Nevada RNformation - March 2011

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Page 20 • Nevada RNformation March, April, May 2021 The Effects of COVID-19 on Organ Donation and Transplantation John A. Lilley, MBA, BSN, RN, CPTC Vice President of Organ Operations DonorNetworkwest.org In December 2020, the Merriam-Webster English Dictionary announced “pandemic” as the word of the year due to its increased use and investigation of meaning. At the same time, Dictionary. com announced the People’s Choice 2020 Word of the Year to be “unprecedented.” The site’s Senior Research Editor, John Kelly, described the use of unprecedented in the form of “...the pandemic, the protests, the presidential election, the extreme climate episodes – 2020 sent us searching for a word that could do justice to the scale and pace of all this upheaval” (Minegar, 2020). For those of us in health care, unprecedented in 2020 meant the added daily stress in witness of suffering and death from COVID-19, the emphasis and availability of personal protective equipment to safeguard the provider, patient, and community, along with navigating the use of precious resources to maintain quality for as many patients as possible. For professionals working in organ donation for transplantation, unprecedented is also a word that was commonly used during the tumultuous year of 2020 and over the last several years. As a community of Organ Procurement Organizations (OPO), transplant centers, and donor hospitals where a potential donor is identified, the number of deceased organ donors has experienced unprecedented growth in the last decade. Since 2011, there has been a 54.9% (4,463) growth in the number of recovered donors in the United States. During the year of the SARS-CoV-2 pandemic, there was a 6.1% (718) growth of recovered deceased donors compared to 2019 (U.S. Department of Health & Human Services, 2021). This increase in deceased donors equated to more transplants. Since 2011, there has been an increase in transplants from deceased donors by 47.8% (10,778) and a growth from 2019 of 3.1% (987). Considering the pandemic’s effect on donation and transplantation, one can call these increases unprecedented in the number of lives impacted and saved through the incredible gift of organ donation (U.S. Department of Health & Human Services, 2021). Nevertheless, there was also a discouraging change in transplantation in 2020 due to COVID-19. In March 2020, out of the uncertainty of the effects of the virus and concern for patients, along with centers focusing their resources on emergent needs, 72% of transplant centers in the U.S. suspended their living-donor transplant programs (Boyarski, et al., 2020). Considered “non-essential” elective medical procedures, kidney transplants, especially from living donors, were placed on hold. In a letter to the Department of Health and Human Services (HHS) in March 2020, the National Kidney Foundation urged centers and specifically HHS to stress the importance of defining “nonessential” procedures that included access to kidney transplantation. “The National Kidney Foundation urged the Administration to distinguish which procedures are truly elective and non-essential from procedures – like organ recovery and kidney transplant – that have immediate, significant, and life-long benefits for patients. These delays and barriers would effectively preclude most life-saving kidney transplants for the near term” (National Kidney Foundation, 2020). Overall, for 2020, national living donation and transplant rates declined by 22.4% (1,655) in comparison to the previous year (U.S. Department of Health & Human Services, 2021). There are currently over 108,000 candidates in the U.S. waiting for a solid organ transplant (Organ Procurement & Transplant Network, 2021). The vast majority (84.5%) of these patients hope for a kidney from the generous gift of either a living or deceased donor. Others are looking forward to a new heart, lungs, liver, pancreas, or intestine to save, heal, and enhance their life. In Nevada, over 600 patients are hoping for a transplant. Nevada has also seen unprecedented growth in donation and transplantation. Since 2011, the number of deceased donors from Nevada residents has increased an extraordinary 206.2% (134), resulting in thousands of transplants across the country, including over 500 