EVALUATING THE DETERMINANTS OF A SUCCESSFUL ORGAN DONOR PROCESS IN A MULTI-HOSPITAL SYSTEM
Open Access
- Author:
- Josiah, Robina
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 26, 2006
- Committee Members:
- Susan Diane Brannon, Committee Member
Karl J Mc Cleary, Ph D , Mph, Committee Chair/Co-Chair
Michelle E Day, Committee Member
Keith E Whitfield, Ph D, Committee Member - Keywords:
- Theory of Planned Behavior
Theory of Relational Coordination
comunication
coordination
health care profesionals
physicians
nurses
attitude
organ donor process
organ donation
Theory of Reasoned Action
factor analysis
qualitative
structural equation modeling - Abstract:
- The disparity between the demand for cadaveric organs and the number of available organs in the United States remains significant. This three-paper thesis assesses the interpersonal, intra-personal and organizational factors which both enhance and impede the critical pathway of the organ donor process (ODP) in a multi-hospital health system. The first study employed exploratory factor analysis and canonical correlation to evaluate the relationships between critical care professionals’ attitudes to organ donation and the organ donor process (ODP) and a set of socio-demographic/organizational factors. Findings suggest at least five meaningful dimensions of attitudes with alpha reliability statistics ranging from á=0.663 to á=0.924. These five factors explain 69% of the variance in survey responses. It was confirmed that there are measurable differences between personal attitudes concerning organ donation and attitudes related to the way the ODP is enacted. There are also significant positive relationships between attitudes and socio-demographic/organizational characteristics. The second study used the Theory of Planned Behavior(TPB) to assess health care professionals’ intentions to participate in the ODP. Results indicate that both attitudes and perceived behavioral control were significant, positive predictors of intention to participate in the ODP, with attitudes being the strongest predictor. And, while a positive relationship between subjective norms and intentions was confirmed, it was not significant. Additionally, while the Theory of Reasoned Action explained less variance in the model (64% versus 84% in the TPB), it provided a better model for the data and suggested positive, significant relationships between intention and its antecedents’ attitudes and subjective norms. The third study retrospectively explored the experiences and perceptions of critical care nurses involved in the ODP. Elaboration of the Theory of Relational Coordination (TRC) through grounded theory was achieved using interview data to delineate the nature of interpersonal relationships and communication among a loosely defined ODP team. Results confirmed that formal coordinating mechanisms by themselves are insufficient for the successful enactment of the ODP. Nurses validated the salience of communication and interpersonal relationships as suggested by the TRC, but also identified other coping strategies which make up for areas of deficit in enacting a successful ODP.