EMOTIONS EXPERIENCED BY TRANSPLANT COORDINATORS IN FAMILY INTERVIEWS FOR ORGAN DONATION

The process of organ donation consists in different stages among which the family interview that is conducted by advanced transplant coordinators. This moment holds high emotional complexity, because it informs about encephalic death and the possibility of donation. In this context, the objective is to know the emotions experienced by transplant coordinators in the family interview for organ donation. Method: qualitative research, descriptiveinterpretative norm; approved by the Ethics Committee of UFF/HUAP. Data was collected by semi-structured interviews with 24 advanced coordinators of Central of Transplants from the Rio de Janeiro State, from January to May of 2012. Results: the emotions were: negative – anger, fear and sadness; positive – love; impartial – surprise; and the denial – emotionless at the interview. Was conclude that different types of emotions permeate the family interview, with a predominance of those negatives. Not all coordinators were able to denominate their emotions, demonstrating the difficulty of dealing with the emotional issues in the workplace. It was observed that by identifying the emotions felt, they initiated the awareness of their own emotions.


INTRODUCTION
The organ trade process is composed for two different essential stages from which we can tell about the familiar (FI) that presents a great emotional/subjective complexity, and is defined as a meeting between the family of the potential donator (p.d) and one or more professionals from the capture team, or another trained Professional, aiming to obtain agreement to the donation (1) .
Coordinators who begin to conduct interviews wanted to find a set of rules to follow.However, it is not possible to establish a list of infallible rules, because the FI takes place between human beings, which cannot be reduced to a formula or common standard (2) .
In this way deal with positive reactions towards possibly arise in the interview, family informed about organ donation and what is brain death (BD) and also those who -on a larger scale -negatively deal with BD, either do not understand how this occurs, for they cling to a religion to search for a miracle or for staying passive or aggressive forward the possibility of organ donation (3) .In addition to coming in contact with a range of p.d the family reactions, engineers also deal with death, and that in non-rare situations, inform the family about the death of their loved one.In this regard, it is known that the occurrence of death for professionals is not a lived naturally phenomenon, as is accompanied by numerous difficulties, suggesting a suffering resulting from routine contact with terminal situations it is often veiled and muted" (4:2626) .
It is claimed also to work with the finitude touches the emotional and physical implications that weaken and generate disease processes, as they are outlined technical and subjective limitations to deal with the issue.In this sense, come personal strategies for dealing with such implications, such as the activation of cognitive resources that assist in the management of this fact in daily work.In this sense, come personal strategies for dealing with such implications, such as the activation of cognitive resources that assist in the management of this fact in daily work.However, such resources does not prevent the professional is marked by these experiences (5) .
Therefore, seek strategy that allows ventilation of emotions silenced through activated cognitive resources in the difficult situation facing process is a way to unravel what are the emotions that are experienced at times like the family interview for organ donation, involving issues such as terminal illness, the denial of the diagnosis by the family, the unpredictability of death and mourning.
The opportunity to have a moment to talk about emotional issues experienced in the family interview is a demand already mentioned by advanced engineers in transplants to demonstrating the importance of being offered emotional support in the form of service provided at work (3) .
This justified this study, which aims to understand the emotions experienced by advanced coordinator transplants in the family interview for organ donation considered remarkable.
We used the term "marked" with the participant's intention to recall the interview that was recorded in your emotional memory.
The findings will be analyzed in the perspective of emotional intelligence, which is "[...] ability to identify our own feelings and those of others, for motivating ourselves and for managing emotions well in ourselves and in our relationships" (6: 337) and Emotional Education: "[...] a path that leads to observe memories and situations in order to understand where our reactions arise and to get everyone to live their emotions [...]" (7: 151 -154) .

