Organ Donation and the Delivery of Nursing Care - Case Study Example

Organ Donation and the Delivery of Nursing Care Name Institution Name Introduction Nurses experience numerous challenges and should have techniques to address many medical related challenges. In addition, registered nurses usually work in the intensive care unit with the regional hospital. Nurses have to assist different patients with different complications, and one of such a patient is Joanne. Joanne is a 32 year old female who has been married for two tears. Due to rupture berry aneurysm, Joanne has had an intracerebral hemorrhage resulting in brain death. The nurse is waiting for the family members for a family conference to inform them on what is wrong. The aim of this essay is to discuss the pathophysiology of the berry aneurysm and how it leads to brain death, demonstrate the role of the registered nurse is assisting patients, differentiate brain death from cardiac death in decision making, and discussing important issues surrounding organ donation. Pathophysiology of the berry aneurysm and how rupture can lead to brain death Berry aneurysm also called saccular aneurysms is round berrylike outpunching that occurs within the bifurcation points and usually within the Willis circle (Hammer, Moynihan & Pagliaro, 2011). It is sometimes referred to as the true aneurysms because it results from vascular lumen dilatations that are attributed to vessel wall layers weakness. An artery wall, which is normal, consists of three layers, which are intima, the media and the adventitia (Yachnis & Rivera-Zengotita, 2013). The Intima is the innermost endothelial layer, and the second is the media that is made of smooth muscle while the last and outermost is the adventitia that consist connective tissue. In addition, the aneurismal sac is composed of adventitia and intima. The intima is usually normal, but there are instances whereby subintimal cellular proliferation occurs (Hammer, Moynihan & Pagliaro, 2011). It results in a reduction of absence of internal elastic membrane, and the end of the media is at the aneurysm neck. Phagocytes and lymphocytes sometimes may infiltrate the adventitia. Due to external or internal pressures, the berry aneurysm sometimes ruptures in the circle of Willis. After it ruptures, it causes subarachnoid hemorrhage. The blood released may result in a stroke and chances of the patient been treated is completely minimized (Hammer, Moynihan & Pagliaro, 2011). Registered Nurse Care for Joanne (The Patient) According to Linos et al. (2007) state that management is important to all the patients even the patients suffering from brain death. According to the researchers, a variety of extra-cerebral organ manifestations may occur, which include immunologic derangements, myocardial stunning, neurogenic pulmonary oedema, and neurogenic pulmonary oedema. These conditions may impair other parts of the body affecting organ donation. The nurse should provide optimum services through adequate organ metabolism and perfusion. Appropriate management mechanisms should be encouraged and championed to ensure the patient is in a good state, allowing the patient to be able to donate most of the organs after receiving consent (Hammer, Moynihan & Pagliaro, 2011). A well managed and maintained patient increases the chances of effective donation. Difference between Brain Death and Cardiac Death in Relation to end of Life Decision Making According to Long, Sque, & Addington-Hall (2008) argue that death is viewed different by different individuals and institutions within the society. They argue lack of effective concepts of cardiac death, brain stem death and brain death both to different healthcare stakeholders influences negatively organ donation. Brain death donor may not mean actual death since the donor is able to manage brain temperature and other functions that include breathing. However, cardiac death is when a prospective donor has ceased breathing and participating in any function (Hammer, Moynihan & Pagliaro, 2011). Therefore, brain death does not mean an individual is death rather cardiac death means an individual has died. Important Issues Surrounding Organ Donation Numerous factors surrounds organ donation. Some of the factors include mismatch of the organs and donors, appropriate legislation, consent from immediate family members of donors, management of the transplantation process and availability of resources to successfully accomplish the transplantation process (Hammer, Moynihan & Pagliaro, 2011). The section discusses these issues. According to McKeown, Bonser & Kellum (2012) states that numerous factors limit organ donation, and the common factors are the availability of organs and suitable donors. It is difficult to access appropriate organs because of lack of suitable donors (McCance & Huether, 2013). The mismatch, first, is a major issue because a donor may be available, but the individual requiring the organ may not be medical compatible. The second aspect is availability of numerous individual requiring organs, but there is a lack of donors. McKeown, Bonser & Kellum (2012) asserts that the mismatch and absence of suitable donors is an inhibitor in ensuring a successful transplantation process. Rudge et al. (2012) associates organ donation and lack of donation to shortage of deceased donors. The decrease in a number of donors has resulted in unethical and illegal practices. Rudge et al. (2012) asserts it is crucial to creating an umbrella approach of addressing illegal and unethical transplantation. The programmes and legislation should prevent and manage organ donation and transplantation. Therefore, a clearly defined international framework is crucial to the success of organ donation and transplantation. Currently, illegal and unethical transplantation has been reported across the world especially from the Asian countries (Robertson & Walter, 2013). It has resulted in healthcare stakeholders to review the issue of organ donation introducing stringent penalties and measures to prevent the illegal and unethical behaviors. However, lack of the appropriate framework that brings together rules and regulations from different jurisdictions has prevented internalization of organ donation (Yachnis & Rivera-Zengotita, 2013). Therefore, the healthcare stakeholders should formulate and implement the framework that addresses organ transplantation ensuring cohesiveness and homogeneous approach on organ donation. Vincent & Logan (2012) says consent is crucial to ensure successful organ donation. Consenting may take different forms, which include before death and after the death of the prospective donor. Moreover, Vincent & Logan (2012) continues to define factors associated with actions that include negative psychological responses and positive, altruistic motives. These are crucial factors that allow understanding and appreciating how consent can be provided. Nevertheless, Vincent & Logan (2012) provide some modifiable factors that include nature of brain death, timing, setting, and emotional support for the family to consent for organ donation. Todd et al. (2007) supports consent and states that time, educational and spiritual considerations are important in ensuring effective organ donation. Furthermore, Sque et al. (2007) factors into consideration ‘sacrifice’ or ‘gift of life.' Some of the family members may oppose because of ideological perspective inhibiting organ donation. Therefore, the societal and cultural factors inform on how prospective donor families would react. Well prepared family members increase the chances of consenting when compared to those family members who lack prior knowledge on organ donation. Sque, Long & Payne (2005) continue to discuss the idea of decision making process within the family that may attribute to provided knowledge or information available to the family members. The bereaved family members’ decision making process is declining or agreeing donation is based on decision making perception. Perception, in the perspective of organ donor, is based on the presumed expectations of the deceased person and the processes leading to the action (Yachnis & Rivera-Zengotita, 2013). The family members should have knowledge on the deceased’s donation wish, attention during hospital care, meaning of death and views that the family associate with organ donation. Chances of acceptance of donation are dependent on how healthcare professionals introduce the issue and how the professionals create a positive impression to the family members. Sque, Long & Payne (2005) introduces three important components: attention, care and time in facilitating family member’s decision making; most of the factors within these components are predetermined by health professional actions. After the brain death of a family member, the family members should be given time to internalize the information, review the information provision processes and determine whether attention was premised on their emotional needs (Forsberg et al. 2014). Therefore, information and circumstances surrounding provision of information determines the family decision on donation (Hammer, Moynihan & Pagliaro, 2011). Hence, the health professionals can play an important role in creating awareness and also creating an environment that is conducive for decision making from the perspective of the bereaved family members. Long, Sque & Addington-Hall (2008) discusses the factors contributing to the decision on whether to consent on organ donation or refuse organ donation. The authors discuss emotional and cognitive factors in understanding circumstances surrounding consent. The family members’ perception of brain death is important and also understands its difference from cardiac death. The family members should understand the brain death testing fundamentals based on the aspect of organ donation. According to Long, Sque & Addington-Hall (2008), the family members should be cognitively and emotionally informed before introducing the aspect of organ donation. Some members of the family may perceive the entire process differently, and it is important to encourage concurrence that is aimed at accepting organ donation. Access to appropriate information regarding organ donation is crucial in ensuring the family members make right decisions that prevent future regrets. According to Berntzen & Bjork (2014), knowledge in organ donation process is important. Some family members usually experience strain after the donation and in most instances is associated with lack of awareness and comprehension (Hammer, Moynihan & Pagliaro, 2011). Reconsolidation should be in place to ensure the family members are involved, and the healthcare professionals should be involved in the provision of recognition and understanding (Yachnis & Rivera-Zengotita, 2013). McKeown, Bosner & Kellum (2013) asserts the usability of any organ especially brain is dependent on management and prevention of physiological instability. Appropriate and effective pathophysiological changes increase the number of organs available for transplantation and quality. Nurses are required to provide therapy and philosophy approach ensuring the organs to be transplanted are safe and reliable. Poor management of the organ donor reduces the number of organs that can be donated since poor management affects the quality of the organs. Vincent & Logan (2012) identifies resource availability is another factor to ensure successful organ transplantation. Availability of equipments, adequately trained personnel increases changes of consent translating in increase and successful rate of organ donation. Watson & Dark (2012) supports the idea of resource and technological advancement. Technological advancement has provided effective preservation solutions, management of immune and vascular anastomoses. Therefore, provision of resources and capacity improves organ donation and transplantation (Yachnis & Rivera-Zengotita, 2013). Well trained organ donor management including availability of important resources and technologies ensures the transplantation process becomes effective and successful. Conclusion In conclusion, even though Joanne has been declared brand dead, the registered nurse should manage and provide assistances to the patient. Provision of appropriate management improves the quality of organ donation and increases the success of the entire process. The bereaved family members should differentiate between brain death and cardiac death and significance of both deaths in transplantation. The important component in transplantation is consenting, and numerous factors affect consent process. Some of the factors include timing, availability of information, understanding the process and cultural/societal perspective on organ transplantation. In addition, lack of resources both human and technology, and lack of effective legislation affects transplantation. Therefore, to ensure successful organ transplantation, it is important to create a conducive environment for transplantation and ensure appropriate information is provided to different stakeholders to make right decisions. References Berntzen, H., & Bjork, I. (2014). Experiences of donor families after consenting to organ donation: A qualitative study. Intensive and Critical Care Nursing, 30, 266—274 Forsberg, A., Floden, A., Lennerling, A., Karlsson, V., Nilsson, M., & Fridh, I. (2014). The core of after death care in relation to organ donation — A grounded theory study. Intensive and Critical Care Nursing, 30, 275—282 Hammer, R., Moynihan, B., & Pagliaro, E. (2011). Forensic nursing: A handbook for practice. New York: Jones & Bartlett Publishers. Linos, K., Fraser, J., Freeman, W., & Foot, C. (2007). Care of the brain-dead organ donor. Current Anaesthesia & Critical Care, 18, 284 – 294 Long, T., Sque, M., & Addington-Hall, J. (2008). Conflict rationalisation: How family members cope with a diagnosis of brain stem death. Social Science & Medicine, 67, 253–261 Long, T., Sque, M., Addington-Hall, J. (2008). What does a diagnosis of brain death mean to family members approached about organ donation? A review of the literature. Progress in Transplantation, 18(2), 118-126 McCance, K., & Huether, S. (2013). Pathophysiology: The biologic basis for disease in adults and children. London: Elsevier Health Sciences Robertson, M., & Walter, G. (2013). Ethics and mental health: The patient, profession and community. New York: CRC Press Rudge, C., Matesanz, R., Delmonico, F., & Chapman, J. (2012). International practices of organ donation. British Journal of Anaesthesia, 108 (S1): i48 – i55 Sque, M., Long, T., & Payne, S. (2005). Organ donation: Key factors influencing families’ decision-making. Transplantation Proceedings, 37, 543–546 Sque, M., Long, T., Payne, S., & Allardyce, D. (2007). 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