Nursing faculty acceptance and knowledge of organ and tissue donation
Izaura Luzia Silvério FreireI; Andréa Tayse de Lima Gomes II; Micheline da Fonseca SilvaIII; Bruno Araújo da Silva DantasIV; Quinidia Lúcia Duarte de Almeida Quithé de VasconcelosV; Gilson de Vasconcelos TorresVI
Nurse. Teacher at the Nursing School and a member of the Research Group
Nursing Procedures Incubator of the Federal University of Rio Grande do
Norte. Natal, Brazil. E-mail: email@example.com
II Nurse. Master's Degree and a member of the Research Group Research Care Laboratory, Safety, Health and Nursing Technologies at the Federal University of Rio Grande do Norte. Natal, Brazil. E-mail: firstname.lastname@example.org
III Nurse. Master's Degree and a member of the Research Group Research Care Laboratory, Safety, Health and Nursing Technologies at the Federal University of Rio Grande do Norte. Natal, Brazil. E-mail: email@example.com
IV Nurse. Master's Degree and a member of the Research Group Nursing Procedures Incubator of the Federal University of Rio Grande do Norte. Natal, Brazil. E-mail: firstname.lastname@example.org
V Nurse. Teacher and a member of the Research Group Nursing Procedures Incubator of the Federal University of Rio Grande do Norte. Natal, Brazil. E-mail: email@example.com
VI Nurse. Titular teacher and leader of the Research Group Nursing Procedures Incubator of the Federal University of Rio Grande do Norte. Natal, Brazil. E-mail: firstname.lastname@example.org
Objective: to ascertain acceptance for, and knowledge of, organ and tissue donation among nursing faculty members at a federal education institution. Method: this exploratory, transverse, quantitative was conducted with 44 nursing faculty members, between May and June 2014. Data were analyzed using descriptive statistics. Results: all participants accepted organ procurement and donation, and affirmed that this action contributed to the possibility of saving lives and was a way to help others. Respondents' knowledge was shown by their all successfully answering the questions with only one correct alternative, while none gave completely correct responses to questions with more than one correct answer. Conclusion: these findings showed good acceptance of donation, but a deficit of knowledge as to the guidelines governing organ and tissue donation in Brazil.
Keywords: Organ donation; knowledge; faculty; nursing.
The organ donation and transplantation have generated controversy and stimulated a lot of discussions in general and the scientific community. The lack of knowledge on the subject, associated with media influences and the lack of policies of campaigns to promote this practice is responsible for increasing the myths and prejudices in population1.
When considering that the process of organ donation and transplantation is performed in a hospital setting, requiring proper management, in addition to scientific knowledge and the ethical and legal principles inherent in its development, the figure of health professionals has extreme importance in procedures relating to such a procedure. The transmission of this knowledge is indispensable in the course of undergraduate courses, a fact that requires teachers, the domain to address the issue. Despite the prominence of nursing and medicine in this area, the participation of other professionals is necessary, systematically, to the effectiveness of the procedure2.
The importance of the teaching knowledge to the domain during the theoretical and practical activities involving the donation and transplantation process of organs and tissues is notorious. Thus, the identification of knowledge about the subject emerges as a way to diagnose the gaps in higher education and high school of nursing. Therefore, the following research question was elaborated: Which is the acceptance and knowledge of nursing teachers about organs and tissue donation for transplants?
To answer the question, this study aimed to assess the acceptance and knowledge of nursing teachers of a federal educational institution before organs and tissue donation.
The Organ Procurement and Transplantation Network (OPTN) shows that the United States are those that perform more transplants. In 2013, 30,552 solid organ transplants were performed, such as heart, lung, liver, pancreas, small intestine and kidney; however, there is still a waiting list of 54,550 people awaiting the procedure. Thus, it is observed that there is an imbalance between the organs supply and the number of individuals who need treatment3.
The Brazilian Association of Organ Transplantation (BAOT) shows that since 2007, the rate of effective donors was growing, however, in 2013 the expected increase of 5% was not achieved, being attributed this decline to family negative. In 2012, there were 7,426 solid organ transplants, while in 2013 7,649 were performed, thus presenting an increase of 3% 4,5.
It is agreed about the complexity and uniqueness in the donation of organs and tissues and that there are several reasons that cause the refusal of family members, among them: religious belief, waiting for a miracle, not understanding the diagnosis of Brain Death (BD) and believe in the reversal of the situation, not acceptance of the body manipulation, fear of the family reaction, inadequacy of information and absence of confirmation of BD, distrust in care and fear of trade in organs, inadequacy in the donation process, deceased patient desire, manifested in life, not to be an organ donor and fear of the loved one lost6.
