Intensivsykepleieres kompetanse i organdonasjonsprosessen : En nasjonal kartlegging

Formål: 1) Å beskrive intensivsykepleieres kompetanse i organdonasjonsprosessen og identifisere utdanningsbehov. 2) Å drøfte teoriens plass i forskning. Funnene fra den empiriske studien er presentert i artikkelform. Drøfting av teoriens plass i forskning er presentert i en refleksjonsoppgave. Teoretisk forankring: I tillegg til forskningslitteratur om ulike aspekter ved organdonasjon ble teoretiske perspektiver på profesjonell kompetanse benyttet til å belyse problemstillingen i den empiriske studien. I profesjonell kompetanse inngår teoretisk og praktisk kunnskap, holdninger og kunnskap formidlet gjennom fellesskapet. Metode: Den empiriske studien har beskrivende survey design. Spørreskjema ble sendt til 801 intensivsykepleiere ved alle 28 norske donorsykehus. 572 svar ble returnert. Data ble scannet og lagt inn i SPSS, versjon 16.0. Data ble analysert med hensyn til frekvens, forskjeller og korrelasjoner. Egne erfaringer med bruk av et instrument uten eksplisitt teoretisk forankring inspirerte refleksjonsoppgavens tema. Litteratur om vitenskap og forskningslitteratur ble benyttet til å belyse og drøfte teorien plass i forskning. Resultater: Intensivsykepleierne hadde en positiv holdning til organdonasjon. Tiden mellom identifisering av en potensiell donor og spørsmålet om organdonasjon og kommunikasjon med pårørende i overgangen mellom liv og død var vanskelig. Det var en sammenheng mellom erfaring med organdonasjon og deltagelse på NOROD-seminar, og kompetanse. NOROD-seminar ble ansett som viktig for utvikling av kompetanse. Teori har betydning for hele forskningsprosessen fra planlegging til diskusjon av funnene. Når forskning er forankret i teori, gir det mulighet til å kritisere, teste og anvende forskningen. Konklusjon: Regelmessig opplæring kan øke intensivsykepleieres kompetanse i organdonasjonsprosessen. Etablering av et miljø for diskusjoner i avdelingen og tilrettelegging for at en uerfaren intensivsykepleier får opplæring av en erfaren kollega kan utvikle en felles definert profesjonell praksis. Forskningslitteratur må granskes i forhold til teoretisk perspektiv for å kunne være kilde til kunnskapsbaserte avgjørelser. Nøkkelord: Intensivsykepleie, organdonasjon, holdninger, kompetanse, survey desig

Donors’ health status and experiences ten years after kidney donation

Live kidney donation is increasingly performed to reduce the gap between the amount of patients on waiting list for kidney transplantation and available organs from deceased donors. Live donors are healthy persons going through major surgery for the benefit of others. The aim of the thesis was to obtain new understanding of long-term outcomes of live kidney donation both from donors’ own perspective and from a clinical perspective. Using a mixed –methods design three sub studies were performed; a cross sectional study investigating self-reported health outcomes in kidney donors in a long-term perspective, a qualitative study exploring donors’ long-term experiences through in-depth interviews, and a prospective study investigating the relationships between long-term clinical and self-reported outcomes, and donation specific factors. The results showed that donors’ health were generally good. The recipients’ status and recognition for being a donor were factors influencing self-reported health outcomes. The donation was mainly a positive experience, and the recipients’ possibility for improved health and life counterbalanced donors’ adverse experiences. There was no relationship between clinical and self-reported outcomes. In summary, there is a complexity in live kidney donation that needs to be addressed. The results from this study will strengthen the knowledge base future potential live donors need to make an informed consent. In addition, the study will be a contribution to evidence based education of health professionals. Systematic education with emphasizes on information, acknowledgement and individual support might be beneficial in creating supportive care both pre- and post-donation

