Taiwanese Nurses Feelings Towards Organ Donation: An Interpretive Study

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Taiwanese Nurses Feelings Towards Organ
Donation An Interpretive Study

• By
• Tzu-Fei ChenMarch,16,2000

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Abstract

• The purpose of this study was to explore
  Taiwanese nurses feelings about organ donation
  based on their experience and involvement in the
  process of organ procurement.
• The results of this study reveal several factors
  that consistently influence acceptance of the
  concept of organ donation in Taiwan.
• In conclusion, several recommendations are made
  for changing circumstances and assisting in the
  development of training programs and curricula in
  relation to the issues that surround organ
  donation.

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Introduction
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A general picture of Taiwan
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Organ Transplantation and donation in Taiwan

• Organ transplantation has been performed
  successfully, developed, and refined in Taiwan
  for over 25 years
• Initially, the sources of donor organs came only
  from cadaver donors
• The government brought in legislation covering
  brain death and the regulation of transplantation
  in 1987

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Culture and philosophical though

• Major barriers traditional cultural beliefs
• Mainstream Chinese philosophical thought
• Confucian cultural ethical plane
• Taoism artistic plane
• Buddhism religious plane
• Practice folk religion and very superstitious

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Health cost
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Recipients experience
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Donor familys experience

• Grief, stress, and sadness
• Some donors families reveal regret
• and continuously question
• themselves

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Nursing in Taiwan

• The role of nurses is limited by the society in
  Taiwan
• The Taiwanese perception of good health care
• Taiwanese nurses need to be very aware of
  patients beliefs and values
• Death is a taboo in hospital
• Poor relative curriculum in nursing education
• Have much stress at work

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Research questions

• What are Taiwanese nurses knowledge, attitudes,
  and beliefs regarding organ donation?
• What role do Taiwanese nurses think they should
  play in informing the family about organ
  donation?
• What role should Taiwanese nurses play in seeking
  consent from the family for organ donation?

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Aims and significance of the study (1)

• Explore in depth Taiwanese nurses feelings
  concerning organ donation
• Assess Taiwanese nurses knowledge, attitudes,
  and beliefs regarding organ donation

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Aims and significance of the study (2)

• Inform nursing and public debate on the role of
  the nurse in regard to organ donation
• Clarify the work of Taiwanese nurses with regard
  to organ donation in order to inform the
  curricula used by hospitals and educational
  institutions to promote training for nurses in
  working with donor families

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Literature Review
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A comparison of Western countries and Taiwan (1)
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A comparison of Western countries and Taiwan (2)
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A comparison of Western countries and Taiwan (3)
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Organ donation strategies, a comparison of
Western countries and Taiwan.
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Methodology
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Content analysis as a methodology

• Focuses on what-is-said therefore through the
  process of content analysis, the researcher can
  directly follow what was described and answered
  to a range of devised questions to derive and
  predict the intention of peoples opinions in
  regard to the phenomena
• The final result of content analysis can alert
  men, sensitive to changes in their intellectual
  environment and quick to exploit the
  possibilities in them

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Advantages and limitations (1)

• Limitations
• Content analysis only proceeds from what-is-said
  in answer to a question but does not produce
  questions as to how or why people react or
  express their meanings in particular ways
• Content analysis can only be conducted by a
  researcher who has extensive knowledge about the
  subject and the background to the study

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Advantages and limitations (2)

• Advantages
• Its direct focus on the facts of phenomena
• Readers can check on the results
• A wide range of questions could be asked
• More clearly and the researcher is able to make
  inferences about likely content from their given
  headings

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Research design

• Setting Two (A and B Hospital) medical centers
  in Taipei
• Sample Taiwanese nursing staff
• Work in the ED or the ICU
• Have more than one years working experience in ED
  or ICU and
• Have experience in looking after brain dead
  patients
• Exclusion criteria Part time staff

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Data collection

• Six nurses A Hospital(3) and B Hospital (3)
• Broad basic questions
• What do you think about organ donation?
• What experiences have you had with organ
  donation?
• What role do you think the nurse should play in
  informing the family about organ donation?
• What role should nurses play in seeking consent
  from the family for organ donation?

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Data analysis

• Preliminary themes
• Attitudes and beliefs
• (a) Nurses
• (b) Doctors
• (c) Patients family
• Nursing role in seeking consent
• Nursing role in informing
• Experience in caring brain dead patients/donors
• Expectations of nurses

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Ethical issues

• Approve by the Research and Higher Degrees
  Subcommittee of the Department of Clinical
  Nursing at the University of Adelaide and the
  Ethics Committee of the Royal Adelaide Hospital,
  South Australia
• Participant anonymity
• Informed consent
• Safe storage of the data
• Participants comfort during the interview

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Analysis and interpretation
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Nurses attitudes, beliefs, and feelings towards
organ donation

• As a professional positive feedback
• Major motivationsthe gift of life and the
  economic issues
• Personal negative
• Influence factorspersonal belief, doctors
  attitudes, and professional working experiences
• Changed in attitudes from negative to positive as
  a result of experience

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Nurses perceptions of doctors attitudes,
beliefs, and feelings towards organ donation

• A Hospital more positive
• B Hospitaltended to avoid talk about donation
  and had a negative view on it
• Reason increase family grief
• Conflict between doctors and nurses
• A Hospital doctors aggressive attitude
• B Hospital nurses and doctors had different
  attitudes

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Nurses perceptions of families attitudes and
beliefs towards organ donation

• Traditional culture beliefs
• keeping the body whole
• Financial situation
• lower educated ? likely to be persuaded by
  outsider than highly educated people
• Educational level
• higher education ? more likely to accept
• lower education ? cannot accept

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Nurses perceptions of families responses to the
brain dead

• Phase 1 total denial
• Phase 2 partial denial
• Deny issue
• A lack of understanding of the concept of brain
  death

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Nurses conflicting roles

• Confuse family and make it complicated
• Inadequacy communication skills
• Value of society
• Fear
• Familys reaction might become violent
• Increase stress and workload

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Nurses perceptions of their proper role regarding
organ donation

• Observing the familys response
• Supporting and advocating for the family
• Consistently provide support and be sympathetic
• Assist in procuring organs and to care for the
  patient (major role)

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Nurses feelings about looking after brain dead
patients

• Heavy psychosocial load
• Feelings away and struggle
• Physically and mentally exhausted
• Dissatisfied with their work

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Nurses recommendations for promoting organ
donation

• Media support
• Education programs should be developed to address
  this knowledge gap
• Professional training
• Clearly explain the situation to family by
  doctors
• Establishing a specialised health care centre and
  professional institution

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Discussion
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Culture ? Attitudes and beliefs

• Extended view ? rethink, re-feel, and
  re-justify
• Significant finding ? clarifying the process of
  organ procurement such and experience in caring
  for brain dead patients, nurses negative
  attitudes are revised and there is a break down
  in personal fatalistic beliefs

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(No Transcript)
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Watching and struggling (1)
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Watching and struggling (2)
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Ambiguous brain death (1)
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Ambiguous brain death (2)
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Whose responsibility to inform the family?

• Recommendation 9 In order to decrease conflict
  and miss out on potential donors, nurses and
  doctors who work in the same environment should
  share and discuss their opinions together and
  cooperate well with each other to confront the
  issues

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Conclusion
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If the educational system does not offer
sufficient and correct information in relation to
organ donation

• If professionals do not cooperate well with each
  other in relation to this issue
• If the society does not change its view on
  nursing

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I think perhaps nurses should not be required to
actively seek or inform the family about organ
donation.
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Thanks for your attention