This
page presents the various scholarly researches and articles done by
people who used Virginia Henderson's Theory as their inspiration. These
works have served as guides for the enhancement of our profession.
Furthermore, more studies are being made incorporating Henderson's model
various aspects. Also in this page, the UPOU-MAN contributors have
summarized a few articles and how it can be applied in our day-to-day
interaction with our clients.
Virginia Henderson's Principles and Practice of Nursing Applied to Organ Donation after Brain Death
by Nicely, Bruce, DeLario, Ginger T
Registered
nurses were some of the first non-physician organ transplant and
donation specialists in the field, both in procurement and clinical
arenas. Nursing theories are abundant in the literature and in nursing
curricula, but none have been applied to the donation process. Noted
nursing theorist Virginia Henderson (1897-1996), often referred to as
the "first lady of nursing," developed a nursing model based on
activities of living. Henderson had the pioneering view that nursing
stands separately from medicine and that nursing consists of more than
simply following physicians' orders. Henderson's Principles and Practice
of Nursing is a grand theory that can be applied to many types of
nursing. In this article, Henderson's theory is applied to the intensely
focused and specialized area of organ donation for transplantation.
Although organ donation coordinators may have backgrounds as physicians'
assistants, paramedics, or other allied health professions, most are
registered nurses. By virtue of the inherent necessity for involvement
of the family and friends of the potential donor, Henderson's concepts
are applied to the care and management of the organ donor, to the
donor's family and friends, and in some instances, to the caregivers
themselves. (Progress in Transplantation. 2011;21:72-77)
The
nurse is temporarily the consciousness of the unconscious, the love of
life of the suicidal, the leg of the amputee, the eyes of the newly
blind, a means of locomotion for the newborn, knowledge and confidence
for the young mother, a voice for those too weak to speak.1
Nursing
theorist Virginia Henderson (1897-1996), often referred to as the
"first lady of nursing," penned these words in "The Concept of
Nursing,"1 in a section titled "Nursing's Unique Function." Of the 4
categories of nursing theory (metatheory, grand theory, middle range
theory, and practice theory), Henderson's grand theory of activities of
living provides a range of ideas that is broad enough for the theory to
be applied to the donation process.2
For
clarity, organ donor in this work is defined as an individual who is
brain dead and is a candidate for solid-organ donation for
transplantation. Although it is possible for living patients to donate
some organs (eg, a kidney, a liver segment, the lobe of a lung),3 this
article is limited to deceased donors. (Note:
Donation after cardiac death is another possibility for organ donation
but is not discussed here either.) Nurse herein refers to both
registered nurses practicing as organ procurement professionals or
nurses practicing in the clinical setting, caring for a patient who has
or may become an organ donor.
Although
most organ procurement organizations do not include nutritional
supplementation in organ donor management, some evidence suggests that
the potential organ donor would benefit from supplementation of
dextrose, amino and fatty acids, and glutamine.'7 Nutrients such as
dextrose, glutathione, adenosine, and raffinose are included in the
various preservation solutions delivered directly to the organs during
recovery and transport.18 For the potential organ donor, Henderson's
concept of assisting a client to "eat and drink adequately" is expanded
to establishing and maintaining hydration and normovolemia to support
adequate organ function.
Elimination of Body Waste
Henderson
lists "elimination of body waste"13 as the third activity. When brain
function is impaired, production of antidiuretic hormone often decreases
and halts completely with brain death. Kidneys are often highly
sensitive to this injury and frequently respond by decreased urine
output, diabetes insipidus, or other anomalies. The nurse, who
understands the delicate balance between kidney function and many other
body systems, will know that monitoring organ function through
laboratory testing at regular intervals is essential and will suggest
interventions as needed. Insightful nurses who are working with
potential organ donors also understand that fluid overload is often an
unfortunate side effect of trauma care- although it may not be evident
for several hours- so the nurses will monitor multiple indicators (eg,
arterial and/or central catheters) and suggest interventions to maintain
stability.
