The effectiveness of an education talk to enhance the KNOWLEDGE AND AWARENESS OF nursing staff

The effectiveness of education talk to enhance the KNOWLEDGE AND AWARENESS OF nursing staff in identifying possible organ donors IN the Neurosurgical

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Introduction / Background

The hospital Authority (HA) plays a supporting role in respecting the wishes of potential donors and their families regarding organ donation in HA hospitals. It also has an obligation to promote the health of organ-failure patients through organ transplantation. Organ Donation Coordinators (ODC) focus on developing and promoting strategies for giving individuals choices in deceased organ donation during the final stages of their lives. HA hospitals provide environments that facilitate discussions and decision-making in all respects for donors and relatives. The ODCs serve as a coordinator, clinical resource persons, facilitators, educators, and quality assurer in enhancing or maintaining the systematic coordination throughout the organ donation process. Since end-of-life care, death and organ donation are very much interlinked. This Guide demonstrates the success of the organ donation pathway requiring interactive collaboration, communication, and cooperation amongst the stakeholders during the patient journey in the phase of the End of life. Organ donation and transplantation is a complex and dynamic topic for the public and health care professionals. The success of organ donation and transplantation has highly relied on the culture and beliefs of the society as well as advanced health care practices. There are two types of deceased-donor donation of organs and tissue in Hong Kong-based on the cause of death and the situation in which it occurs. The majority of the deceased organ donor was suffered from cerebral vascular accidents and cared for by three main units, the Intensive Care Unit. Neurosurgical Unit and Medical Unit. Intensive Care Unit. 

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Identification and Referral of Potential Donors

The current practice of identification of a potential donor is the first crucial step in the organ donation process. “GIVE” is a common tool in identifying potential donors, especially in the general non-ICU area. “GIVE” comprises four elements, including the Glasgow coma scale (< 5 or in-house trigger), Irreversible brain injury, Ventilated, and End of life care. Health care professionals could notify the ODCs at the earliest possible time for patients with severe neurological insult due to post-cardiac arrest, cerebral anoxia, cerebral infarct, cerebral hemorrhage, encephalopathy, traumatic brain injury, whose require mechanical ventilation and level of consciousness assessed by Glasgow coma scale of <5 (or refer in-house GCS trigger) in clinical areas. In addition, ODCs conduct daily visits to wards and units to facilitate the early identification of potential donors. Health care professionals could notify the ODCs at the earliest possible time for patients with severe neurological insult due to post-cardiac arrest, cerebral anoxia, cerebral infarct, cerebral hemorrhage, encephalopathy, traumatic brain injury, whose require mechanical ventilation and level of consciousness assessed by Glasgow coma scale of <5 (or refer in-house GCS trigger) in clinical areas. In addition, ODCs conduct daily visits to wards and units to facilitate the early identification of potential donors.

Referral to Organ Donation Coordinator

Every ODC should work an in-house referral mechanism for potential donors. Hospital staff could notify ODCs of suspected cases of imminent Brain Death (GIVE referral trigger) either by direct call or through the hospital operator at any time on any day. The ODCs should reply to the referring unit within 2 hours for early on-site assessment and evaluation of potential donors after receiving the referral. On every referral or consultation, ODCs and hospital staff should refer to the HA “Guideline for Evaluation and Selection of Deceased Potential Organ / Tissue Donors,” the revised version of February 2018 by the Central Committee of Transplant Service for information. It is clear that more collaborative work should be done among referring clinical team and ODCs for ongoing monitor the progress if certification of brain death criteria is met as set by HA Guidelines.

It thus means that the role of nurses is possible in the establishment of a link between the surgical team and the family, which could also influence in a positive manner or time at the time of decision regarding organ donation. It also means that the nurse will have a very important position to place when it comes to organ transplantation and donation and should be given the right type of training to participate well in the donation process, including notification and identification of the donor to the hospital coordination team, maintenance, and monitoring of the patients as well as embracement of care for the families. Basically, the donor in the neurosurgical department is clinically dead; however, he will still maintain the characteristics of an alive person. Here organ donors are seen as a means and an end by themselves. They are thus a source of hope to other patients waiting for a transplant. With the growing shortage of organ donors, it is important to ensure that nurses’ knowledge and awareness in the identification of possible organ donors within the neurosurgical department is enhanced since they remain the main source of organ donors for transplant currently. 

