Iran Journal of Nursing

Introduction
Brain death is the irreversible loss of all brain functions, including the brainstem. The care process for brain-dead patients involves several challenges for nurses. Sensitivity care for the patient and high anxiety of the patient’s family following the observation of the vulnerable condition of their patient has made nursing care one of the nurses’ heaviest tasks. Because of the increased workload, the sensitivity of care in the Intensive Care Unit affects the performance of nurses in caring for brain-dead patients. Caring for patients with the diagnosis of brain death is one of the heaviest duties for nurses. The importance of organ donation is one of the biggest challenges of nursing in the Intensive Care Unit. This qualitative research aimed to investigate nurses’ experience caring for brain-dead patients who are candidates for organ donation.

Materials & Methods
The present study was qualitative research using content analysis. The data collection process with purposive sampling started through in-depth semi-structured interviews with open-ended and in-person questions, starting by focusing on the main topics or points of the research. Purposive sampling continued until the data was saturated.
The duration of each interview session varied between 40 and 95 minutes depending on the tolerance and desire of the participants and having enough time and the interview process. As the study progressed, the interviews were conducted based on the questions created, and the researcher directed his questions based on the essential categories created. The researcher listened to the topics expressed by the participants and preferably encouraged them to talk about a topic relevant to the purpose of the study. The participants agreed upon the time and place of the interviews, which were conducted individually in a quiet environment. All the interviews were directed by the same researcher (first authors), and the recorded interviews were transcribed word-by-word and reviewed repeatedly. Data analysis was initiated with the first interview.
Data collection in this qualitative research was performed purposefully through in-depth semi-structured interviews with 20 participants and continued until the data saturation stage. Data analysis was performed by conventional content analysis. After each interview, they were transcribed immediately. The text of the interviews was read and reviewed several times. Then the data was broken down into semantic units in sentences and paragraphs related to the central meaning. The semantic units were inspected several times, and then the appropriate codes of each semantic unit were written. Codes were classified based on conceptual and semantic similarity and were as small and concise as possible. Finally, the themes were abstracted. The analysis process was repeated, and each class was corrected with the addition of each interview.
To increase the scientific reliability and validity of the results, the methods used by Lincoln and Guba. These two researchers consider the four criteria of credibility, dependability, conformability, and transferability necessary for the consistency and robustness of qualitative data. Continuous engagement with the data and confirmation of the data by the participants, allocation of sufficient time to the study, and open and empathetic communication with the participants were also factors that increased the validity of the study data. Also, the interviews and the initial coding and contents were reviewed by a research colleague and several researchers in the field of qualitative research. Maximum variance sampling has increased the verification and transferability of data. The credibility of the results was followed by repeated and long-term analysis reviews over one month.

Results
In this qualitative study, 20 semi-structured and in-depth interviews were performed with nurses working in intensive care units (ICU) hospitals affiliated with the Universities of Medical Sciences in Mashhad, Neyshabur, and Sabzevar, Khorasan Razavi, Iran.
Participants were recruited from nurses (36% male and 64% female) aged (28 to 49 years) and 4 to 26 years of experience in care for brain death patients in the ICU. Qualitative data analysis leads to the emergence of 1270 initial codes, 13 subcategories, 4 initial categories, and 2 categories.
 Qualitative analysis of data content led to the extraction of themes reflecting the study of "experiences nurses the care of the brain dead patients" in ICU. These categories include “organ donation; a distinct care element” and “’facing increased tensions and conflicts.” Finally, the theme of “Care stress resonance following a distinct donation situation; a distinct care element” were abstracted.

Discussion
The results showed that the issue of organ donation has caused nurses to provide comprehensive care for the brain-dead patient who is a candidate for organ donation despite enduring a lot of stress. Due to the importance of maintaining the health of donation organs, nurses’ experiences have shown that they face many challenges while caring for brain death patients. But the issue of organ donation is one of the major issues affecting the care of organ donors, so managers can take effective proceedings by identifying nurses’ challenges in these fields to improve the quality of care for these patients. Therefore, it is recommended that the university education and hospitals should provide special training programs on the importance of organ donation and how to care for a patient donor organ to increase knowledge about the organ donation process, taking into account the mental and emotional needs of nurses. Planning for supportive work environment conditions is essential to improve the quality of nursing care. These findings are necessary to increase the quality of nursing care and organ health in transplanting potential organs.

Ethical Considerations

Compliance with ethical guidelines
The ethical approval of this study was received from the Ethics Committee of Mashhad University of Medical Sciences with code IR.MUMS.REC.1394.58.

Funding
This article is a part of Hamidah Yazdi Moghadam's doctoral nursing thesis of the Faculty of Midwifery Nursing, Mashhad University of Medical Sciences (Code 931512) and was done with the financial support of this university.

Authors' contributions
In all sections, the authors have contributed equally, except for the interview section, which was conducted by Hamida Yazdi Moghadam.

Conflict of interest
There are no conflicts of interest.

Acknowledgments
All the participants in this study, who patiently recounted their experiences and provided honest cooperation for the implementation of the research study, are sincerely appreciated and grateful for the support of the Research Vice-Chancellor of Mashhad University of Medical Sciences .

 

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