METHODOLOGY
A study with qualitative approach, because emphasizes the understanding of human experience as it is lived; it was collected and analyzed narrative and subjective materials (8) .A descriptive and interpretative study.Data were collected at the Notification Center, Procurement and Distribution of Organs (NCPDO) in Rio de Janeiro from January to March 2012.
It was used as an inclusion criterion for participation in research: professionals with experience in family interviews for organ donation and who were working in the data collection period in Transplant Center team.And as exclusion criteria: professionals who never held family interviews, and those who worked in NCPDO in question, the data collection period.97% of eligible ATC were approached 3% are on maternity leave and sick leave.The participants were 24 advanced transplant coordinators (ATC): 17 nurses, two social workers, two doctors and three psychologists.
The interviews were initiated from informal approach with participants explaining briefly about the main points of the study, and the importance of their participation in research.It is noteworthy that all participants addressed promptly agreed to participate in the interview and there is therefore, refusals to participate in the study.
We used a semi-structured interview from instrument consisting of 8 questions open about emotions and their management in situations taken place in the family interview for organ donation, and for this crop was explored the question: "Could you tell a considered remarkable interview, highlighting the emotions felt?".
It was used the technique of content analysis (9) for organizing and understanding of the reported data were recorded and therefore fully transcribed.We traveled three steps for material analysis: 1) Pre-analysis, material or coding Exploration and 3) Treatment Results -Inference and Interpretation.The results were discussed in the light of relevant concepts and designs Emotional Intelligence (6) and Emotional Education (10) .
The study was approved by the Research Ethics Committee of the University Hospital Antônio Pedro, from Federal Fluminense University under nº 321/11, CAAE: 0336.0.258.000-11 in 2011.To protect the identity of participants, these were represented in the survey by paint color names to paint on canvas, seeking an analogy between emotional and artistic context.

RESULTS E DISCUSSION
Sociocultural data showed that the mean age of participants is 38.7 years and the majority (15) is female.There are 12 coordinators who work in the institution between 2 and 3 years, which is the large group who entered the service through temporary public tender held in 2009, and only 4 developed this activity for more than 10 years, the latter servers statutory relationship.The average of the participant's graduation time is 12.8 years, and in terms of graduate school, no participant had focused training for the area of transplants, but in other areas such as nephrology, public health, medical and cardiology.Only two study participants perform counseling.

THE EMOTIONS, FEELINGS IMPRESSIONS AND ACTIONS EXPRESSED BY THE COORDINATORS
It was noticed a significant difficulty from the participants to nominate the emotions, even the basic.At the sketches proposed by the Emotional Education, it is affirmed that the expected is to not exist difficulties to feel the emotions when those are externalized with a high intensity, however, it is hard to understand them when they are at a low intensity moment, and it is even harder to access the unconscious emotions.
It is stated that independent of the easy or difficulty level that one can access, the emotions have a strong influence on us, because they are processed by our brain in action.Thereby, the fact that we ignore the actions does not mean that they don't reach us; we just don't realize their influence when they show up on our acting (10) .
It was associated to the emotions felt the impressions, feelings and actions involving situations: unfavorable to the donation, contrary to the diagnosis of BD, pessimistic about the integrity and transparency of the donation process, which caused sadness and helplessness against the lack of care offered to p.d. by the notified hospital staff; satisfaction with family accepted the donation, which promoted the feeling of being supportive of sense of gratitude and fraternity; where coordinators felt that have a commitment to the cause of transplants, of commotion, which generated expectations and empathy; and wherein refused and / or replaced emotion.
Giving the above, are formed four subcategories from the reports of advanced engineers transplants: The negative dimension linked to family interview; the positive dimension linked to family interview; the size of the unexpected linked to family interview; and emotional Contradiction linked to family interview.The categories were grouped taking into account the classification of basic emotions proposed by Pérez-González (11) .