Literature review

Organ transplantation is a very important aspect of healthcare as it saves thousands of lives each year. However, the shortage of organ donation is a limiting factor when it comes to increasing the transplantation rates. For there to be an increase in the number of patients to be transplanted before they die on the list, it is important to ensure an increase in the number of donors. Patients that have an irreversible brain injury are regarded as being medically suitable and can be potential deceased donors, and strategies are required to ensure that they are successfully converted to actual donors. It is important to ensure necessary steps are carried out to increase the number of organs required for transplant. 

Studies by Prins (2019) show that among the greatest challenges when it comes to organ donation is defining the role of the nurse as organ transplant coordinators and the responsibilities that they are required to undertake in the process, which may slightly vary based on the local context, local healthcare system, and country-specific laws. These studies also reveal that there is a shortage of registered nurses who have specialized in organ donation, which is often addressed through an increase in social workers, local religious leaders, and physicians instead of an increased number of specialist nursing staff. It is important to ensure a different approach that can be able to increase knowledge and awareness of nurses when it comes to organ donation by ensuring that these nurses have the ability to address the social, spiritual, and emotional needs of the donor’s family and the beneficiary. This means that the role nurses hold in regard to organ donation is essential throughout the whole organ donation process. There is legitimate worry about divergent viewpoints among members of the general public and the potential ethical concerns associated with the opt-out strategy, despite the fact that it may improve the availability of acceptable organs for donation.

According to Yasuoka (2019), given the rising reliance of Japanese recipients on international brain dead donors, we cannot overlook the real anxiety, notably expressed by Black groups, that their donated organs will be used by someone from their own community. As Yasuoka (2019) points out, American hospital systems admit 5 percent of their patients from nations with limited access to healthcare, but in some situations, this 5 percent can be wholly Japanese. It is mostly due to the progress of immunosuppressive medication that the worldwide sharing of organs is becoming more common, as it decreases the requirement for genetic compatibility. In addition, Kierans (2011) points out that this development is important for the world’s most vulnerable populations. Cyclosporine, the widely used immunosuppressive medicine, maybe a contributing factor to vulnerable populations in the United States rarely experiencing the advantages of organ transplantation inside their own communities, therefore maintaining medical skepticism in the process of treatment. This is recognized by Japanese receivers, who are typically cautious about divulging their nationality in thank you messages to donor kin because they are concerned about their safety.

In addition, according to Yasuoka (2019), donor kin is family members who determine whether or not to donate in the absence of first-person consent, which is granted just at the time of registration. Often, in the presence of first-person permission documents, donor relatives will be urged to honor the desires of the deceased, relieving immediate family members of the burden of deciding whether or not to donate. The findings of quantitative research, which indicate that the highest rates of familial authorization occur when the donor is registered, are supported by narrative data. The ability for family members to discuss and make a decision without feeling coerced or pressured is critical when families decide to donate organs without knowing the wishes of the donor. Feeling coerced or pressured in this decision often leads to intense and lengthy grieving processes, and it is important to allow family members to discuss and make this decision freely. Confronted with coercion, people are more likely to distrust medical experts and the donation procedure. It is possible that donor coordinators in the United States exert pressure and coercion on behalf of donors. According to Shah et al. (2018) and Yasuoka (2019), procurement professionals are subjected to pressure from their bosses, who may impose unofficial monthly donor targets on their employees. The pressure from coordination superiors led to some offering to pay for burial expenses in order to persuade reticent donor families in one instance.

This conclusion is shown by the story of a Japanese father who elected to donate the organs of his twenty-one-year-old daughter despite the fact that she had not previously agreed to give. The donor’s father consented to donation “without hesitation” when the topic was brought up by his daughter’s doctor, but he did so without taking into account all of his family’s perspectives. Twelve years after the decision, he reported feeling remorse and regretted his choice (Yasuoka, 2019). In this circumstance, the pressure may be related to the paternalistic relationship that exists between the doctor and the patient; however, as this dynamic shifts in Japan, more emphasis should be paid to the tactics that doctors and donor coordinators employ to persuade members of the family.

