Rebecca P. Winsett, RN, PhD
Cynthia L. Russell, RN, PhD, FAAN
Professionalism is fundamental to nursing practice, and the behavior that underpins professionalism is civil behavior. In this chapter, we elucidate professional behaviors in scope and practice of transplant nursing. Professionalism embodies the values of altruism, autonomy, human dignity, integrity, and social justice. However, when working in a highly charged atmosphere such as transplantation, these behaviors must be built into the culture of the organization.
II. TRANSPLANT EDUCATION
A. Education of self
The field of transplantation is constantly changing. Examples of change include xenotransplantation, pharmacogenomics, transplantation of extremely young and old individuals, use of technology to enhance transplantation procedures, larger transplant databases, and use of computers to manage transplantation. Consequently, transplant nurses must continuously update their knowledge and skills. The 2011 Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health, provides an action-oriented blueprint for nurses suggesting that nurses should practice to the full extent of their education and training and should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.1
Educational opportunities for transplant nurses may be formal or informal.
Formal options may include the following:
Completing formal degree-supporting coursework from colleges or universities where interprofessional education is increasingly more common
Attending professional transplant conferences where continuing education programs are offered
Reading and discussing peer-reviewed journals
Informal learning opportunities include the following:
Attending lectures and/or educational rounds
Observing and/or participating in teaching at the patient’s bedside
Staffing and economic constraints are changing transplant nursing education. It is becoming increasingly more difficult for transplant nurses to take time away from work, and travel funds provided by employers are greatly limited. To enhance accessibility, formal and informal education programs are offered through online learning and webinar formats. These approaches allow the transplant nurse to participate in relatively low-cost educational opportunities at convenient times. Many programs provide continuing education units for participants who are required by many states for maintaining licensure.
Continued education, coupled with successful clinical practice, enables the transplant nurse to progress from a “novice” to “expert” practitioner and engage in increasingly complex clinical decision-making processes involving clinical reasoning and judgment.2
Certification in the specialty of transplant nursing indicates that a transplant nurse has met a high level of competence and has the knowledge and skills needed to provide quality care for transplant donors, recipients, and families in specialty practice.
Through the American Board for Transplant Certification,3 a transplant nurse may be certified as a Procurement Coordinator, a Transplant Nurse Coordinator, and/or a Clinical Transplant Nurse.
A certification is also offered for Transplant Preservationists.
B. Education of other health care providers
Transplant nurses have a responsibility to educate other health care providers, particularly new staff nurses and nursing students, about organ donation and transplantation.
Education about organ donation
Hospitals are required to implement specific protocols to assist in the identification and evaluation of potential donors and ensure that every potential donor family is informed of the option to donate.4
Health care providers’ lack of knowledge about organ donation, including reticence regarding donation after circulatory death, may contribute to the limited availability of donor organs.
Health care professionals are the critical link in the organ procurement process, because they are the first individuals who establish rapport with a potential donor’s family and consequently have the opportunity to discuss the option of organ donation.5
Education of all health care workers, particularly those who work in emergency departments and inpatient units (including intensive care and transplant units), is an essential component of any transplant program.
Education about transplantation
Transplant nurses must continually educate new transplant staff members and students about the complex and ever-changing field of transplantation. Education should be provided as transplant care is delivered, in a highly interprofessional manner. Interprofessional education is an effective method for simulating “real-life” situations to improve patient, family, and community outcomes.6
Given the growing number of transplant recipients in the general population and their increasing longevity, transplant nurses must
also educate nontransplant staff members who care for recipients upon readmission to the hospital, in an outpatient setting, or in the community.
Transplant standards of care are a valuable resource and should be used to educate and guide all health care providers caring for transplant patients, families, and communities.
C. Education of the general public
There continues to be a gap between the number of patients needing an organ transplant and the number of organs available to transplant. Transplant nurses are active in efforts to narrow this gap.
Transplant nurses facilitate organ donation by educating the public about the following:
The benefits and procedures of organ donation
The need for individuals who wish to be organ donors to communicate this intention to their families
The concept of brain death
Education of the public may be formal or informal. Transplant staff may have opportunities to provide this education in academic and community settings or via the media.
There are many patient and family resources about organ donation. The transplant nurse can support the patient, family, and the community with resources such as those available at the following:
Transplant nurses are involved in influencing public policy related to organ donation, recognizing that policy changes are necessary for improving public health. Transplant nurses are also cognizant of unethical approaches to increase the donor pool through such efforts as organ trafficking and payment for organ donation.7
III. PROFESSIONAL PRACTICE EVALUATION
A. Professional nursing practice includes periodic self-evaluation. The goal of this process is to determine if the transplant nurse’s practice meets the appropriate standards or if there are opportunities for improvement.
