CONTENTS
Acknowledgments
Scope and Standards of Transplant Nursing Practice
Function of the Scope of Practice Statement
Function of Standards
Scope of Transplant Nursing Practice
Introduction to Transplant Nursing
Description of Transplant Nursing
Key Elements
Research
Practice Settings and Roles
Development of Transplant Nursing Practice
Growth of Transplant Care and Transplant Nursing
International Transplant Nurses Society (ITNS)
Practice Characteristics: Collaboration and Role Differentiation
Clinical Transplant Nurse/Transplant Nurse Generalist
Transplant Nurse Coordinator
Advanced Practice Transplant Nurse
Specialty Certification for Transplant Nurses
Educational Requirements for Transplant Nurses
Knowledge and Skills Base of Transplant Nursing
Globalization of Transplant Nursing
Palliative Care and Transplant Nursing
Ethics and Informed Decisions
Future Considerations
Standards of Transplant Nursing Practice
Function of Standards
Standards of Practice for Transplant Nursing
Standard 1. Assessment
Standard 2. Diagnosis
Standard 3. Outcomes Identification
Standard 4. Planning
Standard 5. Implementation
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Standard 5a. Coordination of Care
Standard 5b. Health Teaching and Health Promotion
Standard 5c. Consultation
Standard 5d. Prescriptive Authority and Treatment
Standard 6. Evaluation
Standards of Professional Performance
Standard 7. Quality of Practice
Standard 8. Education
Standard 9. Professional Practice Evaluation
Standard 10. Collegiality
Standard 11.Collaboration
Standard 12. Ethics
Standard 13. Research
Standard 14. Resource Utilization
Standard 15. Leadership
Glossary
References
Index
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SCOPE AND STANDARDS OF TRANSPLANT NURSING PRACTICE
This document addresses the role, scope, and standards of nursing practice
for the specialty of transplant nursing. The scope of practice addresses the
definition of transplant nursing, its various levels of practice based on educational
preparation recognizing its worldwide variations, current clinical practice activities
and sites, and current evidence-based practice relevant to transplant nursing.
The standards of transplant nursing practice are objective, measurable
statements of the responsibilities for which transplant nurses are accountable.
Function of the Scope of Practice Statement
The scope of practice statement (pages xx–yy) describes the “who,” “what,”
“where,” “when,” “why,” and “how” of a particular nursing practice. Each of these
questions must be sufficiently answered to provide a complete picture of the
practice, its boundaries, and membership. The depth and breadth in which
individual registered nurses engage in the total scope of nursing practice is
dependent upon that individual’s education, experience, role, and the population
being served.
Function of Standards
These Standards are comprised of standards of practice (pages zz–aa) and
standards of professional performance (pages bb–cc). These are authoritative
statements that describe the duties of nurses practicing within the roles,
population, and specialties governed by this document (Transplant Nursing: Scope
and Standards of Practice) and those they are expected to competently perform.
The Standards published herein may be utilized as evidence of the legal standard
of care that govern nurses practicing within the roles, population, and specialties
governed by this document. The Standards are subject to change with the
dynamics of the nursing profession and as new patterns of professional practice
are developed and accepted by the nursing profession and the public. In addition,
specific conditions and clinical circumstances may also affect the application of the
Standards at a given time; e.g., during a natural disaster. The Standards are
subject to formal periodic review and revision.
The measurement criteria that appear below each standard are not all-inclusive
and do not establish the legal standard of care. Rather, the measurement criteria
are specific, measurable elements that can be used by nursing professionals
to measure professional performance at the basic level of practice for each
particular role. Nurses practicing within a particular role, population, and specialty
can identify opportunities for development and improvement by evaluating
performance on these elements.
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SCOPE OF TRANSPLANT NURSING PRACTICE
Introduction to Transplant Nursing
Solid organ transplantation remains the best treatment option for improved quality of
life for people of all ages with end-stage solid organ disease. Since the first
successful kidney transplant was performed in 1954, solid organ transplantation has
continued to advance as a treatment for end-stage organ diseases of the kidney,
pancreas, liver, heart, lung, and small bowel; and has expanded as a treatment
option to countries across the globe.
The number of transplants worldwide continues to grow with 114,690 reported in
2012 (http://www.transplant-observatory.org). As an example of this rapid growth in
1988 the number of transplants performed in the United States was 12,623 and by
2013 the number had risen to 28,954 (http://optn.transplant.hrsa.gov). The number
of individuals needing an organ also continues to increase dramatically as people
live longer with chronic conditions such as diabetes and cardiovascular disease
which result in organ failure. The resulting demand for solid organs for
transplantation has for many years outpaced the number of donor organs available
for transplantation in the United States and world-wide. Though living donation has
expanded over the last 60 years to include organs other than kidneys (e.g., liver and
lung), the need for solid organs from both living and deceased donors continues to
