Operation Room Nurses' Ethical Value regarding Their Attitude and Meaning of Life about Organ Transplantation in Brain Death

Hyung-Eun Seo; Miyoung Kim

doi:10.7469/kjan.2016.28.4.355

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Operation Room Nurses' Ethical Value regarding Their Attitude and Meaning of Life about Organ Transplantation in Brain Death

Hyung-Eun Seo, MSN, RN¹, Miyoung Kim, Ph.D., RN²

Korean Journal of Adult Nursing 2016;28(4):355-366.
Published online: August 31, 2016

DOI: https://doi.org/10.7469/kjan.2016.28.4.355

¹Doctoral Student, Graduate School, Ewha Womans University, Seoul

²Associate Professor, College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Kim, Miyoung College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-6694, Fax: +82-2-3277-2850, E-mail: mykim0808@ewha.ac.kr

• Received: April 11, 2016 • Accepted: August 18, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of study was to describe operation room nurses’ ethical values in relationship to the attitude and meaning of life toward organ transplantation in brain death.
Methods
This study used a descriptive correlational survey design. Participants were 174 nurses who had attended to organ transplantation surgery in brain death more than once. Data were collected from September 1 to 11, 2015 and were analyzed using independent t-test, ANOVA, Scheffé test, Pearson's correlation coefficients, and hierarchical multiple regression with SPSS 22.0.
Results
Educational level, attitude on organ transplantation in brain death, and meaning of life were significant variables predicting the level of nursing ethical value, accounting for 82.6% of the variability.
Conclusion
Continued education and self-development programs should be encouraged for operating room nurses to establish professional nursing ethics as well as positive meaning of life and attitude toward the organ transplantation in brain death.
Key Words: Organ transplantation; Nursing ethics; Life; Operating rooms; Nurses

Table 1.

Nurses' General and Organ Transplantation related Characteristics (N=174)

Characteristics	Categories	n (%)	M±SD
Gender	Female	162 (93.1)
Gender	Male	12 (6.9)
Age (year)	20~29	72 (41.4)	32.24±6.23
	30~39	70 (40.2)
	≥40	32 (18.4)
Religion	Yes	92 (52.9)
Religion	No	82 (47.1)
Martial status	Single	92 (52.9)
Martial status	Married	82 (47.1)
Education level completed	3-year diploma	16 (9.2)
	4-year bachelor	141 (81.0)
	≥Master's	17 (9.8)
Job position	Staff nurse	158 (90.8)
Job position	≥Charge nurse	16 (9.2)
Clinical experience (year)	＜5	58 (33.3)
Clinical experience (year)	≥5	116 (66.7)
Number of participation in organ transplantation in brain death	1~4	56 (32.2)
	5~14	47 (27.0)
	15~24	18 (10.3)
	≥25	53 (30.5)
Thoughts about nursing profession	It is the best occupation	17 (9.8)
	It enables to maintain work-family life balance	64 (36.8)
	It is the favorable occupation until I get married	71 (40.8)
	I should leave nursing when I can	22 (12.6)
Experience of ethics education	Yes	174 (100.0)
Experience of ethics education	No	0 (0.0)
Experience of DNR education	Yes	84 (48.3)
Experience of DNR education	No	90 (51.7)
Experience of blood donation	Yes	65 (37.4)
Experience of blood donation	No	109 (62.6)
Will of organ donation after death	Yes	22 (12.6)
	No	83 (47.7)
	I don't know	69 (39.7)

DNR=do not resuscitate.

Table 2.

