Obtaining tissues and organs: empowering actions of nurses in the light of ecosystem thinking

Tolfo, Fernando; Siqueira, Hedi Crecencia Heckler de; Scarton, Juliane; Cezar-Vaz, Marta Regina; Santos, José Luís Guedes dos; Rodrigues, Sidiane Teixeira; Pedroso, Vanessa Soares Mendes

doi:10.1590/0034-7167-2020-0983

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (2) • 2021 • https://doi.org/10.1590/0034-7167-2020-0983 copy

Obtaining tissues and organs: empowering actions of nurses in the light of ecosystem thinking

Obtención de tejidos y órganos: acciones potenciadoras del enfermero a la luz del pensamiento ecosistémico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze, in the light of ecosystem thinking, the actions of nurses that stimulate the potential to increase the rates of organ and tissue donation.

Methods:

descriptive, exploratory, mixed method study, of the embedded type, with simultaneous realization and emphasis on the quantitative approach, including 125 nurses from the Intra-hospital Commission for Donation of Organs and Tissues for Transplants in the Southern Region of Brazil. Data were collected using an online survey questionnaire. Quantitative data were analyzed using the Statistical Package for the Social Sciences software; and qualitative, Bardin content analysis.

Results:

the identified actions refer to the reception of the family, exclusive dedication and remunerated valorization of the nurses of the commission, media and dissemination campaigns for society in general and educational actions for the training of professionals.

Conclusions:

the results of the actions encourage the possibility of increasing the rates of organ and tissue donation for transplantation.

Descriptors:
Tissue and Organ Procurement; Nurses; Ecosystem; Work; Nurse’s Role

Variables	General		Paraná		Santa Catarina		Ri Grande do Sul		p value
Variables	n	%	n	%	n	%	n	%	p value
1.1 In the hospital where you work, are there technological, pharmacological, spiritual and / or psychological and structural supports (room for family interviews, for example), necessary for the maintenance of the potential donor and family support?
Always	51	40.8	19	51.4	24	50	8	20	0.006^* * p estatisticamente significante: p ≤ 0,05.
Often	34	27.2	10	27	14	29.2	10	25
Sometimes	27	21.6	3	8.1	7	14.6	17	42.5
Rarely	11	8.8	4	10.8	2	4.2	5	12.5
Never	2	1.6	1	2.7	1	2.1	0	0
1.2 Do you promote and organize the reception to donor families before, during and after the entire donation process within the institution?
Always	81	64.8	26	70.3	36	75	19	47.5	0.101
Often	33	26.4	7	18.9	11	22.9	15	37.5
Sometimes	7	5.6	2	5.4	1	2.1	4	10
Rarely	4	3.2	2	5.4	0	0	2	5
Never	0	0	0	0	0	0	0	0
1.3 Are you in constant telephone contact with your family for any information?
Always	67	53.6	18	48.6	30	62.5	19	47.5	0.333
Often	37	29.6	15	40.5	11	22.9	11	27.5
Sometimes	11	8.8	1	2.7	4	8.3	6	15
Rarely	7	5.6	2	5.4	3	6.3	2	5
Never	3	2.4	1	2.7	0	0	2	5
1.4 When participating in the donation process, are you present throughout the process?
Always	70	56	20	54.1	34	70.8	16	40	0.024^* * p estatisticamente significante: p ≤ 0,05.
Often	39	31.2	13	35.1	11	22.9	15	37.5
Sometimes	13	10.4	2	5.4	3	6.3	8	20
Rarely	2	1.6	2	5.4	0	0	0	0
Never	1	0.8	0	0	0	0	1	2.5
1.5 Do you, when conducting the interview with family members, follow a specific methodology and focus on the possibility of accepting the donation?
Always	61	48.8	20	54.1	27	56.3	14	35	0.052
Often	36	28.8	6	16.2	15	31.3	15	37.5
Sometimes	16	12.8	5	13.5	2	4.2	9	22.5
Rarely	8	6.4	3	8.1	3	6.3	2	5
Never	4	3.2	3	8.1	1	2.1	0	0
1.6 Do you respect the wishes of the potential donor and your family, even if you do not share your opinion?
Always	77	61.6	28	75.7	33	68.8	16	40	0.023^* * p estatisticamente significante: p ≤ 0,05.
Often	37	29.6	7	18.9	13	27.1	17	42.5
Sometimes	9	7.2	1	2.7	2	4.2	6	15
Rarely	2	1.6	1	2.7	0	0	1	2.5
Never	0	0	0	0	0	0	0	0
1.7 Do you try to help family members to reach a decision regarding organ donation and to continue to live without fear or guilt for the decision made?
Always	110	88	32	86.5	42	87.5	36	90	0.175
Often	11	8.8	4	10.8	6	12.5	1	2.5
Sometimes	2	1.6	0	0	0	0	2	5
Rarely	1	0.8	1	2.7	0	0	0	0
Never	1	0.8	0	0	0	0	1	2.5
1.8 When interviewing a family member to request organ donation, do you think it can cause more pain and suffering to the family?
Always	60	48	21	56.8	26	54.2	13	32.5	0.504
Often	25	20	6	16.2	8	16.7	11	27.5
Sometimes	22	17.6	6	16.2	6	12.5	10	25
Rarely	12	9.6	3	8.1	5	10.4	4	10
Never	6	4.8	1	2.7	3	6.3	2	5
1.9 Are there sufficient resources for the interview, such as a private room, psychological support or social protection in your hospital?
Always	52	41.6	19	51.4	22	45.8	11	27.5	0.058
Often	35	28	10	27	16	33.3	9	22.5
Sometimes	25	20	4	10.8	8	16.7	13	32.5
Rarely	11	8.8	4	10.8	2	4.2	5	12.5
Never	2	1.6	0	0	0	0	2	5
1.10 Do you feel prepared to take a family approach and answer family questions?
Always	38	30.4	5	13.5	19	39.6	14	35	0.124
Often	56	44.8	22	59.5	18	37.5	16	40
Sometimes	24	19.2	7	18.9	9	18.8	8	20
Rarely	5	4	1	2.7	2	4.2	2	5
Never	2	1.6	2	5.4	0	0	0	0
TOTAL	125	100	37	100	47	100	40	100