It
can also be challenging for nurses to reconcile the visible with the
invisible. Nurses may need to review the fact that without the
ventilator there would be no breathing and may need to allow the
patient's family to be present during apnea testing. The nurse may need
to review the legal and ethical definitions of brain death and review
the criteria under which brain death is determined. The nurse's
understanding of, and comfort with, brain death is essential. If a
patient's family perceives uncertainty from the nurse, they may be
hesitant to trust a brain death declaration, which may adversely affect
organ donation.21 The situation can cause fragile emotions, which left
unchecked, can lead to a difficult environment.
Maintain Body Temperature Within Normal Range by Adjusting Clothing/Modifying Environment
"Maintain
body temperature within normal range by adjusting clothing and
modifying environment" is Henderson's next activity.13 Along with loss
of voluntary nervous control, neurological devastation also compromises
the hypothalamus, weakening the body's ability to regulate temperature.
It is not uncommon for a brain-injured patient to experience body
temperatures ranging from hypothermic to hyperthermic. Hyperthermia
increases the metabolic and oxygen consumption rates. Hypotension causes
a left shift in the oxyhemoglobin dissociation curve, impairing oxygen
delivery to the tissue and decreasing the ability of the kidneys to
concentrate urine. External adjustments are required to prevent further
damage.16 Additionally, some patients who become donors have succumbed
to meningitis, either bacterial or viral, which causes even more
temperature fluctuation. Warming- or cooling- the patient should be a
routine part of trauma care, and, as Henderson implies, the nurse
provides this care when the patient cannot. The nurse must respond to
temperature extremes with cooling blankets, heating lamps, or other
technological interventions.
Grooming/Protecting the Integument
Nurses
should take great care in the use of specific language when
communicating with the family. When a patient is declared brain dead,
health care professionals commonly use terminology such as "braindead"
rather than "dead" and "life-support" when referring to the ventilator.
These terms can be confusing to the patient's family. Using the term
"dead" sends a more definitive message to the family that their loved
one is, in fact, dead.22 Terms such as "retrieval," "procurement," and
"harvest" are often used to describe the surgical procedure through
which organs are removed from the donor. Richardson24 argues that the
word "retrieval" implies that the organs belong to someone other than
the donor and we are merely taking them back while "procurement" refers
to commerce and commodities and tends to focus on the recipient rather
than the donor. Although one might argue that "harvest" refers to a time
of plentitude and thanksgiving, harvesting of crops was traditionally
done by "sickle or scythe, the same implements used by the Grim Reaper,
Death."24 For these reasons, nurses should use the term recovery.
Recovery implies healing, and although the donor will not be healed, it
can aid in the healing of the donor family by offering some solace or
comfort in their grief by looking at donation as a way to bring meaning
to the death of their loved one.22 Many people encounter organ donation
with misconceptions that nurses should work to correct, and nurses must
do so with great finesse so as not to undermine individual belief
systems or values.
Worship According to One's Faith
Henderson
lists "worship according to one's faith" as the next activity.13 Most
of the practice of nursing, and certainly death and dying, may prompt
nurses to call upon their own spiritual beliefs. Patients and patients'
families may have different beliefs, which nurses must respect. Nearly
all religious groups support organ donation as long as it does not
impede the life or hasten the death of the donor.25 In the case of an
organ donor, clergy may be called in to support the family. When
considering donation, the family may look to a faith leader for
answers.25 Nurses may find opportunities not only to communicate
information to the clergy, but perhaps also to facilitate worship or
end-of-life rituals for the family at the bedside to outwardly express
their grief.26 Additionally, repeated exposure to episodes of death may
prompt nurses to further explore their own spiritual journey and give
them a choice to participate in worship as grief support for themselves.
Play and Recreation
Of
all health providers, nurses render the most intimate personal service.
