April 21, 2024

Healt Hid

Because health is very important to us

Critical care training for organ donation specialist nurses

14 min read

A bespoke course and educational package were created to develop specialist nurses in organ donation from a non-critical care background

Abstract

Due to increasing difficulties of recruiting specialist nurses in organ donation who have critical care experience, NHS Blood and Transplant broadened the recruitment criteria to include nurses from non-critical care backgrounds. In support of this, a bespoke critical care education package was created to develop these nurses’ competence in critical care areas relevant to managing a potential organ and tissue donor. This educational package was scoped, designed, delivered and evaluated to ensure it met the needs of the specialist nurses in training and fit the organisation’s operational demands. By recognising transferable skills, and adapting training methods and materials, the project created more opportunities for nurses to enter the field of organ and tissue donation.

Citation: McManus H et al (2024) Critical care training for organ donation specialist nurses. Nursing Times [online]; 120: 1.

Authors: Helen McManus is national professional development specialist; Lisa Francis and Edward Davies are professional development specialists; Sarah Mason is national professional development specialist; Helen Bentley is former head of education and professional development; all at NHS Blood and Transplant.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)

Introduction

In the late 1970s, the first donor transplant coordinators (DTCs) were employed by renal transplant units (Department of Health (DH), 2008), and the role varied throughout the UK. In 2009, the DTC role became a specialist nurse (SN) role and employment transferred from local NHS trusts to NHS Blood and Transplant (NHSBT), which manages England’s blood donation service and the UK’s organ donation and transplantation services. This happened as a result of the Organ Donation Taskforce recommending that “the current network of DTCs should be expanded and strengthened through central employment by a UK-wide Organ Donation Organisation” (DH, 2008).

NHSBT’s education training records show that it now employs ~290 SNs in organ donation. This number has increased over the last 10 years: NHSBT’s (ndc) strategy stated that it employed ≤251 SNs, who provided donation services to >300 hospitals in the UK. This growth in the number of organ donation SNs has occurred for many reasons, but is predominantly due to an increase in organ donors.

During the financial year of 2007-08, there were 809 deceased donors of solid organs in the UK (NHSBT, 2008). This low organ donation rate led to the establishment of the Organ Donation Taskforce, which produced a report setting out 14 recommendations to increase the number of organs available for transplantation. Five years after these recommendations were published, the number of annual deceased organ donors had increased by 50% to 1,212 (NHSBT, ndc).

NHSBT then created 27 additional SN posts when, as reported by Mitchell (2020), an ‘opt-out’ system was introduced in England in 2020; this system meant that all adults were “considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the excluded groups” (NHSBT, nda). The purpose of this change in legislation was to increase the number of organ donors. It brought the law in England in line with that of Wales, where the system had already been introduced (Iacobucci, 2020); it was rolled out in Scotland the following year (Scottish Government, 2021) and in Northern Ireland in 2022 (NI Direct, 2023). These changes led to there being a record number of organ donors in the UK in 2018-19 (n=1,600). This number reduced during the Covid-19 pandemic, although it has risen over the last two years (NHSBT, 2023).

“Applicants were required to demonstrate advanced communication skills via a ‘breaking bad news’ role play at interview”

Recruiting organ donation nurses

Historically, nurses recruited to the organ donation SN role have mainly had a background in critical care or emergency department nursing. NHSBT faced recruitment challenges in some areas of the UK (Mitchell, 2020), although the rationale for the reduced interest in the role was not fully understood. To address this, in NHSBT’s professional development team (PDT), we sought local intelligence from SNs working in critical care throughout the UK, via both team meetings and one-to-one conversations.

The overwhelming feedback we received was that there were very few nurses with both the skills and passion required to work in organ and tissue donation, who had not already transitioned into the role. Although this was not the case in every region, it was evident in enough areas to be identified as a real challenge to recruitment and, as such, our ability to save lives through organ and tissue donation.

Seeking solutions to this, NHSBT’s organ donation operational management team asked the PDT to investigate recruiting nurses with different backgrounds who had an interest in the role. Expanding the recruitment pool meant amending the role’s person specification. Critical care experience became desirable, rather than essential, although advanced communication skills and an ability to model NHSBT’s core values of “we care”, “we are expert” and “we provide quality” (NHSBT, ndb) remained essential.

Successful applicants without a background in critical care would need to learn the key elements of critical care that are necessary to facilitate organ donation; they needed to reach full competence for the SN role within six months of commencing employment. To facilitate this, NHSBT took the following steps:

  • Applicants would be required to demonstrate advanced communication skills via a ‘breaking bad news’ role play at interview;
  • Successful applicants would work with multidisciplinary staff in a critical care unit for part of their supernumerary training;
  • Applicants would be supported by a competency framework that would be developed to enable the recruitment pool to be broadened;
  • The PDT would develop a bespoke critical care module (CCM), covering the specific elements relevant to managing a potential organ and tissue donor.