Nevadans (U.S. Department of Health & Human Services, 2021). In 2020, twenty additional deceased organ donors from the previous record year represented an 11.2% increase (U.S. Department of Health & Human Services, 2021). These are remarkable accomplishments. Unfortunately, there are still too many deaths for those who require a solid organ transplant in the U.S. and Nevada. On average, 17 people die every day waiting for a transplant, and another person is added to the national waitlist every nine minutes (Health Resources & Services Administration, 2020). Although these numbers do not compare to our experiences of death during the COVID-19 pandemic, they have been consistent year over year, resulting in tens of thousands of deaths. With the world realizing a death toll from the SARS- CoV-2 virus projected at close to three million and the U.S. over 550,000 by May 1, 2021 (Institute of Health Metrics and Evaluation, 2021), we find ourselves focused on another phrase. What is our “new normal” going to be in 2021 and beyond? Many of us have a current “normal” allowing us to go to restaurants that are restricted to a lower than standard capacity. We have access to grocery stores and our favorite big box store. Moreover, we can enjoy the relative freedom to move about while following mask-wearing guidelines, social distancing, and avoiding crowds outlined by the Centers for Disease Control and our state government. Our “normal” is very different from those in our nation and state awaiting a solid organ transplant. The impact of COVID-19 on donation and transplantation in the U.S. has yet to be fully realized. The initial examination has shown a probable loss of life of those on the waiting list due to the virus’s overall impact. Additional research is needed. All healthcare entities involved in providing transplants are focused on improvement. Also, upcoming governmental changes are pushing for increasing the recovery and transplant of organs. In July 2019, the “Advancing American Kidney Health” presidential executive order was enacted, promoting several goals in improving kidney health, including doubling the number of kidneys available for transplant by 2030. This order put in motion an extensive governmental review of the country’s 58 OPOs. The review included what measures and how all not-for-profit OPOs are evaluated and certified. In November 2020, this evaluation led to the Centers for Medicare and Medicaid Services (CMS) updating guidelines and conditions for coverage for OPOs. The new measures are designed to “…improve the quality of OPO services and hold underperformers accountable” (CMS, 2020). OPOs will be focused on meeting overall donation rates and transplantation rates, with the new proposal estimating the addition of 8000 annual transplants. These measures include a higher level of transparency using reliable data to evaluate each procurement agency and place requirements for quality assurance and performance improvement on underperforming OPOs. These changes continue to focus all OPOs on providing as many organs as possible to reduce the suffering and deaths of those experiencing end-stage organ failure. However, OPOs cannot do this alone. OPOs are reliant upon hospital partners to identify and refer all possible donor candidates. State and federal statutes outline the need for hospitals to refer patients promptly to their affiliated OPO. Studies show that there must be “…a universal understanding that timely referrals provide both the organ procurement and the bedside teams with the time they need to optimally support the family while preserving their opportunity to donate” (Wojda, et al., 2017). Allowing time for OPOs to mobilize their resources for collaborative evaluation, determination of suitability, and families’ interactions is crucial for increasing the number of available organs to waiting recipients. With OPOs and donor hospitals doing everything they can to ensure organ availability, transplant centers should be driven to ensure every healthy and safe organ is implanted. In March 2021, new guidelines outlined by the U.S. Public Health Service (PHS) for assessing donors and recipients for HIV, Hepatitis B virus, and Hepatitis C virus will be implemented. The guidelines remove the term “increased risk” from donors who have previously been classified as posing a possible higher