Document Type : Original Article
Authors
1 Department of Medical‑Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences Mashhad, Iran
2 Department of Medical‑Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences Mashhad, Iran,
3 Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract
BACKGROUND: Caring for brain dead patients is the heaviest of duties for nurses, and despite
tremendous stress, there are no theories/models to support nurses in this situation. This study
designed a supportive model for nurses to provide care for potential organ donors.
MATERIALS AND METHODS: This qualitative study was conducted in two stages. In the first
stage, semi‑structured interviews with 31 nurses and other stakeholders, observation and field
notes continued until data saturation, (on 2018), were analyzed using continuous and comparative
analysis through Corbin–Strauss method. In the second stage, theory synthesis of Walker and Avant’s
strategies for theory construction (2011) was used to design a supportive model/theory. The theory
synthesis includes three stages: (i) selection of focal concept (the concept of “moral obligation to
provide holistic care until the last minute” was selected); (ii) review of studies to identify the factors
related to focal concept relevant studies (42 articles were reviewed, statements and concepts
related to focal concept were then extracted and classified, and their relations were specified);
and (iii) organization of concepts and statements within a relevant general and effective manifestation
of the phenomenon under study which led to developing of a model.
RESULTS: In this supportive model/theory, “improving psychological security and empowerment”
was conceptualized within the conceptual framework. This supportive model entails three main
components, including (i) informational and educational support, (ii) systematically support,
and (iii) management support.
CONCLUSIONS: According to the results, nurses with moral obligation to provide holistic care
were faced with several challenges. Therefore, it is recommended that the healthcare system take
supportive proceedings for nurses in various fields of the care for brain dead patients to resolve
educational, moral, and legal challenges. This supportive model is essential for maintaining the
nurses’ health, increasing the quality of nursing care and the health of potential transplant organs.
Keywords
nurses face in caring for a donor brain dead patient and strategies
for their resolution: A systematic review. Iran J Nurs Midwifery
Res 2020;25:265‑72.
2. Magalhães AL, Erdmann AL, Sousa FG, Lanzoni GM, Silva EL,
Mello AL. Meaning of nursing care to brain dead potential organ
donors. Rev Gaucha Enferm 2018;39:e20170274.
3. Smith Z, Leslie G, Wynaden D. Australian perioperative nurses’
experiences of assisting in multi‑organ procurement surgery:
A grounded theory study. Int J Nurs Stud 2015;52:705‑15.
4. Keshtkaran Z, Sharif F, Navab E, Gholamzadeh S. Lived
experiences of Iranian nurses caring for brain death organ donor
patients: Caring as “halo of ambiguity and doubt”. Glob J Health
Sci 2015;8:281‑92.
5. Magalhães AL, Erdmann AL, Sousa FG, Lanzoni GM, Silva EL,
Mello AL. Meaning of nursing care to brain dead potential organ
donors. Rev Gaucha Enferm 2018;39:e20170274.
6. Cinque VM, Bianchi ER. Stressor experienced by family members
in the process of organ and tissue donation for transplant. Rev
Esc Enferm USP 2010;44:996‑1002.
7. Manzari ZS, Mohammadi E, Heydari A, Sharbaf HR, Azizi MJ,
Khaleghi E. Exploring families’ experiences of an organ donation
request after brain death. Nurs Ethics 2012;19:654‑65.
8. Orøy A, Strømskag KE, Gjengedal E. Approaching families on
the subject of organ donation: A phenomenological study of the
experience of healthcare professionals. Intensive Crit Care Nurs
2013;29:202‑11.
9. Johnson DO, Westphal CG. Addressing religious or cultural
opposition to brain death diagnosis. J Hosp Palliat Nurs
2018;20:252‑9.
10. Miller AC, Ziad‑Miller A, Elamin EM. Brain death and Islam: The
interface of religion, culture, history, law, and modern medicine.
Chest 2014;146:1092‑101.
11. de Paula CavalcanteL, Ramos IC, Araújo MÂ, dos Santos AlvesMD,
Braga VA. Nursing care to patients in brain death and potential
organ donors. Acta Paulista de Enfermagem. 2014;27:567.
12. Kocaay AF, Celik SU, Eker T, Oksuz NE, Akyol C, Tuzuner A.
Brain death and organ donation: Knowledge, awareness, and
attitudes of medical, law, divinity, nursing, and communication
students. Transplant Proc 2015;47:1244‑8.
13. Flodén A, Berg M, Forsberg A. ICU nurses’ perceptions
of responsibilities and organisation in relation to organ
donation‑A phenomenographic study. Intensive Crit Care Nurs
2011;27:305‑16.
14. Salehi S, Kanani T, Abedi H. Iranian nurses’ experiences of brain
dead donors care in intensive care units: A phenomenological
study. Iran J Nurs Midwifery Res 2013;18:475‑82.
15. Yazdimoghaddam H, Manzari Z.S, Mohammadi E. The ethical
obligation to provide care to patients diagnosed with brain death
until the end stages based on grounded theory. J Med Ethics Hist
Med 2021;14:1-13.
16. Corbin J, Strauss A. Basics of Qualitative Research: Techniques
and Procedures for Developing Grounded Theory. London: Sage
Publications; 2008.
17. Walker LO, Avant KC. Strategies for Theory Construction in
Nursing. 5th ed. Upper Saddle River, NJ: Prentice‑Hal; 2011.
18. Alakavuklar ON, Çakar U, Arbak Y. Development process of
conflict management studies in organizational behavior. J Faculty
Bus 2012;13:63‑92.
19. Arogundade OT, Arogundade AB. Psychological empowerment
in the workplace: Implications for employees’ career satisfaction.
North Am J Psychol 2015;17:(1):27‑36.
20. Chang LC, Shih CH, Lin SM. The mediating role of psychological
empowerment on job satisfaction and organizational commitment
for school health nurses: A cross‑sectional questionnaire survey.
Int J Nurs Stud 2010;47:427‑33.
21. Chaghari M, Saffari M, Ebadi A, Ameryoun A. Empowering
education: A new model for in‑service training of nursing staff.
J Adv Med Educ Prof 2017;5:26‑32.
22. Manzari ZS, Mohammadi E, Heydari A ,
Agha Mohammadian Sharbaf HR. Confrontation with Organ
Donation Request in Brain Dead Patients Families and Designing
a Nursing Model. Iran: Tarbiat Modares University; 2012.
23. Gerardi D. Conflict engagement: A new model for nurses. Am J
Nurs 2015;115:56‑61.
24. Graham LJ. Integration of the interaction model of client health
behavior and transactional model of stress and coping as a tool for
understanding retention in HIV care across the lifespan. J Assoc
Nurses AIDS Care 2015;26:100‑9.
25. Nicely B, DeLario GT. Virginia Henderson’s principles and
practice of nursing applied to organ donation after brain death.
Prog Transplant 2011;21:72‑7.
26. Lukose A. Developing a practice model for Watson’s theory of
caring. Nurs Sci Q 2011;24(1):27‑30.Watson J. Human Caring
Science. Sudbury, MA : Jones & Bartlett Publishers; 2011.
27. Moore M, Robinson G, Mink R, Hudson K, Dotolo D, Gooding T,
et al. Developing a family‑centered care model for critical care
after pediatric traumatic brain injury. Pediatr Crit Care Med
2015;16:758‑65.
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