Developing the module

To develop the CCM and optimise the newly recruited nurses’ learning, we needed to identify their potential requirements. We aimed to build their confidence in the critical care environment, including its unique language, technology, routines and culture. We also needed to increase their competence in the areas of critical care pertaining to organ and tissue donation, providing them with the knowledge and skills to assess potential donors and manage their stabilisation or optimisation alongside the critical care staff.

Our initial priority was to create a focus group comprising PDT members with an interest in, and experience of, critical care, who could build a roadmap for the training. They developed the CCM and established its content, teaching delivery methods and competencies. They also recommended that the CCM use the airway, breathing, circulation, disability, exposure (ABCDE) method (Resuscitation Council UK, nd). NHSBT’s operational senior management team established that the CCM would be a three-day course, running alongside the other parts of the package; details of the complete package are illustrated in Fig 1.

During a rapid-improvement event to discuss NHSBT’s training for its current SN cohort, we sought the opinions of the diverse group of organ donation staff in attendance – including SNs, team managers and education personnel – on our CCM ideas. They reached the same conclusion of using an ABCDE model; this is very familiar to nurses, as it is a fundamental principle to assess and treat critically ill patients (Resuscitation Council UK, nd).

To build the CCM based on the ABCDE model, the focus group explored the anatomy and physiology of each ABCDE system in relation to the:

  • Critical care environment;
  • Potential impact of disease on organ donation and transplantation;
  • Role of the SNs, including their existing knowledge from previous roles.

Robeano et al (2019) explored the journey of unique challenges related to transitioning from an experienced nurse to a novice nurse practitioner. Appreciating prior experience and knowledge is key to facilitating the adjustment into a new role.

In addition, Daley and Gordon (2016) highlighted that transitioning from ward-based to critical care nursing is challenging. They developed a competency-based critical pathway for novice critical care nurses and established “step-up guidelines” to lead them through their learning path to competence.

Delivering the module

Leigh (2010) identified the benefits of performing a strengths, weaknesses, opportunities and threats (SWOT) analysis as a benchmark, to break down barriers and identify opportunities for development. On the first day of the CCM, the delegates were asked to complete a SWOT analysis of their requirement to gain the level of competence in critical care to enable them to practise as SNs.

The critical care environment was unfamiliar to the delegates, and the SWOT analysis enabled the facilitator to point out where their opportunities lay and how to access them. It was also important to recognise that the new SNs were bringing vast experience to their new role, which could not be dismissed. The CCM was delivered collaboratively by operational team managers, the PDT and mentors. We used Lombardo and Eichinger’s (2010) 70:20:10 model of learning, whereby 70% of learning is on the job, 20% is based on others’ feedback and 10% is formal training.

Delegates completed a three-week placement in a critical care environment. To develop their competencies, they followed a workbook we adapted from CC3N’s (2018) competency framework; we chose the competencies relevant to the organ donation SN role and requirements for donor management.

Higher levels of engagement can lead to increased learning (University College London, 2021) so, to maintain engagement and fulfil a wide range of possible learning needs, we delivered the ABCDE teaching through a variety of methodologies, including traditional didactic presentations, group work, discussion forums, interactive sessions and the use of digital technology (Box 1).

Box 1. Critical care model programme

Day 1

  • Welcome, introductions and icebreaker
  • SWOT analysis
  • A day in the life of critical care
  • Airway, breathing, circulation, disability, exposure (ABCDE) overview
  • A – airway
  • B – breathing
  • Evaluation

Day 2

  • C – Circulation
  • D – Disability
  • Evaluation

Day 3

  • E – exposure
  • The liver, kidneys, gastrointestinal system and skin
  • Microbiology overview
  • Evaluation and discussion

SWOT = strengths, weaknesses, opportunities and threats

During the Covid-19 pandemic, the CCM programme did not vary. However, the delivery method changed to one that was completely virtual (Table 1), making use of virtual platforms and tools such as breakout rooms, chat functionalities and polls to maintain engagement. Following the pandemic, the CCM’s delivery method is currently under review.

Outcomes

Between August 2019 and May 2022, six cohorts of SNs were recruited, 36 of whom had no clinical care background and undertook the CCM. Of these, 78% (n=28) remain in post; one additional person is on secondment in blood donation, meaning 81% (n=29) remain with NHSBT.

Box 2 shows the varied nursing backgrounds of the first six cohorts who undertook the CCM. This demonstrates that our recruitment pool widened greatly and contributed to a more diverse nursing workforce. These nurses’ skillsets are different from those developed in critical care, but we recognise that there are transferable skills between roles and there is strength in the diversity of our new workforce that needs to be nurtured.

Box 2. Nursing backgrounds of the module’s delegates

  • Hospital nursing
  • Surgical nursing
  • Cardiology
  • Neurology
  • Theatre

Acute or donation-related nursing

  • Emergency department
  • Tissue donation
  • Transplant ward
  • Resuscitation

Community or other nursing

  • Palliative care
  • Community nursing
  • Practice nursing
  • NHS 111
  • Clinical site
  • Prison nursing

Conducting the CCM in small groups allowed for an intimate learning experience, in which facilitators could ensure their pace suited learners. Small groups – ideally of 5-8 people – form a productive academic environment, particularly in healthcare areas (Burgess et al, 2020). They can strengthen learning and interactivity between learners (Zhu et al, 2023).

At the end of the first day of the initial CCM, we held an informal discussion to obtain initial feedback on the module. The feedback was very positive, and delegates felt the CCM’s content was relevant to their role development. They said the environment was “relaxed and friendly” and that they were “more confident and comfortable in a small group”.

Additionally, the initial CCM was evaluated on each of the three days using Europlanet Society’s (nd) quick target-style evaluation tool (Fig 2). Delegates were asked to rate the CCM’s content, delivery and relevance on a five-point scale ranging from one (excellent) to five (poor). They also had the opportunity to add any other comments.

Following this module, we also sent out an electronic survey via Microsoft Forms to get more qualitative and quantitative data on the timing, relevance and use of all the components of the CCM. Overall, the delegates felt it was relevant to their role and it increased their confidence in, and knowledge of, the critical care area.

The PDT will continually evaluate and adapt the CCM to ensure it supports delegates with their workbook, competencies and critical care placements. We will involve all stakeholders in our reviews and recommendations where appropriate. The CCM has become a highly respected course in the organisation and has supported changes to our recruitment pool.

Challenges

Between August 2019 and May 2022, the training package for organ donation SNs with a background in critical care took 20-24 weeks. However, for those from a non-critical care background, it took 26-39 weeks; in some circumstances – for example due to Covid-19 isolation or sickness – it was >52 weeks. Unfortunately, duration was heavily influenced by the Covid-19 pandemic, both because our workforce was redeployed and because donation activity fell (NHSBT, 2023), which meant new SNs had reduced exposure to it. The time taken to achieve competence was, therefore, much longer than expected.

Delivering the CCM in three days was difficult, due to the vast amount of content. The first two cohorts received face-to-face training; for subsequent cohorts, training was delivered virtually. Converting the CCM to a virtual platform also presented several challenges. Stripping back content to accommodate the needs of the virtual environment meant that using an offline workbook became invaluable; this was delivered to the delegates before the CCM took place. This self-directed learning element not only reduced screentime, but also supported neurodiversity by using different learning methods.

Everyone learns differently, and teachers must “open spaces for critical reflection on self” Liddicoat (2022). It was a challenge to achieve this digitally, but incorporating different educational methods into virtual learning made the content more engaging and may have helped students to connect with it. Liddicoat (2022) also highlighted that it is essential for “the educator to be peer-reviewed and included in the evaluation, as critical reflection is core to educational practices”. This is a prerequisite for the reward of a recognised education quality mark from the Clinical Skills Institute (Skills for Health, nd), which the PDT received in 2022.

We recognised that conducting the CCM digitally still posed challenges, as virtual education can make people feel isolated (Zhu et al, 2023). In a study of student perceptions of virtual versus face-to-face teaching, Chandran et al (2021) identified that face-to-face teaching was the preferred method; this has the advantages of improving communication and learning assessment through closer observation of body language and facial expressions (Vermeir et al, 2015). However, face-to-face learning can also have a negative financial impact due to travel and accommodation. In addition, its impact on work–life balance can be positive or negative depending on individual circumstances.

“We aimed to build confidence in the critical care environment, including its unique language, technology, routines and culture”

Conclusion and next steps

The CCM was implemented to develop critical care skills and knowledge for SNs with no critical care experience. The aim of the course was to equip them with the required knowledge to competently assess and manage a potential organ and tissue donor in a critical care environment. Anatomy and physiology were taught based on the ABCDE approach, with the underlying theme of caring for a potential organ and tissue donor and the impact that past medical history and current physiology could have on transplant recipients. The critical care placement was also a vital element of the SNs’ learning journey.

