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Potential donor family behaviours, experiences and decisions following implementation of the Organ Donation (Deemed Consent) Act 2019 in England:A qualitative study
Full text linkBACKGROUND: In May 2020, England implemented "deemed consent" legislation, to make it easier for individuals to donate their organs and convey their decision when alive. Families are supposed to support the decision but can still override it if they disagree. We aimed to learn more about this changed role when families were approached about organ donation.METHODS: A qualitative study using semi-structured interviews with families, feedback from nurses, comparisons with audit data, and public involvement. We used framework analysis with a health systems perspective and utilitarian theory to explore if the law worked.FINDINGS: 103 participants were interviewed representing 83 potential donation cases. In 31/83 (37%) cases donation was fully supported, in 41/83 (49%) cases families supported retrieval of some organs, tissues and procedures, and in 11/83 (13%) cases families declined completely. Themes explaining why the law was not (yet) working included: Understanding and agreeing the family's role, confusion about deemed consent, not supporting the deceased expressed decisions, organ donation as too much of a harm, the different experiences of donation pathways, transition from end-of-life to organ donation discussions, experiences of 'consent', paperwork and processes. Families frequently questioned if their relative wanted to have a surgery rather than supporting the person who died to save lives.CONCLUSION: Families use the unique experience of their relative dying in intensive care to create alternate narratives whereby the outcome satisfies their own utility and not necessarily those of the potential donor. New public ongoing media campaigns crafted to be more supportive of organ donation as a benefit to transplant recipients could help families overcome the many difficulties they encounter at the bedside.IMPLICATIONS FOR CLINICAL PRACTICE: The soft opt-out policy has not empowered nurses to help families at their most vulnerable to increase their support for and consent to deceased organ donation.</p
Review and Analysis of Successful PSA Interventions: An Applied Perspective
Full text linkPublic speaking can be a fear-inducing and anxiety-provoking experience for individuals, potentially resulting in poor performance and missed educational, social, and professional opportunities. In order to provide applied practitioners with effective methodologies for the reduction of public speaking anxiety (PSA), this paper aims to systematically review and meta-analyse theoretically driven interventions that successfully reduce PSA or maintain/increased public speaking performance. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis examined articles from 1st January 2000 to 1st June 2023. Of the 1,293 articles identified, 26 studies with 2,253 participants met the inclusion criteria. Research was of a moderate to high methodological standard, with interventions varying in type, duration, and focus (e.g., symptom vs. source). Intervention types included exposure, cognitive modification, combined, and other strategies. Although, the overall effect of psychological interventions for PSA across 42 interventions was g = 1.17 (95% CI = 0.88-1.45), with high heterogeneity, individual effect sizes varied greatly. While this review provides support for the efficacy of psychological interventions in reducing anxiety related to public speaking, rigorous research is warranted to examine long-term efficacy, real-world implications, self-efficacy development, and individual differences in treatment assignment. Finally, this review provides practitioners with a quick and easy guide to implementing successful interventions that reduce PSA or maintain/increase performance
Re-thinking people and nature interactions in urban nature-based solutions
Full text linkPeople-environment interactions within nature-based solutions (NBS) are not always understood. This has implications for communicating the benefits of NBS and for how we plan cities. We present a framework that highlights a duality in NBS. The NBS as an asset includes both natural capital and human-centred capital, including organisational structures. NBS also exist as a system within which people are able to interact. Temporal and spatial scales moderate the benefits that NBS provide, which in turn are dependent on the scale at which social processes operate. Co-production and equity are central to the interactions among people and institutions in the design, use and management of NBS, and this requires clear communication. Drawing on ideas from culture-based development (CBD), we suggest an approach to communicate the benefits of NBS in a neutral but effective way. We propose guidelines for planning NBS that allow the optimisation of NBS locations and designs for particular outcomes