| 1. |
- Flodén, Anne, 1957, et al.
(författare)
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A phenomenographic study of ICU-nurses' perceptions of and attitudes to organ donation and care of potential donors.
- 2009
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Ingår i: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses. - : Elsevier BV. - 1532-4036. ; 25:6, s. 306-13
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of organs for transplantation and the number of potential organ donors is limited. Several studies indicate that the most crucial factor is the attitude to organ donation among intensive care staff. The aim of this study was to describe intensive and critical care nurses' (ICU-nurses) perceptions of organ donation based on their experience of caring for potential organ donors. A phenomenographic method was chosen. Nine nurses from three different Swedish hospitals were interviewed. All were women; aged 36-53 years, with 3-27 years' ICU experience. The analysis revealed the crucial perception "nothing must go wrong". The findings can be described in three parts: organ donation as a situation, organ donation as a phenomenon and different attitudes to organ donation. In conclusion: various perceptions adopted by ICU nurses might influence the chances of a potential donor becoming an actual donor. This study demonstrates that nurses who promote organ donation strive to fulfil the will of the potential donor by taking responsibility for the perception that "nothing must go wrong".
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| 2. |
- Flodén, Anne, 1957, et al.
(författare)
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Attitudes to organ donation among Swedish ICU nurses.
- 2011
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 20:21-22, s. 3183-95
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Tidskriftsartikel (refereegranskat)abstract
- To present data on Swedish ICU nurses' attitudes to brain death and organ donation and to test a questionnaire designed to explore these issues in terms of validity and reliability.
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| 3. |
- Flodén, Anne, 1957
(författare)
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Attitudes towards organ donor advocacy among Swedish intensive and critical care nurses.
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- End-of-Life Care in the intensive and critical care unit (ICU) involves the rare situation of caring for brain dead persons who, by their death, become potential organ donors (POD). A consequence might be that end-of-life care continues into after-death care in order to facilitate organ donation (OD). In this situation, the concept of organ donor advocacy is critical. Aim: The overall objective was to explore ICU nurses’ attitudes towards organ donor advocacy by capturing their perceptions, experiences and approaches and to develop a context-specific instrument for ICU nurses’ self-assessment of attitudes towards organ donor advocacy. Methods: The data collection methods were both inductive and deductive, including interviews and questionnaires, in an effort to seek the unique in each individual case as well as group correlations. The study groups consisted of ICU nurses: Paper I n=9, Paper II n=702, Paper III n=15 and in Paper IV n=502. The interviews were analysed by phenomenography. The data collection instruments comprised a questionnaire to explore ICU nurses’ attitudes to OD and the Attitudes towards organ donor advocacy scale (ATODAS), which was developed for this thesis. Results: The thesis reveals that less than half of the ICU nurses trusted clinical diagnosis of brain death (BD) without a confirmatory cerebral angiography. Almost half considered that caring for a mechanically ventilated POD was a great burden involving emotional strain. Twenty-five percent of the respondents indicated that mechanical ventilation was withdrawn in order to reduce suffering for a presumably dead person and that the issue of OD was never mentioned. In total, 39% had experienced occasions when the question about OD was never raised with the relatives. The participants perceived BD and the diagnostics of BD in four qualitatively different ways. With the exception of one participant, there was an overall perception of a lack of organisation regarding OD in the ICU. A useful approach might be to move from studying attitudes towards OD to investigating attitudes towards organ donor advocacy, in order to respect, represent and safeguard the donor’s and his or her relatives’ rights and best interests. It is possible to measure attitudes towards organ donor advocacy in three dimensions divided into five factors. Conclusion: Ambiguity and various perceptions of the BD diagnosis seem to be a crucial aspect when caring for a patient who might be a potential organ donor. The lack of structured and sufficient organisation also appears to be a limitation. Both of these aspects are essential for the ICU nurse’s possibility to fulfil his or her professional responsibility towards the deceased, next of kin, colleagues and organ recipients.
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| 4. |
- Flodén, Anne, 1957, et al.
(författare)
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Calculation and comparison of the model for end-stage liver disease (MELD) score in patients accepted for liver transplantation in 1999 and 2004
- 2007
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Ingår i: Transplantation proceedings. - : Elsevier BV. - 0041-1345. ; 39:2, s. 385-6
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Tidskriftsartikel (refereegranskat)abstract
- There has been a need to assess the "sickness degree" in patients with acute and chronic hepatic failure. The Model for End-Stage Liver Disease (MELD) score was developed as a tool for a more objective estimate of the "degree" of sickness in patients with chronic liver disease. In this study, the MELD score was retrospectively calculated and compared in adult patients accepted for orthotopic liver transplantation (OLT) in our institution in 1999 and 2004. We analyzed the gender, age, and MELD score associated with different indications for OLT during this period.
