Volume 33 Issue 2 Article 2

4-30-2020

Organ Procurement Processes in the Operating Room: The Effects of an Educational Session on Levels of Confidence and Understanding in Operating Room Registered Nurses and Surgical Technologists

Ann Ross University of Wisconsin-Green Bay, [email protected]

Janet Reilly University of Wisconsin-Green Bay, [email protected]

Emily Halla Hospital Sisters Health System (HSHS) St Vincent's Hospital, Clinical Educator–Surgical Services, Green Bay, Wisconsin, [email protected] Follow this and additional works at: https://www.journal.acorn.org.au/jpn Kathryn Anderson Univ Persityart of of the Wisconsin–Or Perioperative,gan Oper andating Tissue Room and and Donation, Surgical Hospital Nursing De Commonsvelopment,, and Madison, the Sur gerWisconsiny Commons, [email protected]

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation Ross, Ann; Reilly, Janet; Halla, Emily; and Anderson, Kathryn (2020) "Organ Procurement Processes in the Operating Room: The Effects of an Educational Session on Levels of Confidence and Understanding in Operating Room Registered Nurses and Surgical Technologists," Journal of Perioperative Nursing: Vol. 33 : Iss. 2 , Article 2. Available at: https://doi.org/10.26550/2209-1092.1072 https://www.journal.acorn.org.au/jpn/vol33/iss2/2

This Article is brought to you for free and open access by Journal of Perioperative Nursing. It has been accepted for inclusion in Journal of Perioperative Nursing by an authorized editor of Journal of Perioperative Nursing. Peer-reviewed article

Authors Ann Ross Organ procurement processes MSN, BSN, RN Dr Janet Reilly in the operating room: The DNP, APRN-BC, RN Dr Emily Halla effects of an educational session DNP, MS, BSN, RN on levels of confidence and Kathryn Anderson BS, Business Management understanding in operating room Corresponding author Ann Ross registered nurses and surgical BSN, RN, MSN (student) [email protected] technologists

Abstract Objectives: This project aimed to determine the effects an online educational course about organ procurement procedures (OPPs) in the operating room (OR) had on the levels of confidence and understanding among OR registered nurses (RNs) and surgical technologists (STs). Sample and setting: Data was collected from OR RNs and STs in the United States (US) at a Level II trauma centre with 19 operating rooms that completes eight to ten OPPs per year. A graduate nursing leadership student in this hospital created a Microsoft PowerPoint educational course about OPPs as her capstone project. Methods and variables: The course was developed and offered through the online learning management system the hospital uses. A retrospective pretest– posttest survey was designed and evaluated the effects of the course on participants’ levels of confidence and understanding. Results: The overall levels of understanding and confidence about OPPs improved in the RNs and STs, comparing aggregate scores. Implications for perioperative nursing: An educational course can enhance understanding of and confidence in OPPs for OR RNs and STs. Increased confidence and understanding can advance the successful outcomes of the OPPs. Ongoing education is needed to reinforce confidence and understanding in rarely done surgical procedures like OPPs. Introduction to the US at 31.722. The lack of available organs for transplant is Lack of organs for donation and complex. Only three in one thousand transplantation is a global issue. For deaths occur in a way that allows example, in 2018, over 113 000 people the deceased persons’ organs to be in the United States (US) awaited eligible for donation and subsequent organ transplantation, with 20 people transplant, either through donation dying each day while waiting1. Similar after brainstem death (DBD) or need is evident in Australia. Global donation after circulatory (cardiac) comparison of organ donation rates death (DCD)1,3,4. The limited is measured in donors per million of availability of eligible donated organs population (DPMP) which considers compared to the number of people changes in population over time; awaiting transplantation prioritises Australia’s DPMP is 20.8 compared

