AN Australian Critical Care Research Review Organ and tissue donation: a survey of nurse's knowledge and educational needs in an adult ITU Dr Carol Grech * Senior Lecturer Dr David Gillham • Senior Lecturer School of Nursing & Midwifery, University of South Australia, SA Collins TJ. Organ and tissue donation: a survey of nurse's knowledge and educational needs in an adult ITU. Intensive and Critical Care Nursing 2005; 21(4): 226-233 Introduction Nurses working in intensive care settings are an important [ink in the process of organ donation as they are often among the first group of health care professionals to form a relationship with the family of potential donors. Their involvement in the care of potential donor patients places them in a position to increase the supply of organs for donation, however, nurses must be appropriately educated in this area as successful procurement can depended on the knowledge, skills and attitude they bring to the organ donation process. The aims of this study were to establish the level of knowledge of registered nurses (RNs) working in an intensive care unit (ITU) in relation to organ and tissue donation and to identify where knowledge deficits existed. Method The study surveyed 37 RNs working in one general ITU in the United Kingdom. Length of experience in ITU nursing varied across the sample from weeks to many years. A questionnaire comprising eighteen questions related to organ and tissue donation was used to collect data and anonymity of respondents was maintained by RNs identifying only their nursing grade (level) on the form. The questionnaire consisted of both open-ended and closed-ended questions the researcher devised in consultation with the nurse manager and regional transplant coordinators and were based on similar questions used in an earlier study 1. Ethics clearance and managerial permission were obtained and informed co~sent was assumed through the nurses returning the completed questionnaire in the reply envelope. A content analysis approach was used to interpret the data and recurring themes or patterns were identified. Results A total of 31 registered nurses completed the questionnaire (83.3°/0 response rate). The majority of RNs (81%) had nursed a multi organ donor patient and, of the 19% who indicated otherwise, most were junior level nurses with limited ITU experience. In rating their feelings toward organ donation on a Likert-type scale, 26% of respondents strongly agreed with donation; 32% agreed; 26% were unsure; and, 16% indicated they either disagreed or strongly disagreed with organ donation. The majority of RNs who disagreed were the junior ITU nurses. Only 35% of respondents felt that they were adequately prepared to nurse nmlti-organ donor patients and 39% indicated they were unable, or unsure, whether they could adequately explain brain stem death (BSD) to relatives. The majority of the sample (94%) was aware that a large proportion of patients who die are eligible for tissue donation. However, when asked to identify which human tissue could be donated, 16% could not identify any, 19% could name one tissue, 26% two, 23% three and 16% four types of tissue. When rating who they believed should ask relatives for organ donation consent, 16% indicated the doctor, 10% the nurse caring for the patient, while the majority (74%) indicated it should be the health care worker who had established a significant relationship with the patient's family. Most respondents (61%) thought that the best time to approach the family of potential organ donors was after the first set of BSD tests had been conducted. Four respondents (13%) indicated family menlbers should be approached before any BSD tests were carried out, whereas 13% felt this should occur after the second set of BSD tests and 13% were unsure. Eleven RNs (35%) felt relatives should be given the option to be present when BSD testing was being undertaken, 32% said no, while the other 32% were unsure. In response to the question of whether the UK should adopt a policy of presumed consent (when organ donation is automatic unless the person has formally conmmnicated otherwise) most said no (77 %). Of the others, 13% felt the UK should adopt such a policy with the remainder (10%) unsure. The findings of the study indicated that the sample, particularly the less experienced RNs, had knowledge deficits related to BSD, donor criteria, tissue donation and lacked confidence in approaching families about organ donation. The researcher concluded that while further research needed to be undertaken to fully assess nurses' knowledge in this area, if health professionals lack education about organ donation it is likely that potential donors will be overlooked. Critique While this was a small-scale study undertaken in the UK, it makes a contribution to nursing knowledge by raising awareness of nurses being educated about organ and tissue procurement in intensive care units. The study would be of interest to Australian critical care nurses, particularly when national data indicates that in about 60% of cases, authority from families for organ donation is sought by clinicians working in intensive care units and demand 174 Volume 18 Number 4 November 2005