A thorough self-evaluation should include evaluations from superiors, professional peers, peers from other professions, as well as patients, families, and the community. The professional transplant nurse must be accountable to those receiving care and also to colleagues.
Evaluation of transplant nursing competence occurs through periodic employer-based evaluations using established tools. A 360-degree evaluation involves input from supervisors, peers, and patients, families, and communities. Transplant Nurse Coordinator competency-based evaluation tools are available through the International Transplant Nurses Society.8
Several important standards in general nursing practice include the following:
In the specialty of transplant nursing, the following documents delineate the standards, accountabilities, and competencies for both transplant specialists and generalists:
Worldwide variation in transplant nursing practice influences practice evaluation. Consequently, local, state, or regional standards, guidelines, statutes, rules, and/or regulations should also be considered when conducting a practice self-evaluation.
B. If opportunities for practice improvement are identified, appropriate steps should be taken to remedy the practice-standard gap. This might include formal or informal didactic or practice educational strategies.
A plan for remediation of the identified gap should include the following:
Dates for remediation
Steps that will be taken for remediation
Date when a repeat evaluation will be conducted to determine if remediation was successful
If remediation is not successful, the process is repeated until the standard is met.
IV. QUALITY/PERFORMANCE IMPROVEMENT
A. Transplant programs are required to implement performance improvement plans to improve patient, family, and community outcomes.14 The transplant nurse participates in the program’s performance improvement plan and is able to verbalize the transplant unit’s performance improvement plan goals, processes, and outcomes.
B. The role of the transplant nurse in performance improvement depends upon his/her level of transplant nursing knowledge, skills, and education. For example, the novice transplant nurse may attend unit performance improvement meetings, collect quality data, summarize data, and/or follow performance improvement committee recommendations. The expert transplant nurse may lead unit performance improvement meetings, identify outcomes for improvement, analyze data, make recommendations for action, and share findings across the organization through facility-wide programs.
Quality of transplant nursing care achieves the best outcome for the patient that is safe, effective, and timely. Consistent unit performance is a team effort.
The interdisciplinary transplant team strives to achieve excellent transplant outcomes. As a member of this team, it is important that the transplant nurse should do the following:
Participates in the governance structure of the unit
Understands performance improvement methodology
Promotes the culture of high accountability
C. Chapter 19 addresses quality assurance and performance improvement in more detail.
A. Collegiality is the relationship of colleagues working together toward a mutual goal. A collegial relationship is crucial for ensuring quality and safety and for maintaining professional standards.15 Transplant nurses must work on interprofessional teams and share transplant knowledge and skills with peers and colleagues to improve patient, family, and community outcomes.
B. Collegiality and professional practice evaluation are mutually linked. Transplant nurses must support each other by giving and receiving feedback on nursing practice. This process improves transplant nursing role performance and contributes to a productive and healthy work environment.
C. One aspect of collegiality is mentoring. Mentorship involves someone who is more experienced guiding a less experienced person through a learning process.16 The goal of the mentoring process is career development and professional enhancement. The mentor and mentee have a commitment to the relationship, which often lasts over an extended period of time. The mentor supports and nurtures the mentee in professional growth.
VI. ENVIRONMENTAL HEALTH
A. The connection between air pollution, home energy, water quality, and sanitation is a focus of global environmental health. It is defined by the World Health Organization as “physical, chemical and biological factors” that have an influence in the health of a community or individuals.17
B. Nurses must practice in an evidence-based manner that reduces environmental health risks for all colleagues, health care consumers, families, and communities. The Scope and Standards for Nurses purports that nurses must be educated about environmental health concepts, strategies, and practices.18 Efforts can be health care facility focused and/or community focused.
Health care facility-focused efforts: Nurses must assess the practice environment for factors such as sound, odor, noise, and light that threaten health. The nurse should support the use of appropriate products in health care.
Community-focused efforts: In the community, commonly encountered hazardous materials risks include chemicals used for sterilization and/or compounds found in medical devices. Single-use devices may decrease perceived use of infections but also contribute to landfill waste. Reprocessing single-use devices may reduce waste but must be balanced with occupational, ethical, and quality of care concerns. All nurses, including transplant nurses, must be knowledgeable about environmental health risks and strategies to reduce risks while preserving the environment.
A. Collaboration is defined as working with others to do a task and to achieve shared goals. Transplant nurses should consider the following factors in regard to communicating and collaborating with patients,
peers, colleagues, within and between departments, and within and between organizations.
peers, colleagues, within and between departments, and within and between organizations.
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