【作者】 刘红；

【导师】 徐凌忠；

【作者基本信息】 山东大学 ， 公共卫生（专业学位）， 2015， 硕士

【摘要】 研究背景器官移植是治疗各类终末期器官功能衰竭最有效的手段,被誉为“医学皇冠上的明珠”,给众多患者带来治愈的希望。我国器官移植数量及技术已经达到发达国家水平,但器官移植的供需比为1：30,与美国1：4的比例形成悬殊的差距,使我国的器官移植事业受到严峻的考验。2010年之前我国的器官来源主要以死刑尸体器官和活体器官为主,死刑尸体器官来源一直在国际上备受争议和批评,而活体器官捐献又严重违背了“无损害(prium non nocere)"的医学伦理学原则。随着2015年初我国全面停止所谓“使用死囚器官”的形势下,同时借鉴多国器官捐献的先进经验,使我们充分认识到：公民逝世后遗体器官捐献才是解决器官短缺、保证器官移植医疗可持续发展的关键动力和唯一途径。临床医护人员作为遗体器官捐献者的首要接触者,他们对器官捐献的认知、态度和行为是影响器官捐献工作开展的关键。研究目的通过对某三级教学医院临床医护人员关于器官捐献和潜在器官捐献者的相关认识(Knowledge)、态度(Attitude)和行为(Practice)的调查,分析影响医护人员发现、转介、协调潜在器官捐献者的主要因素；以及对潜在器官捐献者家属拒绝器官捐献的原因总结,分析拒绝捐献的多重影响因素,为提高临床医护人员对于器官捐献工作的积极参与性、发挥他们的专业特长,使器官捐献在临床医疗工作中形成常态化、常规性提供数据支持和建议策略。研究方法研究通过采用自制调查问卷方式,对某三级教学医院取得临床医师执业资格的医生482人和注册护士375人发放问卷收集资料,涉及医院所有专业科室,共发放问卷857份,回收有效问卷812份,有效应答率为94.7%。对调查资料进行分类整理,使用Epidata 3.0软件录入问卷并进行双录入实时校验,采用SPSS17.0统计学软件进行数据的处理和分析。对各指标进行一般性描述分析,计数资料以例数和百分比(%)的形式表示,通过χ2检验分析各组间的差异,P<0.05为差异有统计学意义。研究结果80.5%的护士和55.6%的医师不了解各种器官捐献的时限,90.4%的护士和71.7%的医师不了解捐献器官的流程,93.8%的护士和81.3%的医师不了解无偿器官捐献后的救助补偿机制。医师的知晓状况优于护士；中青年、高级职称医护人员的知晓状况较好,差异有统计学意义。93.2%的医生和90.1%的护士表示在公立医院开展器官捐献协调工作可行；但64.1%的医师和59.5%的护士认为公众多数不认同器官捐献,65.4%的医生和57.5%的护士表示潜在器官捐献者家属中大多数会拒绝捐献,医护无差异。对于个人签署器官捐献志愿书的态度方面医师比护士积极,中高级职称护士较初级职称护士积极,差异有统计学意义。38.8%的医师和39.4%的护士表示会主动向潜在器官捐献者家属提示捐献意向,明确不会的医护人员分别为12.6%和29.5%,其他医护人员(分别为48.6%和31.1%)未明确回答；愿意做专(兼)职协调员的医护人员分别占51.2%和44.8%；赞成签署《器官捐献告知书》的医护人员分别为90%和82.2%,医护人员协调的积极性均明显提高,有79.5%的医师和68.6%的护士表示会积极协调捐献；医师的行为意向高于护士,差异有统计学意义。总结97例潜在器官捐献者家属拒绝捐献的原因,76.3%的家属表示“观念接受不了”,70.1%的家属表示舆论压力大。结论与建议器官捐献工作在我国刚刚起步,“潜在器官捐献者”对于医护人员来讲也是个新概念,通过调查,医护人员对于在临床工作中开展器官捐献均有较高的认可度,但医护人员对于器官捐献工作认知状态不到位,所持态度矛盾以及行为意向表现的顾虑重重,显示医护人员参与此项工作的积极性受到公众对于器官捐献的态度、当前的医疗环境及医患关系的影响。因此加强相关知识的宣传教育,制定合理的工作制度和流程对于提高医护人员的认识态度、消除顾虑并积极参与协调转介潜在器官捐献者具有显著的推动作用。分析发现传统观念和舆论压力是导致潜在器官捐献者家属拒绝捐献的主要原因。因此,加强对中小学生、高等院校的教学理念的设计,从根本上改变民众的观念,为我国器官捐献的发展奠定扎实的基础；推进脑死亡立法、优化双盲原则以及建立健全困难救助体系,对潜在器官捐献者家属提高人文关怀和心理支持,降低拒绝捐献率；加强人体器官捐献协调员队伍建设,使其形成职业化发展,有效推进器官捐献工作的发展。更多还原

