Senior nursing students in the “Introduction to Critical Care” course at Southeast Missouri State University have spent the spring semester piloting a first-of-its-kind online program on tissue and organ donation.
The initiative, “Organ and Tissue Donor Education for Undergraduate Nursing Students,” is made possible thanks to a generous grant awarded to Southeast Missouri State University by Mid-America Transplant (MT) in St. Louis, Missouri, the first organization in the world to have a retrieval center for organ and tissue donation.
The award followed a call for proposals issued by MT on the topic of organ and tissue donation to all universities in its service region. Pam Vargas, director of Southeast’s Office of Research and Sponsored Programs, announced the call to Southeast faculty.
Dr. Linda Heitman, professor in the Southeast Department of Nursing and principal investigator for the project, submitted a proposal for the online learning platform. Heitman completed her graduate research at Saint Louis University on transplantation. Following her graduation, she served on the MT Professional Advisory Board and worked to promote organ procurement at Southeast Hospital, now SoutheastHEALTH, before joining the Southeast faculty.
A Nursing Education Grant team was assembled with MT staff.
“Together, we explored disparities in organ and tissue donation education for nursing students, and we created a learning platform to provide current, comprehensive information to address those disparities,” Heitman said.
“The online program provides nurse educators with current, comprehensive information about organ and tissue donation for inclusion in nursing school curriculums,” Heitman said. “Through the program, nursing students will gain a clearer understanding of the role of an organ procurement organization (OPO), in this case, Mid-America Transplant.”
Southeast President Carlos Vargas and his wife, Pam, recently visited MT’s St. Louis facilities.
“I was very impressed with the site and interested in developing a relationship with Mid-America Transplant,” President Vargas said.
The online program consists of five learning modules, including an Introduction and Pre-test, Overview of Organ Donation, the Nurse’s Role in Organ and Tissue Donation, Family Bereavement and Aftercare, and a Post-test with a Course Evaluation and Certificate of Completion. Each module consists of a narrative, videos, a forum for discussion, a quiz and reference list.
The videos include interviews with MT doctors and nurses, a video tour of MT’s facilities in St. Louis, a behind-the-scenes look at the MT’s Recovery and Call center, a step-by-step guided instruction of the donation recovery and process, in-depth review and definition of brain death determination, and bereavement care for the donors’ families. The multifaceted role of nurses and the organ procurement agency was illustrated throughout each module.
Southeast nursing student Teresa Stephens of St. Louis, Missouri, said comprehensive information on organ and tissue donation and donor care aren’t typical nursing curriculum topics, but that knowledge can be vital in their everyday jobs as nurses, even before graduating.
“We’re encountering potential donors in our clinicals, including two this semester, so if we hadn’t had that program we’d never have known how to care for those patients,” she said.
Heitman said she began realizing the program was making a difference in the students’ understanding’ during an interaction with a student while caring for a patient during a Critical Care clinical experience.
“We stepped out of the patient’s room and I said, ‘I’d like to talk to you for just a few moments about the process of brain death determination.’ She looked at me and said, ‘Dr. Heitman, I have completed Module 4 (of the program), I understand the process.’ It was an epiphany, that moment when I realized the program was having an impact and making a difference because one of the most difficult concepts for a student to understand is that concept of determination of brain death.”
Kevin Lee, vice president of external affairs at MT, said, “Nurses play a critical role in not just identifying a potential donor, but in initiating the donation process through early notification to MT and supporting the families throughout the process.”
For Southeast nursing student Amy Krebs of Breese, Illinois, completing the program boosted her confidence in understanding the fundamentals of organ donation and sharing that information with others.
“Just learning about the beauty of donation and how many lives we can save was amazing,” she said. “I’ve even encouraged my family to be donors and to share the knowledge I’ve learned with them. To be able to answer questions for them was awesome. I’ve wanted to be an organ donor, but this program has changed my thought process of just how beautiful donation is.”
One organ and tissue donor can save and heal more than 75 lives, Lee said. That can positively impact patients and families across the country.
“In 2018, it was our privilege at Mid-America Transplant to work with 260 families that said yes to organ donation, and that resulted in 629 lifesaving organs from 196 organ donors,” Lee said. “We’re talking about lives saved, gifts that allow a transplant recipient to have their first day of school, or walk their daughter down the aisle, or celebrate Thanksgiving with their family. Those things take place through selfless sacrifice. We also had the opportunity to work with 1,986 tissue families. That’s nearly 100,000 tissue grafts that are made available throughout the United States. Those are burn victims, those are people who need a stint in their leg, cancer survivors – it’s a massive impact.”