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| 5. |
- Flodén, Anne, 1957, et al.
(författare)
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Causes Why Organ Donation Was Not Carried Out Despite the
- 2006
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Ingår i: Transplantation Proceedings. ; 38:8, s. 2619-2621
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Several studies have shown that over 70% of the population is positive to donate their organs after their death. Despite this it is not unusual for organ donation to be not performed. The aim of this overview was to identify factors that may have an influence on this failure despite the deceased being positive. This is a review of 343 abstracts and 23 scientific publications between 1977 and 2005 dealing with various aspects of donation. In the analysis there were some topics that were associated with the prevention of donation: medical contraindications, inability to identify a potential organ donor and provide optimal medical care, the treatment and care of next of kin, how the question of consent was addressed to the next of kin, the attitude of intensive care unit (ICU) staff toward the process, the behavior of the transplant team during organ recovery. The most crucial act to increase donation is early identification of a potential subject. Early identification and optimal medical care occur more frequent when there is a good, positive attitude of the ICU staff toward the process. A positive attitude of the questioner and good care of the next of kin frequently resulted in a positive attitude when the question of consent was raised. Transplant units could improve the attitude in the ICUs by serving as a good model, giving feedback and education to the ICU staff.
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| 6. |
- Flodén, Anne, 1957, et al.
(författare)
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Cross-cultural adaptation and psychometric validation of the Floden ATODAI instrument in the North American context
- 2020
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Ingår i: Bmc Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Intensive and critical-care nurses are the key to successful donor management in the critical-care setting. No studies measuring attitudes toward organ donor advocacy existed before 2011, when the 51-item Swedish "Attitudes Toward Organ Donor Advocacy Scale" was developed. The aim of this study was to translate, adapt and establish the psychometric properties of the North American version of the Floden ATODAI (Attitudes Toward Organ Donor Advocacy Instrument) in terms of validity and reliability. Methods A multi-step approach was used: Initial translation; Back-translation; Review and synthesis of these translations;Expert panel(N = 7) rated the prefinal version of the instrument for content validity index (CVI);International panelmade adjustments guided by theexpert panel. Reliability testing with test and retest of the adjusted 46-item version was conducted using intraclass correlation coefficient (ICC), weighted kappa (& x4a1;(Weight)), sign test, and Cronbach's alpha coefficient (alpha), (N = 50); and finally Delphi technique procedure with a preselectedDelphi panel(N = 15). Results The CVI was determined to be greater than the 0.05 significance level. Item level (I-CVI) ranged 0.82-1.0, with a mean of 0.97. Scale level (S-CVI) on the entire instrument was 0.97. Test-retest procedure was performed to estimate stability. In total, 34 of the items had good-to-high ICC. Accepting an ICC of >= 0.70 resulted in a total of 24 items. Homogeneity reliability was estimated by alpha and was calculated for these items where alpha = 0.90. In total, 20 of the items had a substantial or almost perfect & x4a1;(Weight)and 23 showed a moderate & x4a1;(Weight). None of the items showed systematical differences. The Delphi technique procedure was used on the 22 items with ICC < 0.70 resulted in adjustments establishing that consensus was achieved. Conclusions Undertaking this multi-step, cross-cultural adaptation procedure has effectively ensured that the 46-item Floden ATODAI [North American version] produces valid and reliable measurements.
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| 7. |
- Flodén, Anne, 1957, et al.
(författare)
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Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS).
- 2011
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Ingår i: The open nursing journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 5, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- The consequences of advocacy in nursing are critical when caring for a potential organ donor. No specific instrument has been available to measure attitudes toward organ donor advocacy. The aim of this study was to develop and psychometrically evaluate an instrument for measuring intensive and critical care (ICU) nurses' attitudes toward organ donor advocacy. The study was conducted in two stages: instrument development and instrument evaluation and refinement. A questionnaire was developed (Attitude Toward Organ Donor Advocacy Scale (ATODAS)), which was sent to half of all nurses working in ICUs (general-, neuro-, thoracic- or paediatric-) in Sweden (n=1180). The final response rate was 42.5% (n=502). In order to explore validity and reliability, the expected scale dimensionality of the questionnaire was examined both by explorative principal component analysis (with oblique, varimax rotation) and by confirmatory multi-trait analysis. The confirmatory factor analysis indicated that the ATODAS could best be explained by five factors; Attitudes toward championing organ donation at a structural hospital level; Attitudes toward championing organ donation at a political and research level; Attitudes toward actively and personally safeguarding the will and wishes of the potential organ donor, Attitudes toward safeguarding the potential donor's will and wishes by a professional approach and Attitudes toward safeguarding the will and wishes of the relatives. This initial testing indicated that the ATODAS has good psychometric properties and can be used in future research to explore if interventions may influence attitudes and behaviors related to organ donor advocacy.
