6.8.2 The experiences of nurses with regard to brain stem death testing (20)

Christina Ronayne, Lecture Practitioner, Continuous Professional Education and Development, Greater Glasgow and Clyde NHS, Glasgow, United Kingdom christina.ronayne@northglasgow.scot.nhs.uk

Abstract:

Background:

Minimal research has been published seeking to understand the experience of nurses caring for patients undergoing brainstem death testing (Pearson, Robinson-Malt, Walsh, Fitzgerald 2001, Hibbert 1995, Watkinson 1995). The published work has combined the experience of caring for the brainstem dead patient with that of caring for an organ donor, however in the United Kingdom only 50% of brainstem dead patients will become organ donors (UKTS 2006).

Aim:

To understand the experience of nurses caring for a patient being brainstem death tested. Method. A hermeneutic phenomenological study involving in depth interviews with 6 nurses in general intensive care units. Interviews were taped, transcribed, and coded. Codes were clustered into themes and categories.

Findings:

Fell into 5 categories: communication, education, feelings, protection and technology. Within the category of feelings all respondents expressed a degree of confusion or cognitive dissonance, which led to difficulties in explaining brainstem death to the relatives. This confusion is managed by nurses in a variety of ways including maintaining normality and treating the patient as though they were still alive. Within the category of communication it was found that the nurses commonly talked to the brainstem dead patient, as they would to any patient despite the potential for this to create confusion in the relatives.

Conclusion:

The presence of cognitive dissonance can result in increased stress for the nurse and inhibit the full understanding of brainstem death for the relatives. Recognition of this could lead to a less ritualistic approach to care with the development of improved communication strategies such as the provision of written information for the relatives and the greater use of touch instead of verbal communication to the patient. This more individualised approach to care could lessen the degree of confusion and stress in the relatives.

Biography:

After qualifying at St Bartholomew’s Hospital, London in 1987 I have had a varied career including working in the liver unit at Kings College Hospital London for 6 years, medical admissions, a spell in a private hospital and 5 years working in a the neurosurgical intensive care unit in Glasgow. I have a BSc(hons) in applied Biology and recently completed a MSc (critical care) at the University of Glasgow. As a staff nurse I completed and published 2 small research projects looking at skin care for patients with liver disease. I am presently working in the practice development unit in Greater Glasgow and Clyde where I have responsibility for clinical skills education and the critical care course.