Fu-Jin Shih

Impact of Cadaveric Organ Donation on Taiwanese Donor Families During the First 6 Months After Donation

Objective Organ donation is a complex decision for family members of Asian donors. The impact of cadaveric organ donation on both Chinese and Western donor families has not been well investigated within a cultural framework. The purposes of this study were to follow Chinese family members’ appraisal of their decision to donate organs, to explore the possible negative and positive impacts of organ donation on their family life, and to determine what help they expected from healthcare providers during the first 6 months after donation. Methods Twenty-two family members (10 men and 12 women) of cadaveric organ donors who signed consent forms at an organ transplant medical center in Taiwan participated in this project and completed in-depth interviews during the sixth month after donation. Results Participants were 25 to 56 years old (mean = 48.15 ± 8.31 years). The type of kinship of the participants included the donor’s parents, older sister, and spouse. Subjects reported several negative impacts: worry about the donor’s afterlife (86%), stress due to controversy among family members over the decision to donate (77%), and stress due to others’ devaluation of the donation (45%). Positive impacts reported by the subjects included having a sense of reward for helping others (36%), having an increased appreciation of life (32%), having closer family relationships (23%), and planning to shift life goals to the study of medicine (9%). Subjects expected the transplant team to provide information about organ recipients (73%), to submit the necessary documents so that family members could receive healthcare payments from the insurance company (68%), to help resolve legal proceedings and settlements associated with accidents (64%), and to not overly publicize their decision to donate (64%). Conclusions Although all of the subjects reported that organ donation was the right decision, the decision to donate did not protect Taiwanese donor families from negative psychocognitive bereavement. The impacts of organ donation were affected by the subject’s social cultural, spiritual, and legal context and the nature of their bereavement.

The dilemma of "to-be or not-to-be": needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition.

There has been little study of the Chinese cadaveric donor familys decisions to donate organs within the Chinese cultural framework. A convenience sample of 25 cadaveric donor family members (12 men, 13 women) who gave their consent to donation at National Taiwan University Hospital agreed to participate in this study and completed in-depth interviews. Data were analyzed by a three-steps within-method qualitative triangulation method. The factors influencing the donor familys decisions to donate organs, the needs of donor families, and their expectations of health care providers during the pre-donation transition--the critical period of time between signing a donation and consent to organ harvesting--were examined. The background context and a conceptual framework were further developed to discuss and depict this phenomenon. This project aims to broaden the horizon on organ donation and contribute to the understanding of some of the psychodynamic issues in the Chinese family in Taiwan.

Death and Help Expected from Nurses when Dying

This project was undertaken to ascertain the perceptions of a group of Taiwan’s fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because little is known about how Taiwan’s nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students’ reported needs during the dying process were directed towards three main goals: (1) help in reaching the ‘triple targets of individual life’; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife.

A Health Need Satisfaction Instrument for Taiwan's single-living older people with chronic disease in the community.

AIMS The aims of this study were to explore health needs and need satisfaction of Taiwans single-living older people with chronic disease in the community, develop a culturally sensitive Health Need Satisfaction Instrument and examine the relationships between health needs and need satisfaction. BACKGROUND Until now, there has been no reliable instrument for health professionals to assess, comprehensively, health needs and needs satisfaction for Chinese single-living older people with chronic disease in the community. DESIGN Between-method triangulation design was used. The first phase explored the contextual content of health needs from the perspectives of a purposive sampling (n = 44) using the explorative qualitative method. The second phase developed the Health Need Satisfaction Instrument and established its reliability and validity. The final phase implemented the instrument in a cohort study (n = 110) and examined the relationship between the respective/overall health needs and need satisfaction. RESULTS A Health Need Satisfaction Instrument with good validity and reliability encompassing tangible, psychospiritual and informational needs was developed. A significant correlation between tangible and psychospiritual needs (r = 0.238, p < 0.05) and between tangible and informational needs (r = 0.306, p < 0.01) was found. Three types of need satisfaction were inter-related (p < 0.01). A negative correlation between global health needs and need satisfaction (r = -0.223, p < 0.05) was found. Each domain of need satisfaction was negatively correlated with that particular type of health needs (p < 0.01), except for psychospiritual need (r = 0.339, p < 0.01). A measurement model between health needs and need satisfaction was established. CONCLUSION This study set a successful example of a rigorous, cross-cultural instrument development process for community-based Taiwans single-living older people. RELEVANCE TO CLINICAL PRACTICE Using Health Need Satisfaction Instrument, the less satisfied multidimensional health needs of community-based Taiwans single-living older people with chronic disease can be more accurately assessed and met.

Patient positioning and the accuracy of pulmonary artery pressure measurements (180f)

The measurement of pulmonary artery pressure (PAP) is a common nursing practice in hemodynamic monitoring of patients in the emergency room and intensive care unit. Several researchers have proposed that PAP should be measured with the patient in a supine position with legs horizontal in order to promote a relaxed state. The most widely used reference point is the phlebostatic axis, which is located at the intersection of the fourth intercostal space and the midchest level. However, this positioning requirement is in conflict with one of the goals of nursing care, which is to achieve comfortable positioning of the patient without compromising respiratory or cardiovascular function. In addition, since frequent readings are necessary, critically ill patients can lose valuable sleep time. The existing literature still fails to justify the validity of the phlebostatic axis as an external reference point for leveling the pressure transducer. In addition, findings on the accuracy of readings obtained in the supine, Fowlers and lateral recumbent positions are also in conflict. This paper reviewed research related to measurement of PAP in the supine, various Fowlers, and lateral positions in order to clarify the major factors which might have resulted in the conflicts in data on PAP measurements. Suggestions are also provided for nurse clinicians to obtain more accurate PAP measurements.