The CCM’s positive impacts were demonstrated from a recruitment perspective and from positive feedback from both attendees and NHSBT teams. The CCM will be adapted according to evaluations and future needs of the service.

Considerations for future CCM delivery and development continue. The length and timing of the critical care placement is currently being discussed: we are considering whether it would be more beneficial to have placement days throughout training or to start training earlier and complete the placement at the start. These elements need to be considered in collaboration with operational management teams. They must be feasible alongside service delivery, while recognising the individual needs of each SN in training.

Although we are unable to predict our future nursing recruitment pool and the financial costs of running the CCM, we have full organisational support to continue to train SNs, with the aim of helping to save and improve lives through organ and tissue donation.

Key points

  • The donor transplant coordinator role was introduced in the 1970s and transitioned into a specialist nurse role in 2009
  • The number of organ donors increased considerably when an ‘opt-out’ system was introduced
  • To meet increased need, the recruitment pool for organ donation specialist nurses was broadened to include those without critical care backgrounds
  • A critical care module was created to equip these nurses with essential skills, which has received positive feedback from delegates and other teams
  • Acknowledgement The authors wish to acknowledge NHSBT, NHSBT’s PDT, and other members of the CCM working group, including Louise Hubner (head of education and professional development) and Jennifer Hughes and Susan Lee (education and professional development managers).
References

Burgess A et al (2020) Facilitating small group learning in health professional education. BMC Medical Education; 20: 457.

CC3N (2018) Step competency framework. cc3n.org.uk (accessed 13 July 2023).

Chandran DS et al (2021) Student perceptions on synchronous virtual versus face-to-face teaching for leader-centered and participant-centered postgraduate activities during Covid-19. Advances in Physiology Education; 45: 3, 554-562.

Daley I, Gordon E (2016) Stepping it up: transitioning to proficient critical care nurses, does it work? [Abstract for Dynamics of Critical Care conference, 25-27 September 2016, Charlottetown PEI, Canada]. Canadian Journal of Critical Care Nursing; 27: Supplement 2, 17-18.

Department of Health (2008) Organs for Transplants: A Report from the Organ Donation Taskforce. DH.

Europlanet Society (nd) Evaluation tool 10 – target evaluation. europlanet-society.org (accessed 12 December 2023).

Iacobucci G (2020) Organ donation: England will have ‘opt-out’ system from May 2020. BMJ; 368: m752.

Leigh D (2010) SWOT analysis. In: Silber KH et al (eds) Handbook of Improving Performance in the Workplace: Volumes 1-3. Pfeiffer.

Liddicoat AJ (2022) Teacher education for diversity: afterword. Language and Education; 36: 2, 188-194.

Lombardo MM, Eichinger RW (2010) The Career Architect Development Planner. Lominger.

Mitchell G (2020) Organ donation nurse network expanded ahead of law change. nursingtimes.net, 25 February (accessed 12 December 2023).

NHS Blood and Transplant (nda) What is the opt out system? organdonation.nhs.uk (accessed 2 December 2023).

NHS Blood and Transplant (ndb) Our values. nhsbt.nhs.uk (accessed 12 December 2023).

NHS Blood and Transplant (ndc) Taking Organ Utilisation to 2020: A Detailed Strategy. NHSBT.

NHS Blood and Transplant (2023) Organ and Tissue Donation and Transplantation. Activity Report 2022/23. NHSBT.

NHS Blood and Transplant (2008) Transplant Activity in the UK: 2007-2008. NHSBT.

NI Direct (2023) ‘Opt out’ change for organ donation. nidirect.gov.uk, 19 September (accessed 12 December 2023).

Resuscitation Council UK (nd) The ABCDE Approach. Resuscitation Council UK.

Robeano K et al (2019) Optimizing transitional support for novice nurse practitioners. Nurse Leader; 17: 4, 303-307.

The Scottish Government (2021) Donation and Transplantation Plan for Scotland: 2021-2026. The Scottish Government.

Skills for Health (nd) Healthcare quality mark. skillsforhealth.org.uk (accessed 13 July 2023).

University College London (2021) Encouraging student engagement with blended and online learning. ucl.ac.uk, 13 October (accessed 12 December 2023).

Vermeir P et al (2015) Communication in healthcare: a narrative review of the literature and practical recommendations. The International Journal of Clinical Practice; 69: 11, 1257-1267.

Zhu H et al (2023) SmartGroup: a tool for small-group learning activities. Future Internet; 15: 1, 7.

 

Help Nursing Times improve

Help us better understand how you use our clinical articles, what you think about them and how you would improve them. Please complete our short survey.

link

Leave a Reply

Your email address will not be published. Required fields are marked *

Copyright © All rights reserved. | Newsphere by AF themes.