Resilience among organ donation coordinators: a Canadian mixed-methods study.

Background: Organ and Tissue Donation Coordinators (OTDCs) are key to the success of deceased organ donation processes. However, reduced resilience can leave them susceptible to the incidence of work-related issues and decrease the quality of the care provided. Therefore, this study aimed to examine the extent of resilience and influencing aspects among OTDCs in Canada. Methods: Mixed-method (QUAN-qual) explanatory sequential design. Quantitative data was collected using an online cross-sectional survey approach with demographic data and the validated scales and analyzed using descriptive and inferential statistics. Qualitative data was collected using a descriptive approach with a semi-structured interview guide and analyzed using content analysis. Results: One hundred twenty participants responded to the survey, and 39 participants were interviewed. Most participants from the survey were female (82%), registered nurses (97%) and on average 42 years old. The quantitative data revealed that OTDCs had a high level of perceived compassion satisfaction (ProQOL-CS = 36.3) but a resilience score (CD-RISC = 28.5) lower than other groups of healthcare professionals. OTDCs with over a year of experience in the role were more likely to have higher levels of resilience. The qualitative data identified that participants saw resilience as crucial for their work-related well-being. Although coping strategies were identified as a key factor that enhance resilience, many OTDCs reported difficulty in developing healthy coping strategies, and that the use of unhealthy mechanisms (e.g., alcohol and smoking) can result in negative physical consequences (e.g., weight gain) and reduced resilience levels. Conclusion: Participants reported using a series of coping and protective strategies to help build resilience, but also difficulty in developing healthy mechanisms. The lack of healthy coping strategies were seen as contributing to negative work-related issues (e.g., burnout). Our findings are being used to develop tailored interventions to improve resilience and healthy coping strategies among organ donor coordinators in Canada.

Organ donation following medical assistance in dying, Part II: a scoping review of existing processes and procedures.

OBJECTIVE: The objective of this review was to collate and summarize the current literature on what is known about organ donation following medical assistance in dying (MAiD). For this second part of a 2-part scoping review, the focus is on the existing procedures and processes for organ donation following MAiD. INTRODUCTION: Organ donation following MAiD is a novel and contentious issue worldwide. To give direction for future research and initiatives, a comprehensive understanding of the available evidence of existing procedures and processes for organ donation following MAiD is needed. INCLUSION CRITERIA: For this review, the population of interest included all individuals who underwent organ donation following MAiD; the concept was defined as procedures and processes involved in organ donation after MAiD; and the context was reports of organ donation following MAiD at home or in any health care setting worldwide. We considered quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished material provided by stakeholders. METHODS: This scoping review was conducted in line with JBI methodology. Published studies were retrieved from MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Web of Science Core Collection, and Academic Search Complete (EBSCOhost). Gray and unpublished literature included reports from websites and organ donation organizations in Canada, Belgium, and The Netherlands. Two independent reviewers screened all reports (both title and abstract, and full text) against the predetermined inclusion criteria, extracted data, and completed a content analysis. Any disagreements between the 2 reviewers were resolved through discussion or with another reviewer. RESULTS: We included 121 documents across parts I and II, and we report on 107 documents in this second part. The majority of the 107 documents were discussion papers, published in English, and in Canada from 2019 to 2021. In the content analysis, we identified 5 major categories regarding existing procedures and processes of organ donation following MAiD: i) clinical pathways for organ donation following MAiD; ii) organ donation following MAiD and the donor; iii) clinical practice tools for organ donation following MAiD; iv) education and support for health care providers involved in organ donation following MAiD; and v) health care providers' roles and perceptions during organ donation following MAiD. CONCLUSIONS: Findings from this review can be used to provide support and guidance for improvements in procedures and processes, as well as a rich resource for countries currently planning to establish programs for organ donation after MAiD.

Organ donation following medical assistance in dying, Part I: a scoping review of legal and ethical aspects.

