Characteristics of study subjects
An analysis of sociodemographic characteristics of nurses and physicians (Emergency medicine specialists and residents) showed that the mean age of nurses was 34.82 ± 6.96 years and the mean age of physicians was 36.25 ± 6.26 years. The majority of nurses were female, i.e., 83 (57.2%) and the majority of physicians were male, i.e., 30 (61.2%). (Table 1)
Main results
Regarding knowledge questions, 91 nurses (62.8%) and 30 physicians (66.7%) answered the questions correctly. The results show that the majority of nurses, i.e., 113 (77.9%) answered question "The determination of death can be made by the critical care physician, the transplant team, or the official representative of the organ procurement organization" incorrectly and 135 (93.1%) answered question “Only the kidneys and liver can be recovered and successfully transplanted “correctly. The majority of physicians, i.e., 41 (83.7%) answered question " Brain death criteria must also be fulfilled before organ recovery begins " incorrectly while 46 (93.9%) answered questions " Family members are allowed to be present at the time life support is withdrawn until death " and " Only the kidneys and liver can be recovered and successfully transplanted " correctly. (Table 2)
Regarding the attitude of nurses and physicians, the results showed that they had a relatively positive attitude toward DCD, as nurses’ attitude score was 101.9±84.88 and physicians’ attitude was 106.53±11.77 out of a maximum score of 170. The results showed that 26 nurses (17.9%) were completely in agreement and 59 (40.7%) were in agreement with the question "I feel less comfortable with the death criteria for DCD than for brain death". Also, the majority of physicians agreed with question" I feel that the DCD donation process is “eerier” than the brain death donation process", i.e., 15 (30.6%) strongly agreed, and 17 (34.7%) agreed, indicating a low attitude of nurses and physicians to DCD. (Table 3)
One-way analysis of variance was used to compare the mean total scores of attitude among nurses, specialists and emergency medicine residents, indicating a statistically significant difference between the groups in terms of the attitude score F (2.191) = 4.512, P=0.012. (Table 4) Meanwhile, Tukey's HSD test showed that the attitude score of emergency medicine specialists was significantly higher than that of other groups (P = 0.016). A comparison of attitude scores with sociodemographic characteristics scores in different age groups, sex, service records, etc. revealed no statistically significant difference in the attitude score. (P> 0.05).
Of the 194 physicians and nurses, 182 (93.8%) were in favor of organ donation, comprising 136 nurses (93.8%) and 46 physicians (93.9%), while 12 (6.2%) were against organ donation, comprising 9 nurses (6.2%) and 3 physicians (6.1%). Only 32 participants (16.5%) had an organ donation card, which included 15 nurses (10.3%) and 17 physicians (34.7%). As many as 191 participants (93.5%) did not have a family history of donation, comprising 143 nurses (98.6%) and 48 physicians (98.0%).
The relationship of the attitude of physicians and nurses with the following questions was examined: Do you agree with organ donation? Do you have a donation card? And do you have a family history of donation? It was revealed that physicians who had an organ donation card had a more positive attitude toward DCD and this relationship was statistically significant. However, there was no statistically significant relationship in the physician group concerning the question on agreement with DCD, having a family history of donation and attitude toward DCD. The results also showed that there was no statistically significant relationship between nurses' attitude and having a donation card, agreement with DCD and having a family history of donation. (p≥0.05).
The results of the relationship between the nurses’ sociodemographic characteristics with questions about agreement with DCD, having an organ donation card and having a family history of donation showed that ethnicity and gender had a significant relationship with the question of agreement with DCD and other sociodemographic characteristics, while they produced no statistically significant differences with sociodemographic characteristics.
The results of the relationship between sociodemographic characteristics of the physicians and questions on agreement with DCD, having an organ donation card, and family history of organ donation showed a significant relationship between marital status and agreement with DCD whereas other sociodemographic characteristics had no significant relationships.
Limitation
The present study has several limitations. The main limitation of the study is that only the knowledge and attitude of nurses and physicians has been evaluated. However, in order to design such services, the views of health and medical managers, as well as the opinions of patients and their families, should be considered.