The pilot study revealed that more than half of the students who participated in the pilot study have seen that impact in their own lives, whether through a family member or friends who were donors or recipients.
The Bereavement module of the program shares what MT does to honor donors and their families, and how nurses are an important aspect of that process as well. They learned about donor tributes from moments of silence, music and blankets during donation operations to the Path of Honor – another program initiated in Cape Girardeau at Saint Francis Medical Center – when family, friends and staff line a hospital’s halls to honor donors as they make their way to donate.
Southeast nursing student McKenzie Lynch participated in that first Path of Honor to remember her high school friend. The program, coupled with her memories, have helped her learn about how, as a nurse, she can be there for patients and their families.
“I learned about what the nurses and healthcare staff do and how to put ourselves in the families’ situations, to be more compassionate, understanding and caring,” she said.
Southeast nursing student Gavin Brown of Cape Girardeau agreed, saying “The program taught us how to take care of our patients as well as the families — that it’s just as important to take care of families. They are going to be the ones making a decision, so you really keep them in your thoughts as well.”
Making the program comprehensive and compliant with current organ and tissue donation protocols provides the students with the knowledge they need to help patients and families make informed end-of-life decisions, Heitman said.
Students also learned the various cultural and religious aspects of donation, and the importance of Bereavement Care for donor families and support for themselves as nurses.
The death of a patient is difficult. “Working with donors and families is also a very emotional experience for nurses,” Heitman said. “We, as nurses, go through a grieving process. The grant team felt it was essential to include the importance of emotional support for nurses and entire health care team involved in the donation process.”
“We truly put so much effort into trying to keep them (our patients) alive. To watch them pass would be really hard and you don’t realize that until you go through it,” said Southeast nursing student Ashley Tilley of Bloomfield, Missouri. “I feel like there’s this stigma as nurses that you have to keep up or that you have to get over it and not take it home with you, but I think if you’re really being compassionate with your patients in the way that you should be, you’re going to probably take it home with you. I just didn’t realize that until I felt that, until I saw it. I didn’t even know that was a thing to provide nurses with emotional support, but I definitely see how that would be important.”
“Having those discussions as part of their nursing education and knowing how to participate in MT’s supportive events and grief centers, prepares the students to provide better end-of-life care to patients and their families,” said Heitman.
No matter where the students begin their nursing careers, organ and tissue donation will at some point be a part of their professional responsibility. The “Organ Donor Education for Undergraduate Nursing Students” program will have provided the tools and knowledge they will need to for their patients and their families, as well as themselves and the health care team they will be a part of,” said Heitman.
“Bedside nurses are vital in the organ and tissue donation process,” Lee said. “This project set out to empower the end-of life wishes of patients and families, and for the students, soon to be nurses, to have the skills and knowledge to help in that process.”
The knowledge gained by Southeast students from completing this online learning platform has the potential to improve their early detection of potential donors, enhance the donation process for the patients they care for and their families, and help them understand the significant, multifaceted role of the OPO to assist nurses throughout the process.
The program will be shared with undergraduate nursing schools in the MT service region in phases. The first phase will begin this fall with Saint Louis University, Goldfarb School of Nursing, University of Missouri–St. Louis and Arkansas State University. Southeast students will be included. It is estimated that potentially 300 students will be enrolled in the program this fall.
The grant team will present an overview of the platform and the results of the pilot study at the Association of Organ Procurement Organizations in Houston, Texas, this summer.
With the positive results, evaluations and dynamic student interest and involvement in this semester’s study, we feel the program’s potential is unlimited, said Heitman.
“This was truly a team effort between Southeast and MT. Our students were amazingly engaged throughout the semester, and, as a result, are now more prepared,” she said. “Nursing programs have not had this level of education regarding organ and tissue donation in the past. The team that created this online platform hopes that by sharing it we can help to improve the process of organ and tissues donation for nurses, patients and families in the future.”
MT hopes to one day share the program with the 73 universities and schools of nursing within its service area.
“We believe this program is going to be very successful because nothing like it truly exists,” Lee said. “We’re proud to say it started at Southeast.”
About Mid-America Transplant
For 45 years, Mid-America Transplant has facilitated and coordinated organ and tissue donation, and now serves 84 counties covering eastern Missouri, southern Illinois and northeast Arkansas that together are home to 4.7 million people. It saves lives by providing expert and compassionate care for organ donors, donor families, and recipients, and transforms the clinical processes required to recover and transplant organs and tissues. Mid-America Transplant is federally designated as one of 58 such organizations in the U.S. and is the first organ and tissue procurement organization to be recognized as a recipient of the Malcolm Baldrige National Quality Award for Performance Excellence. For more information, visit www.midamericatransplant.org.