Even if an individual register, it is still important for family members to explicitly discuss their wishes with each other to prevent negative personal experiences through this process. For an African-American mother approached by doctors who disclosed her son’s donor registry, she worried if he still wanted to donate at the time of his death. Her hesitation in supporting the decision created a sour experience that left her feeling very disrespected by medical professionals (Williamson et al., 2017). Only her son’s corneal tissue was viable for procurement by the time these issues were resolved (Williamson et al., 2017).

Critical Reflection framework

In this study, the reflection framework used will be the Gibbs Model, where the steps taken will involve: describing the experience accurately, feelings involved, evaluation of the positive and negative experience and what led to the experience, and an analysis of what was learned, and the conclusion. After the conclusion, the study will also look at the actions taken to improve nurses’ knowledge and awareness in the identification of possible organ donors in the neurosurgical department. 

Gibbs reflection framework  

The incidence that I am reflecting on is on creating awareness of nurses’ knowledge in the identification of possible organ donors in the neurosurgical department. The reflection looked at the experience of a nurse in the donation process, which analyzed the obstacles experienced during the process of donation and various interventions performed. The meaning of the awareness development to ensure maintenance of the viability of the tissues and organs for transplant also looked at the humanization of the donation process and expansion of the donation as a strategy for saving human life. During the process of donation, the nurse can go to the ward with members of the surgical team that were viewing the donor details as being part of the process. When the nurse approached the patient, she informed the surgical neurologists that the patient had already signed consent toward the donation of the organ. On hearing the nurse’s words, the patient wanted to know more about what was involved and began crying, shrieking, and becoming restless; it took time; however, the nurse managed to calm him down by talking to him in a soothing manner regarding what was involved. 

Feelings

What I felt about the whole exercise is that the nurses in the surgical ward concentrated mostly on the transplant theme in regard to the recipient and not the donor. This means that there was still a lot of knowledge gap when it comes to approaching the nurse’s experience in the process of donation and the required actions of the professional when it comes to the viability related to the tissue or organs for transplantation. There were also some concerns that emerged in the process, like finding the strategies to ensure nurses’ experience was positive in regard to the donation of tissues or organs during the transplant process in the neurosurgical department. Also, it was important to ensure that nurses’ perception in regard to donor transplants is improved and expectations of their actions in such a scenario do not hinder the whole process. 

Evaluation

In my study, the experience had both positive and negative elements. The positive elements came from the neurosurgical team, where once the potential donor was identified, the physical carried out the examinations in regard to brain death diagnosis. The other challenge was from the side of nurses that did not have the knowledge to report a diagnosis since they lacked experience, training, and contact with the situation during their professional life. I realized that some nurses do not have experience when it comes to the examination of organ donation and assessment of patient physical and psychological requirements, which are related to a lack of experience and training, meaning most of them may fail to make the right analysis.  

Analysis

Evidence shows that most nurses say that excess work within the healthcare team, in addition to the shortage of material and human resources, often interferes with their performance when it comes to organ donation within the neurosurgical department, where the potential donor may end up staying in the background. Also, there are situations where the hospital has few human resources and fewer material resources, meaning it becomes difficult to obtain a diagnosis for a patient that could be in need of a donor; the nurse thus works at the mercy of the physician’s knowledge which could also have some shortcomings. In some instances also, the donor maintenances are usually flawed since they are left to be in the background in regard to care, meaning the donor could still be not well resolved. Most nurses also do not understand that donors require the same type of care as the patient in intensive care, and if the donor needs to be transferred to intensive care, this may not happen. The donor often remains in the background. Also, the maintenance of the donor by the nurses is usually impaired because of the overload of work, including the inadequate physical and human resources within the healthcare system where the neurosurgical ward could be full and work overload among the nursing staff. 

