Glossary
NK - New Knowledge, Innovation, and Improvements

NK4EO. Nursing research studies from the past 2 years, ongoing, or completed generated from the structure(s) and process(es) in NK4. Provide a table including:

  • Study title
  • Study status
  • Principal investigator name(s)
  • Principal investigator credential(s)
  • Role(s) of nurses in the study
  • Study scope (internal to a single organization, multiple organizations within a system, independent organizations collaboratively
  • Study type (replication –yes or no; qualitative, quantitative or both)

Select one completed study and respond to four (4) criteria listed in the EO guidelines provided in this chapter (page 52)

A copy of the table of nursing research studies from the past two years that have been completed and are ongoing can be found in Reference NK4EO-A. These studies were developed and supported by members of the nursing research council. Nursing leadership at JCMC and other collaborative relationship supported these studies through consultation, mentoring, and educational support as described in NK4. Two of these studies are described further below.

Research Study 1 - Rate of Consent for Tissue Donation in an institution with Emergency Room & ICU Nurses trained as Designated Requestor.

Investigators:

Principal Investigator: Chris Amato BSN, RN, CEN, MICN

Chris Amato is the Clinical Educator for the Emergency Department (ED). She obtained her BSN degree from Rutgers University in 2006 and began working at JCMC as a new graduate nurse. She went on to obtain Certification in Emergency nursing in 2008. She is currently enrolled in the acute care NP track at UMDNJ. This is her first study as a Primary Investigator.

Co- Investigator: Christina Vassallo BSN, RN, CEN, Tara Ryan BSN, RN, and Maria Bernardo BSN, RN

Tara Ryan, Christina Vassallo, and Maria Bernardo, are staff nurses in the Emergency department at JCMC.

Please refer to Reference NK4EO-B to view the full IRB proposal.

Purpose and Background

The ED nurses at JCMC, recognize that 110,000 Americans currently wait for life-saving organ transplants and thousands more require life-enhancing tissue transplants. According to statistics provided by the NJ sharing Network (http://www.sharenj.org), an estimated 220,000 Americans are treated with transplanted bone and tissue each year. One individual who donates can provide corneas, skin, bone and tissue for 50 or more people in need.

The Emergency Department (ED) nurses at JCMC identified that family members are asked to give their consent over the phone, by organ procurement personnel, at a point in time when they are extremely vulnerable. Literature suggests that the less surprise a family feels by contact regarding organ donation, the more likely they are to donate. Family members who are prepared for a conversation regarding donation, are more likely to donate then those who are surprised by the phone call or in person meeting. By implementing trained “designated tissue requestors”, nurses and social workers can approach family members with confidence and sensitivity.

For the purposes of this study the New Jersey Sharing Network held a “Designated Requestor” training seminar for the ED, critical care, and social workers (Appendix NK4EO-A). The one-day session included 8 hours of lecture and interactive presentation by The Sharing Network staff. Topics explored in seminar-style presentations included the following:

  • Centers for Medicare & Medicaid Services Conditions of Participation
  • The Tissue Process and Referral to Consent, Tissue Recovery and Transplantation
  • A Donor’s Family Experience
  • A Recipient’s Experience
  • Phases of Grief and Objectives of Active Listening
  • Creating the Proper Environment and Family Interaction (Offering the Opportunity for Donation and Addressing Questions)
  • Donor Family Support and Services.

This training seminar addressed the gap that exists in nurses’ knowledge about tissue donation. Its purpose was to empower nurses with current factual information about tissue donation and the therapeutic communication skills necessary to convey this information to families.

Objectives:

The chief objective of this study was to:

  • Evaluate if the overall rate of consent for donation at JCMC increased after implementation of the nurse “designated tissue requestor” training
  • Compare JCMC’s consent rate after implementation of a nurse “designated tissue requestor” training with St Joseph’s Healthcare System (SJHS) in Newark a comparable institutions without a “designated tissue requestor” program

Methodology:

The study used a case control analysis to evaluate the effectiveness of the training program. All nurses were eligible to participate in the course offered by the Sharing Network. The nurses who obtained the training implemented the knowledge and communication skills when broaching the topic of tissue donation with families of loved ones who have passed at JCMC. After one year, the rates of consent from JCMC were compared with the rate of consent from SJHS located in Paterson. This hospital was selected for comparison due to similar size and comparable demographic population served. During the study period, the NJ Sharing Network agreed not to hold a Designated Requestor training seminar at SJHS. IRB approval was obtained in both facilities (Appendix NK4EO-B, Appendix NK4EO-C).

Data Collection:

The New Jersey Sharing Network provided data collection for JCMC and SJHS. Monthly updates on the number of individuals referred and the rate of consent was provided.

Subjects:

Due to the nature of the study, subjects could not be preselected. Any family member whose loved one has passed at Jersey City Medical Center would benefit from the staff’s additional training.

The only risk to families, whom were offered information about donation, was the potential for emotional distress due to the nature of the conversation. However, The Uniform Anatomic Gift Act is a federal law that already requires hospitals to ensure that families are offered the option to donate. Therefore this study would not introduce any new existing potential for harm. In addition, having specially trained requestors approach family members should decrease this risk.

The tissue requestor course was offered to all ED and Critical Care Nurses. The Nurses and Case Managers who attended the “Designated Tissue Requestors” course did it on a voluntary basis.

“Designated Tissue Requestors”

NK4EO-Table 1

Results:

Please refer to (Appendix NK4EO-D) for the complete data collection.

2009 Tissue Donation Rates

2009 Tissue Donation Rates

Discussion and Impact

This study did not indicate an increase in organ donation consent rates with the RN as the first contact. Barriers identified were RN workload, time constraints, and scheduling. Further investigation of the findings revealed missed opportunities identified when a trained contact was unavailable to speak with the family. An increase in the number of trained “designated tissue requestor” RNs who have received training was needed for increased exposure to the families at the time of patient death and end of life decisions.

A second phase of this study was approved by the IRB of JCMC and St. Joseph in 2011 (Appendix NK4E0-E, Appendix NK4EO-F), A second “designated tissue requestor” training session was held on May 26, 2011 (Appendix NK4EO-G). In addition, to improve the process an in-service regarding the organ donation processes was provided to all ED RNs who were not trained as “designated tissue requestors”. This brought all ED RNs to the same knowledge base and increased their comfort levels when speaking with patients and families regarding death and organ donation. The in-service was followed by a short quiz to test knowledge and was provided for all night and day shift nurses. In addition, a binder with resources was displayed for easy access to all RNs. The second phase of the study is projected to be completed in October 2012

Designated Tissue Requestors 2011

NK4EO-Table 2

A pamphlet (Appendix NK4EO-H) was also developed by the investigators to provide families who experience death in the ER detailed information regarding the next steps in end of life care, including area funeral homes, restaurants, and hotels. This information would assist in making the transitions easier for families. This pamphlet assisted in standardizing the information received by families. The nurses in the ED continue to be invested in improving the process of tissue donation as well as provide assistance to family members.