Heidi B. Bringsvor

Bakgrunn: Intensivsykepleiere har en viktig rolle i organdonasjonsprosessen. Tidligere studier indikerer ulikheter i kunnskap og erfaring relatert til organdonasjon, og at intensivsykepleiere kan oppleve donasjonsprosessen krevende. Relativt nylig er controlled Donation After Circulatory Death (cDCD) implementert som metode i Norge. Hensikt: Å utforske intensivsykepleieres erfaringer, utfordringer og holdninger knyttet til organdonasjon generelt, og cDCD spesielt. Metode: Studien benytter kvalitativ metode, basert på semistrukturerte intervju, henholdsvis fokusgruppe, dyadiske eller individuelle. Utvalget er strategisk, - ni intensivsykepleiere med egenerfaring fra arbeid med organdonasjon, fra intensivavdelinger ved tre middels store donorsykehus i Norge. Intervjuguiden var utarbeidet med utgangspunkt i Consolidated Framework for Implementation Research (CFIR). Systematisk tekstkondensering som metode ble brukt i analysearbeidet. Resultater: Analysene identifiserte fire hovedkategorier av spesiell relevans for intensivsykepleieres opplevelser, forventninger, kunnskap om og holdninger til organdonasjonsprosessen generelt og cDCD spesielt. Hver hovedkategori har underkategorier som belyser relaterte, men likefullt differensierte, aspekt. Konklusjon: Intensivsykepleiere er generelt positive til organdonasjon. De erfarer organdonasjonsprosessen som kompleks og krevende. Fokus må økes på organdonasjon i intensivsykepleierutdanningen og i helseforetakene, ettersom egenerfaring ofte er begrenset. Implementering av cDCD øker krav til faglig oppdatering, og påvirker teamarbeidet. I tillegg medfører cDCD endrede rammer for avslutning av organstøttende behandling, med påfølgende behov for forberedelse av pårørende. ENGLISH ABSTRACT Intensive Care Nursing and Organ Donation – Description of Experiences and Attitudes Background: Intensive care nurses play a crucial role in the organ donation process. Previous studies indicate disparities in knowledge and experience related to organ donation, and intensive care nurses may find the donation process challenging. Recently, controlled Donation After Circulatory Death (cDCD) has been implemented as a method in Norway. Objective: To explore intensive care nurses’ experiences, challenges, and attitudes related to organ donation in general, with a specific focus on cDCD. Methods: The study employs a qualitative approach based on semi-structured interviews, including focus groups, dyadic, or individual interviews. The sample consists of nine intensive care nurses with firsthand experience in organ donation from medium-sized donor hospitals in Norway. The interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Systematic text condensation was used for data analysis. Results: The analyses identified four main categories relevant to intensive care nurses’ experiences, expectations, knowledge, and attitudes toward the organ donation process in general and cDCD specifically. Each main category has subcategories that illuminate related but distinct aspects. Conclusion: Intensive care nurses generally hold positive views on organ donation. They perceive the organ donation process as complex and demanding. Increased focus on organ donation in intensive care nurse education and healthcare institutions is necessary, given limited personal experience. The implementation of cDCD requires ongoing professional updates and impacts teamwork. Additionally, cDCD introduces new considerations for discontinuing life-sustaining treatment, necessitating preparation for family members.

Purpose Although it is well-known that persons with COPD experience lower health related quality of life (HRQoL), little is known about the importance of self-management related domains on HRQoL in persons with COPD. Therefore, the purpose of this study is to examine associations between self-management related domains and HRQoL, adjusting for sociodemographic and clinical characteristics, self-efficacy, and sense of coherence. Methods Cross-sectional data of 225 persons with COPD, recruited from a hospital register, were analyzed. Self-management related domains were measured using the Health education impact questionnaire (heiQ) and HRQoL was measured using the St. George’s Respiratory Questionnaire (SGRQ). Multiple linear regression analysis was used. Results The final models showed significant associations between the self-management domains constructive attitudes and approaches and emotional distress and HRQoL. Dyspnea, number of comorbidities, self-efficacy, and the various self-management related domains explained 51.3 to 55.1% of the variance in HRQoL. Conclusions The findings suggest that addressing self-management related domains, in addition to self-efficacy, dyspnea, and comorbidities, may be of importance for enhancement of HRQoL in persons with COPD.

Background: This study examines the effects of the COPD-specific health promoting self-management intervention “Better living with COPD” on different self-management-related domains, self-efficacy, and sense of coherence (SOC). Methods: In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA). Results: The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13). Conclusion: Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects.

Purpose: Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and symptom burden in people with COPD. Patients and methods: In this cross-sectional study with 225 participants diagnosed with COPD grades II–IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables. Results: Higher symptom burden was significantly associated with worse scores in all self-management domains (pp=0.012). Higher disease severity (p=0.004) and numbers of comorbidities (pp=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities (p=0.006) and self-monitoring and insight (ppR²) across the eight heiQ scales. Conclusion: A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD.