Lived Experiences of Iranian Nurses Caring for Brain Death Organ Donor Patients: Caring as “Halo of Ambiguity and Doubt”

Abstract

Background:Brain death is a concept in which its criteria have been expressed as documentations in Harvard Committee of Brain Death. The various perceptions of caregiver nurses for brain death patients may have effect on the chance of converting potential donors into actual organ donors.Objective:The present study has been conducted in order to perceive the experiences of nurses in care-giving to the brain death of organ donor patients.Methods:This qualitative study was carried out by means of Heidegger’s hermeneutic phenomenology. Eight nurses who have been working in ICU were interviewed. The semi-structured interviews were recorded by a tape-recorder and the given texts were transcribed and the analyses were done by Van-Mannen methodology and (thematic) analysis.Results:One of the foremost themes extracted from this study included ‘Halo of ambiguity and doubt’ that comprised of two sub-themes of ‘having unreasonable hope’ and ‘Conservative acceptance of brain death’. The unreasonable hope included lack of trust (uncertainty) in diagnosis and verification of brain death, passing through denial wall, and avoidance from explicit and direct disclosure of brain death in patients’ family. In this investigation, the nurses were involved in a type of ambiguity and doubt in care-giving to the potentially brain death of organ donor patients, which were also evident in their interaction with patients’ family and for this reason, they did not definitely announce the brain death and so far they hoped for treatment of the given patient. Such confusion and hesitance both caused annoyance of nurses and strengthening the denial of patients’ family to be exposed to death.Conclusion:The results of this study reveal the fundamental perceived care-giving of brain death in organ donor patients and led to developing some strategies to improve care-giving and achievement in donation of the given organ and necessity for presentation of educational and supportive services for nurses might become more evident than ever.

Significados do cuidado de enfermagem ao paciente em morte encefálica potencial doador

“…This situation generates a feeling of confusion, and is a major source of stress for nurses, which may interfere with their actions, as demonstrated in other studies (4,11) .…”

“…In addition, caring for this patient embodies the dichotomy between life and death. When they experience the process of care to brain dead patients, nurses become aware of the fragility of their lives, of their own finitude and the possibility of experiencing this situation with their relatives and friends (4,11,19) . Thus, it is difficult to accept death as part of the human condition.…”

“…Also, a study conducted in Iran (11) reported that nurses are involved in an atmosphere of ambiguity and doubt when they care for brain-dead potential organ donors. There is confusion and hesitation about the diagnosis of brain death, and this may even lead to hope in reversing the patient's condition.…”

Analysis of the reasons for nurses' confusion in relation to the concept of brain death from clinical and legal points of view

“…This increases levels of stress in the nurses responsible for their care and leads to problems for nurses in the perception of diagnosing brain death ( 3 ). In a study by Keshtkaran et al, there was a lack of confidence in the diagnosis and confirmation of brain death among the nurses ( 33 ). So, the nurses were in a particular kind of uncertainty and doubt in exposing and taking care of brain death organ donor patients, which was also evident in the interaction with the patients’ families.…”

A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation

“…Comparatively fewer studies have examined the wider process of donor care in the ICU. [13][14][15] While a high donation rate is the most obvious measure of success in donor care, even the best donor management may not result in organs suitable for transplant (e.g., a substitute decision-maker (SDM) decides organ donation is not consistent with the patient's wishes). Research into the process of care for organ donors therefore requires a ''program approach'' that considers donation as a series of inter-related steps, in which ''success'' consists of the best possible outcome for an individual case at each step.…”