Parental grief following the brain death of a child: does consent or refusal to organ donation affect their grief?

The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved parents who consented to, and 11 parents who declined organ donation. Findings suggest that the core themes that characterize their grief and the main variables that affect their grieving process are similar for both donor and non-donor parents. Consent or refusal of organ donation per se does not seem to affect the overall grieving process. It is the meaning attributed to the act of donation that affects how parents perceive the child's death and subsequently facilitate or hinder their adjustment to loss.     

Parental Grief Following the Brain Death of a Child: Does Consent or Refusal to Organ Donation Affect Their Grief?

The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved parents who consented to, and 11 parents who declined organ donation. Findings suggest that the core themes that characterize their grief and the main variables that affect their grieving process are similar for both donor and non-donor parents. Consent or refusal of organ donation per se does not seem to affect the overall grieving process. It is the meaning attributed to the act of donation that affects how parents perceive the child's death and subsequently facilitate or hinder their adjustment to loss.     

Kidney organ donation knowledge and attitudes among health care professionals: Findings from a Greek general hospital

Identified barriers of organ donation advancement include lack of knowledge, personal beliefs, and a negative attitude from health professionals. This article reports on current knowledge and attitudes toward kidney donation among nurses and physicians in a Greek general hospital. A previously used questionnaire was applied. More physicians than nurses were donor card holders, with registration rates being lower than expected. Over half of the participants did not consider themselves well informed about registering as a kidney donor. Older nurses differed significantly from younger ones in their willingness to become live donors if an adult required a kidney. Nurses who were blood donors had higher odds ratio of feeling well informed when compared with nurses who were not blood donors. Integrating organ donation issues into undergraduate health science curricula and continuous education interdisciplinary programs is essential in increasing awareness, eradicating negativism, and reversing inertia.     

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PurposeInternational operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia.DesignThe phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences.MethodsSemistructured interview data were transcribed verbatim.FindingsInternational OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice.ConclusionsRecognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.     

Organ donation education initiatives: A report of the Donor Management Task Force

PurposeIt is essential that hospitals and health professionals establish systems to facilitate patients' organ donation wishes. Donation education has been neither standardized nor systematic, and resources related to donation processes have not been widely accessible. This report describes 2 free, publicly available educational resources about the organ donation process created to advance the mission of basic education and improve donation processes within hospitals and health care systems.Materials and methodsMembers of the Donor Management Task Force of the Organ Donation and Transplantation Alliance (the Alliance) and the Health Resources and Services Administration of the US Department of Health and Human Services convened annually in person and by teleconferencing during the year to develop 2 educational vehicles on organ donation.ResultsTwo educational products were developed: the Organ Donation Toolbox, an online repository of documents and resources covering all aspects of the donation process, and the Educational Training Video that reviews the basic foundations of a successful hospital donation system.ConclusionsThere is a need for more research and education about the process of organ donation as it relates to the medical and psychosocial care of patients and families before the end of life. The educational products described can help fill this critical need.     

Health care personnel's experiences of a bereavement follow-up intervention for grieving parents

The aim of this study is to investigate the experiences of health care personnel of a bereavement follow-up intervention for grieving parents and of the ways to develop it. The intervention included three components: a support package for grieving parents, peer supporters' and health care personnel's contact with parents. The sample included 29 health professionals. Data were collected via open-format questionnaires and telephone interviews from health care personnel. Content analysis was used as a means of data analysis. The support package for grieving parents was considered important and versatile. Health care personnel perceived the intervention and its viability as mostly good. Parents' willingness to receive support, health care personnel's good resources and organizational preconditions were important for the follow-up contact. The intervention clarified the policy related to supporting grieving parents. It was enabled by a good attitude, shift arrangements and co-worker support. However, the implementation was considered difficult because of scarce resources. Parental support engendered negative feelings in health care personnel and they desired systematic supervision to deal with these. Follow-up care of grieving parents is a demanding task. Continuous education about bereavement follow-up care and systematic supervision to health care personnel is needed. Family-focused care in supporting grieving families after leaving from hospital should be increased. Inter-organizational cooperation in supporting parents is important and feasible.     