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| 8. |
- Flodén, Anne, 1957, et al.
(författare)
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ICU nurses perceptions of responsibilities and organisation in relation to organ donation - A phenomenographic study
- 2011
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397. ; 27:6, s. 305-316
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses' perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death. METHODS: A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas. RESULTS: The findings pertain to three domains: ICU nurses' perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death. CONCLUSION: The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses' opportunities to fulfil their professional responsibility during the organ donation process.
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| 9. |
- Flodén, Anne, 1957, et al.
(författare)
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MELD [corrected] score in patients accepted for liver transplantation 1994 to 2004
- 2006
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Ingår i: Transplantation proceedings. - 0041-1345. ; 38:8, s. 2673-4
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Tidskriftsartikel (refereegranskat)abstract
- There has been a need to be able to grade the "degree of sickness" in patients with acute and chronic hepatic failure. The Model for End-Stage Liver Disease (MELD) score was developed as a tool to give a more objective estimate of the degree of sickness in patients with chronic liver disease. In this study the MELD score was compared retrospectively in adult patients accepted for liver transplantation (OLT) at our institution in 1994, 1999, and 2004. Gender, age, and MELD score associated with different indications for OLT were analyzed for the same period. The MELD scores were unchanged between the examined years, and there was no difference between male and female patients accepted for OLT. Comparing MELD score between male and female patients, there was a potential risk for discrimination of female patients due to their reduced muscle mass, resulting in a lower serum creatinine and a lower MELD score. There was no difference in MELD score comparing 1994, 1999, and 2004 for patients with cirrhosis. Patients with acute hepatic failure had the highest MELD scores while patients undergoing OLT because of malignancy had the lowest MELD score. MELD score seemed to be a useful tool for retrospective analyzes of potential OLT recipients.
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| 10. |
- Forsberg, Anna, et al.
(författare)
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Attitudes towards organ donor advocacy among Swedish intensive care nurses
- 2015
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Ingår i: Nursing in Critical Care. - : Wiley. - 1362-1017 .- 1478-5153. ; 20:3, s. 126-133
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo explore the attitudes of Swedish intensive care nurses towards organ donor advocacy. BackgroundThe concept of organ donor advocacy is critical to nurses who care for potential donors in order to facilitate organ donation (OD). MethodsInclusion criteria in this survey were to be a registered nurse and to work in a Swedish intensive care unit (ICU). Participants were identified by the Swedish association of health professionals. A number of 502 Swedish ICU nurses answered the 32-item questionnaire Attitudes Towards Organ Donor Advocacy Scale (ATODAS), covering the five dimensions of organ donor advocacy: attitudes towards championing organ donation at a structural hospital level, or at a political and research level, attitudes towards actively and personally safeguarding the will and wishes of the potential organ donor, or by using a more professional approach and finally to safeguard the will and wishes of the relatives. Data were analysed with the SPSS version 180 and the results were assessed by using Student's t-test and post hoc test, analysis of variance (ANOVA), (2), Pearson's correlation and regression analysis. ResultsThe most favoured advocacy action was safeguarding the POD's will and wishes by a professional approach, closely followed by actively and personally safeguarding the POD's will and wishes. Nurses at local hospitals reported a more positive attitude towards organ donor advocacy overall compared with nurses at larger regional or university hospitals. Important factors leading to positive attitudes were seniority, working experience, participating in conversations with relatives, caring for brain-dead persons and private experiences from OD or organ transplantation. ConclusionsIntensive and critical care nurses with short working experience in university hospitals showed the least positive attitude towards organ donor advocacy. This is problematic because many ODs and all transplantations are performed in university hospitals. Relevance to clinical practiceThis study emphasizes the importance of organizing the care of PODs and their relatives in a way that promotes advocacy.
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