risk of transmitting these viruses through a solid organ transplant. Since 2013, this label is thought to have led to the discard of hundreds of organs annually (Volk, Wilk, Wolfe, & Kaul, 2017). The dramatic improvement in evaluation and testing in the last several decades for potential organ donors has led to the PHS changes for risk assessment in hopes that more organs will help waiting recipients (Jones et al., 2020). Patients waiting for a transplant who were already facing daily challenges of managing chronic and acute demands of living with organ failure such as dialysis, ventricular assist devices, oxygen therapy, and frequent lab and medical assessments did not decrease in 2020 during the COVID-19 pandemic. With over 91,000 patients on the national kidney waiting list, the majority of whom receive maintenance dialysis, merely managing the exposure of COVID-19 while trying to provide safe transplants for these vulnerable patients has been challenging. COVID-19 has affected potential recipient patients around the country and here in our local communities within Nevada. The precious gifts from deceased and living donors continue to trend upward, but we, as a collective of donor hospitals, transplant centers, and OPOs, have an obligation to those waiting recipients that most of us will never meet. Are you doing your part? References Boyarski, B. J., Werbel, W. A., Durand, C. M., Avery, R. K., Jackson, K. R., Kernodle, A. B., . .. Massie, A. B. (2020). Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic. American Journal of Transplantation, 20(11), 3131-3139. doi:10.1111/ajt.16167 Centers for Medicare & Medicaid Services. (2020, November 20). CMS finalizes policy that will increase the number of available lifesavings organs by holding organ procurement organizations accountable through transparency and competition. Retrieved from CMS.gov: News Room: https://www.cms.gov/newsroom/press-releases/cmsfinalizes-policy-will-increase-number-available-lifesavingsorgans-holding-organ-procurement#:~:text=The%20 first%20new%20measure%20is,an%20organ%20 transplantation%20rate%20measure. Centers for Medicare & Medicaid Services. (2020, November 20). Organ Procurement Organization (OPO) Conditions for Coverage Final Rule: Revisions to Outcome Measures for OPOs CMS-3380-F. Retrieved from CMS.gov: Newsroom Fact Sheet: https://www. cms.gov/newsroom/fact-sheets/organ-procurementorganization-opo-conditions-coverage-final-rulerevisions-outcome-measures-opos Health Resources & Services Administration. (2020, September). Organ Donation Statistics. Retrieved from Organdonor.gov: U.S. Government Information on Organ Donation and Transplantation: https://www. organdonor.gov/statistics-stories/statistics.html Institute of Health Metrics and Evaluation. (2021, January 15). IHME: COVID-19 Projections. Retrieved from Institute of Health Metrics and Evaluation: http://www.healthdata.org/ Jones, J. M., Kracalik, I., Levi, M. E., Bowman, J. S., Berger, J. J., Bixler, D., . . . Basavaraju, S. V. (2020). Assessing solid organ donors and monitoring transplant recipients for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection — U.S. public health service guideline, 2020. MMWR. Recommendations and Reports, 69(4), 1-16. doi:10.15585/mmwr.rr6904a1 Minegar, A. (2020, December 16). Merriam-Webster's 2020 Word of the year is 'pandemic,' people choose 'unprecedented'. Retrieved from WWMT News - West Michigan: https://wwmt.com/news/offbeat/merriamwebsters-2020-word-of-the-year-is-pandemic-peoplechoose-unprecedented National Kidney Foundation. (2020, March 19). National kidney foundation urges clarity and flexibility on elective surgery procedures during COVID-19 outbreak. Retrieved from National Kidney Foundation: https:// www.kidney.org/news/national-kidney-foundationurges-clarity-and-flexibility-elective-surgeryprocedures-during Organ Procurement & Transplant Network. (2021, January 21). Organ Procurement & Transplantation Network: Data. Retrieved from U.S. Department of Health & Human Services: https://optn.transplant.hrsa.gov/data/ U.S. Department of Health & Human Services. (2021, January 21). National Data: Donors Recovered in the U.S. by Donor Type. Retrieved from Organ Procurement and Transplantation Network: https://optn.transplant. hrsa.gov/data/view-data-reports/national-data/# U.S. Department of Health & Human