Knowledge and attitudes of medical, nursing, dentistry and health technician students towards organ donation: a pilot study

Aim. This pilot study assesses the knowledge and attitudes of medicine, nursing, dentistry and health technical students toward organ donation. Background. Medicine, nursing, dentistry and health technical students’ knowledge of and attitudes towards organ donation may be a factor in organ procurement rates. There is a lack of information about how Turkish medicine, nursing, dentistry and health technical students perceive organ donation, and what they know about it. Method. Students completed a self‐administered questionnaire after a lecture. The questionnaire included a test that was used to assess knowledge of and attitudes about organ donation. Results. Of the students, 56·8% were men, 91·4% were 18–24‐year old and 89·4% from east region of Turkey. Of students, 65·5% were willing, 9% were not willing, 25·5% were hesitant about organ donation and 6% of willing students reported carrying a signed card. The most common reason for unwillingness to organ donation was worries about illegal behaviours (2·4%). There was a statistical relationship between willingness of students for organ donation and gender but were not any statistical relationship between willingness of students for organ donation and age, school, region and recognizing relatives whose need organ transplantation. Majority of the students listed transplantable organs truly but 63·1% were had no idea about organ donation process. Conclusion. Students’ had a lack of information about organ donation. The results of this study support a greater emphasis on providing information regarding transplantation in medicine, nursing, dentistry and health technical schools to improve the knowledge of future heath care professionals about transplantation and organ donation issues. Relevance to clinical practice. These findings highlight a need to review these schools’ curricula and emphasize the importance of organ transplantation. This strategy may be part of the solution to the chronic shortage of donor organs for transplantation.     

"I have to turn myself inside out": caring for immigrant families of children with asthma

In multicultural societies, health care professionals encounter immigrant families of children with asthma. They play an important role in supporting these families, but few studies have focused on this phenomenon. The aim of the present study is to gain a broader understanding of the challenges health care professionals face in their encounters with non-Western immigrant parents of children with asthma. Seventeen professional caregivers were interviewed, and their narratives were analyzed using qualitative content analysis. The results show that health care professionals' main challenges when encountering immigrant parents can be described by the theme, "Turning oneself inside out." This theme is characterized by five categories: gender and professional issues, impact on professional relationships, communication challenges, unfamiliar disease and treatment perceptions, and time issues. The results highlight the importance of providing health care professionals with support and organizational conditions that increase opportunities to understand the unique situation of these families.     

Non-heart-beating organ donation: Issues and ethics for the critical care nurse.

Non-heart-beating organ donation is an important topic that continues to be misunderstood by many health care professionals. As organ transplantation has become an accepted mode of treatment for end-stage organ failure, the need for organs has increased. Non-heart-beating organ donation provides an option for families wishing to donate when their loved one does not meet brain death criteria. The author will review the history of organ donation, focusing on the process of non-heart-beating organ donation. A patient case study is presented to facilitate understanding of the critical care nursing role essential to the success of this process that can provide a positive outcome for families involved in very tragic situations.     

Informed decision making regarding antenatal screening for fetal abnormality in the United Kingdom: A qualitative study of parents and professionals

The aim of this study was to explore the views of parents and health professionals regarding informed decision making for antenatal screening for Down syndrome. This qualitative study was based on thematic analysis and conducted in England, where screening for Down syndrome is universally offered to all pregnant women. Four focus groups were held with pregnant women and/or their partners (n = 22), and another four groups were held with health professionals who offer antenatal screening (n = 22). Data were analyzed through coding of the transcribed focus group discussions and extraction of main themes. Extracted themes were: information overload, gaps in information, challenges in providing information and involvement of both parents in the decision. Parents and professionals believed that burdening parents with untimely information on a wide range of topics in the first trimester detracted from decision making about screening. Many parents also reported they were not sufficiently informed and wanted individualized discussion with a health professional. To ensure parents make informed decisions, information on screening should be provided at the appropriate time, with opportunity for personal discussion with a knowledgeable health professional.     