Journal of Perioperative Nursing Volume 33 Number 2 Winter 2020 acorn.org.au e-5 the need for successful outcomes in Therefore, OR RNs and STs who may nurse educators. The session was organ procurement and transplant be less familiar with OPPs participate offered to OR RNs and STs through procedures. in these procedures, possibly feeling the hospital’s online learning vulnerable and more uncertain about management system. All 59 RNs and In the US, organ transplant their roles and responsibilities7. STs employed received an automated procedures can only be completed Education about OPPs can alleviate email when the session was available by an authorised organ procurement some of their uncertainty and result to be completed with periodic email organisation (OPO)5. However, the in successful functioning and job reminders to encourage completion organ procurement procedure (OPP) satisfaction12. prior to the due date. Participants can occur in any hospital in the US were able to log on and complete that has an operating room (OR), Objectives the self-directed education session ventilator and the staff with the individually on any hospital ability to manage a patient requiring This project was developed by computer during work time. The ventilation. The OR registered nurses a nursing graduate student in content in the session was identified (RNs) and surgical technologists (STs) a leadership and management in the literature6,13,14 and included that participate play an important program. The focus was to determine an overview of OPP, perioperative role in the success of OPPs in the the effects of a self-directed responsibilities for OR RNs and STs, US. RNs in the US are licensed and education session about OPPs for information on the criteria for DBD have completed a two- to four-year OR RNs and STs on their level of and DCD, and post-mortem care. nursing program at a technical or understanding and confidence in Content was presented in a format university college. The RNs function the processes, using a retrospective similar to a PowerPoint presentation. in the role of the circulator in the OR, pretest–posttest design. The education session also included ensuring the team works together a video showing a meeting between for the patient’s best interest. While Sample and setting organ donor and recipient family not a role in Australia, STs in the US The project setting was a non-profit, members, which is voluntary in are trained through a specialised 517-bed hospital in the midwestern the US. The education session took program at local technical colleges. US, which is part of a health care 30 minutes to complete and was Their focus is on handling the system with fifteen hospitals available for one month. Responses instruments in the operating room. and numerous clinics across two were de-identified except by role (RN states. Fifty-nine RNs and STs were While the literature addresses or ST). After completing the session, employed in the hospital OR and education that RNs receive about the participants were directed to invited to participate in the project. patient care prior to the OPP, it is complete an anonymous online The OR RNs and STs verbalised to the limited in regard to education that survey which identified their levels of nurse educator concerns about their RNs and STs receive about patient confidence and understanding before lack of comfort providing care during care during the OPP. This education and after the OPP education session. OPPs. This hospital completes eight is predominantly hospital-based to ten OPPs per year (almost equal The survey used a retrospective and provided either as in-service numbers of DBD and DCD) and works pretest–posttest design, which training sessions taught by the OPO with a regional OPO, located about allowed each participant to rate organ donor coordinators or offered 300 kilometres away. his or her perceptions before and during OR employee orientation, after the training from the same neither of which include the RN Methods and variables frame of reference. This design can or ST responsibilities during the remove response shift bias15. This OPP6. Lack of, or insufficient, organ The project was deemed Institutional form of evaluation was also used and tissue donation procedure Review Board (IRB) exempt for the because individuals ‘may not know education is a global issue and the graduate student’s university and what they do not know’ nor be need for more specialised education the hospital. An education session able to accurately reflect and self- for health professionals closely was developed by the nursing report their level of knowledge and involved in OPPs has been identified graduate student to help address OR confidence prior to participation in by international studies7,8,9,10,11. In RNs and STs’ concerns. Throughout the educational session16. Before both Australia and the US, dedicated its development, the education answering survey questions, teams to complete OPPs are not session was edited with feedback informed consent was obtained always available in smaller hospitals from the RN and ST managers, from participants after they read and those in less urban areas7. regional OPO staff and two hospital

e-6 Journal of Perioperative Nursing Volume 33 Number 2 Winter 2020 acorn.org.au a summary of the project title, 50 investigators, purpose, procedure, Q 6 benefits, risk, safeguards, and IRB 78 72 approval (see additional files). Q 7 100 The survey consisted of demographic 78 Q 8 questions (Q1–5) and quantitative 100 questions regarding participants’ 72 understanding and confidence in Q 9 100 OPPs (Q6–11) that were answered 61 using a five-point Likert-type scale Q 10 89 (‘strongly agree’, ‘agree’, ‘neutral’, 61 ‘disagree’, ‘strongly disagree’). Two Q 11 83 qualitative, open-ended questions were also asked (Q12–13). De- 0 20 40 60 80 100 120 identified results of the survey Per cent combined ‘agree’ and ‘strongly agree’ Before questions were analysed in the After aggregate. Figure 1: Comparison of survey responses before and after the education Results session The OPP session was completed by 41 RNs and STs employed in the hospital or ‘strongly agreed’ (collectively frames for transplantation (n=1) and (69%). Eighteen of these RNs (n=11) hereafter called as ‘agreed’) after OPP in-service for new OR RN and and STs (n=7) also consented and session completion, compared to 62% STs (n=1). One participant echoed the completed the survey. The majority (n=11) before completing the session. purpose of this project by saying an of survey participants (72%, n=13) had Unanimous agreement was reported educational session can be helpful participated in less than five OPPs by participants after completing the to new employees or people who do and had varied surgical experience. education session in three areas. All OPPs infrequently to ‘know what it’s Six participants (33%) had more than eighteen participants (100%) ‘agreed’ like to be in a transplant procedure 15 years of experience in their current they were able to differentiate just so you are more prepared’. OR position, while seven participants the two types of OPPs, and they (39%) had worked less than five years. understood their responsibilities Implications for More than half of the participants before and during OPPs. perioperative nursing (56%, n=10) indicated they had some Survey responses There are important implications form of formal education or training from this project, although they are about OPPs prior to completing this Participants identified what they not generalisable nor statistically online education session, mostly learned that would help them the significant due to the small sample through in-service trainings (Q5). next time they participated in an OPP. size. After the education session, These were information about set up Aggregate survey responses to Q6–11 every survey question related to for each of the rooms (n=3), charting noted increased confidence and participants’ levels of understanding or paperwork to be completed (n=3), understanding related to OPPs after and confidence in OPPs improved. differences between DBD and DCD the education session compared Participants were also able to identify (n=2), and roles (n=2). For example, to before the session (see Figure things they could apply in future participants’ responses included 1 below). For example, the number OPPs. Despite participants having learning whether anaesthesia was of responses rating confidence in previous education and surgical needed for the OPP and knowing the ability to explain two types of experience, the need for ongoing that family members were able to OPPs (DBD, DCD) improved after specialised education for those be in the OR. Information that RNs completing the education session participating in OPPs was found, as and STs stated should be included in 7 (78%; n=14), compared to before supported by the literature . future educational sessions involved the education session (50%; n=9). the processes before patients come Similarly, confidence to perform OPPs into the OR (n=2), charting and forms changed from 83% (n=15) who ‘agreed’ (n=1), what happens after OPPs, time