THE NEGATIVE DIMENSION RELATED TO THE FAMILIAR INTERVIEW
The emotions related to the remarkable familiar interview, were the sadness, fear and angry.
[...] because of that mother was ill and I was sad because she was losing a child and even today I get emotional when I remember that (Permanent Dark Violet).
Look! Too much sorrow!I think it's a very sad case, very painful, difficult and we feel it (Earth Burnt Sienna).
Continuous monitoring of families facing the loss makes engineers feel tired, exhausted and express feelings of sadness, pointing to the need for emotional support, so that they can reframe these feelings (12,13) .
Speaking of non-acceptance by the priest's relatives to the diagnosis of BD and aggressive reaction p.d's mother who tried to beat the engineers, assaulting them verbally to insinuate that would kill his son to steal his organs, Cadmium Orange exposes his emotions down reported.
So first I think any human being would be afraid of the situation.I particularly out very sad, very upset with the situation, understanding that was very aggressive for her too (Orange Cadmium).
When asked by the family of p.d. if there would be no payment for the donation of organs, and insisted on the issue of financial exchange as the only way to accept the donation, Dark Rose said: Anger, I felt anger that being.I said: hey, you cannot, we were talking about here being beautiful act, which is an act of giving.We at no time exchange of speech, we say that is a moment that he will be helping someone, and it is something intimate feel to it as well.I got angry and said: Damn it, get out!(Dark Pink).
In this context, it is clear that although the act of donating organs the banner of solidarity and love of neighbor, we can see that these features are not always that permeate this gesture.Coordinators nurses who do not take care of p.c. before his brain death behave as if there were bond before the other died.Thus, there may be a nurse's identification with the donor for their condition of being human.Death as an end generates the professional sadness, because this design does not allow the continuity of his being, revealing its finitude, exposing its fragility and vulnerability (13) .
Characteristics of basic emotions also emerged in the statements, and these were suffering and despair (characteristics Sadness); fear, nervousness and anxiety (characteristic of Fear); and irritation (characteristic of Anger) (6,10) .The most prominent features were the fear, which by definition is: 1. Resulting mental state of the idea of a real danger or apparent or the presence of some strange or dangerous thing; fear, terror; 2. Anxiety, fear or apprehension [...] before something you want to avoid [...]; 3. Concerning or fearing of being unpleasant to offend or cause harm [...] (14:841) .
Situations involving fear and their characteristics were: the expectation of the complexity of interviewing parents who had just learned of brain death of the child; the verge of being assaulted/suffer physical violence by family members; and fear of loss of someone close, in which case kept similarity with a family of the interviewer.
As in its definition, fear is an emotion that involves danger as we can look in the reports.The anxiety creates with the expectation to get this or that answer, or the type of reaction of relatives are also contained in the set of characteristics that make up the fear when we think of family interview.
However, one should not overlook the manner and frequency of how fear is being experienced, paying attention to situations in which this emotion is touched upon, so that it becomes aware of when fear is propellant or limiting the confrontation scene in which it is inserted.But for this exercise is done, you need to start the connection of thought to emotion, standing open to the emotional world (10) .In this way, we advance in the first domain "Knowing one's emotions" proposed to build the Emotional Intelligence (6) also in the development of emotional education that demand: [...] see what happens, observe the present; focus on people and maintain the connection; pay more attention to interactions than in structures; be aware that everything is interconnected.Nothing happens separately; to realize the feelings (12: 225) .By understanding the situation with which he was dealing in the family interview, it was a serious child unattended in the hospital emergency room; he could transfer to the Intensive Care Unit (ICU) only to have evolved to brain death criteria, thus becoming a potential donor, Lacquer Orchid felt: I was very scared to see the father, because he had no idea of the severity of the case of the child and felt bad too because the child was there move in the emergency room and only when there was the possibility of organ donation he was transferred to ICU, "Got it"?[...] Oh, and the worst: in fact it was so bad that we could not catch any of it, we dismiss the case (Lacquer Orchid).
The report Laca Orchid reinforces the view of nurses coordinators who perform family interview that point as they consider dehumanizing situations of the organ harvesting process: the lack of structure in the pre-hospital care giver, lack of donor care conditions or streamline the donation process, the donor's media exposure, lack of awareness on the part of the professionals in maintaining the clinical condition of the individual brain death to become p.d, to the lack of standardization work (13) .