Services. (2021, January 21). National Data: Transplants by Donor Type. Retrieved from Organ Procurement & Transplantation Network: https://optn.transplant.hrsa.gov/data/viewdata-reports/national-data/# U.S. Department of Health & Human Services. (2021, January 21). State Data: Donors Recovered in the U.S. by Donor Type. Retrieved from Organ Procurement and Transplantation Network: https://optn.transplant.hrsa. gov/data/view-data-reports/state-data/# U.S. Department of Health & Human Services. (2021, January 21). State Data: Transplants by Donor Type. Retrieved from Organ Procurement and Transplantation Network: https://optn. transplant.hrsa.gov/data/view-data-reports/state-data/ Volk, M. L., Wilk, A. R., Wolfe, C., & Kaul, D. R. (2017). The “PHS increased risk” label is associated with non-utilization of hundreds of organs per year. Transplantation, 101(7), 1666-1669. doi:10.1097/ TP.0000000000001673 Wojda, T. R., Stawiski, S. P., Yandle, K. P., Bleil, M., Axelband, J., Wilde-Onia, R., . . . Shultz, J. (2017). Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing healthcare organization. International Journal of Critical Illness & Injury Science, 7(2), 91-100. doi:10.4103/IJCIIS. IJCIIS_30_17
March, April, May 2021 Nevada RNformation • Page 21 Focus on Fighting the Pandemic, Not Each Other Angela Fountain, RN Reprinted with permission from Arizona Nurse January 2021 With the stress of fighting the yearlong pandemic while nurses are being stretched to new lengths in their work environments, it is a good time to revisit the topic of incivility. What is it? Does it really matter? How can I prevent my work environment from having the toxic effect of incivility? Incivility – What is it? Incivility has been referred to as lateral violence, horizontal violence, and bullying (Blair, 2013). Incivility has further been defined as “any behavior toward a coworker that is perceived as or intended to humiliate, demean, belittle, diminish, and/or isolate and leads to a power relationship in which the abuser attempts to control the victim” (Bunk & Magley, 2013, p. 87). Incivility violates social norms of workplace etiquette and can involve being condescending, displaying impatience, refusing to answer questions and general disrespect toward another co-coworker (Kaiser, 2017). We, as nurses, should focus on understanding the impact of uncivil behaviors as incivility affects all personnel and can diminish communication, which is vital to promoting the delivery of safe patient care. Incivility – Who does it? Does it really matter? Incivility has the potential to occur in all workplaces in all parts of the world. Healthcare has had especially high incidences of reported bullying worldwide and the subject of incivility has been studied in undergraduate programs, advanced practice specialties, medical school programs, residencies, and some advanced practice student roles in all areas of the world (Winston, 2017). Within the United States, incivility has been studied specifically within the nursing profession and has been reported to be as high as 48% (Keller, Budin, & Allie, 2016). Professional advocacy agencies, like the American Nurses Association, (ANA) have taken strong positions against bullying in an attempt to reduce medical errors and improve the health care and safety of patients (ANA, 2015). In order for us to know about whether there is incivility within our workplace, workplace culture should be assessed periodically as culture can change rapidly. As nurses, we recognize that for every action, there is a reaction. This should prompt us to think about the collateral damage uncivil work cultures cause. Not only can errors be made, or patients harmed, there are physical consequences for persons exposed to incivility. Sauer et al., (2017), found that nurses who experience bullying, have decreased physical functioning, have more complaints of body pain, and overall felt in poorer general health. Healthy nurses are better able to care for patients, have fewer complaints of burnout and display less compassion fatigue. By assessing and understanding the direct relationship between perceived bullying and burnout, we can prevent burnout, keep our patients safe and our staff healthy. Feng et al., (2016) found that varying levels of experience and work areas are key contributors of workplace bullying. Areas that are highly