Assess the Knowledge on Nursing Management of Brain Death among Nursing Students AIMS, Kochi, Kerala

 

Ms. Regina Antony¹*, Mr. Amal V Saju²,  Ms. Aleena Abraham², Ms. Aleena N M²

¹Assistant Professor, Amrita Vishwa Vidhyapeetham University, Kochi 41

²IV year BSc Nursing Student, Amrita College of Nursing, AIMS, Amrita Vishwa Vidhyapeetham University, Kochi 41

 

ABSTRACT:

Brain death occurs when there is destruction of the brain cells, including the brain stem and cerebellum. Having correct knowledge of identification of early signs of brain death and the nurse’s role in managing the condition increases the student nurses’ self-confidence and they can answer questions of the bereaved families. However shortage of the knowledge among nurses is observed practically such as making mistake in diagnosing the difference between brain death and persistent vegetative state. The study titled “Assess the knowledge on nursing management of brain death among nursing students AIMS, KOCHI” was done with the Objectives.1) Determine the knowledge of nursing students regarding nursing management of brain death.2) Associate the knowledge of nursing students with the selected demographic variables. Purpose:  the study findings will facilitate the nursing students to have a positive approach to meet the needs of the bereaved families. Methodology: A quantitative approach with a descriptive study design was used. Non probability convenience sampling technique was used and selected 80 nursing students from III & IV year BSc Nursing, Amrita College of Nursing. Data was collected using knowledge questionnaire tool. Data analysis of the study was be done using descriptive & inferential statistic technique. Results: The finding shows that the majority  of the nursing students 53 (66.2%) have poor knowledge  regarding brain death, 20 (25%) have average knowledge, 4 (5%) have good knowledge & only 3 (3.8%) have excellent knowledge. A significant association was found between age (x2=14.082,p=.003) and class (x2=12.825,p=0.005) with level of knowledge. Conclusion The study findings reveal that majority of the students have poor knowledge regarding brain death . This  emphasis the need for inclusion of brain death in the curriculum  which will enhance the knowledge of brain death and promote the confidence of Nursing students  in managing clients with brain death.

 

 

INTRODUCTION:

Brain death is defined as irreversible cessation of all functions of the entire body, including the brainstem¹. It occurs when all vital functions of the brain, brain stem and spinal reflexes are irreversibly nonexistent as determined by accepted medical standards². In developed countries, organ donation rate is 20 to 30 percent for every million people of population^3. Brain death had been known about 40 years ago and had been considered as an ideal condition for organ donation. Now a day’s brain death has been accepted as certain death in most of the western countries, but in some Asian countries it is not like this. Ambiguity and different understandings of brain death diagnosis seem very important and  is a limiting factor of organ donation. Since all the patients who suffer from brain death are hospitalized in ICU, knowledge about comprehensive content of brain death and its irreversibility is counted as a critical component  in critical care nursing profession.  In the process of organ procurement, nurses play an important role. Success in organ procurement from corpse is dependent on ICU doctors and nurses’ good cooperation, they can be a great help not only in reporting potential cases of brain death but also because of their closeness to the relatives of the patients they can be a great help for coordination organ donation request. Studies have showed that one of the main reasons of organ shortage is refusal of families for giving satisfaction for organ donation of the patients with brain death, because of fear of wrong diagnosis of brain death, fear of organ trade and etc .Having friendly relationship with the members of the patient’s family by the nurses who are taking care of the organ donators (patients with brain death) leads to their faster successfulness. Having correct knowledge of organ donation process increases nurses’ self-confidence and they can answer questions of the bereaved families⁴. Vijaya Lakshmi, Nagarajaiah , Suresh Bada Math,and Ramachandra (2015) conducted a study regarding nurses perceptions and attitudes towards organ donation. The purpose of this study was to identify Indian ICU nurses’ attitudes towards organ donation. This cross-sectional survey conducted among those nurses directly involved in patient care at a tertiary care hospital in South India. A non-probability convenience sample with quantitative descriptive design was adopted for the present study. Data were collected through self-report questionnaire. A majority (81%) of the respondents were ‘willing to sign the card’ for organ donation; however, only 3.8% (n=7) of them actually ‘signed the organ donation card’. There were significant associations found between intentions to sign the organ donation card and gender (x2=5.852; p<0.054), religion (x2=40.175; p<0.000), and experience caring for brain-dead patients (x2=22.790; p<0.001). The researchers strongly suggest continuing education for nurses to enhance skills and knowledge, as well as sensitivity to cultural, ethical, social, and religious issues, and advocacy in the area of organ donation^5.

 

Knowledge of diagnosis of brain death is important for all physicians and health personnel in clinical setting especially the need to establish irreversible cessation of all function of the cerebrum. Patient advocacy and vigilance are vital to identify and aggressively treat the consequences of injury to other body systems at the earliest opportunity^6.

 

Family members of a patient with devastating brain injury are under stress and need empathy, training and an environment of trust^7.

