organ donation. We conducted this study, guided by Grounded Theory, to explore relatives' experiences, their interactions with health care providers and what influenced their memories. We interviewed 40 relatives (31 consenting to and 9 refusing organ donation) of 33 brain-dead individuals. Relatives described their experiences as a difficult process composed of several stages spanning from the initial encounter to the final decision about donation. Long-term memories of bereaved relatives were influenced by the characteristics of their decision-making style (clear vs. ambivalent) and the perceived quality of the interaction with professionals on the intensive care unit. Organ-focused behavior of professionals and an ambivalent decision-making style of relatives appear to be risk factors for traumatic memories.     

Co‐producing novel wound care products for Epidermolysis bullosa; an empirical case study of the use of surrogates in the design and prototype development process

The Woundcare for Epidermolysis bullosa (WEB) project aims to enable people with Epidermolysis bullosa (EB), their carers and clinicians to co‐produce wound care products to meet their needs. EB is an inherited disorder causing extensive, painful skin blistering and wounds. It is relatively rare, with approximately 300 000 patients worldwide, but it incurs high costs (up to £50 000 per month on products alone). During the course of four workshops, adults with EB, their carers and specialist nurses gave detailed accounts of their experiences with pre‐sized, pre‐shaped dressings, including the need to patchwork individual dressings over large areas of broken skin. Five themes were identified from the workshop data relating to the limitations of existing products for EB wounds: dressing fit, stability, comfort, temperature and exudate. Novel designs were generated from these themes and although the intention was to develop the designs iteratively with the workshop participants, issues arose necessitating the interim use of surrogates. Our account of the design process is given, presenting the arguments for and against the use of surrogates, with suggestions for incorporating surrogate input into product development in a way that does not undermine the integrity of patient experiences or the co‐production process.     

Survey of abuse and violence by patients and relatives towards intensive care staff

A postal survey of senior nurses in intensive care units in England and Wales was conducted. The aim was to ascertain the frequency of abusive and violent behaviour by patients and relatives towards intensive care staff, discover the perceived causes, effects and documentation of such behaviour and define the current and proposed security arrangements for intensive care units. Response rate was 94%. During the study period, verbal abuse of nurses by patients and by relatives occurred in 87% and 74% of intensive care units, respectively. The relevant figures for doctors were 65% and 59%, respectively. Nurses experienced physical abuse by patients and by relatives in at least 77% and 17% of intensive care units, respectively (doctors 38% and 8%). Illness was the main perceived cause of offences by patients whereas 'distress' (45%), alcohol (24%), sociopathic behaviour (27%) were the main putative causes amongst relatives. Whilst 43% of intensive care units have no security system at the door, staff awareness, training and communication skills may be the principle tools in reducing the frequency and consequences of violent and abusive behaviour. This survey probably underestimates the problem.     

Study examining attitudes of staff, patients and relatives to witnessed resuscitation in adult intensive care units

Background. Witnessed resuscitation is widely accepted in paediatricpractice and is becoming more common in adult emergency departments,but information on this topic is sparse. Methods. We gave a questionnaire to 50 intensive care medicaland nursing staff and 55 patients and next of kin before electivepostoperative admission to the intensive care unit to examinestaff opinion about witnessed resuscitation, patient and relatives’demand for witnessed resuscitation, and their perception ofthe benefits. Results. We found that 56% of doctors and 66% of nurses favouredgiving relatives the option to stay. If relatives requestedto be present, 70% of doctors and 82% of nurses would allowthis if the relatives were escorted. The role of the escortwas felt to explain, prevent interference, and to provide emotionalsupport. We found that 29% of patients and 47% of relativeswanted to be together during resuscitation, the commonest reasonsbeing to provide support and to see that everything was done.We found that 95% of patients and 91% of relatives felt theirviews should be formally sought before ICU admission. Conclusions. Intensive care staff support witnessed resuscitation.Many intensive care personnel have experienced witnessed resuscitationand the majority felt that relatives gained benefit. Almostall agree that the views of both patient and relatives shouldbe sought formally before admission to intensive care. Br J Anaesth 2003; 91: 820–4     

Interdisciplinary communication in the intensive care unit

BACKGROUND: Patient safety research has shown poor communication among intensivecare unit (ICU) nurses and doctors to be a common causal factorunderlying critical incidents in intensive care. This studyexamines whether ICU doctors and nurses have a shared perceptionof interdisciplinary communication in the UK ICU. METHODS: Cross-sectional survey of ICU nurses and doctors in four UKhospitals using a previously established measure of ICU interdisciplinarycollaboration. RESULTS: A sample of 48 doctors and 136 nurses (47% response rate) fromfour ICUs responded to the survey. Nurses and doctors were foundto have differing perceptions of interdisciplinary communication,with nurses reporting lower levels of communication opennessbetween nurses and doctors. Compared with senior doctors, traineedoctors also reported lower levels of communication opennessbetween doctors. A regression path analysis revealed that communicationopenness among ICU team members predicted the degree to whichindividuals reported understanding their patient care goals(^adjR² = 0.17). It also showed that perceptions of the qualityof unit leadership predicted open communication. CONCLUSIONS: Members of ICU teams have divergent perceptions of their communicationwith one another. Communication openness among team membersis also associated with the degree to which they understandpatient care goals. It is necessary to create an atmospherewhere team members feel they can communicate openly withoutfear of reprisal or embarrassment.     