stressful such as intensive care units, emergency departments, and operating theaters yield a higher perceived level of incivility. Novice nurses also perceived more incivility than did more experienced nurses. While this has a variety of factors that can be the cause, it is important to recognize and support novice nurses as they begin their practice while providing ongoing support for more experienced nurses. Through the study of incivility, it has been identified that colleague support and promoting professional competence reduce incivility in the workplace while increasing job performance and satisfaction. How can I prevent the ill effects of incivility in my workplace? It takes work but promoting a civil work environment is not only personally rewarding by having a work environment where we enjoy, it promotes better patient care, better outcomes and less attrition. Reforming flawed processes of tolerating incivility may help reduce chronically high turnover which also helps reduce the costs associated with turnover. Promoting civil work environments supports effective communication which yields to greater patient safety and the promotion of an effective team environment. An effective team environment may result in a decrease in attrition with the possibility of providing greater productivity. Creating a positive workplace culture is a win-win-win. You win, patients win, the hospital wins. Don’t let your workplace culture become tainted by incivility. This pandemic is hard enough on us- take care of each other. Angela Fountain, DNP, CRNA References American Association of Nurse Anesthetists [AANA]. (2014). Promoting a culture of safety and healthy work environment practice considerations. Retrieved from: http://www.aana.com/resources2/professionalpractice/ Documents/PPM Promoting a Culture of Safety and Healthy Work Environment.pdf Apt, C. (2016). The bullying of nurses by nurses. Psychology and Education: An Interdisciplinary Journal, 53(1-2), 50- 55. Retrieved from http://login.ezproxy1.lib.asu.edu/ login?url-https://search-proquest-com.ezproxy1.lib.asu. edu/docview/1835035530?accountid-4485 Blackstock, S., Harlos, K., Macleod, M. L. P., & Hardy, C.L. (2015). The impact of organizational factors on horizontal bullying and turnover intentions in the nursing workplace. Journal of Nursing Management, 23(8), 1106-1114. http://dx.doi.org.exproxy1.lib.asu. edu/10.1111/jonm.12260 Blair, P. (2013). Lateral violence in nursing. Journal of Emergency Nursing, 39(5), e75-e78. Doi: 10.1016/j. jen.2011.12.006 Boyd, D., & Poghosyan, L. (2017). Certified registered nurse anesthetist working conditions and outcomes: A review of the literature. American Association of Nurse Anesthetist Journal, 85(4), 261-270. Bunk, J. A. & Magley, V. J. (2013). The role of appraisals and emotions in understanding experiences of workplace incivility. Journal of Occupational Health Psychology, 18(1), 87-105. http://dx.doi.org.ezproxy1.lib.asu. edu/10.1037/a0030987 Chrysafi, P., Simou, E., Makris, M., Malietzis, G., & Makris, G. C. (2017). Bullying and sexual discrimination in the Greek health care system. Journal of Surgical Education, 74(4), 690-697. 10.1016/j.jsurg.2016.12.005 Clark, C. M. (2011). Pursuing a culture of civility: An intervention study in one program of nursing. Nurse Educator, 36, 98-102. Doi:10.1097/ NNE.0b013c3182161238 Cuff, P. A, & Institute of Medicine. (2014). Establishing transdisciplinary professionalism for improving health outcomes: Workshop summary. Washington, D. C.: National Academies Press. Retrieved from http://www. napedu/catalog/php?record_id=18398 Elblad, R., Kodjebacheva, G., & Lebeck, L. (2014). Workplace incivility affecting CRNAs: A study of prevalence, severity, consequences with proposed interventions. AANA Journal, 82(6), 437-445. Giorgi, G., Mancuso, S., Perez, F., D’Antonio, C. A, Mucci, N., Cupelli, V. & Arcangeli, G. (2016). Bullying among nurses and its relationship with burnout and organizational climate. International Journal of Nursing Practice 22(2), 160-168. http://dx.doi.org.ezproxy1. ib.asu.edu/10.1111/ijn.12376 Guidroz, A., Geimer, J., Clark, O., Schwetschenau, H. & Jex, S. (2010). The Nursing Incivility Scale: Development and Validation of an Occupation-Specific Measure. Journal of Nursing Measurement. 18. 176-200. 