 

Transplantation has become a nearly universal therapy of choice for patients with organ failure. The number of patients waiting for solid organs is on the rise in every country. Despite all efforts, the number of available organs is inadequate and 5-25% of all patients on the waiting list will die⁸. Throughout the world there is a shortage of suitable organs for organ transplantation⁹. There are important barriers that lead to organ shortage. For example need of kidney in middle east is 120 to 130 million per year while provided organs of the patients with brain death in this area is 4 to 10 million per year. So increase of the organs number that can be harvested and transplanted is one of the important strategic programs in most of the societies. This issue needs wide interventions in different levels, such as; organ procurement organization, society and nursing and medical staff and students education about content of brain death. Transplantable organs of a patient with brain death include; heart, lungs, liver, kidneys, pancreas, small intestine, and also cornea, heart valve, skin, bone and trachea. Brain death is totally accepted as a content that shows death. Transplantation is totally dependent on the supply of viable organs for implantation ^10.

 

However shortage of knowledge among nurses is observed practically such as making mistake in diagnosing the difference between brain death and vegetable death. Some critical care nurses believe that patients with brain death may return to consciousness in the future. The important question is that some critical care nurses  do not believe in brain death as certain death, how can they have relationship with the bereaved family of the organ donator and how can they talk to them?^11.

 

Nurses are pivotal to establish trust and help the family understand the torrent of information from multiple health care providers. Taking time and building on the trust can help the family understand brain injury, progression of the injury and what brain death means. All those consideration are vital with or without organ recovery and transplantations possible as end points. Providing clear, consistent terminology and definitions and ensuring family members understanding of brain death is paramount before discussing organ donation and to avoid later misunderstanding. 

 

They can be involved in the procurement process and counseling of potential donors. She can advocate the patients and families in the informed choice process, recognizing and respecting their cultural and religious beliefs etc^12. The nurses’ role also includes informational support (counseling), emotional support and bereavement support^13.

 

Nurses with a little knowledge regarding brain death will find it difficult in dealing with the situation of the bereaved family and will have lack of self confidence in providing care of the bereaved family. Nowadays nurses are involved in cases of brain death and organ donation and they play a critical role confronting such cases. Data provided by nurses can increase the organ donation rate if they have enough information on the subject^14.

 

Hence the investigators designed this study to assess the knowledge of brain death among nursing students and to impart knowledge since nursing students are the future nurses.

 

MATERIALS AND METHODS:

The approach used in this study is Quantitative research and the design selected for the study is non experimental descriptive design. The study was conducted among III  year and  IV  year B.Sc Nursing students of Amrita College of Nursing, Kochi. The setting was selected because of the easy accessibility of the group, familiarity with setting, convenience in terms of adequate sample and the cooperation offered by the student and management.  80  B.Sc Nursing students  were the sample size and  Non-probability convenience sampling technique. Data was collected using knowledge questionnaire tool. Data analysis of the study was be done using descriptive & inferential statistic technique. A semi structured questionnaire were used for data collection to assess the knowledge of nursing students regarding the management of brain death and these  tools where prepared by referring various book, suggestions and guidance from experts. A semi structured questionnaire was used to assess the knowledge of nursing students regarding the management of brain death. Section A: Socio Demographic Data: It consists of information related to the nursing students such as age, sex, religion, previous experience. Section B: Knowledge Assessment Questionnaire: Physiology of brain death, Determination of brain death, Legal and ethical issues in brain death, nursing responsibility after brain death. The researcher introduced himself to the students regarding the purpose and nature of the study. The informed consent was taken from the students on the day of data collection (14-11-2015) and the 15 questionnaire was administered to 80 students and explained about the objectives and nature of the study. Total score of the questionnaire was 15 with each response carry 1 score. Based on the scoring the samples were categorized are in the following; Excellent -13-15 [>80%], Good -11-12 [70-80%], Average - 08-10 [50-69%], Poor <07 [<50%] .The data was analyzed using descriptive and inferential statistics.

 

RESULTS

Table 1-Frequency and percentage distribution according to demographic variables

Demographic variables	Frequency (f)	Percentage (%)
(a)   Age 19-20 yrs 21-22 yrs	65 15	81.3 18.8
(b)   Gender Male Female	3 77	3.8 96.3
(c)   Class 3rd year 4th year	68 12	85.0 15.0
(d)   Previous exposure Health magazine/literature Television/any other media Health professionals Informal sources Clinical exposure/seminars/classes All of the above	12 6 14 8 29 11	15.0 7.5 17.5 10.0 36.3 13.8

 

 

Table 2: Frequency and percentage distribution of sample according to the level of knowledge n=80

Items	Knowledge
	Poor		Average		Good		Excellent
	F	%	F	%	F	%	f	%
Physiology of brain death	47	58.75	22	27.5	9	11.25	2	2.5
Nursing responsibility of brain death	6	7.5	29	36.25	38	47.5	7	8.75
Determination of brain death	55	68.75	14	17.5	7	8.75	4	5
Legal and ethical issues in brain death	44	55	19	23.75	0	0	17	21.25

 

 

Table 2 shows that the subjects 47(58.75%) have poor knowledge on physiology of brain death, 22(27.5%) subjects have average knowledge, 9(11.25%) subject have good knowledge and only 2(2.5%) subjects have excellent knowledge.6(7.5%) subjects had poor knowledge on nursing responsibility after brain death, 29(35.25%) have average knowledge, 38(47.5%) subjects have good knowledge and 7(8.75) subjects have excellent knowledge.55 (68.75%) subjects have poor knowledge on determination of brain death, 14(17.5%) subjects have average knowledge, 7(8.75%) subjects have good knowledge and only 4(5%) subjects have excellent knowledge.44(55%)  subjects have poor knowledge on legal and ethical issues in brain death,19(23.75%) subjects have average knowledge, no subjects have good knowledge and 17(21.25%) subjects have excellent knowledge.