OBJECTIVE: The objective of this review was to collate and summarize the current literature on what is known about organ donation following medical assistance in dying (MAiD). Additionally, for this first part of a 2-part scoping review, the focus is on legal and ethical considerations regarding organ donation following MAiD. INTRODUCTION: Organ donation following MAiD is a relatively new procedure that has sparked much debate and discussion. A comprehensive investigation into the legal and ethical aspects related to organ donation following MAiD is needed to inform the development of safe and ethical practices. INCLUSION CRITERIA: In this review, we included documents that investigated legal and/or ethical issues related to individuals who underwent organ donation following MAiD in any setting (eg, hospital or home) worldwide. We considered quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished material provided by stakeholders. METHODS: This scoping review followed JBI methodology. Published studies were retrieved from databases, including MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Web of Science Core Collection, and Academic Search Complete (EBSCOhost). Gray and unpublished literature included reports from organ donation organizations in Canada, The Netherlands, and Belgium. Two independent reviewers screened all reports (both by title and abstract and by full text) against the inclusion criteria, extracted data, and completed a content analysis. Disagreements between the 2 reviewers were resolved through discussions among the reviewers and the lead reviewer. RESULTS: We included 121 documents for parts I and II of our scoping review, 89 of which are included in part I. The majority of the 89 documents were discussion papers published in English and in Canada from 2019 to 2021. In the content analysis, we identified 4 major categories regarding ethical and legal aspects of organ donation following MAiD: i) legal definitions, legislation, and guidelines; ii) ethics, dilemmas, and consensus; iii) consent and objection; and iv) public perceptions. We identified the main legislation regulating the practices of organ donation following MAiD in countries where both procedures are permitted, the many ethical debates surrounding this topic (eg, eligibility criteria for organ donation and MAiD, disclosure of donors' and recipients' information, directed organ donation, death determination in organ donation following MAiD, ethical safeguards for organ donation following MAiD), as well as the public perceptions of this process. CONCLUSIONS: Organ donation following MAiD has raised many legal and ethical concerns regarding establishing safeguards to protect patients and families. Despite the ongoing debates around the risks and benefits of this combined procedure, when patients who request MAiD want to donate their organs, this option can help fulfill their last wishes and diminish their suffering, which should be the main reasons to offer organ donation following MAiD.

Opioid deprescribing in long-term care in Ontario: A comparison of resident and facility characteristics.

Residents of long-term care (LTC) homes have potentially painful conditions and are prescribed opioids to manage their pain, despite the risks associated with the use of these high-risk medications. Therefore, the overall aim of this study was to describe the associations between resident and facility characteristics of residents prescribed long-term opioid therapy and those who remained on opioids or had opioids deprescribed. We conducted a retrospective cohort study utilizing health administrative databases housed within ICES. Our cohort included 26,592 of 121,564 LTC residents (21.9%) of Ontario LTC homes who were prescribed long-term opioid therapy at cohort inception. Of these residents, 4,299 (16.2%) residents had opioids deprescribed during the follow-up period. Opioid deprescribing was associated with younger age, high comorbidity, and co-prescription with benzodiazepines and gabapentinoids. Our findings suggest that there is variation in the characteristics of residents who continued long-term opioid therapy and those who subsequently had opioids deprescribed, and these characteristics need to be considered as part of individualized pain management plans of care.

Quality improvement tools to manage deceased organ donation processes: a scoping review.

OBJECTIVE: To collate and summarise the literature on the quality improvement tools that have been developed for deceased organ donation processes after circulatory determination of death and neurological determination of death. DESIGN: Scoping review using the Joanna Briggs Institute framework. DATA SOURCES: We searched for published (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science) and unpublished literature (organ donation organisation websites worldwide). The search was initially conducted on 17 July 2021 and updated on 1 June 2022. Included articles discussed the creation and/or use of quality improvement tools to manage deceased organ donation processes. Two independent reviewers screened the references, extracted and analysed the data. RESULTS: 40 references were included in this review, and most records were written in English (n=38), originated in Canada (n=21), published between 2016 and 2022 (n=22), and were specific for donation after neurological determination of death (n=20). The tools identified included checklists, algorithms, flow charts, charts, pathways, decision tree maps and mobile apps. These tools were applied in the following phases of the organ donation process: (1) potential donor identification, (2) donor referral, (3) donor assessment and risk, (4) donor management, (5) withdrawal of life-sustaining measures, (6) death determination, (7) organ retrieval and (8) overall organ donation process. CONCLUSIONS: We conducted a thorough investigation of the available quality improvement tools for deceased organ donation processes. The existing evidence lacks details in the report of methods used for development, testing and impact of these tools, and we could not locate tools specific for some phases of the organ donation process. Lastly, by mapping existing tools, we aim to facilitate both clinician choices among available tools, as well as research work building on existing knowledge.

Outcomes from organ donation following medical assistance in dying: A scoping review.