10.1891/1061-3749.18.3.176. Henson, R. (2001). Understanding Internal Consistency Reliability Estimates: A Conceptual Primer on Coefficient Alpha. Measurement and Evaluation in Counseling and Development, 34. 177-89. Hutchinson, M., & Hurley, J. (2013). Exploring leadership capability and emotional intelligence as moderators of workplace bullying. Journal of Nursing Management, 21(3), 553-562. http://dx.doi.orgezproxy1.lib.asu. edu/10.1111/j.1365-2834.2012.01372.x Kaiser, J. A. (2017). The relationship between leadership style and nurse to nurse incivility: Turning the lens inward. Journal of Nursing Management, 25(2), 110- 118. http://dx.doi.org.ezproxy1.lib.asu.edu/10.1111/ jonm.12447 Keller, R., Budin, W. C., & Allie, T. (2016). A task force to address bullying. American Journal of Nursing, 116(2), 52-58. http://dx.doi.org/10.1097/01. NAJ.0000480497.63846.d0 Krathwohl, D.R., Bloom, B.S., Masia, B.B., (1964). Taxonomy of educational objectives: The classification of educational goals. Handbook II: Affective Domain. David McKay Co., Inc: New York. Li, Y., & Zhang, L. (2016). Workplace bullying among nurses in south Taiwan. Journal of Clinical Nursing. 25(8). 2450-2456. Retrieved from http://login.ezproxy1. lib.asu.edu/login?url=https://search-proquest-com. exproxy1.lib.asu.edu/docview/870550069?account id=4485 Livine, Y., & Goussinsky, R., (2017). Workplace bullying and burnout among healthcare employees: The moderating effect of control-related resources. Nursing & Health Sciences, 1-10. 10.1111/nhs.12392 Logan, T. R., & Malone, M. D. (2018). Nurses perceptions of teamwork and workplace bullying. Journal of Nursing Management Jan 2018. 10.1111/jonm.12554 Mangold, K., Denke, N., Gorombei, C., Ostroski, T., & Root, L. (2014) Principles of successful partnerships. Nursing Administration Quarterly. 38(4), 340-347. Occupational Safety and Health Administration. (n.d.) Safety and health topics workplace violence. Retrieved from https://www.osha.gov/SLTC/workplaceviolence/ Sciences, (3)2, 13-222. Olsen, E., Bjaalid, G., & Mikkelsen, A. (2017). Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: A study among hospital nurses. Journal of Advanced Nursing, 73(11), 2709-2719. Retrieved from http:// login.ezproxy1.lib.asu.edu/login?url=https://searchproquest-com.exproxy1.lib.asu.edu/docview/19739891 24?accountid=4485 Quinn, L. P. (2017). Bullying and nurses’ work experience, coping self-efficacy beliefs, job satisfaction and intent to leave one’s job (Ph.D.) Available from PsycINFO. (18789901724; 2016-47717-284). Retrieved from http://login.ezproxy1.lib.asu.edu/login?url-https:// search-proquest-com.ezproxy1.lib.asu.edu/docview/181 2936936?accountid=4485 Sauer, P. A., & McCoy, T. P., (2017). Nurse bullying: Impact on nurses’ health. Western Journal of Nursing research 39(12) 1533-1546. 10.1177.0193945916681278 Srabstein, J. C., & Leventhal, B. L. (2010). Prevention of bullying-related morbidity and mortality: a call for public health policies. Retrieved from www.who.imt/ bulletin/volumes/88/6/10-077123/en/ Trepaier, S., Fernet, C., Austin, S., & Boudrias, V. (2016). Work environment antecedents of bullying: A review and integrative model applied to registered nurses. International Journal of Nursing Studies, 55, 85- 97. http://dx/doi.org.ezproxy1.lib.asu.edu/10.1016/j. ijnurstu.2015.10.001 Vessey, J. A., Demarco, R. F., Gaffney, D. A., & Budin, W. C. (2009). Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 16(1), 47-56. Winston, M. E. (2017). Student registered nurse anesthetists’ perceptions of bullying and its impact on learning (D.N.P.) Available from PsycINFO (1987917782; 2017-54451-193). Retrieved from http:// login.zproxy1.lib.asu.edu/login?url=https://searchproquest-com.exproxy1lib.asu.edu/docview/195146745 4?accountid=4485 Wood, R. M. W. (2016). Workplace bullying between registered nurses; Occurrence and perceived effects on work productivity (Ph.D.). Available from PsycINFO. (1951467454; 2017-23163-151). Retrieved from http:// login.ezproxy1.lib.asu.edu/login?url=https://searchproquest-com.ezproxy1.lib.asu.edu/docview/19514674 54?accountid=4485 Yanofsky, S. D. & Nyquist, J. G. (2010). Using the affective domain t enhance teaching of the ACGME competencies in anesthesiology training. Journal of Education Perioperative Medicine 12 (1). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4719552/.
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