 

Table 3: mean knowledge of nursing students  n =80

Knowledge score	Mean	Standard deviation
Physiology of brain death Nursing responsibility of brain death Determination of brain death Legal and ethical issues in brain death	2.25 1.43 1.15 0.66	1.185 0.632 1.295 0.795

 

Table 3 shows that the mean knowledge score of physiology of brain death is 2.25 and the standard deviation 1.185, mean knowledge score of nursing responsibility after brain death is 1.43 and standard deviation .632, knowledge score of determination of brain death is 1.15 and standard deviation 1.295, and the mean knowledge score of legal and ethical issues in brain death is .66 and standard deviation .795.  The findings shows that the knowledge on the physiology of brain death is known to nursing students but the legal and ethical issues in brain death is poor.

 

Figure 1: Distribution of subjects based on knowledge level  n=80

 

Above figure1 depicts that majority of the subjects 53(66.2%) have poor knowledge level, 20(25%) of the subjects have average knowledge, 4(5%) of the subjects have good knowledge and only 3(3.8%) have excellent knowledge regarding the nursing management of brain death.

 

 

 

Table 4: chi-square value between the level of knowledge with age, class, gender and previous exposure    n=80

Variable		Knowledge level				Chi-square value	df	p value
		Poor	Average	Good	Excellent
Age	19-20	46	17	1	1	14.082*	3	0.003
	21-22	7	3	3	2
Class	III yr	49	16	2	1	12.825*	3	0.005
	IV yr	4	4	2	2
Gender                 Previous exposure	Male Female Health magazine/literature Television/any other media Health professionals Informal sources Clinical exposure/seminars/classes   All of the above	3 50 7 6 9 7 20     4	0 20 5 0 3 1 6     5	0 4 0 0 1 0 1     2	0 3 0 0 1 0 1     0	1.588               16.699	3               15	0.662ns             0.340ns

ns – not significant ; **=significant p<0.005

 

 

Table 4 shows that there was highly significant association between the level of knowledge and age (x²*14.082, p<0.003) and the level of knowledge and class (x²*12.825, p<0.005) also there was no significance between level of knowledge and gender and level of knowledge and previous exposure of information. From the above table it is clearly evident that the older age and ordinal class has better knowledge level.

 

DISCUSSION:

The first objective of the study was to determine the knowledge of nursing students regarding nursing management of brain death

Figure1 depicts that majority of the subjects 53(66.2%) have poor knowledge level, 20(25%) of the subjects have average knowledge, 4(5%) of the subjects have good knowledge and only 3(3.8%) have excellent knowledge regarding the nursing management of brain death. Kocaay AF, Celik SU, Eker T, Oksuz NE, Akyol C et.al. conducted a study on “Brain Death and Organ Donation: Knowledge, Awareness, and Attitudes of Medical, Law, Divinity, Nursing, and Communication among Students” The aim of this study was to assess the level of knowledge, awareness, and attitudes of medical, law, divinity, nursing, and communication among students, who will be involved in this issue in the future, regarding brain death and organ donation. Data were collected with the use of a 30-item questionnaire. Only 71 participants, most of them medical, divinity, and law students, correctly answered all questions about brain death; 68.6% stated that organ donation is allowed by religion, and 5% expressed that it is religiously forbidden; 37.3% did not have confidence in health care policy. Law students were more confident, nursing students less confident^9.

 

The above study finding correlates with the findings of the present study. From this it is a clear cut evident for introducing the topic of nursing management of brain death on the nursing curriculum

 

The second objective of the study was to associate the knowledge of nursing students with the selected demographic variables

Table 4 shows that there was highly significant association between the level of knowledge and age (x2*14.082, p<0.003) and the level of knowledge and class (x2*12.825, p<0.005) also there was no significance between level of knowledge and gender and level of knowledge and previous exposure of information. From the above table it is clearly evident that the older age and ordinal class has better knowledge level. The variables studied were age, gender, class, previous exposure with knowledge of nursing management of brain death in nursing students. In the present study there was highly significant association was found between the level of knowledge and age(x²*14.082, p<0.003) and the level of knowledge and class (x²*12.825, p<0.005).

 

No statistical significant association was found between gender of students and their knowledge on nursing management of brain death, the study findings also shows there is no association of level of knowledge with the previous exposure of information; it may be because of the small sample size. There are insufficient studies to substantiate with the present study findings regarding the association of demographic variables with the level of knowledge.

 

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Received on 17.06.2016                Modified on 30.06.2016

Accepted on 20.07.2016                © A&V Publication all right reserved