THE POSITIVE DIMENSION RELATED TO THE FAMILIAR INTERVIEW
Was identified here the Love, presented by the speech of Overseas Blue.I do not know if it's an emotion, but a sense of a brotherhood, solidarity -do not know, brotherly love so intense that I feel the people who are going through this situation that in most cases I get very excited.The fact is that we want to do more for them.And honestly, you cannot do much.Basically is this: that love thing circulating there […] (Overseas Blue).
Although not recognized as emotion, love quoted in speech transcends the difficult spaces, the missing notifying teams, family members who do not understand the diagnosis, those aggressive, those who want to bargain the donation for money, anyway...It helps to overcome many of the difficulties arising at this time.Concerning the Overseas uncertainty about love even be an emotion, this doubt is commonly observed, because "society has advanced greatly in terms of technology; but suffers from a deep emotional illiteracy, which is manifested through the ignorance that people have about the emotions that affect them" (15:24).When you can see the mechanism by which this process takes place, it is allowed to be started the way to becoming more conscious emotional experience, which opens the door to a fuller life (10) .
Regarding emotions characteristics identified the happiness (emotional characteristic of Joy) and satisfaction (emotional characteristic of Pleasure) (6,10) , as shown by the following lines.
Oh, I was very happy.I think the feeling is satisfaction that you're helping not just one person but several, and also understand that your communication was satisfactory.Because somehow you informed and the family understood and you managed to reverse a situation that at first would be a negative and then he backtracked really.It was very satisfying, a feeling of happiness really.(Orange Cadmium) Ah, emotionally.... Look is... ah, it was a mixed way: I was surprised and happy at the same time because that mother was giving [...].(Permanent Dark Violet) The characteristics marked by participants show that in a family interview we may have an understanding of the family, his greatness as people who understand and adhere to the cause of the donation and the change of a 'negative unclear' to a 'yes oriented'.Based on these situations, engineers reveal aspects that somehow represented to them emotions that were translated as: gratitude, the good feeling, the feeling of accomplishment, security, solidarity, brotherhood, compassion, tranquility and appeasement, and comfort yourself.

THE UNEXPECTED DIMENSION RELATED TO THE FAMILIAR INTERVIEW
The emotion which was most frequent was the surprise that is at the neuter emotions category (11) .This was one of the few that the participants could classify as emotion.Other terms that tried to represent the emotions were: thrilled, commitment, commotion, expectative and empathy.
It was possible to see the recognition of emotions in the stories of some participants, such as Green English with that experienced with a 16 year old whose parents took her evangelical pastor in the FI, which uttered a few words.The family serenity allowed Green English feel safe.
[...] safe, thrilled with the whole situation, I was sure of what I was doing there (English Green).
On the other hand the light red by creating the expectation of a 'no' of the family of an inmate, having received a "yes" to donation, exposed: Faced contexts involving most of the time expectations, conflicts, dilemmas and contradictions, the professional search significance in their doing, considering his work as dignified and extremely significant for doing a good, something good, that can generate lives (13) and knowledge.
Regarding the recognition of basic emotions, as exemplified by the surprise identification, refers to the so-called Emotional Skills (10) which are represented by: ability to be open to the emotional world at the time of interview; ability to welcome, calm and support the other, as some interviewers reported to; ability to be aware of: listen, understand, consider, nominate and give meaning to one or more emotions; and, finally, the ability to bind thought and emotion.
In terms of emotional intelligence, also called socio-emotional skills are a comprehensive personal tool to achieve higher levels of personal, family, social, academic, vocational and professional adaptation.Thus, in the last five years has been proven by relevant scientific evidence, the possibility of improving the emotional intelligence levels are well-founded theoretical and structurally (11) .