Study of patient satisfaction in a surgical unit of a tertiary care teaching hospital

BackgroundThe hospitals have evolved from being an isolated sanatorium to a place with five star facilities. Patients and their relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth of media and its exposure, as well as commercialization and improvement in facilities. The aim of this study was to evaluate the level of patient/relatives satisfaction at tertiary care teaching hospital and feedback from them for improvement of the same.MethodsThe study was conducted by1. Review of available national and international literature on the subject.2. Carrying out survey amongst 50 patients and their relatives at one of the surgical unit by using structured questionnaire.3. By analyzing the data using appropriate statistical methods.ResultsEighty two percent people were satisfied with the service at admission counter while 81% were satisfied with room preparation at the time of admission. The nursing services satisfied 80% of people while 92% were satisfied with explanation about disease and treatment by doctor. The behavior of nurses, doctors and orderlies satisfied 92, 92 and 83% of people. The cleanliness of toilets satisfied only 49% while diet services satisfied 78% of people.ConclusionThe five major satisfiers were behavior of doctors, explanation about disease and treatment, courtesy of staff at admission counter, behavior and cooperation of nurses. The five major dissatisfiers were cleanliness of toilets, quality of food, explanation about rules and regulation, behavior of orderlies and sanitary attendant and room preparedness.     

Ist das Screening auf abdominelle Aortenaneurysmen in Deutschland m?glich?

Introduction

Despite better clinical and surgical treatment options for abdominal aortic aneurysms (AAA) mortality rates are still increasing in Germany. The high rates are substantially due to spontaneous ruptures which in most cases prove fatal. International studies recommend screening programmes for AAA as these lead to a significant decrease in aneurysm-dependent mortality. However, in Germany such programmes are still lacking. The general possibility of ultrasound screening by family doctors was evaluated using a questionnaire.

Methods

A written survey of 2,000 representative family practitioners in Germany was initiated to determine the availability of ultrasound devices, knowledge relating to screening procedures and motivation to perform screening. The representativeness of the results was measured by a telephone re-test.

Results

The survey revealed that all of the approximately 60,000 family doctors in Germany are able to participate in an ultrasound screening program. More than two thirds of them possess an ultrasound machine and are trained to perform ultrasound screening. Most family doctors are motivated to take part in training courses and 75% would participate in a nationwide screening program.

Conclusions

A nationwide AAA screening in Germany is basically possible as participants are within easy reach of a family doctor with screening facilities in all areas of Germany. However, in order to do this it will be necessary to design a target group-oriented introduction campaign and a suitable financial remuneration structure must be established.     

Difficulties With the Organ Donation Process in Small Hospitals in Germany

The discrepancies between the need and the number of organs donated in Germany lead to a search for the causes of this deficit. In the present study, 78 small hospitals in Germany were interviewed about the difficulties with the organ donation process. Data were acquired by means of a structured telephone interview. No organ donor between 2004 and 2008, was reported by 44% of the participating hospitals while the remaining 56% had ≥1 donor. The main results show that one third of these small hospitals already had difficulties communicating with bereaved relatives about donation. In addition, 31% of the respondents reported problems during the organ removal process and 41% in identifying potential organ donors.     

Searching the core of emergency medicine

BACKGROUND: The purpose of this study was to test whether focus groups involving medical students, house officers, senior doctors, and nurses could identify an undergraduate emergency medicine core curriculum. METHOD: From May 2001 to January 2002, we interviewed 12 homogeneous focus groups within all 88 participants. Three focus groups were composed of medical students; three of house officers, three of senior doctors, and three focus groups were composed of nurses. Each interview lasted 2 h. Interviews were recorded, transcribed, and analysed using qualitative methods. RESULTS: The focus groups suggested and discussed in all 196 objectives. Students, physicians, and nurses agreed that newly graduated physicians should master history taking, 21 clinical disorders, 15 practical skills, interpretation of two diagnostic tests, two general diagnostic skills, and two leadership skills. Apart from these 43 core objectives, disagreement was substantial. Participants gave very different priorities to communication, knowledge about clinical disorders, practical clinical skills, leadership, and "the art of medicine". CONCLUSION: In conclusion, focus groups could identify an emergency medicine core curriculum. However, participants had very different perspectives on the curriculum. Focus groups could be one very practicable part of seeking consensus on what is core and securing local roots and ownership to an undergraduate emergency medicine curriculum before and during implementation.     

Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking

IntroductionThis study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes.MethodsA cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined.ResultsEighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p < 0.001, p = 0.004, p = 0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking.ConclusionKnowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.     