Ministerial actions about the issue, on the one hand, although punctual, has conducted nationwide campaigns for organ donation, trying to demystify and mitigate the anxiogenic effects, and fear, doubt and uncertainty regarding brain death and organs donation and thus, potentiate not refusal of the family for the donation. On the other, it has also invested in the training of health professionals about the steps of the donation and collection process, which ranges from the early detection of the potential donor (PD) BD diagnosis, maintenance of PD clinical parameters, family interview to the removal of organs and tissues for transplantation.
Brazilian law emphasizes two types of donors, living donor and deceased donor, described synthetically by clarification. It is considered living donor, a healthy individual, legally able and agrees to the donation. The law emphasizes that the spouse or blood relatives to the fourth degree or any other person, carrier of judicial authorization, can be donors. This donor can provide cells, such as blood and bone marrow, in addition to the double organs, such as kidneys, lungs and part of the liver7.
It is characterized as a deceased donor, the one with the heart beating and with the heart stopped. The heart beating donor and with BD confirmed the diagnosis, will depend on the consent of the spouse or relative of legal age, given the succession, straight or collateral to the second degree. This type of donor can donate heart, lungs, liver, pancreas, intestine, and kidneys, and also cornea, sclera, bone, cartilage, tendon, meniscus, fascia, heart valve and amniotic membrane. The deceased donor with the heart stopped can donate tissues, such as the cornea, bone, cartilage, tendon, meniscus, fascia, valve, skin, and vessels7,8.
It is an exploratory and descriptive study, cross-sectional and quantitative approach, performed with teachers of higher education and high school of nursing of a federal university in the Northeast of Brazil.
Data collection was conducted through a questionnaire with closed questions during the months from May to June 2014. The sample was composed of 44 teachers of higher education and high school of nursing, through the following inclusion criteria: being an active exercise teacher in the institution and to participate in the research by signing the Informed Consent Form. As exclusion, it was adopted filling less than 80% of the questionnaire, but there were no losses.
The data collection instrument was developed by the researchers, based on the laws that regulate the donation and transplantation of organs and tissues in Brazil and subjected to pre-test in the research group Health and Society of the nursing school in a federal university in the Northeast of Brazil, after an extension course, lasting eight hours, addressing the theme about the process of organ and tissue donation for transplantation 7,8. After the construction process and pre-test, the questionnaire was modified regarding the wording, structure, content, sequence, categorization and codification of information, to facilitate the implementation and understanding.
The final version of the questionnaire was composed of three parts. Part I relates to socio-demographic characteristics data of teachers, such as age, gender, education, race, religion, marital status, occupation, family income, and origin. Part II deals with the acceptance of teachers about post-mortem organ donation, consisting of the following items: Are you in favor for organ/tissue donation? Do you want your family to authorize the donation of your organs/tissues after your death? Did you already tell your family about your desire? Have you already attended a course, lecture or lesson about donation and transplantation of organs and tissues? Do you think this issue should be more addressed in teaching? And finally, Part III (ANNEX A) contains ten multiple choice questions related to the knowledge of teachers about the ethical and legal aspects of organ and tissues donation of Brazil, in which each teacher could mark one or more alternatives, considered as correct.
Data were categorized and tabulated in a spreadsheet in Microsoft Excel 2010® software and analyzed through descriptive statistics in the statistical program SPSS 20.0®, which results were presented in tables and graphs.
The study met the ethical principles governing research involving human beings, as recommended by Resolution Number 466/2012 of the National Health Council, previously submitted to ethical consideration by the Ethics Committee of the University Hospital Onofre Lopes (CEP/HUOL) and approved under the Presentation Certificate for Ethics Assessment (CAAE) No 007.0.294.000-10.
RESULTS AND DISCUSSION
The socio-demographic data show that among those surveyed, it was a female predominance (90.9%), aged between 31 and 40 years old (31.8%), 65.9% were married or in a stable relationship and had a creed (95.5%). Most of the teachers had a master's degree as the highest academic degree (47.7%) and an income of up to ten monthly minimum wages (65.9%), as explained in Table 1.
Socio-demographic characterization of teachers of a federal educational
institution in the Northeast. Natal / RN, Brazil, 2015. (n=44)
The predominance of female in the profile of respondents was expected since it is known that the feminization is a strong feature of the health sector, representing currently over 70% of the entire contingent of professions, and markedly enhanced in nursing, with the team formed almost entirely by women. For example, this fact also occurs in the educational sector in Brazil. However, there is a new scenario: the data show that there is a growing presence of the male contingent in nursing, showing a trend that is here to stay9.