Nurses' Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value (N=174)

Variables	Subcategories		M±SD	Min	Max	n (%)
Attitude toward organ transplantation in brain death		Total mean	3.39±0.36	2.31	4.42
	Positive	Subtotal mean	3.45±0.56	2.13	4.63
		Recognition brain death as legal death	3.70±0.64	2.13	4.63
		Will for organ donation in case of brain death	2.88±0.71	1.25	5.00
		Inclusion of organ transplant education in undergraduate course	3.88±0.52	2.00	5.00
		Offering a gift of life to others	4.03±0.53	1.33	4.67
		Connection to professional agency	3.41±0.92	1.67	5.00
		Declaration of brain death to be necessary	3.51±0.72	1.33	5.00
		Legislation for brain death at government level	3.61±0.72	2.00	5.00
		Beneficience for organ transplant	3.53±0.87	1.00	5.00
	Negative	Subtotal mean	2.81±0.42	1.69	3.88
		Against to religion and dignity of life	2.40±0.60	1.00	4.00
		Harmful to cause adverse events once brain death is determined	3.05±0.83	1.00	5.00
		Distrust for healthcare providers when organ donation	2.59±0.68	1.00	4.00
		Moral distress when asked to offer organ donation	3.57±0.65	1.33	5.00
		Financial benefits of organ donation	3.52±0.95	1.00	5.00
Meaning of life			139.14±13.58	100	181
Domain	Recognition and acceptance of life		26.38±3.61	12	35
	Creative value realization		47.70±5.27	33	60
	Empirical value realization		30.11±3.64	20	40
	Satisfaction with the past and present life		34.95±3.85	21	47
Stages	Loss of meaning of life		120.19±7.95	100	129	12 (6.9)
	Seeking for meaning of life		138.17±8.83	130	146	83 (47.7)
	Finding meaning of life		158.17±8.83	147	181	79 (45.4)
Ethical value of nursing			3.13±0.28	2.24	3.89
	Relationships between nurses and co-workers		3.34±0.35	2.64	4.57
	Relationships between nurses and patients		3.24±0.31	2.57	4.43
	Respect for life		2.95±0.53	1.67	4.56
	Links between nurses and nursing practice		2.85±0.40	1.63	3.75

Table 3.

Nurses' Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value of Nursing according to General and Organ Transplantation related Characteristics (N=174)

Variables	Categories	Attitude toward organ transplantation in brain death		Meaning of life		Ethical value of nursing
Variables	Categories	M±SD	t or F (p) Scheffé	M±SD t	t or F (p) Scheffé	M±SD t	t or F (p) Scheffé
Gender	Female	3.39±0.36	0.74	139.07±13.37	0.25	3.14±0.27	2.30
Gender	Male	3.47±0.43	(.459)	140.08±16.84	(.805)	2.95±0.34	(.022)
Age (year)	20~29^a ^b	3.35±0.33	1.75	137.97±12.36	0.46	3.11±0.21	3.98
	30~39^b ^c	3.46±0.38	(.177)	139.91±13.67	(.635)	3.09±0.27	(.021)
	≥40^c	3.36±0.39		140.09±16.07		3.25±0.39	b＜c
Religion	Yes	3.39±0.37	-0.06	140.20±14.44	1.08	3.15±0.27	1.04
Religion	No	3.39±0.36	(.960)	137.96±12.53	(.280)	3.10±0.29	(.300)
Martial status	Single	3.35±0.34	-1.75	137.34±13.00	-1.87	3.09±0.22	-1.82
Martial status	Married	3.44±0.39	(.082)	141.17±14.01	(.063)	3.17±0.34	(.072)
Education level completed	3-year diploma^a ^b	3.44±0.48	0.17	137.69±15.50	0.60	2.58±0.14	202.05
	4-year bachelor^b	3.39±0.35	(.841)	138.91±13.09	(.549)	3.12±0.15 (	(＜.001)
	≥Master's^c	3.39±0.42		142.41±15.97		3.65±0.18 a	a＜b＜c
Job position	Staff nurse	3.40±0.36	0.27	138.60±13.15	-1.66	3.10±0.26	-3.29
Job position	≥Charge nurse	3.37±0.42	(.788)	144.50±16.83	(.098)	3.40±0.36	(.004)
Clinical experience (year)	＜5	3.36±0.36	-0.77	139.72±15.11	0.40	3.13±0.29	0.10
Clinical experience (year)	≥5	3.41±0.36	(.443)	138.85±12.81	(.691)	3.12±0.28	(.924)
Number of participation in organ transplantation in brain death	1~＜5^a	3.31±0.37	3.82	136.68±14.05	1.56	3.05±0.30	3.04
	5~＜15^b	3.34±0.40	(.011)	138.79±13.15	(.201)	3.14±0.26	(.031)
	15~＜25^c	3.38±0.34	a＜d	138.67±10.81		3.09±0.20	a＜d
	≥25^d	3.53±0.30		142.23±14.04		3.20±0.28
Thoughts about nursing profession	It is the best job^a	3.49±0.43	1.92	148.12±15.58	8.96	3.14±0.41	0.49
	It enables to maintain ^b	3.42±0.37	(.128)	141.63±13.56 (	(＜.001)	3.14±0.29	(.688)
	work-family life balance^b			a	a＞c＞d
	It is the favorable job until getting married^c	3.40±0.31		138.07±11.26	b＞d	3.13±0.21
	I must quit nurse when I can^d	3.23±0.42		128.45±12.37		3.06±0.34
Experience of DNR education	Yes	3.40±0.37	0.24	139.19±14.92	0.04	3.11±0.28	-0.56
Experience of DNR education	No	3.39±0.36	(.814)	139.10±12.29	(.905)	3.14±0.28	(.574)
Experience of blood donation	Yes	3.33±0.39	1.89	138.95±14.41	0.14	3.19±0.31	-2.08
Experience of blood donation	No	3.43±0.35	(.061)	139.26±13.12	(.887)	3.09±0.26	(.040)
Will of organ donation after death	Yes^a	3.62±0.38	5.55	147.41±16.41	5.60	3.18±0.21	0.40
	No^b ^c	3.34±0.35	(.005)	139.10±12.15	(.004)	3.12±0.28	(.668)
	I don't know^c	3.39±0.35	a＞b, c	136.57±13.39	a＞b, c	3.12±0.30

