Aims and Objectives To explore nurses’ experiences when approaching families for organ donation authorisation to guide nursing practice. Background Organ donation after brainstem death implies that bereaved families are approached to discuss organ donation authorisation, and in many countries, specialist nurses do this approach. The literature describes the social, psychological and emotional challenges of health professionals in this role. However, lack of conceptual clarity regarding nurses’ experiences on approaching families to guide nursing practice was found. Design Constructivist grounded theory. Methods Between October 2017 and July 2019, seven months of observations were conducted across two large public hospitals in Chile. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) with 71 participants (51 healthcare professionals and 20 bereaved families) were included. Data collection and analysis followed the principles and practices of Charmaz’ constructivist grounded theory. The COREQ checklist was followed in reporting the study. Results Edgework emotion management of organ donation nurses was developed as a threefold process: 1) being present to recognise inner and family emotions, 2) being on an emotional edge when approaching families and 3) extending the emotional edge to make sense of their experiences. The grounded theory was conceptualised using edgework emotion management by Lois (2003), which allowed to elucidate organ donation nurses’ experiences and practices on managing their emotions. Conclusions Organ donation nurses develop a sophisticated and complex emotional regulation process to approach and care for families when negotiating organ donation authorisation for transplantation. Relevance to Clinical Practice The experiences of specialist organ donation nurses entail a sophisticated emotion management process, which may explain the complexities of a critical role within healthcare institutions. Findings can be locally and internationally used to understand, educate and guide nursing practice, in an area of increasing specialisation and staffing shortages such as organ donation and transplantation.

Aims and ObjectivesExplore families' experiences when being approached for organ donation authorisation after brainstem death.BackgroundThe complexities of potential organ donor families' experiences include challenges related to emotional distress, coping with the loss and the organ donation decision‐making process, and support needed. A lack of conceptual clarity was found concerning families' experiences when being approached for organ donation authorisation, which guided the study.DesignConstructivist grounded theory.MethodsSeventy‐one participants, including healthcare professionals and families, were recruited from two large hospitals in Chile between 2017 and 2019. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) were collected and analysed following Charmaz's constructivist grounded theory principles and practices until theoretical saturation was reached. The study is reported using the COREQ checklist.ResultsA third type of ambiguous loss of bereaved families' experience was developed as a fourfold process: (1) impending loss, (2) confirming loss, (3) ambiguous loss and organ donation decision‐making and (4) organ donation as a third type of ambiguous loss. This grounded theory expands the concepts of ambiguous loss by Boss, dying by Glaser and Strauss and grief by Brinkmann, enabling explanation of families' experiences.ConclusionFamilies of potential organ donors develop a highly complex grieving process, which may play a significant role in the organ donation decision‐making process. Ambiguity is embedded in how donor families reframe the existence of the donor through the act of giving life.Relevance to clinical practiceThe findings shed light on families' experiences on the organ donation process after brainstem death. The study can be used in nursing practice, education and to inform policy nationally and globally, mainly due to the current focus on quantitative measures and legislative changes fostering individual decision‐making.Patient or Public ContributionFamilies contributed through their first‐hand experiences of the organ donation process.

Background. Advanced practice nursing (APN) requires nurses to support their knowledge and clinical experience in a nursing care model that delivers holistic and comprehensive care adjusted to the needs of each patient. Objetives. To identify the technological tools available to nurses in a chemotherapy unit, to select one of the specific technologies used and to generate a proposal that can be used in advanced practice. Methods. Data was collected using non-participant observation in an adult outpatient chemotherapy unit. Results. It was observed that nurses properly used hard technologies in their unit. In so far as hard-soft technologies, although there is a specialized knowledge in oncology, there is no theoretical framework associated to the nursing care provided. With regards to the use of soft technologies, their use seems to be related more with personal characteristics that a structured and conscious intervention. Conclusions. Technologies are tools that, coupled with nursing expertise, allow nurses to provide safe and effective care. The chemotherapy unit is a center where APN could be conducted. This study proposes enhancing patient-oriented care based on the knowledge of the discipline as expressed in three different models that are suggested, thus making it possible to state that advanced practice nursing is being provided to patients undergoing ambulatory chemotherapy