The results related to religion are consistent with a study conducted in São Paulo, where 100% of nurses of the surveyed institution had a creed, with a predominance of the Catholic religion. It is noteworthy that until now in Brazil, no religion adopted a negative attitude towards organs and tissue donation10,11.
It is understood that religions see organ donation as an act of detachment process result of the matter, when men become aware of the transience of their material and body life, and opens to the possibility of spiritual life. A minimum of understanding is essential on the part of health professionals, cultural and religious diversity, and an important condition for the provision of culturally sensitive care10,12.
Concerning titration, the presented data show high teacher training, with most participants with master's or doctorate, revealing the positive results of the institutional policy of qualification of teachers of higher education institutions. In recent years, some universities have created strict sense postgraduate programs or even encouraging teacher training, with interinstitutional postgraduate courses and release of teachers for courses at other institutions13.
Regarding the acceptance and knowledge of nursing teachers in the matters related to the post-mortem donation, all the surveyed participants were in favor for organ captivation and donation and affirmed that the act contributes significantly to the possibility of saving lives and a way to help others.
Knowledge about BD and the process of organ donation is considered a major factor concerning the decision of donation or not of organs and tissues of families facing the loss of a loved one. Although studies indicate the cause of the refusal as multifactorial, the idea of knowledge about the subject is strengthened by research findings that point, concomitantly, most people with complete high school, as well as the prevalence in the desire to donate14.
This study also highlights the high number acceptance by the teachers regarding the desire to donate organs after death. Contradictorily, about the fact of self-declared and inform the family about the decision, the results showed a significant statistical decline. It is believed that this fact occurs because death came to be seen, from the twenty-first century, as an enemy, hidden, shameful, that hurts the man omnipotence. Now, it is considered an interdict theme, causing barriers in communication among people15.
In Table 2, it was observed that the majority of teachers (93.1%) expressed the wish about the authorization of the family to donate their organs and tissues after death; however, a lower percentage (65.9%) reported that desire to family members.
Concerning the participation of courses, lectures or classes about donation and transplantation of organs and tissues, there was equivalence between the teachers, since 54.5% had participated in any activity that would address the issue and 45.5% never attended. Also, most respondents (95.4%) affirmed that this issue should be more addressed in education as noted in Table 2.
Acceptance of teachers for the donation of their post-mortem
organs. Natal / RN, Brazil, 2015. (n=44)
Given the importance of knowledge of the processes involving organs donation and transplantation, a study conducted in São Paulo-SP, in 2013, suggests the need for closer ties between the medical academy and the dynamics of the process of transplantation of organs and tissues, which applies to other areas of health. Thus, the medical students studied in that work, 41.3% affirmed they had participated in some event or lesson about the subject16.
After the BD finding, the physiological functions are maintained through machines and maneuvers to the viability of the transplant, in addition to the patient's submission to a series of clinical and laboratory tests to verify and diagnose health risks of a possible receiver. Through the examination results, certain organs are intended for transplantation, and this process must occur quickly to release the donor's body17. Thus, the complexity of these actions requires experience and capacity/training of health team members to consider the needs of patients and their families concerning the rules and laws governing the development of these phases.
The Federal Nursing Council, through Decree 292/2004 determines the nurse responsibility for action planning, implementation, supervision and evaluation of nursing procedures directed to the donor. Added to this, the nurse's presence becomes essential in the PD identification process and organs collection. This fact helps in the diagnosis of BD performed by the medical team, making the process agiler and less functional impairment of organs17,18.
The distribution of the number of correct answers of teachers according to the questions that had only one right answer and surveyed had the right to indicate only one option, and it was observed that 100.0% answered correctly the question C7, which elaborates on the concept of the heart beating deceased donor. On the other hand, the question six (C6) which addresses about the definition of living donor had the lowest percentage of correct answers (52.3%) of the questions.
It is noteworthy that the sample consists of high and middle-level teachers and their skills and competencies defined by the National Curriculum Guidelines regarding the training of human resources through educational projects of what is expected of graduates with the civil society, organizated from health care levels.
Given that the theme involves ethical, moral and cultural issues, the act of commercialize organs in Brazil was also an assessed inquiry as to its legality before the laws. Despite being a small figure, two teachers self-declared a positive position, which may be linked to the interpretation of the question, since it was not specified that the answer should be the light of current legislation in Brazil. Thus, they can be informed that exists illegal trade of organs in the Brazilian reality, not representing humanistic and inconsequential mistake associated with agreement or disagreement of the research participant.