escalate.
Throughout the history of organ transplantation, nursing has played a major role
in the provision and advancement of the care of organ recipients and donors as well
as their families. Multiple factors influence the provision of transplant nursing care
that requires specialized care based upon expert knowledge and skills from
experienced transplant nurses. The acuity of transplant recipients and complexity of
deceased and living donor care, tied with the movement to minimize the length of
hospitalization after transplantation requires the provision of high-level, expanded
care inside and outside the traditional hospital setting.
The field of organ transplantation has advanced rapidly since its inception and
continues to make major strides as new technology, procedures, and treatments
emerge. This changing landscape requires that transplant nurses make a lifelong
commitment to learning and assume roles outside traditional patient care. Providing
collaborative care as members of an interprofessional team of specialists is just one
of the roles of transplant nurses. Because of the shortage of organs for
transplantation, transplant nurses play an essential role in donor awareness. Other
transplant nurses may become involved in research to help improve transplant
recipient outcomes or the care of organ donors.
A global shortage of nurses exists which presents particular challenges for
transplant nurses who must provide the best care possible to transplant patients in a
multifaceted and dynamic field at a time of limited resources. Moreover, as the
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population continues to age and experience multiple chronic conditions, the care
required by transplant recipients both in the hospital and community is becoming
increasingly complex. Transplant nurses practicing in this changing environment
continue to provide specialized care to organ recipients and donors, their
families, and communities incorporating both the science and the art of nursing.
The roles and functions of transplant nurses are differentiated according to
education, position description, and practice setting, with these factors further
defining practice. As an international specialty, transplant nursing is further
influenced by differences in nursing education, nursing practice, nursing
research, and systems of health care delivery across national boundaries.
Because each country, state, and province has its own laws regulating nursing
practice, the limits, functions, and titles for nurses may differ by state and
country, particularly at the advanced practice level. Nurses must ensure that their
practice remains within the boundaries defined by their respective governmental
agencies. However, regardless of where they live and work, transplant nurses
must continually be in search of methods and strategies to improve and enhance
nursing practice and science.
Solid organ transplantation is distinct from bone marrow transplantation which
is used to treat hematologic disorders. Nursing care of bone marrow transplant
recipients is described by the Oncology Nursing Society in the Statement on the
Scope and Standards of Oncology Nursing Practice: Generalist and Advanced
Practice (2014)and also by the Hematology/Oncology Nurses in the Pediatric
Oncology Nursing: Scope and Standards of Practice(2009).
Description of Transplant Nursing
Transplant nursing is the delivery of specialized nursing care focused on protection,
promotion, and optimization of the health and abilities of both the transplant recipient
and the living donor across the life span. Throughout this document, the term
‘patient’ denotes both transplant candidates/recipients and living donors. Care of
these patients includes prevention, detection, and treatment of illness and injury
related to diseases treated by solid organ transplantation, and diseases that may
result from living donor donation. Such care may be delivered at the level of the
individual, their family and support system, community, and to populations of all
ages. In addition, transplant nursing includes the prevention of further disease and
promotion of optimal health and well-being of organ recipients and donors.
Transplant nurses not only care for the patient but also have a commitment to the
care of their families.
Transplant nursing encompasses care and support of the patient awaiting
transplantation or an organ recipient who may have multi-organ and multi-system
disease processes, the deceased donor, and the healthy person who desires to
donate or has donated an organ. To accomplish this, transplant nurses must have a
knowledge base in immunology, transplant pharmacology, and infectious diseases.
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Transplant nurses must also understand the psychological implications of caring for
transplant recipients in regard to the risks of subsequent morbidities and the
possibility of death. In communities, transplant nurses provide education and
support for organ donation. These activities are accomplished through the
application of evidence-based care to individuals, families, and communities through
all phases of the transplant process with the goal of optimizing health, functional
ability, and quality of life.
Transplant nursing also encompasses the optimization of the health care
system in which transplant care is delivered. These aspects of care center on
quality monitoring, collaboration, education, research, and administration. Other
key elements of nursing care provided by transplant nurses include development,
initiation, and maintenance of systems and processes that promote teamwork,
collaboration, efficiency, and patient satisfaction.
Key Elements
Key elements of transplant nursing include:

Education of the patient, their family and support system, and the
community

Interventions that maintain or improve physiologic, psychological, and
social health

Interventions that facilitate and optimize behavioral change and
treatment adherence with complex, lifelong therapies

Advocacy to support patients, their families and support systems, in the
planning, implementation, and evaluation of their care

System improvements to support optimal transplant outcomes

Research to broaden and enrich the knowledge base of transplant
nursing, provide evidence for practice, and bridge practice and theory
Practice Settings and Roles
The transplant nurse works in a variety of inpatient, outpatient, and community
settings, including wards or clinical units, intensive care units, operating rooms of
hospitals, ambulatory care clinics and other clinical facilities in the community.
Regardless of role or setting, all transplant nurses serve as ambassadors for organ
donation and transplantation.
The roles transplant nurses in these settings focus on:

Clinical care (Clinical Transplant Nurse or Transplant Nurse Generalist)

Coordination of care (Transplant Nurse Coordinator)
o for transplant recipients (Recipient Nurse Coordinator),
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o for deceased donors (Procurement Nurse Coordinator),
o for living donors (Living Donor Nurse Coordinator)

Advanced clinical care (Advanced Practice Transplant Nurse)
The Clinical Transplant Nurse, also known as the Transplant Nurse Generalist
in some countries, provides patient care primarily at the bedside, in inpatient wards
or units and operating rooms, and may practice in outpatient clinics in the
community. Regardless of the setting, or type of transplant, clinical transplant
nurse generalists focus on the delivery of direct care and education to recipients,
donors, and/or their families.
The Transplant Nurse Coordinator provides both direct and indirect patient
care. Transplant coordinators are responsible for synchronizing all aspects of
transplant care across settings ensuring high quality, efficacious, safe care.
Transplant coordinators further their efforts for optimal patient and family outcomes
through education and research for patients and families, as well as the transplant
healthcare team. Transplant Nurse Coordinators often focus on provision of care
for recipients or organ donors as described below.
The Transplant Recipient Coordinator usually practices in an outpatient
or clinic environment with responsibilities that often extend into the
community. Transplant Recipient Coordinators are responsible for guiding
candidates for organ transplantation through the pre-transplant evaluation.
This involves coordinating all aspects of care including assuring all
necessary pre-transplant tests and procedures are performed, providing
educational information and emotional support, and following patients for
varying lengths of time post-transplant.
The Procurement Nurse Coordinator may practice in the intensive care
environment, emergency and trauma units, and operating rooms, but may
also travel to distant centers to provide patient and staff education and to
assist in organ procurement. Following donation efforts, the procurement
nurse coordinator has a significant role in providing follow-up support and
advocacy for donor families.
The Living Donor Nurse Coordinator works predominantly in clinics or
outpatient settings to prepare and educate potential donors about organ
donation. Following donation, the living donor nurse coordinator will follow
patients for varying lengths of time to help promote full recovery of both
physical and mental health.
The Advanced Practice Transplant Nurse works in a multitude of settings such
as inpatient units, outpatient clinics, and the community. In the United States,
there are four categories of Advanced Practice Registered Nurses (APRN); Nurse
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Practitioners, Clinical Nurse Specialists, Nurse Anesthetists, and Nurse Midwives.
However, these categories, related titles, role responsibilities, and educational
requirements vary across national boundaries. Regardless, Advanced Practice
Nurses are generally the most experienced nurses who serve in a variety of roles