Variables	General		Paraná		Santa Catarina		Rio Grande do Sul		p value
Variables	n	%	n	%	n	%	n	%	p value
2.1 Does your hospital's CIHDOTT give lectures on organ donation and transplants to professionals in hospital units that serve neurocritical users?
Always	19	15.2	9	24.3	5	10.4	5	12.5	0.655
Often	44	35.2	13	35.1	16	33.3	15	37.5
Sometimes	44	35.2	10	27	21	43.8	13	32.5
Rarely	14	11.2	4	10.8	4	8.3	6	15
Never	4	3.2	1	2.7	2	4.2	1	2.5
2.2 Does CIHDOTT give lectures at schools or universities?
Always	20	16	6	16.2	7	14.6	7	17.5	0.694
Often	18	14.4	3	8.1	7	14.6	8	20
Sometimes	32	25.6	8	21.6	13	27.1	11	27.5
Rarely	32	25.6	13	35.1	13	27.1	6	15
Never	23	18.4	7	18.9	8	16.7	8	20
2.3 Do you encourage professionals from the hospital units (ICU, Block, Emergency or others) to participate in events, congresses, lectures that deal with guidelines and education for organ donation?
Always	49	39.2	14	37.8	24	50	11	27.5	0.561
Often	42	33.6	12	32.4	14	29.2	16	40
Sometimes	23	18.4	8	21.6	7	14.6	8	20
Rarely	10	8	3	8.1	3	6.3	4	10
Never	1	0.8	0	0	0	0	1	2.5
2.4 Do you use scientific knowledge to ensure that your organ donation work is evidence-based?
Always	81	64.8	25	67.6	31	64.6	25	62.5	0.759
Often	31	24.8	8	21.6	12	25	11	27.5
Sometimes	9	7.2	2	5.4	3	6.3	4	10
Rarely	3	2.4	2	5.4	1	2.1	0	0
Never	1	0.8	0	0	1	2.1	0	0
TOTAL	125	100	37	100	47	100	40	100

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[1] Corresponding author: Fernando Tolfo. E-mail: fernandotolfo@gmail.com