DNR=do not resuscitate.

Table 4.

Correlations among Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value of Nursing (N=174

Variables	Attitude toward organ transplantation in brain death	Meaning of life	Ethical value of nursing
Variables	r (p)	r (p)	r (p)
Attitude toward organ transplantation in brain death	1
Meaning of life	.56 (＜.001)	1
Ethical value of nursing	.31 (＜.001)	.35 (＜.001)	1

Table 5.

Influencing Factors on Ethical Value of Nursing (N=174)

Variables	Model 1		Model 2		Model 3
Variables	β	t (p)	β	t (p)	β	t (p)
Gender (male)	-0.01	-0.11 (.911)	0.00	-0.11 (.911)	0.00	-0.11 (.916)
Age 1 (30~39=1)	-0.01	-0.28 (.779)	-0.04	-1.18 (.240)	-0.04	-1.16 (.250)
Age 2 (≥40=1)	-0.01	-0.09 (.931)	-0.01	-0.16 (.873)	0.00	-0.06 (.951)
Education level 1 (4-year bachelor=1)	0.76	12.49 (＜.001)	0.79	16.51 (＜.001)	0.78	16.83 (＜.001)
Education level 2 (≥master's=1)	1.15	18.13 (＜.001)	1.16	23.25 (＜.001)	1.15	23.83 (＜.001)
Job position (≥charge nurse=1)	-0.03	-0.49 (.626)	-0.02	-0.40 (.690)	-0.04	-0.83 (.409)
Experience of organ transplantation in brain death (5~14=1)	-0.03	-0.50 (.621)	-0.05	-1.14 (.256)	-0.05	-1.27 (.206)
Experience of organ transplantation in brain death (15~24=1)	-0.03	-0.63 (.531)	-0.05	-1.38 (.168)	-0.05	-1.46 (.146)
Experience of organ transplantation in brain death (≥25=1)	0.08	1.63 (.106)	-0.01	-0.24 (.810)	-0.01	-0.28 (.780)
Experience of blood donation (yes=1)	-0.03	-0.69 (.492)	0.02	0.58 (.560)	0.01	0.35 (.726)
Attitude toward organ transplantation in brain death			0.35	10.10 (＜.001)	0.27	6.73 (＜.001)
Meaning of life					0.14	3.66 (＜.001)
Adj. R²		.697		.813		.826
F (p)	40.77 (＜.001)		69.27 (＜.001)		69.48 (＜.001)