【Abstract】 BackgroundOrgan transplantation is known as "the pearl of the medicine crown". It is one of the most effective ways to treat various types of end-stage organ failure and it brings hopes of cure for many patients. The number of organ transplants and technology in China have reached the level of developed countries, but the ratio of supply and demand of organ transplants is 1:30, with the ratio of US is 1:4, which formed disparity gap between our country and US, making the cause of organ transplant in our country faced with severe challenge. Before 2010, the main organs of our country were mainly from the body of the death penalty and living organs, and the former source has been controversial and criticized in the world, while the living organ donation was a serious violation of the principle of medical ethics of "non nocere prium". With a full cessation of the so-called "use organs from executed prisoners" at the beginning of 2015, and with reference to advanced experience of organ donation in many other countries, we are fully aware of that the citizen body organ donation after death is the key driving power and only way to solve the shortage of organs and guarantee the organ transplantation to develop sustainably. As the primary contact persons of the body and organ donors,, As the primary contacts of potential organ donors, clinical staffs’ cognition, attitude and behavior play the key role in the affection of organ donation work.ObjectivesCollect data about related knowledge, attitudes and behavior of hospital clinicians, nursing staff in a first-class teaching hospital of three classes about organ transplantation and potential organ donors, and analyze he main influence factors on hospital clinicians, nursing staffs finding, referrals, coordination of potential organ donors. Analyze the reason why the relatives of potential organ donors refuse to donate organs and affective elements. Finally, provide data support and advice strategy in order to improve the active participation of the medical personnel in the work of organ donation, play their professional expertise, and make the organ donation a routine and normalization in the clinical medical work.MethodsWe totally distributed 857 copies of self-made questionnaires among 482 doctors and 375 registered nurses form different sections in a tertiary first-class hospital.812 valid questionnaires were collected, and the effective rate was 94.7%. Sorting the materials and using Epidata 3.0 software for data entry. SPSS 17.0 was used for data analysis and processing. Descriptive statistics was adopted to analyze each index, case number and percentage were used to show enumeration data, which were compared with chi-square test. P< 0.05 was considered significant.Results80.5% of nurses and 55.6% of clinicians did not understand the time limit of organ donation.90.4% of nurses and 71.7% of physicians did not understand the process of organ donation,93.8% of nurses and 81.3% of the physicians did not understand compensation mechanism after organ donation. Doctors knew more about the donation than the nurses, and the young middle-aged and senior medical personnel of the medical staff knew better, the difference was statistically significant.93.2% of physicians and 90.1% of nurses in public hospitals considered that it was feasible to coordinate organ donation. But 64.1% of physicians and 59.5% of nurses believed that the public did not identify the majority of organ donation,65.4% of doctors and 57.5% nurses represented that the majority relatives of potential organ donors would refuse to donate, no difference between doctors and nurses. For individuals to sign the volunteer contract of organ donation, physicians were more positive than the nurses, the nurses with senior professional titles were more positive than those with junior titles. The difference was statistically significant.Only 38.8% of physicians and 39.4% of the nurses said they would take the initiative to prompt the families of potential organ donors to donate, other health care workers (48.6% and 31.1%, relatively) did not express their opinions,12.6% of doctors and 29.5% nurses clearly expressed their unwillingness.51.2% of physicians and 44.8% of nurses were willing to act as medical coordinator and there were statistically significant between each other.82.2% of nurses and 90.0% of physicians were in favor of the signing of "organ donation informed book", and the coordination initiative has significantly improved.68.6% of nurses and 79.5% of physicians were willing to actively coordinate potential organ donors and there were statistically significant between each other.By summing up 97 cases of potential organ donors, we found that 76.3% of families said that "the concept can not be accepted’was the main reason why they rejected to donate organs while 70.1% of families members showed higher pressure from the public.ConclusionOrgan donation work in our country has just started, the potential organ donors is also a new concept for medical staff. Through the survey we found that physicians and nurses had a higher degree of recognition for the conduct of organ donation in clinical works but their enthusiasm would be affected by public’s attitude to organ donation and current health care environment. Therefore, strengthening publicity, developing a reasonable work system and procedures would be helpful to enhance staffs’awareness, eliminate certain concerns and actively participate in coordinating work. Through the analysis we also found that traditional values and public pressure were the main reason why relatives of potential organ donors rejected donation. Therefore, in the future we should put more attention on the teaching concept design for primary pupils and students in high schools and universities, and change the attitudes of people fundamentally so as to lay a solid foundation for the development of organ donation. We should promote the legislation of brain death, optimize double-blind principle and establish a sound rescue system for vulnerable people. We also need to improve humane care and psychological support, reduce the rate of donation refuse and strengthen coordination team building to promote the progress of organ donation.更多还原