Ethical and Cultural Issues in Transplantation: The Views and Attitudes of Nurses.

Organ transplantation is lifesaving for individuals with end-stage organ failure. However, many people are still waiting for organ transplantation due to religious beliefs and the perspectives of society. Many studies on organ donation have shown that the knowledge levels and attitudes of nurses have an important effect on organ donation rates. The aim of this study was to evaluate the views and attitudes of nurses about ethical and cultural issues related to transplantation. This descriptive study was conducted on 220 nurses who worked in a university hospital in Istanbul, Turkey. Data were collected using a questionnaire form included sociodemographic characteristics, ethical-cultural values, and knowledge levels about transplantation of the participants. Descriptive statistics and Chi-square test were used for the analysis of data. The mean age of the participants was 24.8 ± 6.04 years. Sixty percent of the participants reported that a person with brain-death was the most ideal candidate for organ donation. Seventy-seven percent of them suggested that organ sale was the most common ethical problem in organ transplantation. Sixty-three percent reported that the patient awaiting transplantation for a long time had priority order for organ transplantation. Most of the nurses (91.0%) believed that organ transplantation was religiously and culturally appropriate; however, 67.7% of them reported that it was not considered appropriate by the society due to religious and cultural beliefs. Sixty-two percent of them suggested that the society believed that organ transplantation was unlawful (haram) religiously. Nurses generally had positive views and attitudes about organ transplantation.

State of the Science of Palliative Care in Solid Organ Transplantation.

INTRODUCTION: Both solid organ transplant candidates and recipients and their family caregivers have complex care needs and may benefit from palliative care. But palliative care is not often considered as part of transplant care despite palliative care being promoted as an important component of transplant care both before and after solid organ transplantation. Further, the current state of the science of palliative care in solid organ transplantation has not been well-documented. OBJECTIVE: To describe the state of the science of palliative care in solid organ transplant and identify gaps in the literature. METHODS: Four electronic databases were searched using controlled vocabulary words and synonymous free text to find articles on palliative care and solid organ transplant. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were also used. RESULTS: Twenty articles were included in the final review for synthesis, 18 of which involved transplants for adults only. Twelve articles described palliative care for patients before transplant, four articles examined palliative care for patients after transplant, primarily at the end-of-life, and four articles described transplant provider perspectives on palliative care. The reviewed evidence suggested that patients could be benefited by palliative care both pre and posttransplant, particularly for symptom management and advance care planning and that transplant providers faced many barriers to implementing palliative care in practice. DISCUSSION: There is limited research on palliative care following solid organ transplantation, particularly outside of hospice care. Much of the prior research on this topic has described adult patients.

Empowering Nurses to Engage With Transplant Quality Data and Outcomes.

BACKGROUND: Understanding patient outcome data and quality improvement metrics can help the health-care team target interventions to improve patient care and guide practice. Challenges to understanding and use of data include finding time during clinical work, determining meaning, and understanding a connection to practice. PROBLEM STATEMENT: Acute care nurses who routinely care for organ transplant patients could not speak to transplant quality data or outcomes. This was evidenced by 81% accuracy in interpreting transplant quality data. METHODS: The setting was an inpatient/acute care organ transplant and progressive care unit. A survey was employed to staff; the lowest scoring areas were training to accurately interpret and having time to understand transplant quality data and outcomes. A multimodal intervention that included an education session at a mandatory staff education event followed by routine posting quality data on the unit was devised. Goals were to improve the accuracy of transplant quality data interpretation to an average of 90% and the average key confidence indicators to 6.0 (out of 7.0). PROCESSES ADDRESSED: Education was created to cover background and initial results, data interpretation, and clinical significance. A display board in the staff lounge was dedicated to transplant quality data. OUTCOMES: All goals were met. Accurate interpretation improved to 90% and average key confidence indicators increased to 6.54. IMPLICATIONS FOR PRACTICE: An interdisciplinary team process that involved stakeholders was essential to success. A similar method could be employed with nurses and other frontline staff.

Qualitative Analysis of Factors That Hinder Intensive Care Unit Nurses in Western China From Encouraging Patients to Donate Organs.

BACKGROUND: Organ transplantation is an important method to save the lives of patients suffering from organ failure. However, the low rate of organ donation is a common problem worldwide. Many potential organ donors in the intensive care unit (ICU) are not properly identified, which is one reason for the low donation rate. ICU nurses play a key role in organ donation but may be uncertain regarding some issues. In this study, an analysis of the reasons why ICU nurses in western China are reluctant to encourage patients and their families to donate organs is performed, providing a reference for promoting ICU nurse participation in organ donation work. METHODS: From August to November of 2017, using a purposive sampling method, we conducted semi-structured, in-depth interviews using a phenomenological research method with 18 ICU nurses who were working in 4 large hospitals with organ transplant accreditation in Chongqing City, China, and analyzed the data with phenomenology. RESULTS: Reasons for the reluctance of ICU nurses in encouraging patients to donate organs were categorized into the following 4 themes: limitation of the nurses' professional role, influence of the family's negative emotions, lack of training regarding organ donation in medical institutions, and impact of a conservative social attitude. CONCLUSION: Chinese medical and health institutions need to attach importance to the duties and roles of ICU nurses in organ donation work, the creation of a good death culture, the implementation of training for organ donation specialist nurses, and the strengthening of advocacy efforts for organ donation so that ICU nurses' reluctance in engaging in organ donation coordination in China can be mitigated and the nurses can better participate in promoting organ donation to potential donors.

Pilot study protocol of a mHealth self-management intervention for family members of pediatric transplant recipients.

Solid-organ transplantation is the treatment of choice for end-stage organ failure. Parents of pediatric transplant recipients who reported a lack of readiness for discharge had more difficulty coping and managing their child's medically complex care at home. In this paper, we describe the protocol for the pilot study of a mHealth intervention (myFAMI). The myFAMI intervention is based on the Individual and Family Self-Management Theory and focuses on family self-management of pediatric transplant recipients at home. The purpose of the pilot study is to test the feasibility of the myFAMI intervention with family members of pediatric transplant recipients and to test the preliminary efficacy on postdischarge coping through a randomized controlled trial. The sample will include 40 family units, 20 in each arm of the study, from three pediatric transplant centers in the United States. Results from this study may advance nursing science by providing insight for the use of mHealth to facilitate patient/family-nurse communication and family self-management behaviors for family members of pediatric transplant recipients.

Síndrome del equilibrio fisiológico deteriorado en potenciales donantes de órganos: identificación de las características definitorias / Síndrome do equilíbrio fisiológico prejudicado em potenciais doadores de órgãos: identificação de características definidoras / Impaired physiological equilibrium syndrome in potential organ donors: identification of defining characteristics

Introducción: la mayor parte de los diagnósticos de enfermería sobre los potenciales donantes de órganos están relacionados a alteraciones fisiológicas. Es común que estos pacientes presenten todos los diagnósticos citados para esta población. Pero todavía no existe en NANDA International un diagnóstico único que sea capaz de plantear este severo caso. Objetivo: identificar en la literatura las posibles características definitorias para la propuesta de diagnóstico Síndrome del equilibrio fisiológico deteriorado en pacientes con muerte encefálica y potenciales donantes de órganos. Método: revisión integrativa de la literatura con estudios publicados entre el 1997 y el 2017 en las bases de datos Web of Science, LILACS y PubMed. Resultados: la muestra constó de 37 artículos, de los cuales se identificó 44 posibles características distintas para el diagnóstico de enfermería en desarrollo. Se dividieron las características definitorias en cinco grupos principales: alteraciones endocrino-metabólicas; alteraciones hemodinámicas y/o cardiovasculares; alteraciones respiratorias; alteraciones nutricionales y alteraciones de la coagulación, inflamatorias e/o inmunológicas. Conclusiones: el desarrollo de este diagnóstico puede colaborar con la calificación de la taxonomía de NANDA Internacional, así como ampliar el conocimiento de la enfermería en el campo de mantenimiento del posible donante de órganos, lo que contribuye a la enseñanza e investigación. El empleo de este diagnóstico puede mejorar la sistematización del cuidado, auxilia en el mantenimiento del potencial donante y, en consecuencia, mejora la viabilidad de órganos para trasplante

Introdução: a maior parte dos diagnósticos de enfermagem prevalentes para potenciais doadores de órgãos está relacionada com alterações fisiológicas. Não raro estes pacientes apresentam todos os diagnósticos citados para esta população. Todavia, não existe na NANDA International um diagnóstico único que aborde este quadro agudo. Objetivo: identificar na literatura possíveis características definidoras para a proposta de diagnóstico Síndrome do equilíbrio fisiológico prejudicado para pacientes em morte encefálica e potenciais doadores de órgãos. Método: revisão integrativa da literatura incluindo artigos publicados entre 1997 e 2017 nas bases de dados Web of Science, LILACS e PubMed. Resultados: a amostra foi constituída por 37 artigos identificando 44 possíveis características definidoras para o diagnóstico de enfermagem em desenvolvimento. As características definidoras foram divididas em cinco grandes grupos: alterações endócrino-metabólicas, alterações hemodinâmicas e/ou cardiovasculares, alterações ventilatórias, alterações nutricionais e alterações de coagulação, inflamatórias e/ou imunológicas. Conclusões: o desenvolvimento deste diagnóstico pode colaborar com a qualificação da taxonomia da NANDA International, além de ampliar o conhecimento da enfermagem na área de manutenção do potencial doador de órgãos contribuindo para o ensino e pesquisa. O uso desta proposta de diagnóstico na prática pode proporcionar uma melhor sistematização do cuidado, auxiliando a adequada manutenção do potencial doador e consequentemente melhor viabilidade dos órgãos ofertados para transplantes

Introduction: most of nursing diagnoses for potential organ donors is related to physiological changes. These patients often have all diagnoses cited for this population. However, NANDA International does not have a diagnosis to address this acute condition. Objective: to identify possible defining characteristics for the diagnosis of impaired physiological equilibrium syndrome for brain death patients and for potential organ donors in the literature. Method: integrative literature review including articles published between 1997 and 2017 in the databases Web of Science, LILACS and PubMed. Results: the sample consisted of 37 articles identifying 44 possible defining characteristics for the nursing diagnosis to be developed. The defining characteristics were divided into five major groups of changes: endocrine-metabolic changes, hemodynamic and/or cardiovascular changes, ventilatory changes, nutritional changes, coagulation changes, inflammatory and/ or immune changes. Conclusions: developing this diagnosis can collaborate to the taxonomy of NANDA International, as well as to extend the nursing knowledge of the area of maintenance of the potential organ donor, contributing to teaching and research. The practical use of this diagnosis purpose can provide a better systematization of care, enabling the proper maintenance of the potential organ donor and consequently improving the viability of organs for transplantation

Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.

Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.

Infectious Complications Following Solid Organ Transplantation.

Infections in solid organ transplant recipients are complex and heterogeneous. This article reviews the clinical syndromes that will likely be encountered in the intensive care unit and helps to guide in the therapy and management of these patients.

The role of specialist nurses for organ donation: A solution for maximising organ donation rates?

AIMS AND OBJECTIVES: To explore the role that Donor Transplant Co-ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN-ODs), within organ donation strategies in the UK and other countries. BACKGROUND: Organ donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt-out system of organ donation, in line with the Wales change. DESIGN: This discursive paper explores the role from Donor Transplant Co-ordinator to Specialist Nurse in Organ Donation (SN-OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation. IMPLICATIONS FOR NURSING: The current scope and future potential of Donor Transplant Co-ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation. CONCLUSION: There is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation.

Estrés y bienestar en profesionales de enfermería intensiva dentro del ámbito de la donación y el trasplante de órganos: una propuesta desde la psicología de la salud ocupacional / Stress and well-being in nursing professionals of intensive care within the organ donation and transplantation field: a proposal from the occupational health psychology

Los profesionales de enfermería que trabajan en unidades de cuidados intensivos y que participan en las actividades relacionadas con la donación y trasplante de órganos están expuestos a un número importante de estresores en su trabajo, lo que favorece la aparición de determinados riesgos psicosociales como son el estrés laboral, el desgaste profesional, el trabajo emocional, el estrés traumático secundario, el estrés moral y el conflicto entre el trabajo y la familia. Además, los nuevos escenarios que se presentan y van consolidando en nuestro país en relación a la donación de órganos, como son la donación en asistolia controlada y no controlada, o los cuidados intensivos orientados a la donación, generan nuevas situaciones y estresores a estos profesionales que aumentan su exposición al riesgo psicosocial en su trabajo. Por todo ello, aquí llevamos a cabo una revisión y propuesta de las demandas específicas y las causas que podrían influir en el desarrollo de estos riesgos entre estos profesionales, así como sus posibles consecuencias. También se proponen una serie de recursos laborales y personales que podrían ser útiles para afrontar las demandas laborales y que satisfacen muchas de las necesidades apuntadas por organismos de referencia en éste ámbito para la prevención y promoción de la salud y bienestar dentro de este colectivo, así como para la mejora del proceso de donación y trasplante de órganos

Nursing professionals who work in intensive care units and participate in activities related to organ donation and transplantation are exposed to a significant number of stressors their work, which favors the appearance of certain psychosocial risks such as work stress, burnout, secondary traumatic stress, moral stress, and the conflict between work and family. In addition, the new scenarios in our country in relation to organ donation, such as uncontrolled and controlled donation after cardiac death, or the intensive cares oriented to organ donation, generate new situations and stressors among these professionals that increase their exposure to psychosocial risks. Therefore, this paper reviews and proposes the specific demands and causes that could influence the development of these risks these professionals, as well as their possible consequences. It also proposes a series of job and personal resources that could be useful to these workers to face these job demands. These proposals meet many of the needs pointed by reference institutions in this field to prevention and promotion of health and well-being in this group of professionals, as well as to improve the process of organ donation and transplantation

La inserción del enfermero en la comisión intrahospitalaria de donación de órganos y tejidos / A inserção do enfermeiro em comissão intra-hospitalar de doação de órgãos e tecidos / The insertion of the nurse in intra-hospital commission of organ and tissue donation

Objetivo: Conocer cómo es la inserción del enfermero en la comisión intrahospitalaria de donación de órganos y tejidos para trasplante, así como la adquisición de conocimientos para actuar en ella. Método: Investigación cualitativa, descriptiva y exploratoria, realizada con 12 enfermeros de la comisión intrahospitalaria de donación de órganos y tejidos. Los datos fueron recolectados a través de entrevistas semiestructuradas y analizados mediante análisis de contenido. Resultados: Mostraron que los enfermeros son señalados para trabajar en la comisión intrahospitalaria de donación de órganos y tejidos para trasplante sin la preparación adecuada. El conocimiento se produce después de la inclusión en la referida comisión, normalmente con los eventos y apoyo en la literatura de área, ya que no existe un enfoque consistente sobre el tema en la formación profesional. Conclusión: Las medidas educativas deben ser incluidas en la academia y en los servicios de salud, con el fin de proporcionar los apoyos necesarios para que el enfermero puedan tener una participación más efectiva en estas comisiones

Objetivo: conhecer como se dá a inserção do enfermeiro em comissão intra-hospitalar de doação de órgãos e tecidos para transplante, bem como a obtenção de conhecimento para atuação nesta. Método: pesquisa qualitativa, descritiva e exploratória, realizada com 12 enfermeiros de comissão intra-hospitalar de doação de órgãos e tecidos. Os dados foram coletados por meio de entrevista semiestruturada e analisados através de análise de conteúdo. Resultados: evidenciou-se que os enfermeiros são indicados para atuar em comissão intra-hospitalar de doação de órgãos e tecidos para transplante, sem o preparo adequado. O conhecimento ocorre posteriormente à inserção na referida comissão, normalmente, junto a eventos e apoio na literatura da área, já que não há abordagem consistente sobre o tema na formação profissional. Conclusão: medidas educativas devem ser inseridas na academia e serviços de saúde, como forma de prover subsídios necessários para que o enfermeiro possa ter uma participação mais efetiva nessas comissões

Objective: To recognize how the insertion of the nurse in an in-hospital commission of donation of organs and tissues for transplantation is, as well as the obtaining of knowledge to act in this one. Method: It is a qualitative, descriptive and exploratory research, carried out with 12 nurses of intra-hospital commission of organ and tissue donation. Data were collected through a semi-structured interview and analyzed through content analysis. Results: It was evidenced that the nurses are indicated to act in intra-hospital commission of donation of organs and tissues for transplantation without adequate preparation. The knowledge occurs later to the insertion in the referred committee, usually, next to events and support in the literature of the area, since there is no consistent approach about the subject in the professional formation. Conclusion: Educational measures should be included in the health services and academia as a way of providing the necessary subsidies so that nurses can have a more effective participation in these commissions

Family attitudes, actions, decisions and experiences following implementation of deemed consent and the Human Transplantation (Wales) Act 2013: mixed-method study protocol.

INTRODUCTION: The Human Transplantation (Wales) Act 2013 (the Act) introduced a 'soft opt-out' system of organ donation on 1 December 2015. Citizens are encouraged to make their organ donation decision known during their lifetime. In order to work, the Act and media campaign need to create a context, whereby organ donation becomes the norm, and create a mechanism for people to behave as intended (formally register their decision; consider appointing a representative; convey their donation decision to their families and friends or do nothing-deemed consent). In addition, family members/appointed representatives need to be able to put their own views aside to support the decision of their loved one. The aim of this study is to evaluate initial implementation, outcomes and impact on families and appointed representatives who were approached about organ donation during the first 18 months. METHODS AND ANALYSIS: Prospective mixed-method coproductive study undertaken with National Health Service Blood and Transplant (NHSBT), and multiple patient/public representatives. The study is designed to collect information on all cases who meet specified criteria (≥18 years, deceased person voluntarily resident in Wales and died in Wales or England) whose family were approached between 1 December 2015 and 31 June 2017). Data for analysis include: NHSBT routinely collected anonymised audit data on all cases; Specialist Nurse in Organ Donation (SNOD) completed anonymised form for all cases documenting their perception of the families' understanding of the Act, media campaign and outcome of the donation approach; questionnaires and depth interviews with any family member or appointed representative (minimum 50 cases). Additional focus groups and interviews with SNODs. Anonymised donation outcomes and registration activity reports for Wales provide additional context. ETHICS AND DISSEMINATION: Approved by NHSBT Research, Innovation and Technology Advisory Group on 23 October 2015; Wales Research Ethics Committee 5 (IRAS190066; Rec Reference 15/WA/0414) on 25 November 2015 and NHSBT R&D Committee (NHSBT ID: AP-15-02) on 24 November 2015. REGISTRATION: The protocol is registered on the Health and Care Research Wales Clinical Research Portfolio. Study ID number 34396, www.ukctg.nihr.ac.uk.

A enfermagem intensivista frente à doação de órgãos: uma revisão integrativa / La enfermería intensiva frente a la donación de órganos: una revisiónintegrativa / Intensive nursing front of organ donation: an integrative review

Objective: To identify the productions that address the role of the intensive care nurse in the context of brain death, identifying their results and conclusions. Methods: It was used the literature integrative review in SciELO database with six stages, namely: problem formulation, data collection, data evaluation, analysis and interpretation of results and synthesis of knowledge. The data of the selected articles were organized into tables for better understanding of them. Results: There were 17 articles on theme, of these, 3 had the inclusion criteria of the study. Conclusion: One can see the relevance of a specific knowledge of health professionals, especially nurses, in donation and transplantation area, and the limited number of publications on the subject by the nurses and the precarious approach to donation and transplantation in the curriculum graduation.

Objetivo: Identificar as produções que abordam o papel do enfermeiro intensivista no contexto da morte encefálica, identificando seus resultados e conclusões. Métodos: Utilizou-se a revisão integrativa da literatura na base de dados Scielo com seis etapas, sendo elas: formulação do problema, coleta de dados, avaliação dos dados, análise e interpretação dos resultados e a síntese do conhecimento. Os dados dos artigos selecionados foram organizados em tabelas para melhor compreensão dos mesmos. Resultados: Foram encontrados 17 artigos sobre tema, destes, 3 apresentavam os critérios de inclusão da pesquisa. Conclusão: Pode-se perceber a relevância de um conhecimento específico dos profissionais da saúde, principalmente os enfermeiros, na área de doação e transplantes, bem como o limitado número de publicações sobre o tema por parte dos enfermeiros e a precária abordagem sobre doação e transplantes nos currículos da graduação.

Objetivo: Identificar las producciones que abordan el papel delenfermero de cuidados intensivos en el contexto de la muerte cerebral, la identificación de sus resultados y conclusiones. Métodos: Se utilizó la revisión integradora literatura en la base de datos SciELO con seis etapas, a saber: formulación del problema, recopilación de datos, evaluación de datos, análisis e interpretación de los resultados y síntesis del conocimiento. Los datos de los artículos seleccionados se organizaron en mesas para una mejor comprensión de las mismas. Resultados: Se encontraron 17 artículos sobre el tema de estos, 3 tenían los criterios de inclusión del estudio. Conclusión: Se puede ver la relevancia de un conocimiento específico de profesionales de la salud, sobre todo enfermeras, en la donación y el trasplante de área y el número limitado de publicaciones sobre el tema de las enfermeras y el enfoque precaria a la donación y el trasplante en los planes de estudios de pregrado.

Attitude and Impact Factors Toward Organ Transplantation and Donation Among Transplantation Nurses in China.

BACKGROUND: Health workers' awareness and knowledge of transplantation medicine can improve people's sensitivity and reduce their degree of opposition to donations. The medical literature contains numerous examples of attitudes toward organ transplantation and donation aimed at university students or medical staff members, but rarely for transplantation nurses. OBJECTIVE: The purposes of the study were to investigate the attitudes toward organ transplantation and donation among transplantation nurses and to explore the impact factors. METHODS: The study was conducted in 37 transplantation surgery wards in 22 hospitals using cross-sectional approach. SPSS (International Business Machines Corporation, Armonk, New York, USA) 7.0 software was used to analysis descriptive and inferential statistics for data. RESULTS: Five hundred thirty-six effective questionnaires were received and the effective rate was 89.33%. Nurses' mean age was 28.40 years with a mean service length of 6.54 years. Among these nurses, 66.6% and 78.0% were willing to accept organ transplantation surgery for themselves and their relatives, respectively. Of these nurses, 33.4% would donate their organs after death; whereas 39.9% were uncertain. Only 38.2% were willing to register in the national organ donation system. Of these nurses, 28.2% were willing to sign the organ donation consent forms when their relatives became potential organ donors, and 45.7% were uncertain. Eight independent variables that affected nurses' attitudes toward donating their organs from most to least significant were: ratio of nurse to bed, title, employment form, age, length of service, position, monthly income, and the highest educational degree earned. Pearson correlation analysis showed a significant correlation among nurses' attitudes toward organ transplantation, organ donation, and online registration. CONCLUSION: The attitude toward donation and transplantation in the hospitals was not too optimistic, and an improvement in the training regarding transplantation and donation among nurses in China is necessary. Nurses are an important group who generate opinion in the patient population, and their negative attitudes can have a significant negative impact on society's attitudes toward organ donation.

[Transplant nurse coordinator, a key mission]. / Infirmière coordinatrice de greffe, une mission essentielle.

An essential link in the functioning of a transplant ward, the kidney transplant nurse coordinator plays a major role in supporting the donor and recipient along the living donor transplant pathway. Informing, organising, supporting are part of their daily practice.

Transplant Nurses' Work Environment: A Cross-Sectional Multi-Center Study.

BACKGROUND Numerically, nurses represent the largest healthcare profession, thus setting norms for the quality and safety of direct patient care. Evidence of a global shortage of nurses in all clinical practice settings across different healthcare systems and countries has been documented. The aims of the present study were: (1) to assess work environments in a sample of German transplant nurses, and (2) to compare their statements with a US-based sample. MATERIAL AND METHODS In a cross-sectional study, 181 transplant nurses from 16 German transplant centers provided information on their work environments. The translated version of the Job Design (JD) and Job Satisfaction (JS) survey showed satisfactory internal consistency for the JD (0.78) and JS (0.93) subscales. German nurses' work environments were compared with 331 transplant nurses from the US. RESULTS The majority of transplant nurses were female (81.8%), 55.4% were age 21-40 years, and 78.1% were employed full-time. German (versus US) transplant nurses reported their job design to be best for 'skill varieties' (p≤0.0002), and worst for 'autonomy' (p≤0.01). Job satisfaction was best with 'opportunities for autonomy and growth' (p≤0.0001), and 'pay and benefits' (p≤0.0001) was lowest. A higher professional degree (OR 1.57; p≤0.03; 95% CI 1.19-2.86), and longer time in transplant (OR 1.24; p≤0.001; 95% CI 1.11-1.38) showed a positive impact on German transplant nurses' perceptions of 'job satisfaction'. Nurses with time-dependent working contracts perceived more stress negatively affecting job satisfaction (OR 1.13; p≤0.009; 95% CI 1.02-12.82). CONCLUSIONS German specialty nurses working in the field of solid organ transplantation rate their work environments with respect to job design and job satisfaction as satisfactory. Institutions' investment into satisfactory nurse work environments and specializing nurses might increase the quality of care, thus improving patient outcomes.

[The transplant coordinator nurse, the harvesting of organs and tissues]. / L'infirmière coordinatrice hospitalière pour le don, les prélèvements d'organes et de tissus.

Development of the transplantation of organs and tissues are not linked solely to the feats of surgery and biology. Without quality of the organization for the donation and the organ removal, nothing would be possible. Figurehead of this organization: the coordinator nurse for donation and the organ procurement.

Estratégias implementadas pelo enfermeiro para aprendizagem do transplantado renal em imunossupressão / Estrategias implementadas por enfermeros para el aprendizaje en inmunosupresión para trasplantados renales / Strategies implemented by nurses for learning kidney transplant immunosuppression

RESUMO Descrever a vivência da enfermagem na implementação de estratégias de aprendizagem em imunossupressão para transplantados renais. Caracteriza-se como um estudo qualitativo, descritivo, que utiliza o referencial teórico da pesquisa convergente assistencial, realizado em uma unidade de transplante renal. Para a obtenção dos dados, utilizou-se de entrevistas e oficinas temáticas. Foram desenvolvidas estratégias de aprendizagem para três oficinas com grupos de transplantados renais: pacientes sem déficit cognitivo - estratégia discursiva, com recursos visuais; pacientes com déficit cognitivo - estratégia do discurso repetitivo com recursos visuais; pacientes com déficit visual - recursos auditivos e táteis. As estratégias adotadas para os transplantados na oficina com déficit cognitivo e visual requisitaram adaptações, mas na alta hospitalar os pacientes demonstraram capacidade para o autocuidado e a apreensão dos imunossupressores. A vivência possibilitou ao enfermeiro o planejamento, a implementação e a utilização de estratégias de aprendizagem que favoreceram a emancipação do autocuidado, influenciando na adesão ao tratamento e na qualidade de vida do transplantado.

RESUMEN Describir la experiencia de la enfermería en la implementación de estrategias de aprendizaje en inmunosupresión para trasplantados renales. Se caracteriza como un estudio cualitativo y descriptivo que utiliza el marco teórico de la investigación convergente asistencial, realizado en una unidad de trasplante de riñón. Para obtener los datos, se utilizaron entrevistas y talleres temáticos. Las estrategias de aprendizaje se desarrollaron en el transcurso de tres talleres con grupos de trasplantados renales: pacientes sin deterioro cognitivo - estrategia discursiva, con efectos visuales; pacientes con deterioro cognitivo - estrategia de discurso repetitivo, con efectos visuales; pacientes con deterioros visuales - recursos auditivos y táctiles. Las estrategias adoptadas para los trasplantados en el taller con deterioro cognitivo y visual requirieron adaptaciones, pero en el alta hospitalaria los pacientes demostraron capacidad para el autocuidado y la adquisición de los inmunosupresores. La experiencia permitió que el enfermo planifique, implemente y utilice estrategias de aprendizaje que favorecieron la emancipación del autocuidado, influyendo en la adhesión al tratamiento y en la calidad de vida del trasplantado.

ABSTRACT To describe an experience by nurses in the implementation of learning strategies in immunosuppression for kidney transplants. Characterized as a qualitative, descriptive study using the theoretical framework of convergent care research, performed in a kidney transplant unit. To obtain the data, we used interviews and thematic workshops. Learning strategies were developed for three workshops with groups of kidney transplant patients: patients without cognitive impairment - discursive strategy, with visuals; patients with cognitive impairment - repetitive speech strategy, with visuals; patients with visual deficits - auditory and tactile resources. The strategies adopted for the transplant with cognitive and visual impairment ordered adaptations, although at discharge patients demonstrated capacity for self-care and acquisition of immunosuppressive drugs. The experience made it possible for nurse planning, implementation and use of learning strategies that favored the emancipation of selfcare, influencing treatment adherence and quality of life of the transplant patient.

Educación para la salud en el paciente trasplantado y su familia en una unidad de cuidados intensivos / Health education in transplant patients and their families in an intensive care unit

La educación para la salud (EpS) en el paciente trasplantado y su familia es fundamental dada la importancia de promover un adecuado autocuidado en esta nueva etapa de la vida. La unidad de cuidados intensivos ofrece múltiples oportunidades a la enfermera para la promoción activa de la salud ya que en esta se puede iniciar el proceso educativo donde la interacción enfermera-paciente-familia es constante. La EpS eficaz del paciente trasplantado engloba tres dimensiones: los conocimientos -información relacionada con el autocuidado para llevar a cabo un estilo de vida saludable y para reducir la ansiedad del paciente y familia; las habilidades relacionadas con el poder y saber hacer, donde adquiere importancia la familia; y por último, las actitudes-ambivalentes, vivenciadas por el paciente trasplantado. El objetivo del trabajo es conocer el nivel de desarrollo de la EpS en una Unidad de Cuidados Intensivos para los pacientes críticos trasplantados y sus familias. Para ello, se desarrolla una revisión bibliográfica no sistemática en Pubmed y CINHAL. Como conclusiones, se destaca que el desempeño de la competencia enfermera de EpS en una Unidad de Cuidados Intensivos es importante para promover estilos de vida adecuados a las necesidades cognitivas, afectivas y psicomotoras del paciente trasplantado. Su puesta en práctica conlleva efectos positivos en los resultados clínicos del paciente, en la disminución de la morbimortalidad, costes y recursos sanitarios

Health Education (HE) is extremely important in transplant patients and their families in order to promote suitable self-care in this new stage of life. Intensive Care Units offer various opportunities by nurses in order to improve their Health Education. This process could start in this unit where the interaction between nurse and family is constant. The HE of transplant patient includes three dimensions: Knowledge: information about self-care in order to have a healthy way of life, and getting some information on how to reduce anxiety in patients and their families; Skills: as regards the abilities to properly apply the Health Education, where the families are really important; and finally Attitudes: ambivalent attitudes that are experienced by transplant patients. The objective is to describe the level of development of HE for critical transplant patients and their families from Intensive Care Units. A non-systematic literature review was performed in Pubmed and CINHAL data bases. In conclusion, it is emphasised that the skill of the HE nurse in an Intensive Care Units is important to promote lifestyles appropriate to the cognitive, affective, and psychomotor needs of transplant patients. Its implementation entails positive effects on clinical outcomes of the patient, decreased morbidity and mortality, costs, and health resources

Scope of Transplant Nursing.

By 2025 India will be the leading country for such chronic illness as hypertension, cardio vascular diseases and diabetes mellitus.There is a high level of prevalence of non-communicable diseases,such as asthma, chronic obstructive pulmonary disease (COPD), hypertension diabetes, mental problems, injuries, etc. Organ transplantation is evolving very fast -as a mode of: treatment for end-stage diseases. Every week, many people die waiting for an organ transplant. These lives could be saved by improving knowledge of organ donation and recovery among health team members and lay public alike. Nurses are in a unique position to advocate for donation and to educate theirpatients on the importance of being an organ donor.