Transcript Taiwanese Nurses’ Feelings Towards Organ Donation: An Interpretive Study By

Taiwanese Nurses’ Feelings
Towards Organ Donation:
An Interpretive Study
By
Tzu-Fei Chen
March,16,2000
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.
Introduction
A general picture of Taiwan
人口
22 millions1
平均壽命
主要宗教 1
信仰人口 1
1
2
外交部, 1999.
衛生署, 1996.
年齡層2
< 15 歲
15 – 64 歲
百分比
23.21%
68.95%
7.84%
> 64 歲
男：72 歲 、女：78 歲
佛教、道教
11 millions (平均每 2 人中就有 1
人有信仰)
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
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
Health cost
Recipients’ experience
一切如昔，地球還是在轉。
只是，我的世界即將消失！
（莫, 1998, P71）
Donor family’s experience
• Grief, stress, and sadness
• Some donors’ families reveal regret
and continuously question
themselves
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
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?
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
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
Literature Review
A comparison of Western countries and
Taiwan (1)
country
items response
Western Countries
Taiwan
Public crisis


Strategies


Public attitudes
negative
fear, religious
belief,
lack of knowledge,
misconception of
the brain dead
negative
religion, culture,
family value,
belief (afterlife&
reincarnation)
A comparison of Western countries and
Taiwan (2)
Families
reactions
Western Countries
Early:
Refuse to accept
Do not want the donor
to suffer
Late:
1.Understand
 donation
2.Angry and complain
if professionals avoid
to talk
Taiwan
Refuse
1.Keep the body
whole
2.cannot move
the body for 8
hrs
3.filial piety
4.dying at home
A comparison of Western countries
and Taiwan (3)
Western Countries Taiwan
Professional Doctors：
attitudes
Struggle – suggest
nurse to take over
Nurses：
Struggle –
30% refused
75% felt disturbed
Doctors：
Unknown
Nurses：
Professional(+)
Personal(-)
Organ donation strategies, a comparison of
Western countries and Taiwan.
The gift of life1
Donor card2
Driver license
endorsements
Required
request3
Family consent
Selling or
buying organs4
Western countries Taiwan




(legal status)
(no legal status)








The gift of life has achieved to increase donation rate (Henderson, 1998b).
1
Donor card has failed to increase the donation rate (Gibson, 1996).
1
The required request has failed to increase donation rate (Caplan and Welvang, 1990, Ross et al, 1990, Norris, 1990, cited in Thompson et al, 1995;
Caplan and Welvang, 1989, cited in Sanders et al, 1992).
1
The idea of selling or buying organs is still under debates (DeJong et al, 1995; Randall and Marwick, 1991; Sanders et al, 1992).
Methodology
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 people’s
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’
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
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
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
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?
Data analysis
Preliminary themes
Attitudes and beliefs:
(a) Nurses
(b) Doctors
(c) Patient’s family
Nursing role in seeking consent
Nursing role in informing
Experience in caring brain dead patients/donors
Expectations of nurses
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
Analysis and
interpretation
Nurses’ attitudes, beliefs, and feelings
towards organ donation
• As a professional — positive feedback
Major motivations：the gift of life and the economic
issues
• Personal — negative
Influence factors：personal belief, doctor’s attitudes,
and professional working experiences
• Changed in attitudes from negative to positive
as a result of experience
Nurses perceptions of doctors’ attitudes,
beliefs, and feelings towards organ
donation
• A Hospital ：more positive
• B Hospital ： tended 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
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
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
Nurses’ conflicting roles
•
•
•
•
Confuse family and make it complicated
Inadequacy communication skills
Value of society
Fear
• Family’s reaction might become violent
• Increase stress and workload
Nurses perceptions of their proper
role regarding organ donation
• Observing the family’s 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)
Nurses’ feelings about looking
after brain dead patients
•
•
•
•
Heavy psychosocial load
Feelings away and struggle
Physically and mentally exhausted
Dissatisfied with their work
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
Discussion
Culture  Attitudes and beliefs
• “Extended view”  rethink, re-feel, and rejustify
• 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
Recommendation 1: Both nursing training curricula and
public educational curricula should provide more and
accurate information about the concept of organ donation
from a variety perspectives.
Recommendation 2: In-hospital training programs
should provide information about organ donation to all
professionals. Also, hospitals should regularly organise
conferences on organ donation and transplantation and
invite different professionals who have experience to
share their experiences with other professionals who are
not experienced in this area.
Watching and struggling (1)
Recommendation 3: Taiwanese hospitals should
provide appropriate in-service programs for nurses,
enabling them to seek help in order to release their
work stress, such as counselling services
Recommendation 4: Head Nurses should be aware
of their staff’s invisible stress and encourage them to
express their feelings and problems in ward meetings
or in one to one meetings
Watching and struggling (2)
Recommendation 5: Nursing training curricula
should provide some programs such as terminal care
nursing, thanatology, and coping strategies for
students to discuss and to further understand what the
death is and how to have a correct attitude when
facing dying people.
Ambiguous brain death (1)
Recommendation 6: Both public educational
curricula and nursing curricula should include
content on brain death
Recommendation 7: The Taiwanese Government
should reevaluate the appropriateness of organ
transplantation legislation and make changes in order
to promote organ donation
Ambiguous brain death (2)
Recommendation 8: The media should be
encouraged to report medical news fairly. Also the
media has a responsibility to provide some programs
in relation to organ donation and transplantation to
educate the public and to present correct information
about brain death to the public.
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
Conclusion
Culture
Fatalism
Attitudes and belief
Powerless
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
I think perhaps nurses should not
be required to actively seek or
inform the family about organ
donation.
Thanks for your attention