Long-term, self-reported health outcomes in kidney donors

Background The wide use of healthy persons as kidney donors calls for awareness of risks associated with donation. Live kidney donation may impair quality of life (QOL) and result in fatigue. Long-term data on these issues are generally lacking in the donor population. Thus we aimed to investigate long-term self-reported health outcomes in a nationwide donor cohort. Methods We assessed self-reported QOL, fatigue and psychosocial issues after donation in 217 donors representing 63 % of those who donated 8–12 years ago. QOL was measured using the generic Short Form-36 Health Survey (SF-36), fatigue using the Multidimensional Fatigue Inventory (MFI) and psychosocial issues using donor specific questions. For each of the 8 domains of SF-36 and the 5 domains of MFI, we performed generalized linear regression. Results Donors scored high on QOL with mean scores between 63.9 and 91.4 (scale 1–100) for the 8 subscales. Recognition from family and friends was associated with higher QOL scores in four domains. There were no significant gender differences. Fatigue scores were generally low. Females generally scored higher than males on all five dimensions of fatigue, although significantly only on two. Recipient still alive was associated with lower scores on mental fatigue. Regretting donors scored higher than average on all domains of fatigue. Recipient death, worries about own health and worsened relationship with the recipient influenced willingness to donate in retrospect. Donor age did not affect long-term health outcomes. Conclusions Eight till 12 years after donation QOL scores were generally high and improved with recogniton from family and friends. Fatigue was independent of donor age and more pronounced in females and in those who regretted donation

Relationships between clinical, self-reported, and donation specific outcomes: a prospective follow-up study 10 years after kidney donation

Background: Long-term consequences of donor nephrectomy might be reduced kidney function, increased risk for cardiovascular disease, impaired quality of life, and fatigue. Few studies have investigated associations between clinical and self-reported outcomes in a long-term perspective. Thus, we aimed to investigate relationships between clinical, self-reported, and donation-specific outcomes in a nationwide cohort. Material/Methods: We conducted a prospective follow-up study and assessed pre- and post-donation data from 202 donors who donated in 2001–2004. During 2012–2013, data on donors’ self-reported (quality of life and fatigue) and donor-specific outcomes were collected. We performed linear regression for each component score of the generic instrument Short-Form, SF36v2, measuring quality of life, and the 5 domains of fatigue. Clinical parameters tested as independent variables were medical treatment of hyperlipidemia or hypertension, current smoking status, BMI, hemoglobin, and eGFR. Data were adjusted for age and gender. Results: Approximately 10 years after donation, 67 donors were hypertensive and 54 donors had eGFR <60 ml/min/1.73 m2. Mean increase in plasma creatinine was 16.6 μmol/l (SD=16.3). None of the clinical parameters were significant predictors for QoL. Female gender was significantly associated with general fatigue. There was a significant difference in perception of recognition from health personnel between donors with hypertension and donors without hypertension. Conclusions: Our results show no associations between clinical and self-reported outcomes. However, we found a significant relationship between hypertension and donation-specific outcomes. Hypertension or reduced kidney function was identified in a minority of the donors. The increased risk for fatigue among female donors needs more investigation

Long-term experiences of Norwegian live kidney donors: Qualitative in-depth interviews

Objective: Live kidney donation is generally viewed as a welcome treatment option for severe kidney disease. However, there is a disparity in the body of research on donor experiences and postdonation outcome, and lack of knowledge on long-term consequences described by the donors. This study was conducted to provide insight into donors' subjective meanings and interpretation of their experiences ∼10 years after donation. Design: Qualitative explorative in-depth interviews. The sampling strategy employed maximum variation. Setting Oslo University Hospital is the national centre for organ transplantation and donation in Norway, and there are 26 local nephrology centres. Participants: 16 donors representing all parts of Norway who donated a kidney in 2001–2004 participated in the study. The interviews were analysed using an interpretative approach. Results: The analysis resulted in 4 main themes; the recipient outcome justified long-term experiences, family dynamics—tension still under the surface, ambivalence—healthy versus the need for regular follow-up, and life must go on. These themes reflect the complexity of live kidney donation, which fluctuated from positive experiences such as pride and feeling privileged to adverse experiences such as altered family relationships or reduced health. Conclusions: Live kidney donors seemed to possess resilient qualities that enabled them to address the long-term consequences of donation. The challenge is to provide more uniform information about long-term consequences. In future research, resilient qualities could be a topic to explore in live donation