Critical care family needs: nurse-family member confederate pairs

Article Abstract:

Nursing care must address not only the needs of the patient, but those of the whole family. The needs of patients in intensive care and those of their families are especially complicated by the physical and emotional demands on all concerned. Families experience severe stress and anxiety, and may feel helpless and unable to cope. Accurate assessment of their needs is one of the first steps in providing appropriate care to ICU patients and their families. A different nurse was assigned to each of 92 critical care families in order to determine how well the needs of the families matched the nurses' perceptions of those needs. Both families and nurses indicated that the families' most important needs were reassurance that the patient was getting the best possible care, and that they were receiving honest answers to their questions. The families also wanted to know the facts about the patient's condition, how the patient was being treated, information about the prognosis, and that they would be called at home in case the patient's condition changed. The nurses thought the other most important needs were to feel that hospital personnel cared about the patient, to be given understandable explanations, and to know why certain things were being done for the patient. Nurses and patients agreed that a telephone near the waiting room and having visiting hours start on time were unimportant. Patients also felt that explanations of the environment before going in, talking about feelings, and having friends nearby for support were among the least important items. The nurses thought the other least important needs were: to talk about the possibility of the patient's death, to feel accepted by hospital staff, and to talk about feelings. The researchers conclude that intensive care nurses may be right in their assessments of family needs about half the time. This study was limited to a defined set of needs; however, there may be other needs that have not yet been identified. In addition, the subjects in this study were inner city residents, and the nurses were young and relatively inexperienced. The results of this research may not be applicable to middle class patients, or patients from other ethnic or socioeconomic backgrounds. The nurses also chose the family member about whom they filled out the questionnaire, thus leading to a bias toward those people who were best integrated into the system. Nurse assessment of critical care needs may therefore be worse than indicated in this study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Medical care needs assessment, Intensive care nursing

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Required request: why it has not significantly improved the donor shortage

Article Abstract:

Twenty thousand people are waiting for an organ to become available for transplant, and thousands more are waiting for skin, corneas, bones, and heart valves. Legislation proposing that all families should be made aware of the option of organ and tissue donation began to pass in state legislatures in 1985, at the prompting of patients waiting for transplants, donor families, and also those families who had not been given the option of donating a loved one's organs. The federal government stepped in and required hospitals to present the option of donation as a condition for Medicare and Medicaid reimbursement. The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) did the same as a condition of accreditation. In spite of required request (also known as routine inquiry), the hoped-for increase in donations has not materialized. The problem seems to be with the implementation. Many health professionals feel uncomfortable with the regulation, and interpret it to mean that they are to ask for donations, which is not the purpose of the rule. They are required to make the family aware of the option, although unfortunately the common name given to the law implies that organs are being solicited. Another problem is that institutions have not considered the comfort level of doctors and nurses who are to provide this information, and designate whoever is caring for the person at the time of death to speak to the family about donation. Those who are uncomfortable about doing so will find ways to avoid talking about it, or more likely, they will not present the information effectively. Research has shown that the comfort level of nurses greatly influences whether or not the family donates. Most often there is no training for those who must talk to families. Finally, many health professionals are unaware of donor criteria, and exclude young or old patients, or patients with certain diseases such as cancer and diabetes, although these are not reasons for exclusion. The criteria change frequently because of increasing transplant sophistication. Workshops to train personnel in talking to families and to understand the donor's perspective, in-service education to provide updates of donor criteria, and attention to the comfort level of the medical staff will help increase the effectiveness of communication with potential donors and their families, and therefore increase the number of donations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Donation of organs, tissues, etc., Tissue donation, editorial

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Disparities for minorities in transplantation: the challenge to critical care nurses

Article Abstract:

The issues surrounding tissue and organ transplantation include physiological, psychosocial, and ethical factors. The road from donor to recipient is tenuous. The process of organ and tissue allocation is based on an objective scoring system that fails to record the race of the patient. Black Americans, however, receive transplants half as often as whites. Women receive fewer transplants than men, and the poor receive transplants less often than higher income patients. There are some reasons for these apparent inequities. Women who have been pregnant may present crossmatching problems that make it more difficult to find an appropriate match. Blacks choose transplantation half as often as whites. In addition, about 20 percent of blacks can only be matched with another black. Since most organ donors are white, the option of transplantation may be further reduced for some black patients. However, there is serious speculation that organ and tissue transplantation may be infrequently discussed as a possible treatment with women, blacks and low-income patients. The critical care nurse can play an important role in issues related to minority transplantation. Specifically, the nurse can present the choice to the patient as a treatment option, and assist the patient and his or her family through the often lengthy process. The minority donor, as well as the minority recipient, should be counselled. The critical care nurse is in a particularly good position to provide the kind of information needed by the potential transplant candidate who should be enabled to make an informed, intelligent decision. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Ethical aspects, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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