Original Article

The ethical obligation to provide care to patients diagnosed with brain death until the end stages based on grounded theory

Abstract

Nurses are faced with tremendous pressure when providing brain-dead patients with care. There is limited guidance for nurses on the care of these patients. The present study aimed to report the experiences of nurses regarding the care of patients diagnosed with brain death.Semi-structured interviews were conducted with 31 nurses and other stakeholders, and the observations and field notes were analyzed using continuous and comparative analysis based on grounded theory.The qualitative analysis of the data resulted in extraction of six final categories, including 'facing increased tensions and conflicts', 'organ donation: a distinct care element', 'inconsistency of care management', 'effective care requirements', 'challenges, rights and duty requirements', and 'moral obligation to provide holistic care until the last minute'. Data analysis identified 'Challenges, rights and duty requirements' as the main issue and showed that the nurses managed this issue using the strategy of 'moral obligation to provide holistic care until the last minute' as the core variable.According to the results, it is recommended that the healthcare system (especially hospital management) take supportive action for nurses in various fields of care of brain-dead patients to resolve educational, moral and legal challenges.

 

Alligood MR. Nursing Theory - E-Book: Utilization & Application, 5th. USA: Elsevier Health Sciences; 2013, p. 27.

Sarbey B. Definitions of death: brain death and what matters in a person. J Law Biosci. 2016; 3(3): 743-52.

Sandroni C, D'Arrigo S, Callaway CW, et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med. 2016; 42(11): 1661-71.

Kiani M, Abbasi M, Ahmadi M, Salehi B. Organ transplantation in Iran; current state and challenges with a view on ethical consideration. J Clin Med. 2018; 7(3): 45.

Tocher J, Neades B, Smith GD, Kelly D. The role of specialist nurses for organ donation: a solution for maximising organ donation rates? Journal of Clinical Nursing. 2019; 28(9-10): 2020-7.

Simonsson J, Keijzer K, Södereld T, Forsberg A. Intensive critical care nurses' with limited experience: experiences of caring for an organ donor during the donation process. Journal of Clinical Nursing. 2020; 29(9-10): 1614- 22.

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(3): 705-15.

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. 2016; 8(7): 281-92.

Vijayalakshmi P, Nagarajaiah, Ramachandra, Math SB. Indian ICU nurses' perceptions of and attitudes towards organ donation. Br J Nurs. 2015; 24(13): 694-7.

Lomero MD, Jiménez‐Herrera MF, Rasero MJ, Sandiumenge A. Nurses' attitudes and knowledge regarding organ and tissue donation and transplantation in a provincial hospital: a descriptive and multivariate analysis. Nurs Health Sci. 2017; 19(3): 322-30.

De Grande H, Liu F, Greene P, Stankus JA. Developing professional competence among critical care nurses: an integrative review of literature. Intensive Crit Care Nurs. 2018; 49: 65-71.

Manzari ZS, Mohammadi E, Heydari A, Aghamohammadian Sharbaf HR, Modabber Azizi MJ, Khaleghi E. Exploring families' experiences of an organ donation request after brain death. Nurs Ethics. 2012;19(5): 654-65.

Mills L, Koulouglioti C. How can nurses support relatives of a dying patient with the organ donation option? Nurs Crit Care. 2016; 21(4): 214-24.

Oroy A, Stromskag 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(4): 202-11.

Hosinrezaei H, Ranjbar H, Arab M. Brain death and organ donation: experiences of families. Journal of Qualitative Research in Health Sciences. 2012; 1(1): 34-40.

Jawoniyi OO, Gormley K. How critical care nurses' roles and education affect organ donation. Br J Nurs. 2015; 24(13): 698-700.

Miller AC, Ziad-Miller A, Elamin EM. Brain death and Islam: the interface of religion, culture, history, law, and modern medicine. Chest. 2014; 146(4):1092-1101.

Altınors N, Haberal M. Brain death and transplant in Islamic countries. Exp Clin Transplant. 2016;14(Suppl. 3): 48-52.

Victorino JP, Mendes KDS, Westin ÚM, Magro JTJ, Corsi CAC, Ventura CAA. Perspectives toward brain death diagnosis and management of the potential organ donor. Nurs Ethics. 2019; 26(6): 1886-96.

de Paula Cavalcante L, Ramos IC, Araújo MÂM, dos Santos Alves MD, Braga VAB. Nursing care to patients in brain death and potential organ donors. Acta Paulista de Enfermagem. 2014; 27(6): 567-72.

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(6): 475-82.

Stadlbauer V, Steiner P, Schweiger M, et al. Knowledge and attitude of ICU nurses, students and patients towards the Austrian organ donation law. BMC Med Ethics. 2013; 14: 32.

Corbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 3rd ed. London: Sage Publications; 2007.

Forsberg A, Flodén A, Lennerling A, Karlsson V, Nilsson M, Fridh I. The core of after death care in relation to organ donation–a grounded theory study. Intensive Crit Care Nurs. 2014; 30(5): 275-82.

YazdiMoghaddam H, Manzari ZS, Heydari A, Mohammadi E. Challenges in the management of care of brain-dead patients in the donation process: a qualitative content analysis. Int J Organ Transplant Med. 2020; 11(3): 129-42.

Yousefi H, Roshani A, Nazari F. Experiences of the families concerning organ donation of a family member with brain death. Iran J Nurs Midwifery Res. 2014; 19(3): 323-30.

Gómez M, Pérez B, Manyalich M, editors. International registry in organ donation and transplantation- 2013. Transplant Proc; 2014 ;46(4): 1044-8.

Files
IssueVol 14 (2021) QRcode
SectionOriginal Article(s)
Published2021-02-15
DOI https://doi.org/10.18502/jmehm.v14i2.5435
Keywords
Brain death; Nurses; Advance care planning; Tissue donors; Grounded theory.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Yazdimoghaddam H, Manzari ZS, Heydari A, 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. 14.