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Operation Room Nurses' Ethical Value regarding Their Attitude and Meaning of Life about Organ Transplantation in Brain Death

Korean J Adult Nurs. 2016;28(4):355-366. Published online August 31, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.4.355

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Operation Room Nurses' Ethical Value regarding Their Attitude and Meaning of Life about Organ Transplantation in Brain Death

Korean J Adult Nurs. 2016;28(4):355-366. Published online August 31, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.4.355

Operation Room Nurses' Ethical Value regarding Their Attitude and Meaning of Life about Organ Transplantation in Brain Death

Table 1.

Nurses' General and Organ Transplantation related Characteristics (N=174)

Characteristics	Categories	n (%)	M±SD
Gender	Female	162 (93.1)
Gender	Male	12 (6.9)
Age (year)	20~29	72 (41.4)	32.24±6.23
	30~39	70 (40.2)
	≥40	32 (18.4)
Religion	Yes	92 (52.9)
Religion	No	82 (47.1)
Martial status	Single	92 (52.9)
Martial status	Married	82 (47.1)
Education level completed	3-year diploma	16 (9.2)
	4-year bachelor	141 (81.0)
	≥Master's	17 (9.8)
Job position	Staff nurse	158 (90.8)
Job position	≥Charge nurse	16 (9.2)
Clinical experience (year)	＜5	58 (33.3)
Clinical experience (year)	≥5	116 (66.7)
Number of participation in organ transplantation in brain death	1~4	56 (32.2)
	5~14	47 (27.0)
	15~24	18 (10.3)
	≥25	53 (30.5)
Thoughts about nursing profession	It is the best occupation	17 (9.8)
	It enables to maintain work-family life balance	64 (36.8)
	It is the favorable occupation until I get married	71 (40.8)
	I should leave nursing when I can	22 (12.6)
Experience of ethics education	Yes	174 (100.0)
Experience of ethics education	No	0 (0.0)
Experience of DNR education	Yes	84 (48.3)
Experience of DNR education	No	90 (51.7)
Experience of blood donation	Yes	65 (37.4)
Experience of blood donation	No	109 (62.6)
Will of organ donation after death	Yes	22 (12.6)
	No	83 (47.7)
	I don't know	69 (39.7)

DNR=do not resuscitate.

Table 2.

Nurses' Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value (N=174)

Variables	Subcategories		M±SD	Min	Max	n (%)
Attitude toward organ transplantation in brain death		Total mean	3.39±0.36	2.31	4.42
	Positive	Subtotal mean	3.45±0.56	2.13	4.63
		Recognition brain death as legal death	3.70±0.64	2.13	4.63
		Will for organ donation in case of brain death	2.88±0.71	1.25	5.00
		Inclusion of organ transplant education in undergraduate course	3.88±0.52	2.00	5.00
		Offering a gift of life to others	4.03±0.53	1.33	4.67
		Connection to professional agency	3.41±0.92	1.67	5.00
		Declaration of brain death to be necessary	3.51±0.72	1.33	5.00
		Legislation for brain death at government level	3.61±0.72	2.00	5.00
		Beneficience for organ transplant	3.53±0.87	1.00	5.00
	Negative	Subtotal mean	2.81±0.42	1.69	3.88
		Against to religion and dignity of life	2.40±0.60	1.00	4.00
		Harmful to cause adverse events once brain death is determined	3.05±0.83	1.00	5.00
		Distrust for healthcare providers when organ donation	2.59±0.68	1.00	4.00
		Moral distress when asked to offer organ donation	3.57±0.65	1.33	5.00
		Financial benefits of organ donation	3.52±0.95	1.00	5.00
Meaning of life			139.14±13.58	100	181
Domain	Recognition and acceptance of life		26.38±3.61	12	35
	Creative value realization		47.70±5.27	33	60
	Empirical value realization		30.11±3.64	20	40
	Satisfaction with the past and present life		34.95±3.85	21	47
Stages	Loss of meaning of life		120.19±7.95	100	129	12 (6.9)
	Seeking for meaning of life		138.17±8.83	130	146	83 (47.7)
	Finding meaning of life		158.17±8.83	147	181	79 (45.4)
Ethical value of nursing			3.13±0.28	2.24	3.89
	Relationships between nurses and co-workers		3.34±0.35	2.64	4.57
	Relationships between nurses and patients		3.24±0.31	2.57	4.43
	Respect for life		2.95±0.53	1.67	4.56
	Links between nurses and nursing practice		2.85±0.40	1.63	3.75