. . . Perhaps the quality people most often seek in the nurse is that
of a comforting presence. If there is a universal concept of nursing it
embodies the characteristics of a service that is intimate, constant and
comforting.
Conclusion
Virginia
Henderson's Activities for Client Assistance within her concept of
nursing apply logically and easily to the complex process of organ
donation for transplantation. Applied within the broader context of the
nursing metaparadigm- person, environment, health, and nursing-
Henderson's activities provide an excellent framework within which
nurses can work competently. Henderson was cognizant of the need to
include the patient's family, and her tenets work equally well in caring
for them. Nurses must advocate for patients. Unfortunately, not all
health care professionals, including physicians and nurses, understand
brain death.28 It can be an ethical minefield if the health care team
compromises care that could save the patient's life, fails to take
appropriate actions to preserve organ function, or takes actions
incongruent with the Nurse Practice Act.
Henderson
said of her theory that "the complexity and quality of the service is
limited only by the imagination and the competence of the nurse who
interprets it.'" She also alluded to nurses' autonomy. Expanding
opportunities for nurses to specialize in advanced practices, such as
organ donation and transplantation, is an ideal fit for Henderson's
concept of nursing. The activities she lists as crucial elements of
excellent patient care extend to the patient's family, and in the case
of organ donation, to the recipients of donated organs. The nurse who
applies Henderson's concepts throughout the donation process will
contribute significantly to transferring the gift of life from one human
being to one or more patients at the next phase of the donation
process.
Comments from the Contributor
The
article best describes the theory of Henderson which explains the
interactions and consequences of interactions that are related to
assessment, diagnosis and interventions; which also explain the context
of health and illness that account for human variations. A patient has
his set of human basic needs and problems in dealing with daily
activities.
However,
ethical issues ad protocols and permissible societal boundaries should
be brought into consideration regarding organ donation after brain
death. In order to maintain and protect the integrity of
transplantation, this practice should be based on concise scientific
data and accepted principles and protocols so as to serve its purpose,
and that is to bring about new hope and new life for a person. Based on
Henderson’s Theory in which there is the identification of 14 basic
needs, the outcome of transplantation will bring about the enhancement
of a person’s life for the better.
The
roles nurses play provide an image of someone who is active and helpful
to the patient who is striving for independence and focused on doing a
deliberate and well planned activity, that is pursuing to have a will to
do daily activities; and that is complementing and supplementing
knowledge for the good of the patient and of the patient’s significant
others. The nurse thus assists and aides in the promotion and recovery
of a patient who had just undergone transplantation, as well as educate
the significant others to provide support for the recovery and wellness
of the patient.
Nicely, Bruce "Virginia Henderson's principles and practice of nursing applied to organ donation after brain death".
Progress in Transplantation. FindArticles.com. 10 Jul, 2011.
http://findarticles.com/p/articles/mi_qa4117/is_201103/ai_n57242444/
Copyright North American Transplant Coordinators Organization Mar 2011
Provided by ProQuest Information and Learning Company. All rights Reserved
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2. Henderson, Virginia. "Excellence in Nursing." American Journal of Nursing 100 (October 2000): 961.
3. Acceptance and Commitment Therapy (ACT) http://www.nursingplanet.com/pn/acceptance_commitment_therapy.html
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Related sites/links
1. Nursinglibrary.org
2. Evidence-Based Nursing http://ebn.bmjjournals.com
3. Online Journal of Issues in Nursing http://www.nursingworld.org
4. Virginia Henderson International Nursing Library (VHINL) database http://www.nursinglibrary.org/portal/main.aspx "The
Virginia Henderson International Nursing Library is committed to
providing knowledge resources to help advance nurses and patient care.
The library is dedicated to bringing you the latest research on nursing
knowledge that is important to all nurses – clinicians, researchers,
educators, and students."
5. http://www.nlm.nih.gov/ --biography
-Nadine Mamontuan
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