EMOTIONAL CONTRADICTION RELATED TO THE FAMILIAR INTERVIEW
This subcategory presented the speech of the participants who didn't nominate the emotion, however, showed an emotional involvement at the speech.Was also presented the ones who had difficulties to nominate the emotion and replaced it by adjectives, impressions, actions, sensations Cienc Cuid Saude 2016 Jan/Mar; 15(1):53-60 or feelings, how it is showed in the following speeches.

I wonder if I am getting cold (laugh)
. Oh what a horrible thing I remember that... Well, victory is something "so" rewarding, because you could change a situation, you made the person see the act and it had nothing to transfer, she donated normally for free will after all be explained situation...I was able to reverse the situation, then so is victory, right?(Lemon Yellow).
Professionals who perform the FI are used the cold to preserve emotionally in contact with family members.They think that it is not exposed to human vulnerability, and this is due to inability to reframe the emotions and feelings of sadness and helplessness at that time (13,3) .
Note also Yellow Ochre which has not appointed any interviews as striking, calling himself "emotionally a brick".
None, none {remarkable interview}.What has marked me, so this was our...No one.They had moments things that happened that I remember, but not remarkable because it is emotional...More the bizarre side of it than the emotional side.Emotionally a brick.He had no.I can not at this moment remember any, and so, there have been, have had other times they have asked me this, and I can not, there is nothing.No time so that ours that was.Did not stay!I do not have (Yellow Ochre).
Carmine denied having felt some emotion, but concerns emotional involvement in his speech.
Fear of losing my brother "is"... it was inevitable because there I saw a lot like child physically with my brother motorcycle accident, and my brother also has bike so at first was afraid of losing my brother in the same situation... Now with respect to family interview as well... of course we regret for family and such, but I did not get involved, I did not feel involved within that context of family loss, did not get involved, I did not feel so but I felt afraid of losing my brother with the same situation that boy died but did not feel involved with the loss of that family (Carmine).
You can see in the speeches that participants do not realize what they feel, either for lack of conscious contact with the body, or personal emotional energy, which translates Emotional Incompetence related himself (10) .In practical terms, these people have the feeling of "feel nothing" to live the emotion itself with coldness, stiffness or stereotyping (10) as noted in Lemon speech.They do not recognize the emotion or state of mind in which you are or have a vague awareness, feel bad and do not realize, being irritable, pessimistic or discouraged without assuming responsibility for this state, thinking that the world and life are like this (10) , as is clear in the Yellow Ochre speech.And make confusion when naming the emotions felt like not to take the fear, as in speech Carmin.
The literature reiterates that mentioned Carmine by stating that, in establishing ties with the family and to experience suffering, engineers who perform FI becoming afraid that something happens to someone they love (13) .
In this scenario, personal characteristics are necessary and professionals to be acquired by the coordinator for carrying out the FI, as: charisma, sensitivity, good judgment, convey emotion, empathy, know themselves, have active listening/to listen/learn to be silent/identify the family time, be good about yourself, have emotional balance, dealing with the body, automotive to provide preparation and realization of the objectives (16,17) .

CONCLUSION
The emotions lived by the ATC are mainly the basic, from the negative, positive and neuter categories, added to the emotion's characteristics from the two first groups.It was noticed the prevalence of the negative emotions because of their wide array, said by the coordinators.
We observed that to recall the striking family interviews, not all coordinators were able to name their emotions demonstrating the difficulty of dealing with the emotional issues that tangent the workplace.
Was also observed that by making them identify the emotions felt, if possible, start the awareness of their own emotions in participants, which is the opening to the emotional world.It is recommended the promotion of a space speaks to the ATC in their work environment and the issue of deepening study aimed to know the consequences of silencing of emotions to the process of transplantation.
[...] It was very exciting.Because the mother was very touched and very...It was the impact of surprise as we should not judge things, it was a learning experience.(Light red)