delivering an advanced level of patient care. Advanced practice transplant nurse
roles have evolved from general APRN roles to those that are specialty-based
within transplant.
New Roles continue to emerge as health care systems around the world and
will continue to evolve as the field of transplantation expands and becomes more
complex. As these new roles develop and are integrated into the practice
environment it should be anticipated that many will have overlapping functions or
alternate names for existing or similar roles. Over time, as these roles are
incorporated in the health care system, roles that are sustainable will become
more well-defined and consequently the nomenclature will become more
consistent.
A more detailed discussion of the roles of transplant nurses roles begins on
page xx.
Development of Transplant Nursing Practice
Growth of Transplant Care and Transplant Nursing
Since the first kidney transplant was performed over 60 years ago transplant
nursing has continued to evolve as solid organ transplantation became the
treatment of choice for many end-stage organ diseases. Major advances in the
field are primarily the result of progress in transplant pharmacology, state-of-theart technologies, and advanced surgical techniques. More recently, advances
that are impacting practice include the development of an innovative system of
“transplant chains” to generate a series of linked living-donor transplants which
has increased the donor pool and progress in the areas of genetics, immunology,
ventricular assist, sustainable organ perfusion pumping, stem cell, and composite
transplantation.
As we look toward the future we can anticipate further innovations in the areas of
total artificial heart implantations; immunosuppression-free tolerance, and xenotransplantation; further development and use of electronic health records,
telemedicine, direct consumer use of self-monitoring devices, artificial
intelligence, bioinformatics, and application of nanotechnology.
As the field of transplantation has developed, so has the role and scope of
transplant nursing practice. Initially, transplant nursing practice involved providing
hospital- and community-based care to individuals and families experiencing
acute, chronic, and critical illnesses requiring transplantation, and to deceased
and living donors. The scope of practice has expanded to include transplant
candidates in the hospital or community on life-supporting bridge technology,
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long-term survivors of solid organ transplantation, and the post-operative living
donor.
Today, care delivered by transplant nurses goes beyond the basic care of
transplant candidates, recipients, donors, and their families. The complex
healthcare needs of today’s patients require a high degree of proficiency among
transplant nurses. Being a proficient transplant nurse, at any level or in any role,
requires a thorough knowledge of transplant nursing knowledge and skills that is
appropriate for the nurse’s level of practice, is setting-specific, and includes
assessment, diagnosis, planning, implementation, and evaluation of transplant
care that attains, maintains, or restores health or supports palliative care. To
accomplish this, transplant nurses must demonstrate a keen interest in improving
the care of this population and seek new knowledge and specialty-enhancing
interests through education, mentoring, professional organizations, and clinical
experiences.
International Transplant Nurses Society (ITNS)
There are several transplant organizations that provide continuing education and
professional growth opportunities for transplant professionals. Among these, the
International Transplant Nurses Society (ITNS) was founded in 1992 as an
organization specifically committed to the promotion of excellence in transplant
clinical nursing through the provision of educational and professional growth
opportunities, interprofessional networking, collaborative activities, and nursing
research. ITNS serves the educational and professional needs of over 1,900
transplant nurses and is composed of 32 national and international local chapters
that promote transplant nursing throughout their geographical region and
transplant centers..
The goals of ITNS are to:








Provide a network for communication among professional nurses with a
focus and commitment to transplantation.
Provide a means of continuing education for professional nurses with a
focus in transplant nursing.
Examine new trends in transplantation affecting patient care and the role
of the transplant nurse.
Promote and support research in transplant nursing.
Distribute the results of scientific investigations among professionals
interested in transplantation.
Foster an awareness of ongoing ethical considerations in procurement,
donation, and recipient awareness.
Ensure the accomplishment of the proper and lawful purposes and
objectives of the Society.
Ensure the accomplishment of the proper and lawful purposes and
objectives of the society.
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Through the Board of Directors, ITNS is committed to the field of
transplantation and strives to maintain the mission and integrity of the society
through its activities and educational collaborations. ITNS promotes transplant
research and evidence-based practice by providing several research grants each
year. The grant recipients disseminate their findings through the ITNS annual
symposium and publication. ITNS promotes adherence and patient self
management through the publication of educational brochures in a variety of
languages that address post-transplant problems (diabetes, skin cancer, gingival
hyperplasia, gastrointestinal complications, etc.) as well as strategies for
maintaining a healthy lifestyle following transplantation.
Practice Characteristics: Role Differentiation and Collaboration
Given the complexity of care required by a diverse transplant population, the
need exists for a variety of roles within transplant nursing to optimize patient
outcomes. These roles include caregivers, coordinators, educators,
administrators, care managers, quality specialists, and others. Within these roles,
transplant nurses manage and provide complex and often unique care to donors
and transplant recipients. For example, transplant recipients typically have
multiple co-morbidities that require comprehensive care and patient education
that addresses the multiple disease processes, self-monitoring and management
of each condition, and the psychosocial aspects of transplantation including role
change, the potential for family stressors, financial concerns and mood disorders.
The transplant nurse must have a thorough understanding of these complex
topics in order to provide the appropriate care and teach individuals and families
how to care for their health and when to contact the transplant team.
Due to the complexity and growing body of knowledge related to the care of
transplant recipients, transplant nurses commonly specialize their practice in
either donor or recipient care. Such role differentiation also serves to enhance
donor and recipient advocacy and confidentiality, reduce conflict of interest, and
facilitate the acquisition of more in depth knowledge and skills.
The various roles fulfilled by transplant nurses may include, but are not limited to
the clinical or transplant nurse generalist, transplant nurse coordinator, educator,
case manager, counselor, patient advocate, consultant, research nurse, nurse
scientist, leader, administrator, and advanced practice registered nurse. Some
emerging roles transplant nurse are assuming are in the areas of quality
improvement, regulatory education and oversight, and patient safety.
Regardless of their role, the transplant nurse serves as an advocate for organ
donation and transplantation, working to increase awareness among healthcare
professionals and the community.
Role differentiation provides a cadre of highly skilled expert professionals
within nursing and across the health professions, all focused on providing the
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best possible care of their patients. However, the interplay of multiple comorbidities, patient care requirements, and overlapping areas of practice require
close collaboration among all health care providers. Such collaboration often
takes place in team meetings where patient needs and care is discussed, as well
as on a daily basis as patient care is undertaken and problems unfold.
Regardless of the setting or circumstances where collaboration among health
professions occurs, the goal is always to provide comprehensive, ethical, and
evidence-based care. The accomplishment of this goal requires mutual respect
among professional colleagues for the unique knowledge and skills each
possess. It is these unique talents possessed by individual team members that
enable the group as a whole to address the vast array of problems transplant