Table 3.

Nurses' Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value of Nursing according to General and Organ Transplantation related Characteristics (N=174)

Variables	Categories	Attitude toward organ transplantation in brain death		Meaning of life		Ethical value of nursing
Variables	Categories	M±SD	t or F (p) Scheffé	M±SD t	t or F (p) Scheffé	M±SD t	t or F (p) Scheffé
Gender	Female	3.39±0.36	0.74	139.07±13.37	0.25	3.14±0.27	2.30
Gender	Male	3.47±0.43	(.459)	140.08±16.84	(.805)	2.95±0.34	(.022)
Age (year)	20~29^a ^b	3.35±0.33	1.75	137.97±12.36	0.46	3.11±0.21	3.98
	30~39^b ^c	3.46±0.38	(.177)	139.91±13.67	(.635)	3.09±0.27	(.021)
	≥40^c	3.36±0.39		140.09±16.07		3.25±0.39	b＜c
Religion	Yes	3.39±0.37	-0.06	140.20±14.44	1.08	3.15±0.27	1.04
Religion	No	3.39±0.36	(.960)	137.96±12.53	(.280)	3.10±0.29	(.300)
Martial status	Single	3.35±0.34	-1.75	137.34±13.00	-1.87	3.09±0.22	-1.82
Martial status	Married	3.44±0.39	(.082)	141.17±14.01	(.063)	3.17±0.34	(.072)
Education level completed	3-year diploma^a ^b	3.44±0.48	0.17	137.69±15.50	0.60	2.58±0.14	202.05
	4-year bachelor^b	3.39±0.35	(.841)	138.91±13.09	(.549)	3.12±0.15 (	(＜.001)
	≥Master's^c	3.39±0.42		142.41±15.97		3.65±0.18 a	a＜b＜c
Job position	Staff nurse	3.40±0.36	0.27	138.60±13.15	-1.66	3.10±0.26	-3.29
Job position	≥Charge nurse	3.37±0.42	(.788)	144.50±16.83	(.098)	3.40±0.36	(.004)
Clinical experience (year)	＜5	3.36±0.36	-0.77	139.72±15.11	0.40	3.13±0.29	0.10
Clinical experience (year)	≥5	3.41±0.36	(.443)	138.85±12.81	(.691)	3.12±0.28	(.924)
Number of participation in organ transplantation in brain death	1~＜5^a	3.31±0.37	3.82	136.68±14.05	1.56	3.05±0.30	3.04
	5~＜15^b	3.34±0.40	(.011)	138.79±13.15	(.201)	3.14±0.26	(.031)
	15~＜25^c	3.38±0.34	a＜d	138.67±10.81		3.09±0.20	a＜d
	≥25^d	3.53±0.30		142.23±14.04		3.20±0.28
Thoughts about nursing profession	It is the best job^a	3.49±0.43	1.92	148.12±15.58	8.96	3.14±0.41	0.49
	It enables to maintain ^b	3.42±0.37	(.128)	141.63±13.56 (	(＜.001)	3.14±0.29	(.688)
	work-family life balance^b			a	a＞c＞d
	It is the favorable job until getting married^c	3.40±0.31		138.07±11.26	b＞d	3.13±0.21
	I must quit nurse when I can^d	3.23±0.42		128.45±12.37		3.06±0.34
Experience of DNR education	Yes	3.40±0.37	0.24	139.19±14.92	0.04	3.11±0.28	-0.56
Experience of DNR education	No	3.39±0.36	(.814)	139.10±12.29	(.905)	3.14±0.28	(.574)
Experience of blood donation	Yes	3.33±0.39	1.89	138.95±14.41	0.14	3.19±0.31	-2.08
Experience of blood donation	No	3.43±0.35	(.061)	139.26±13.12	(.887)	3.09±0.26	(.040)
Will of organ donation after death	Yes^a	3.62±0.38	5.55	147.41±16.41	5.60	3.18±0.21	0.40
	No^b ^c	3.34±0.35	(.005)	139.10±12.15	(.004)	3.12±0.28	(.668)
	I don't know^c	3.39±0.35	a＞b, c	136.57±13.39	a＞b, c	3.12±0.30

