The Ultimate Act of Love: Living Organ Donation—In the U.S. today, over 98,000 people of all ages are waiting to receive a donated liver, kidney, heart, or other organ to give them a second chance at life. The good news is that organ donation is on the rise, though need still far outstrips demand, particularly among minority populations whose donation rates remain below the national average. Three-quarters of transplants are from individuals whose organs are donated at their death as a last act of love by the donors themselves or their families. Today, a growing number of people actually see the result of their ultimate gift of love. They are living organ donors, and they make possible over one-fifth of all transplants each year. But who become a living donor and why? What information do they need to guide their decision? Who should be involved in the decision? And how can nurses best help support the patients and family involved in the process? Those are exactly the kinds of questions JHUSON Associate Professors Marie Nolan, PhD, MPH, RN; and Laura Taylor, PhD, RN, have been asking and answering in their groundbreaking research focused on the physical and emotional impact of living donor decisions.
Nolan's work, which also informs the fields of bioethics and end-of-life caregiving, has explored the process of living kidney donation, from the initial decision through surgical recovery. Her findings will help guide living donor education and informed consent, providing nurses and other transplant professionals information to help donors negotiate the decision regarding donation and for those who do donate, the recovery process. Taylor's findings " the first of their kind to be reported in the literature " give nurses insight into working with the family of a living kidney donor, including the stress that she found often is reported by family caregivers of living kidney donors during postoperative recovery. To help better educate and prepare potential living organ donors and their families, she developed and is pilot testing the Living Donor Information Network for Caregivers (LINC), a web-based information and support intervention. "Every living kidney donor is so generous," says Taylor. "We want them and their families to feel confident in their decision and for those who do donate, supported in their recovery."
Nolan observes, "Research on living organ donor decision-making is exciting and rewarding because it has the potential to improve so many lives." Maybe that is why she and Taylor have been joined in this work by their JHUSON colleagues Drs. Benita Walton-Moss, Linda Rose, and Anne Belcher. Their research shows great promise to inform living donor decision support and care at home and around the world.
Nurses Reach the Heart of Diverse Communities—The love of a grandmother who fought, but ultimately lost, the good fight against heart disease is the rock on which JHUSON researcher and assistant professor Deborah E. Jones, PhD, RN, determined to build nursing career. Researcher and Assistant Professor Hae-Ra Han, PhD, RN, tells a similar story about how the death of family members from heart attacks motivated a nursing career dedicated to improve both education about and management of high blood pressure. Both she and Jones were determined to make a difference in heart disease research, education, and treatment, particularly among diverse ethnic populations, including African-American women and Korean Americans. Like a number of their JHUSON colleagues working in the field of cardiovascular disease (CVD) and health, such as Professor Miyong Kim, PhD, RN, that is exactly what Jones and Han have been doing. Not surprisingly, Han's work (often in collaboration with Kim) is directed to the heart health of Korean Americans; Jones emphasizes heart issues among African-American women.
Their research into these diverse populations has found that when CVD is an issue, both populations experience the same four health problems implicated in heart disease: obesity, diabetes, high blood pressure, and high triglyceride levels. With appropriate, culturally competent outreach, people can learn how to reduce those problems through diet, exercise, medication, and stress reduction. To be successful, Jones and Han urge that misunderstandings and myths about health and illness be dispelled, such as a belief that stroke is a normal part of aging or that excessive weight is a sign of affluence and good health. Frequently, the greatest challenge is gaining the trust of the community, readying it to be open to learn about getting heart healthy. Han and Jones agree that nurses are ideally positioned to accomplish this task. Han points out, "Nurses are good communicators. We're not afraid to go to a place we don't know, talk with people we've never met, and ask them to change their health behaviors." That change in behavior is precisely what Jones and Han are after among people with or at risk for heart health problems. "When we get the community involved in our research, they invest in the outcomes and in their own improved health," Jones notes.
While Jones's grandmother did not live to see the benefits of her granddaughter's work, countless people of all ages and ethnicities are living longer, with healthier hearts, thanks to the community-based research that she, Han, and their JHUSON colleagues continue to pursue.
Getting to the Heart of the Hurt—When JHUSON Associate Professor Daniel J. Sheridan, PhD, RN, is at work, his patients' injuries speak to him, often in the language of violence, abuse, and neglect, confirming or contradicting what the patient, an attentive family member, or other caregiver has told him. When he isn't listening to injuries, Sheridan teaches his students how to listen to injuries and to communicate with patients with empathy and compassion. It sounds like the plot of a new high-tech, high-drama television series patterned after CSI, The Mentalist, or Lie to Me, each of which inevitably begins with a victim of foul play. It's not; it's the daily work of one of the leading forensic nurses in the country. In contrast to the television version, which Sheridan says "is five percent reality and 95 percent Hollywood," his work is decidedly low drama, is grounded in medicine and science, and involves many more living patients than dead bodies.
The rapidly-growing field of forensic nursing is routinely involved with cases of sexual assault, domestic violence, child abuse and neglect, elder abuse, and other forms of traumatic violence. A forensic nurse works where the criminal justice and health care systems meet, most often either a crime scene or a hospital room. Sheridan believes nurses' skills and knowledge makes them ideally poised to work with victims of violence with the compassion and empathy needed to gain important evidence and information and, at the same time, to help the healing. "Victimization is as much a medical issue as it is a social ill," he observes. "It's probably easier to train a nurse in the principles of evidence collection and preservation and crime scene analysis than it is to train a cop in health care principles." That may explain why Sheridan oversees the JHUSON master's program in forensic nursing and two doctorate-level forensic nursing programs, and has recently completed development of a nationwide curriculum to train nurses to recognize abuse and neglect in vulnerable and elderly people.
Forensic nursing, sadly, is a job with growth potential; unless statistics change markedly, it is likely to be with us for some time. At some time in her life, one in three women will be in a violent relationship with someone who professes to love her; one in four will be sexually assaulted, many times by an intimate who doesn't understand the meaning of "no." And while intimate partner homicides have decreased, women are still nine times more likely to be killed by an intimate partner than by a stranger. The major risk factor? Prior domestic violence.
As one of few men in the field of nursing and even fewer forensic nurses, Sheridan looks to the day when just as many men as women are helping rape victims, working with battered women, and assisting abused older or disabled people. He observes, "Women advocates can only take this issue so far; we need to get the other half of the human population involved. Only then will we stop the violence." Sheridan became involved in forensic nursing before the discipline even had a name and looks forward to the day that the job can be relegated to history books.
The Johns Hopkins University School of Nursing is a global leader in nursing research, education, and scholarship. The School and its baccalaureate, master's, PhD, and Doctor of Nursing Practice programs are recognized for excellence in educating nurses who set the highest standards for patient care and become innovative national and international leaders. For more information, visit http://www.nursing.jhu.edu.
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