Intercountry adoption and nursing care

AIMS AND OBJECTIVES: This paper is based on a Norwegian study that addressed the importance of nurses understanding adoptive families' particular needs. The study aimed to provide a diverse picture of adoptive families' challenges and resources. It addressed adoptive families' experiences with welfare professions, particularly public health nurse services, and explored their need for support before and after adoption. This paper focuses particularly on challenges confronting 'transracial' families. PARTICIPANTS AND METHOD: The qualitative research interview was used as the methodological approach. Nine couples of adoptive parents, four adoptive mothers, three public health nurses and four adult adoptees were interviewed. The analysis process was an ad hoc generation of meaning, and the data were systematically reviewed and categorized through an intuitive analysis style. RESULTS: The study indicates that adoptive families manage their 'most common' challenges on their own, but the informants also spoke about a need for professional support and assistance in many cases. Recurring themes in the study were challenges linked to 'attachment difficulties', 'external categorization', 'grief' and 'the meaning of biological heritage and roots'. Findings indicate that there is a substantial demand for increased knowledge of adoptive families' special needs, not least in the public health nurse services; there is also limited knowledge within other welfare professions. Nurses particularly need to strengthen their understanding on how external categorization affects transracial adoptive families. CONCLUSIONS: The study recommendations call for improved follow-up after adoptions. This can be met by establishing a special programme for adoptive families at maternity and child health centres. In addition, public health nurses can support adoptees in their teenage years through individual consultations.     

Mort encéphalique traumatique et don d’organes en pédiatrie. Comment optimiser le prélèvement d’organes lorsqu’un obstacle médicolégal pourrait s’y opposer ?

Pediatric organ donors are rare and mainly due to unnatural brain death. These traumatic circumstances issued from accidental or nonaccidental events can lead to forensic reservations, which complicate the donation process. In the aim to recruit these young potential donors, health care professionals have to prove a close collaboration with the judiciary team, by not interfering in the research of the exact cause of death. They must make available any medical and radiological date before and during operative period. In response, prosecutors will be more attentive to these intensive care doctors and the Organ Donation Service Teams (ODST) who solicit them for an authorization of a Multiple Organ Procurement. If the judiciary investigation permits it, the prosecutors can initially give an agreement in principle. Later, if the donation process develops favorably with a parental agreement, an official judiciary authorization can be given to the ODST who claim it. This close collaboration and mutual respect between the health care workers and the judiciary team has contributed to facilitate recruitment of potential donors with an increased organ procurement in this cohort of 22 brain dead children under 3 years old, identified by the ODST.     

Consumer's perceptions of Recovery‐oriented mental health services: An Australian case‐study analysis

Recovery approaches to health care now feature in the mental health policies of many Western countries. There are, however, continuing challenges to the operationalization of these approaches. This study aimed to identify the nature of these challenges for a public mental health service organization located in a major urban center in southeastern Australia, where Recovery‐oriented services have been implemented; and to develop recommendations to address these challenges. These aims were achieved by asking mental health consumers about their experiences of the implementation of Recovery‐oriented services. Research participants described an uncertainty in health professionals and consumers alike about how to practice within a Recovery model, with many health professionals taking a “hands off” approach in the name of Recovery, rather than working in partnership with consumers and other stakeholders, including the community managed organizations. Solutions to these challenges included more targeted, practice‐focused education for consumers and health professionals, with this education provided by consumer representatives. Insights derived from this research add to the growing body of evidence related to the implementation of Recovery‐oriented services in Western countries.     

The impact of health professionals' attitudes about being registered donors on the availability of organs

The mismatch between supply and demand in organ donation is well documented. Although there are many reasons for this mismatch, failure of health professionals to identify potential donors or to gain consent from bereaved relatives is considered to be significant. Such failures may be due to the attitudes of health professionals themselves towards becoming organ donors. This study focuses on the level of commitment shown by health care professionals and their student equivalents to organ donation, and assesses the ways in which they identify themselves as potential organ donors. These findings are evaluated and suggestions for future practice are offered.     

Professionals' experiences of supporting two-mother families in antenatal and child health care in Sweden

Background

In Sweden, antenatal and child health care are offered free of charge to all expectant and new parents. Professionals in antenatal and child health care play an important role in supporting parents. Previous research shows that same-sex mothers face heteronormative assumptions and insufficient support during their transition to parenthood.

Objective

To explore professionals' experiences of supporting two-mother families in antenatal and child health care.

Method

A qualitative method with focus group discussions was used. An interview guide was followed, and the discussions were held online. The data was analysed according to inductive content analysis.

Settings and participants

The participants were midwives (n = 8) and nurses (n = 5) in antenatal and child health care from different parts of Sweden. Participants were recruited through the coordinating midwives and child health care nurses in the different regions.

Findings

One main category was identified: Striving to be open-minded in supporting same-sex mothers. Health care professionals described meeting well-prepared mothers, with an equal commitment between each other, and mothers on guard against heteronormative views. Professionals provided support through empowerment by creating a safe environment and aiming at providing equal support to all parents or tailored support to same-sex mothers. Mothers described handling challenges, as a balancing act to acknowledge both mothers. Struggling with documents and communication and a lack of information were other challenges to be handled. Professionals reflected on their own professional competence and expressed that knowledge acquired through education, experience and personal interest all contributed to their competence.

Conclusions

Forms and documentation need to be updated to be gender neutral to be including to a variety of family constelleations. Health care professionals need time to reflect on norms and challenges to better support both mothers in a two-mother family.     

The enigma of severe mental illness: a Swedish perspective

Today mental health professionals are challenged in supporting people with severe mental illness that live within their communities. The community treatment is, however, characterized by an uncertainty about how to best support them in their everyday lives, and professionals from different disciplines often have divergent opinions about the care. The aim of this study is to explicate the existential meaning of living with severe mental illness. Interviews with persons who relocated from an institutional setting to a community placement were analyzed within an interpretive approach. The results of the study found that people with severe mental illness experience an existential loneliness due to difficulties in changing previous suppositions about human relationships. They do not develop connections through shared new experiences with other people in their lives. One central implication of the findings is that because people with severe mental illness seem unable to benefit from new experiences, mental health nurses should consider relational aspects when planning, implementing, and evaluating nursing care.     

The experiences of Hong Kong Chinese parents of children with acute lymphocytic leukemia.

The purpose of this study was to explore the experiences of Chinese parents of children diagnosed with acute lymphocytic leukemia (ALL). Respondents consisted of a convenience sample of nine mothers and eight fathers. Data were collected through in-depth interviews and were scheduled to coincide with the disease trajectory, and were analyzed using the matrix system described by Miles and Huberman. Major categories identified include parental reactions, methods used by the parents to disclose the child's diagnosis to others, changes in the family routine, and the preferred sources of parental support. Implications for health professionals include a need for thorough psychosocial assessment of the affected children, parents, and siblings. Limitations of the study and recommendations for future research are also discussed.     

Organ procurement and the donor family

The need for transplantable cadaveric organs for outweighs the supply. Improvements in the relatively new field of transplantation have dramatically improved success rates. Legislation at the state and federal levels has removed many legal roadblocks to donation. The network for the recovery and distribution of organs is well-developed and effective. OPOs, whose sole responsibility is the recovery and distribution of transplantable organs, can guide the medical staff through the process with minimal disruption of hospital routine. The recognition and referral of all potential organ donors is the responsibility of all health care professionals and helps alleviate the current shortage of transplantable organs. When simple and caring techniques are used, family consent rates for donation can approach 75%. Health care professionals remain the key to closing the imposing gap between a patient's need for transplantation and those suitable for donation.