AIM: To collate and summarize the current international literature on the transplant recipient outcomes of organs from Medical Assistance in Dying (MAiD) donors, as well as the actual and potential impact of organ donation following MAiD on the donation and transplantation system. BACKGROUND: The provision of organ donation following MAiD can impact the donation and transplantation system, as well as potential recipients of organs from the MAiD donor, therefore a comprehensive understanding of the potential and actual impact of organ donation after MAiD on the donation and transplantation systems is needed. DESIGN: Scoping review using the JBI framework. METHODS: We searched for published (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Academic Search Complete), and unpublished literature (organ donation organization websites worldwide). Included references discussed the actual and potential impact of organ donation following MAiD on the donation and transplantation system. All references were screened, extracted and analysed by two independent reviewers. RESULTS: We included 78 references in this review and our finding were summarized across three categories: (1) Impact in the donor pool: (2) statistics on organ donation following MAiD; and (3) potential and actual impact of MAiD on the donation and transplant system. CONCLUSIONS: The potential impact of the MAiD donor on the transplant waiting list is relatively small as this process is still rare, however, due to the current organ shortage worldwide the contribution of this procedure should not be disregarded. Additionally, despite being limited, the existing research provided scanty evidence that organs retrieved from MAiD donors are associated with satisfactory graft function and survival rates and that outcomes from transplant recipients are comparable to those of organs from donation following brain death and may be better than those of organs from other types of donation after circulatory determined death. Still, further studies are required for comprehensive and reliable evidence.

Building a national network of student leaders in gerontology: Reflections on the student representative program.

The Canadian Association on Gerontology's Student Connection facilitates a national Student Representative program to promote the field of gerontology at local post-secondary institutions. Student Representatives are expected to host professional development and networking events on their campus to bring together students interested in the field of aging. Student-run groups help foster interest in aging-related careers and research, yet few studies explore how these groups are developed and sustained. As part of this quality improvement project, we examined (1) who participates as a Student Representative; (2) why students choose to participate in the program; and (3) how Student Representatives fulfil their role (including barriers and facilitators). We conclude with a discussion of the challenges that the Student Connection's executive committee has faced supporting this national network and identify opportunities to further enhance the program. Practical implications to support student engagement and promote sustainability of student-driven aginginterest groups are outlined.

Quality improvement tools to manage deceased organ donation processes: A scoping review protocol.

AIM: To collate and summarize the literature on what quality improvement tools have been developed on safety of deceased organ donation processes for donation after circulatory determination of death and neurological determination of death. BACKGROUND: The increasing organ shortage requires that organ donation organizations take preventive measures to improve their processes and maximize organ donation opportunities. Quality improvement tools can be used to facilitate daily activities, prevent errors and enhance organ donation processes. Still, there is a paucity of comprehensive evidence around the use of these strategies to manage organ donation processes. METHODS: Scoping review methodology according to the Joanna Briggs Institute framework. We will search MEDLINE, Embase, PsycINFO, CINAHL, Web of Science - Science Citation Index and Social Science Citation Index and Academic Search Complete. We will also conduct a web search of Google and request unpublished material (e.g., institutional protocols and quality improvement tools) from key stakeholders in the organ donation field worldwide and we will consider reports dated after 2000. Two independent reviewers will screen the literature against the inclusion criteria, extract data according to the data extraction tool and perform descriptive analysis. Results will be assembled, summarized and presented through tabular form accompanied by a narrative summary to answer the review question. EXPECTED RESULTS: Results from this scoping review will be used to develop and update quality improvement tools in decease organ donation, will be used to guide the second phase of a study aiming at developing a set of quality improvement tools to decease organ donation process, as well as these results can be used to inform future policy development in deceased organ donation.

Burnout, compassion fatigue and work-related stressors among organ donation and transplantation coordinators: A qualitative study.

AIM: Organ and Tissue Donation Coordinators (OTDCs) are healthcare professionals who manage deceased organ donation cases. This study investigated the experiences and perceptions of OTDCs, pertaining to compassion fatigue, burnout, and resilience as it relates to their daily work. METHODOLOGY: A qualitative descriptive study was undertaken using semi-structured interviews conducted with a convenience sample of OTDCs. SETTING: A Canadian Organ Donation Organization. FINDINGS: Seven out of the ten OTDCs contacted participated in this study. Coordinators all agreed that they work in a high-pressure and demanding environment and the constant exposure to work-related stress and grief has resulted in the majority of them experiencing signs and symptoms of burnout and compassion fatigue occurring throughout their career. Participants described that the emotional toll of work-related stressors and difficult cases led them to use a variety of defence strategies to protect and support their well-being. They also recognised that more strategies to help mitigate work-related stressors and to prevent burnout and compassion fatigue are needed and that management and institutions should lead the development of such interventions. CONCLUSION: Our results describe how coordinators' mental health is affected by their daily work. Further research is needed to comprehensively examine these work-related stressors and to generate additional data to support the development of interventions to mitigate burnout and compassion fatigue among OTDCs.