DNR=do not resuscitate.

Table 4.

Correlations among Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value of Nursing (N=174

Variables	Attitude toward organ transplantation in brain death	Meaning of life	Ethical value of nursing
Variables	r (p)	r (p)	r (p)
Attitude toward organ transplantation in brain death	1
Meaning of life	.56 (＜.001)	1
Ethical value of nursing	.31 (＜.001)	.35 (＜.001)	1

Table 5.

Influencing Factors on Ethical Value of Nursing (N=174)

Variables	Model 1		Model 2		Model 3
Variables	β	t (p)	β	t (p)	β	t (p)
Gender (male)	-0.01	-0.11 (.911)	0.00	-0.11 (.911)	0.00	-0.11 (.916)
Age 1 (30~39=1)	-0.01	-0.28 (.779)	-0.04	-1.18 (.240)	-0.04	-1.16 (.250)
Age 2 (≥40=1)	-0.01	-0.09 (.931)	-0.01	-0.16 (.873)	0.00	-0.06 (.951)
Education level 1 (4-year bachelor=1)	0.76	12.49 (＜.001)	0.79	16.51 (＜.001)	0.78	16.83 (＜.001)
Education level 2 (≥master's=1)	1.15	18.13 (＜.001)	1.16	23.25 (＜.001)	1.15	23.83 (＜.001)
Job position (≥charge nurse=1)	-0.03	-0.49 (.626)	-0.02	-0.40 (.690)	-0.04	-0.83 (.409)
Experience of organ transplantation in brain death (5~14=1)	-0.03	-0.50 (.621)	-0.05	-1.14 (.256)	-0.05	-1.27 (.206)
Experience of organ transplantation in brain death (15~24=1)	-0.03	-0.63 (.531)	-0.05	-1.38 (.168)	-0.05	-1.46 (.146)
Experience of organ transplantation in brain death (≥25=1)	0.08	1.63 (.106)	-0.01	-0.24 (.810)	-0.01	-0.28 (.780)
Experience of blood donation (yes=1)	-0.03	-0.69 (.492)	0.02	0.58 (.560)	0.01	0.35 (.726)
Attitude toward organ transplantation in brain death			0.35	10.10 (＜.001)	0.27	6.73 (＜.001)
Meaning of life					0.14	3.66 (＜.001)
Adj. R²		.697		.813		.826
F (p)	40.77 (＜.001)		69.27 (＜.001)		69.48 (＜.001)

Table 1. Nurses' General and Organ Transplantation related Characteristics (N=174)

DNR=do not resuscitate.

Table 2. Nurses' Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value (N=174)

Table 3. Nurses' Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value of Nursing according to General and Organ Transplantation related Characteristics (N=174)

DNR=do not resuscitate.

Table 4. Correlations among Attitude toward Organ Transplantation in Brain Death, Meaning of Life and Ethical Value of Nursing (N=174

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