Exposure to Trauma and Mental Health Service Engagement Among Adults Who Were Children of the Northern Ireland Troubles of 1968 to 1998

Northern Ireland is an appropriate region to examine the impact of traumatic experiences, owing to the many years of civil violence that have characterized its recent history, known colloquially as the “Troubles.” Given the prominence of traumatic experiences among the aging population of Northern Ireland (NI), an evidence base is required to inform the planning and provision of effective mental health and other services. We analyzed the follow‐up interviews (n = 225) of individuals from the Northern Ireland Study of Health and Stress (NISHS), aged 45 years and older, who experienced one or more conflict‐related traumatic events. This study demonstrated that in NI traumatic events, such as being involved in an explosion, seeing someone killed or seriously injured, and living in a region of terror were most likely to be related to the Troubles. However, event types that we had not previously known to be related to conflict (such as the sudden death of a loved one), were also often related to the Troubles. Two‐thirds of participants (67.1%) reported exposure to a Troubles‐related event, and 57.8% reported being a civilian in a region of terror. The vast majority (85.9%) of participants who experienced a Troubles‐related trauma never sought help, despite 59.1% meeting the criteria for a lifetime mental disorder. The reasons for not seeking help and sources of help are outlined. Policy makers must address Troubles‐related mental health effects, in terms of how they carry forward into aging, and consider ways of improving engagement with services and treatments.     

Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals

Hospital staff are at risk from occupational exposure to blood-borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.     

Psychological well‐being and psychosocial work environment characteristics among emergency medical and nursing staff

The aim of this study was to determine if the effect of psychosocial work environment on psychological well‐being was different for doctors and nurses who work in emergency departments in Spain. A cross‐sectional survey was carried out among 945 emergency doctors and nurses staff from Spain. The outcome variable was the psychological well‐being measured by two dimensions of SF‐36 Health Survey (SF‐36) (mental health, vitality) and one dimension of Maslach's Burnout Inventory (emotional exhaustion). The explanatory variable was the psychosocial work environment evaluated according to Karasek and Johnson's demand‐control model that includes the dimensions of psychological demands, job control, supervisor social support and co‐workers' social support. The adjusted odds ratios and their 95 per cent confidence intervals were calculated by logistic regression. The prevalence of low vitality, bad mental health and high emotional exhaustion was higher among doctors than nurses. Exposure to high psychological demands increased the probability of low vitality, bad mental health and high emotional exhaustion among doctors and nurses. Low job control and low co‐workers' social support at work were associated with poor psychological well‐being only among doctors. Low job supervisors' social support increased the risk of bad mental health among doctors and of high emotional exhaustion among nurses. There is a different effect of psychosocial work environment on psychological well‐being between doctors and nurses. Copyright © 2007 John Wiley & Sons, Ltd.     

The importance of the orthopaedic doctors' appearance: A cross-regional questionnaire based study

ObjectivesCritics of the Department of Health ‘bare below the elbow’ guidelines have raised concerns over the impact of these dress regulations on the portrayed image and professionalism of doctors. However, the importance of the doctor's appearance in relation to other professional attributes is largely unknown. The purpose of this study was to determine the opinion of patients on the importance of appearance and the style of clothing worn by doctors.DesignPatient questionnaire survey, administered across four Scottish regions.SettingOrthopaedic outpatient departments.Participants427 patients and accompanying relatives.Main outcome measuresThe absolute and relative importance of the doctors' appearance, as reported using a 5-point Likert scale. The absolute and relative importance of the style of clothing worn by doctors, as reported using a 5-point Likert scale. The rank preferences for four different styles of doctors' attire as illustrated by standardised clinical photographs.ResultsThe study was appropriately powered to identify a 0.5 difference in mean rank values with 0.90 power at a = 0.05. The majority of participants felt the doctors' appearance was important but not as important as compassion, politeness and knowledge. Only 50% felt that the style of doctors clothing mattered; what proved more important was an impression of cleanliness and good personal hygiene. In terms of how patients would prefer doctors to dress in clinic, the most popular choice proved to be the smart casual style of dress, which conforms with the ‘bare below the elbows’ dress code policy. The smart casual clothing style was the highest ranked choice irrespective of patient age, gender, regional or socioeconomic background.ConclusionsThe doctors' appearance is of importance to patients and their relatives, but they view many other attributes as more important than how we choose to dress. While not specifically addressing the role of doctors clothing in the transmission of infection, our results do support the preference of patients for ‘bare below the elbows’ workplace attire.     

Knowledge and Attitudes of Health Care Professionals and Laypeople in Relation to Brain Death Diagnosis and Organ Donation in Hungary: A Questionnaire Study

ObjectivesThe aim of the present work was to assess the knowledge and attitudes of different health care workers and laypeople toward the donation and transplantation procedure.Subjects and methodsA survey consisting of questions regarding brain death diagnosis, legal organization or organ donation, and the transplantation procedure were sent to participants: 56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320 general practitioners (GPs). Laypeople were also asked to complete the survey.ResultsThe majority of participants reported being aware of legal regulations for organ donation in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses (34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs (22.4%) and medical students (20%) performed even worse on this item. The willingness of ICU specialists (57%) and ICU nurses (45%) to support donating their own organs was moderate.ConclusionsThe results of this survey indicate a need for graduate and postgraduate education and regular teaching programs regarding organ donation and transplantation. More active use of modern media is proposed to improve public awareness and acceptance of organ donation.