Journal of Perioperative Nursing Volume 33 Number 2 Winter 2020 acorn.org.au e-7 Knowledge translation 3. National Health Service, UK. Blood and 10. Flodén A, Forsberg A. A phenomenographic Transplant. Donation after brainstem death study of ICU-nurses’ perceptions of and Ongoing education, in an easily [Internet]. London: NHS; Available from: odt. attitudes to organ donation and care of accessible and convenient format, nhs.uk/deceased-donation/best-practice- potential donors. Intensive Crit Care Nurs guidance/donation-after-brainstem-death/ 2009;25(6):306–313. needs to be provided for RNs and STs 4. National Health Service, UK (NHS). Blood 11. Meyer K, Bjørk IT, Eide H. Intensive care in each hospital in the US and RNs and Transplant. Donation after circulatory nurses’ perceptions of their professional in Australia where OPPs may take death [Internet]. London: NHS; Available competence in the organ donor process: A place 6. A standardised presentation from: odt.nhs.uk/deceased-donation/ national survey. J Adv Nurs. 2012;68(1):104–115. of the OPP information from the best-practice-guidance/donation-after- 12. Carter-Gentry D, McCurren C. Organ circulatory-death/. education session in this project procurement from the perspective of 5. Health Resources and Services perioperative nurses. AORN J 2004;80(3):417– could be customised for use in other Administration (HRSA). Organ Transplant 431. hospitals. Similar education could and Procurement Network policies 13. Gao W, Plummer V, Williams A. Perioperative increase participants’ understanding [Internet]. Rockville, USA: HRSA; 2019. nurses’ attitudes towards organ and confidence in other infrequent Available from: optn.transplant.hrsa.gov/ procurement: A systematic review. J Clin media/1200/optn_policies.pdf. surgical procedures. Nurs 2017;26(3/4):302–319. 6. Smith Z, Leslie G, Wynaden D. Experiential 14. Lyons P, Treasure E. The design and Funding learning not enough for organ procurement implementation of an organ donation surgery: Implications for perioperative education workshop for perioperative No monies were received, and the nursing education. Prog Transplant nurses. ACORN J 2014;27(1):28–29. 2015;25(4):339–350. authors have no financial interests. 15. Chang R, Little TD. Innovations for 7. Smith Z, Woods D, Lea J, Usher K. Australian evaluation research: Multiform protocols, References perioperative nurses’ attitudes, levels of visual analog scaling, and the retrospective knowledge, education and support needs pretest–posttest design. Eval Health Prof 1. Health Resources & Services Administration related to organ donation and procurement 2018;4(2):246–269. (HRSA). Organ donation statistics [Internet]. surgery: A national survey. JPN 2019;32(2):7–15. 16. Brook J, Akin B, Lloyd M, Bhattarai J, Rockville, USA: HRSA; 2018. Available from: 8. Collins TJ. Organ and tissue donation: McDonald T. The use of prospective versus www.organdonor.gov/statistics-stories/ A survey of nurse’s knowledge and retrospective pretests with child-welfare statistics.html. educational needs in an adult ITU. Intensive involved families. J Child Fam Stud 2. ShareLife. Australian organ donation Crit Care Nurs 2005;21(4):226–233. 2016;25(9):2740–2752. performance-leading practice and global 9. Kim JR, Fisher MJ, Elliott D. Attitudes of comparison [Internet]. Sydney: ShareLife; intensive care nurses towards brain death 2018. Available from: www.sharelife.org.au/ and organ transplantation: Instrument australian-organ-donation-comparison. development and testing. J Adv Nurs 2006;53(5):571–582.

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