Organ donation after medical assistance in dying: a scoping review protocol.

OBJECTIVE: This scoping review will collate and summarize the current literature on what is known worldwide about organ donation following medical assistance in dying. The information gathered will be used to inform updates of current and future policies on organ donation following medical assistance in dying in Canada. INTRODUCTION: Medical assistance in dying is a controversial and contentious issue worldwide. While more countries are legalizing medical assistance in this regard, very few allow organ donation after such assistance has been given. At present, Canada, Belgium, and The Netherlands are the only three countries that permit this procedure. This scoping review will be conducted to summarize the current state of evidence and practices regarding organ donation following medical assistance in dying. INCLUSION CRITERIA: This review will consider articles and documents on individuals who choose organ donation following medical assistance in dying. Articles will be considered for inclusion if they explore organ donation following medical assistance in dying at home or in any health care setting in any country. Quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished materials provided by researchers will be considered for inclusion. METHODS: This review will be conducted in accordance with the JBI methodology for scoping reviews. Published and unpublished materials will be included. Databases will include MEDLINE, Embase, CINAHL, PsycINFO, Web of Science - Science Citation Index and Social Science Citation Index, and Academic Search Complete. Relevant gray literature and materials from organ donation organizations will be included. Two independent reviewers will screen all material, extract data, and complete the descriptive examination.

Burnout and compassion fatigue among organ and tissue donation coordinators: a scoping review.

OBJECTIVES: To collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide? DESIGN: Scoping review using Joanna Briggs Institute methodology for scoping reviews. DATA SOURCES: Medline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020. STUDY SELECTION: Studies reporting aspects of burnout and CF among OTDCs, including risk and protective factors. DATA EXTRACTION: Two reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis. RESULTS: The searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence. CONCLUSION: We identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs.

Leading Indicators in Occupational Health and Safety Management Systems in Healthcare: A Quasi-Experimental Longitudinal Study.

OBJECTIVE: To evaluate the feasibility of implementing interventions guided by six leading indicators, and the effectiveness of these interventions on improving employee's perception of their organization's health and safety climate. METHOD: A quasi-experimental longitudinal design was used in two hospitals. Occupational health and safety management systems (OHSMS) were assessed using the Leading Indicator Assessment Tool. To address the gaps identified in the assessment, tailored interventions were developed, pilot tested, and evaluated. Data were collected pre- and post-interventions. RESULTS: Interventions were developed to improve three leading indicators: senior management commitment, employee involvement, and communication. Overall, both sites supported using leading indicators to guide proactive interventions. Employees' perceptions of the health and safety climate improved at one site only. CONCLUSIONS: The results suggest the utilization of leading indicators to assess an organization's current OHSMS, identify areas for improvement, and implement tailored interventions is feasible to support a culture of safety in healthcare.

Teamwork and Patient Care Teams in an Acute Care Hospital.

The literature suggests that effective teamwork among patient care teams can positively impact work environment, job satisfaction and quality of patient care. The purpose of this study was to determine the perceived level of nursing teamwork by registered nurses, registered practical nurses, personal support workers and unit clerks working on patient care teams in one acute care hospital in northern Ontario, Canada, and to determine if a relationship exists between the staff scores on the Nursing Teamwork Survey (NTS) and participant perception of adequate staffing. Using a descriptive cross-sectional research design, 600 staff members were invited to complete the NTS and a 33% response rate was achieved (N=200). The participants from the critical care unit reported the highest scores on the NTS, whereas participants from the inpatient surgical (IPS) unit reported the lowest scores. Participants from the IPS unit also reported having less experience, being younger, having less satisfaction in their current position and having a higher intention to leave. A high rate of intention to leave in the next year was found among all participants. No statistically significant correlation was found between overall scores on the NTS and the perception of adequate staffing. Strategies to increase teamwork, such as staff education, among patient care teams may positively influence job satisfaction and patient care on patient care units.