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Federal Conditions of Participation from the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) introduced in 1998 require that all families be presented the option of organ and tissue donation when death is imminent. The perception that physicians were being excluded from participating in this process led to a resolution at the American Medical Association House of Delegates meeting in December 1999, calling on the American Medical Association Council on Scientific Affairs to review the Conditions of Participation "to ensure that there is no prohibition of physician involvement in the organ donation process..." The number of organs procured for transplantation in the United States is insufficient to meet needs. Families' hospital experiences significantly affect their decisions to donate organs. Discussing severe brain injury, brain death, and organ donation after brain death with families is a specialized form of end-of-life decision-making and care in the intensive care unit; however, the knowledge, skills, and attitudes necessary for physicians and nurses to promote good end-of-life decision-making are widely variable. The federal Conditions of Participation require that those making requests of families for organ donation receive specific training. They do not prohibit physician involvement in initiating organ donation requests, provided these individuals are properly trained. Physicians have an important role in caring for patients and families in these circumstances, and the care they provide is enhanced through training, attention to the special issues involved, and collaboration with organ procurement organization personnel.

<H4>ABSTRACT</H4> <P>Teaching nursing students therapeutic communication skills begins in the classroom and extends to the clinical environment. The usual method of instruction consists of random patient encounters observed by faculty and measures of competence that rely on paper-and-pencil tests. Using standardized patients (SPs) offers an alternative approach to the traditional method of teaching. Standardized patients are individuals who have been carefully trained to present an illness or scenario in a standardized, unvarying manner. This pilot study compared use of SPs with the usual method of instruction in a class of undergraduate nursing students. Results indicated that students who participated in the SP method overwhelmingly described the experience as positive, creative, and meaningful. No significant differences were found between the two groups on measures of interpersonal skills, therapeutic communication skills, and knowledge of depression.</P> <H4>AUTHORS</H4> <P>Received: July 30, 2002</P> <P>Accepted: February 1, 2005</P> <P>Ms. Becker is Assistant Professor and Coordinator of the Adult Nurse Practitioner Program, Dr. Rose is Director, Baccalaureate Program, Ms. Berg is Instructor, and Ms. Park is a doctoral student, Johns Hopkins University School of Nursing; and Dr. Shatzer is Director, Office for Teaching and Learning in Medicine and Center for Experiential Learning and Assessment, Johns Hopkins University School of Medicine, Baltimore, Maryland.</P> <P>Address correspondence to Kathleen L. Becker, MS, CRNP, Assistant Professor, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, #459, Baltimore, MD 21201; e-mail: <A HREF="mailto:KBECKER@son.jhmi.edu">KBECKER@son.jhmi.edu</A>.</P>