Contributing to the evolution of NYU Langone Health’s (previously known as New York University Langone Medical Center) face transplant care protocol has been a remarkable journey for four nurses, who published a detailed article on nursing care at all stages of the procedure.
“Perioperative Nursing Management of Donor and Recipient Patients Undergoing Face Transplantation,” which was authored by Nicole Sweeney, MS, RN, CNOR, AGACNP-BC; Kathryn Allen, MSN, RN, CNOR; Brooke Miller, MS, RN, CCRN, AGPCNP-BC; Theresa Nolan, MSN, RN, CAPA; and Kathleen Sheerin, BSN, RN, CNOR, was published by the AORN (Association of periOperative Registered Nurses) journal in July.Sweeney, the medical center’s face transplant coordinator, said the manuscript is the first one to speak to the actual nursing care involved with face transplantation patients, especially in the perioperative setting.
“[The article] is meant to help other institutions get their nursing care up and running for this procedure,” Sweeney said.
Since 2005 at least 35 face transplants have been documented worldwide, according to an article published in the Plastic Surgery Education Network’s online news page.
Sharing her team’s research and experience in the AORN Journal, Sweeney said, can benefit other nurses who will be part of face transplantation teams, enabling them to meet challenges more effectively and provide seamless patient care.
“Just hearing the words ‘face transplant’ can be kind of daunting to those who haven’t heard of that kind of patient,” Sweeney acknowledged.
She explained that there are some similarities with patients who undergo solid organ or free-flap transplants. But much is different.
Preparation and collaboration are key
The nurses’ article describes a substantial amount of preparation necessary before the transplantation. It details the steps and processes that enabled this team to successfully reach the transplant stage.
Sweeney said the team benefitted from having all the transplant staff involved in the entire planning process, including briefing before and debriefing after multiple cadaver rehearsals. These rehearsals enabled the surgeons and the intraoperative nursing team and surgical techs to practice needed skills under what were seen as real-time conditions.Kathryn Allen, MSN, RN, CNOR, director of perioperative services, said cadaver practice experiences were invaluable in planning for instruments, supplies, equipment, room set up, patient flow and staff needs. These practice runs also built confidence in the nurses before the actual procedure.
More than 100 staff from many medical disciplines took part in the face transplantation procedure. As the nursing teams in and outside of the OR prepped and planned, each individual had a voice in the process, Allen said.
Working within a multidisciplinary team environment was routine for the nurses, Sweeney said, but one different element was their involvement with the organ procurement team from Live On NY, a nonprofit organ procurement organization dedicated to the recovery of organs and tissue for transplant in the greater New York metropolitan area.
“[The collaboration] was eye-opening for the OR team since intraoperative nurses are unusually not involved with the organ procurement process,” she said.
Kathleen Sheerin, BSN, RN, a nurse manager for NYULMC’s main OR, agreed. “Collaboration included an inservice that Live On NY presented to the entire OR staff regarding facts and myths surrounding organ donation,” she said. Live On NY also was present at every practice run leading up to the procedure, Sheerin said.Sheerin also said continuity of care was a facet that stood out to the nursing team. “We planned ahead and did a lot of practice [in maintaining continuity of care]; that’s what made it such a success,” she said. “We never planned like this for other transplants.” Pre-op, perioperative and post-op nursing members worked together in an unprecedented manner for this procedure, according to Sheerin.
Sweeney said that as a nurse practitioner she also appreciated the continuity of care. Face transplantation surgery meant the patient received inpatient care for an extended time while awaiting the surgery, as well as postoperatively. “We can’t often do [ongoing care] with other patients,” Sweeney noted.
As a result of the pre-op process, the perioperative nursing teams had an opportunity to meet with the patient and establish the nurse-patient relationship, an integral partnership needed to guarantee safe and effective management, the authors stated in the article.
To assist nurses who may be part of a similar care experience in the future, the authors provided a wealth of tools, such as clinical pathway guidelines, patient care needs intraoperatively, detailed scheduling for the two operating rooms that were in use simultaneously during the procedure, and room setups for both donor and recipient teams.
Since the article’s publication, the nursing team has received positive responses. “We’ve been really proud [of the outcome],” Sweeney said. “We touched on every detail that we did in preparation for making sure the nurses were comfortable ahead of time, making sure their voices were heard.”
The article, she said, has also demonstrated how well the team accomplished their work. “[The article] exemplifies the work we do — autonomous, being the patient’s advocate, working cohesively as a team,” Sweeney said. “There’s not a lot of literature out there [related to face transplantation] especially for nurses. It’s been important for us to give back to others to make sure they can give great care using what we’ve learned.
Freelance writer Karen Schmidt, RN, contributed to the research and writing of this article.
Courses Related to ‘Organ Donation and Perioperative Nursing’
CE339-60: The Organ and Tissue Donation Choice (1 contact hr)
Nurses are most likely to identify a patient who may be a prospective donor, call the organ procurement organization, and collaborate with the OPO team when there is the possibility of donation. This module focuses on the role of the nurse in organ procurement.
CE541: Perioperative Nurses Lead the Way in Managing Surgical Patients’ Skin Integrity (1 contact hr)
Pressure injury affects the more than 2.5 million hospitalized patients each year in the U.S. Studies have shown that patients who develop pressure ulcers have an increased rate of mortality. The people most affected are older adults and people with a major injury or comorbid disease. In the OR, management of a patient’s skin integrity is a challenge. Anesthetized patients cannot adjust their position in response to physiological discomfort and lack of sensation. The state of anesthesia (general, local, block, or sedation) and anesthetic agents may compromise physiological response to ischemic tissue under pressure. Pressure injury may not be noticed until up to four days postop, and it may appear as a reddish-maroon or purple area by floor personnel. In the OR, the injured area may look reddish, which is caused by reperfusion after prolonged ischemia. This module will provide nurses with evidence-based practice changes that will promote their management of skin integrity in the OR.