It is known that the presence of nurses in the medical staff, to identify the BD, is essential to the viability of organ donation, which in turn, requires the professional knowledge of cause and clinical reasoning to made the maintainance of each organ or tissue that may be donated 19,20. It is stressed that through contact with such situations during their training, the professional acquires the skill and knowledge required for their development in the practical field, which is fundamental to the teaching-learning process.
Concerning questions containing more than one correct alternative, shown in Table 3, it was found that the third question (C3) had two correct alternatives (live and died with the heart beating), the C4 also had two correct options (deceased with the heart beating and died with the heart stopped), the C8 contained five (lung, kidney, blood, liver, and bone marrow) and C9 had 10 certain alternatives (heart, lung, kidney, vessels, bones, liver, intestine, pancreas, corneas, and skin) as shown in Table 3. It is noteworthy that the researcher could mark more than one option on a single issue.
Distribution of the number of correct answers of teachers on issues with
more than one correct answer. Natal / RN, Brazil, 2015.
I C10 question was not included for presenting only one right answer, despite the possibility to mark more than one statement depending on the survey participant's judgment.
It was observed that anyteacheranswer correctly 100% of the four questions containing more than one correct alternative. Only the third alternative of C8 question, which deals that the living donor can donate kidney, 100% of teachers marked correctly. Also, the highest number of correct answers was in question C3, which questions about the types of organ donors, averaging 75.8% and the lowest was in the C4, which deals with the types of tissue donors, averaging 62.5% of the hits.
Based on the results of this research it was found that there is a deficiency of knowledge of teachers reated to the types of tissue donors. However, the success level was highest addressing the types of organ donors. This suggests shortcomings in the definition of the types of donors, being of organs, tissues or cells. Also, it can reveal a removalof the teachers about interventions in the clinical and hospital area.
Despite the positive findings relating to organ donors,there is the issue related to organs that can be donated by deceased donors with a beating heart (C9) which results showed a significant level of errors in considering the correct ansewrs average. This result may lead to the inference as to the lack of knowledge, doubts and theoretical uncertainties, methodological, procedural and functional,related to the physiological changes caused by BD, which can lead to the interruption of the donation process.
Authors state that one of the causes for the non-realization of organ and tissue transplantation is due to insufficient knowledge of health professionals about the physiology and pathophysiology of BD; and consider as a fundamental aspect of the care of PD, the systematized assistance supported by the clinical assessment, in the early diagnosis of BD, in recognition of physiological changes resulting from this process, in the planning of appropriate treatment, in implementing the care, in the evolution and reassessment of conducts and treatment, and permanent educational work. This knowledge should be seized first at the Academy; therefore, it is essential that teachers hold current information about issues related to organ donation and solid transplantation21,22.
The process of organ and tissue donation requires a broad field of physiological changes resulting from the BD process by the health team that assists the PD, whose success rate attributed to a complex process, requires agility in the procedures because it substantially changes the physiology of all organ systems. Failure to proper conduct, failure results in front of multiple organ dysfunctions, affecting the quantity and quality of organs to be transplanted21.
It is noteworthy that the diagnosis of BD needs to be understood and known by all health professionals, including teachers. The current practical and scientific knowledge about the PD maintenance care, concerning the nursing staff, is declared as insufficient, poor and superficial. There is a need for education and improvement about the subject to avoid unnecessary expenses, professional stress, family suffering, as well as to enable the increased supply of organs and tissues for transplantation, generating benefits for all society23.
It was found that the applied methodological approach allows understanding of the acceptance and knowledge of teachers about organ donation, thus responding to the objective proposed in this study. Meanwhile, it was found that all the teachers were for organ donation; however, just over half had expressed the desire to donate to the family and held knowledge of the law and involved ethical principles.
Moreover, it is observed that there is insufficient knowledge of teachers about the types of donor organs and tissues. This reality demonstrates the need and the importance of increased investment in upgrading courses for the higher and middle school teachers in this subject. Since such professionals are transmitters of knowledge in an academic universe focused on the training of general health workers. And the own survey participants expressed that the knowledge about donation and transplantation organs and tissues should be more addressed in teaching.
Furthermore, it recognizes the relevance of the experts; however, the basic knowledge is necessary for other areas, because the teaching nurse, whether a technician or graduate course, is responsible for training general nurses.
Finally, although answering the research question, this study has the following limitation: the involvement of professionals crowded into one educational institution, making it difficult to generalize the results. Therefore, it is recommended to perform similar studies at other institutions both the national and international scene.
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