Conclusion

Based on this experience with nurses in the neurosurgical department, I am now more aware of the importance of holistic care when it comes to dealing with organ donors and recipients since failure to educate, inform and care for both the patient and the donor could lead to the donor stopping the process if similar situations happen in future. The insights gained from this experience mean that I am now more away from the implications of leaving the donor in the background, as this can also reduce or discourage the number of volunteers for an organ transplant. 

Action Plan

Based on the experiences of nurses presented in the study, it is evident that action needs to be done to improve knowledge and awareness. One of the key action plans is to provide nurses working in the neurosurgical department with enough education regarding donor identification, treatment, and care, as this is the most appropriate manner to conquer the challenges and implement strategies that can be used to overcome the obstacles while also optimizing the viability of organs and tissues required in the performance of transplant. The relevance of organ donor transplants needs to be anchored on the experience of nurses, as this will make it possible to comprehend the meaning in regard to the action which the nurse’s experience can contribute to positive results in relation to tissue and organ donation and transplantation. 

Goals

The following are the project goals:

1. To improve my presentation skill by evaluating 80% of my peers by reporting satisfaction with my presentation skill by the End of this project. 
2. To consolidate nursing staff knowledge in identifying a possible organ donor by conducting Pre and Post knowledge assessments by 30th April 2022
3. To promote the awareness of nursing staff in organ donation by minimizing the number of missed referrals of potential organ donors to less than 10% by 31st May 2022
4. To enhance the timely referral to Organ Donation Coordinator, not less than 2 hours if “GIVE” is identified in the NS department by 31st May 2022
5. To improve organ donation rate by increasing referral rate to 5% by 31st May 20

Steps to complete the project

The following are the steps taken to complete the project, including a timeline.

Inclusion criteria

The inclusion criteria will be made of nurses that have worked in the organ donation neurosurgical department for at least a year. Those that have less than one year of experience in organ donation coordination and with serious cognitive or psychiatric and inability to communicate or cannot provide informed consent will be excluded as well as those that may not participate in the study. Purposive sampling will be used as part of the methodology in regard to the study goal. 

References

Crymble, K., Etheredge, H. R., Fabian, J., & Gaylard, P. (2017). Nurses’ knowledge about and attitudes toward organ donation in state and private hospitals in Johannesburg, South Africa. Critical care, 33(2), 52-57. https://doi.org/10.7196/SAJCC.2017.v33i2.322

References

Kierans, C., & Cooper, J. (2011). Organ donation, genetics, race, and culture: The making of a medical problem (Respond to this article at HTTP://www.therai.org.uk/at/debate). Anthropology Today, 27(6), 11-14. https://doi.org/10.1111/j.1467-8322.2011.00837.x

Prins, L. (2019). Early identification and referral of organ donors in five private hospitals: A survey to determine the knowledge and views of critical care professional nurses pre and post a PowerPoint training intervention. Critical care, 35(2), 48-55. https://doi.org/10.7196/SAJCC.2019.v35i2.370

Serrano, M., & Sposari, V. (2019). Searching for missing donors: a 12-month audit of deaths in two large Sydney teaching hospitals. Hospitals. JTA Journal, 28(2), 18-21. https://doi.org/10.33235/tja.28.2.18-21

Shah, M. B., Vilchez, V., Goble, A., Daily, M. F., Berger, J. C., Gedaly, R., & DuBay, D. A. (2018). Socioeconomic factors as predictors of organ donation. Journal of Surgical Research, 221, 88-94. https://doi.org/10.1016/j.jss.2017.08.020

Weng, L., Chiang, Y., Huang, H., Tsai, Y., Chen, K., Wang, W., & Lin, M. (2021). Actors associated with registration for organ donation among clinical nurses. PLOSE One. https://doi.org/10.1371/journal.pone.0247424

Witjes, M., Jansen, N. E., van der Hoeven, J. G., & Abdo, W. F. (2019). Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review. Critical care, 23(277). https://doi.org/10.1186/s13054-019-2509-3

Yasuoka, M. K. (2019). Organ donation in Japan: A medical anthropological study. https://doi.org/10.1097/01.tp.0000611616.97351.af

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