patients encounter.
Clinical Transplant Nurse/Transplant Nurse Generalist
The transplant nurse working at the generalist level, most commonly a clinical
nurse, delivers specific services on a routine basis to patients and their families.
A registered nurse license or international equivalent is required. At a minimum,
the transplant nurse practicing at this level must obtain pre-licensure education,
clinical experience, and ongoing continuing education as recommended for all
nurses. Preparatory courses are offered to the nurse who wants to specialize in
transplantation, or the nurse may receive formal or informal institution-specific
training under the supervision of an experienced transplant nurse. Transplant
nursing practice at the generalist level includes, but is not limited to, assessment,
diagnosis, outcome identification, plan of care, interventions, and evaluation of
care.
Transplant Nurse Coordinator
While the general role of transplant nurse coordinator is unique to
transplantation, it is similar to a case manager in its role diversity. Most transplant
coordinators are registered nurses however, they may be licensed as other
healthcare providers such as social workers or paramedics. Transplant
coordinators often have population-specific roles as described below; however,
all transplant nurse coordinators have some common role characteristics. The
transplant nurse coordinator:
 Has experience in nursing and transplantation
 Has a global transplant nursing perspective with a focus on long-term
outcomes
 Learns from experience what to expect in a given situation and alters
plans accordingly
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 Has an intuitive grasp of situations and operates from a deep
understanding of the situation
 Recognizes when situations are outside the expected and uses analytical
skills and abilities to investigate alternative perspectives
 Conducts comprehensive assessments
 Promotes health and the prevention of injury and disease
 Serves as an advocate and educator
 Mentors, delegates, and provides feedback to their support team,
 Participates in quality assurance process improvement (QAPI) to improve
transplant nursing practice, patient outcomes, and processes
 Provides consultation and education to healthcare providers and the
community regarding transplant issues
 Possesses an understanding of regulatory requirements and incorporates
these into their practice
 Participates in research to improve transplant nursing practice
The procurement nurse coordinator ensures compassionate and confidential
care for all deceased donors and their support system, allowing them to fulfill
their wish to donate the gift of life. The role of this coordinator varies
internationally. In addition to the care delivered by the general transplant
nurse coordinator, the procurement nurse coordinator’s care includes, but is
not limited to:
 Assessment and management of physiological processes of the
deceased donor
 Teaching team members, community partners, and/or deceased
donor families and others about the donation process
 Coordinating the process of organ removal
 Facilitating allocation to the recipient
The living donor nurse coordinator works with people who wish to donate an
organ to ensure potential donors are fully prepared for this experience, are
competently evaluated from both physical and psychological perspectives,
and followed closely long-term to optimize outcomes. In some cases, this
coordinator is also designated as a “donor advocate”. In addition to the
general transplant nurse role, the living donor nurse coordinator’s care may
also include:
 Education of the potential donor regarding the donor and recipient
process
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 Assessment and management of the living donor’s emotional
response to donation during all phases of the process
 Management of the living donor’s goals and outcomes of donation
 Recognition of the financial impact on the living donor
 Follow-up of the long-term health of the donor
The recipient nurse coordinator provides care to the potential transplant
recipient both before and after transplantation. It may be a role with
combined pre- and post-transplant care responsibilities or focused on a
specific time period within the continuum of transplant care.
Pre-transplant care – The recipient nurse coordinator focuses on
managing issues related to organ failure to ensure the patient remains
in optimal health, enabling the patient to proceed with transplantation
when a suitable organ is available. In addition to the general transplant
nurse role, the recipient nurse coordinator’s pre-transplant care
includes, but is not limited to:

Managing the potential recipient’s evaluation to determine
candidacy status

Assessing and managing the candidate’s health throughout the
process and while on the waiting list so that the candidate is in
optimal physiological, psychological, and psychosocial health at
the time of transplant

Supporting the transplant candidate during the potentially long
wait for transplant by developing and enhancing their coping
skills

Providing anticipatory teaching about post-transplant issues
including: medications, signs and symptoms of infection and
rejection, chronic care needs, post-transplant follow-up routines,
and potential psychosocial issues
Post-transplant care – The recipient transplant nurse coordinator helps
the patient achieve the highest level of wellness possible. In addition to
the general transplant nurse role, the nurse’s post-transplant care
includes:
 Providing emotional support
 Patient education including: medications and adherence; signs,
symptoms, diagnosis, treatment and outcome of rejection and
infection; chronic care needs and potential post-transplant
complications; psychosocial needs and complications; follow-up
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schedule with the transplant team; routine labs, procedures and
tests; and healthy living issues post-transplant.
Advanced Practice Transplant Nurse
The Advanced Practice Registered Nurse (APRN) is “a registered nurse who has
acquired the expert knowledge base, complex decision-making skills and clinical
competencies for expanded practice, the characteristics of which are shaped by
the context and/or country in which s/he is credentialed to practice. A master’s
degree is recommended for entry level”
(http://international.aanp.org/Practice/APNRoles).
In transplant nursing, the APRN functions in the position of nurse practitioner or
clinical nurse specialist. Most countries require graduation from an approved
school of nursing for advanced practice but may or may not require a registered
nursing license. The advanced practice roles include, but are not limited to:

Specialized and expanded knowledge and skills

Advanced assessment and ability to synthesize data and interventions

Significant role autonomy, with the integration and application of a broad
range of theoretical and evidence-based knowledge.
The overall role of the APRN in transplant nursing is to provide leadership and
advanced clinical expertise to promote optimal patient outcomes and promote the
growth of transplant nursing at the institutional, national and international level.
The nurse practitioner (NP) specializing in transplant care is a nurse who has
completed advanced nursing preparation at the master's or doctoral level. The role
requires expanded knowledge and skills for providing expert care to individuals or
populations who require solid organ transplantation for end stage organ disease.
The NP is skilled in formulating a differential diagnosis. The NP combines patient
assessment findings with scientific and clinical knowledge, behavioral science,
health and illness experience, pathophysiology, psychopathology, epidemiology
and infectious disease. The NP assesses clinical manifestations of acute illness,
chronic disease, emergency health needs, and normal health events; using these
skills and their knowledge to diagnose illness and disease.
Collaboration and consultation with other disciplines helps provide targeted
health services that meet individual patient’s needs according to evidence-based
practice, scientific rationale, and evidence-based guidelines. From the differential
diagnosis through the physical exam and diagnostic and laboratory investigations,
the NP provides pharmacologic and non-pharmacologic treatments for the
management and treatment of acute and chronic illness and disease. The NP’s
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practice demonstrates effective health promotion and prevention of illness and
complications in the transplant recipient’s care. The NP practices in primary, acute,
and long-term settings and performs both autonomously and in collaboration with
other healthcare professionals to treat and manage health problems related to
transplantation. The NP serves as a patient advocate for individuals, families,
groups and communities, and may also practice as a researcher and a consultant.
The clinical nurse specialist (CNS) in transplant care is a nurse who has completed
advanced nursing preparation at the master's or doctoral level as a CNS. The CNS
is a clinical expert who works with patients and their families, the healthcare team
and the organization (AACN 2011). As an expert in evidence-based transplant
nursing practice, the CNS promotes prevention strategies as well as treats and
manages the health problems of transplant patients and populations. The CNS
practices autonomously, integrating knowledge of disease and medical conditions
into the prevention, assessment, diagnosis and treatment of patients' illnesses.
The CNS works collaboratively with other members of the healthcare team. The
CNS designs, implements, and evaluates both patient-specific and populationbased programs of care. The CNS in transplantation acts as a leader by advancing
the practice of transplant nursing to achieve quality and cost-effective patient
outcomes and by guiding interprofessional groups to design and implement
innovative solutions to systems and patient care problems. As a direct care
provider, the CNS in transplantation performs comprehensive health assessments,
forms differential diagnoses, and in some states and countries, may have
prescriptive authority to prescribe pharmacologic and non-pharmacologic
treatments for the direct management and treatment of acute and chronic illness
and disease. The CNS in transplantation serves as a patient advocate, consultant
and educator, and conducts and interprets quality improvement projects and
research to improve practice.
Specialty Certification for Transplant Nurses
The transplant nurse can further demonstrate commitment to improving the
quality of nursing care by pursuing certification in the field of transplantation.
Certification is available through transplant organizations in North American and
Europe with various eligibility requirements. The transplant nurse who has the
necessary knowledge and skills to care for transplant donors and/or recipients
may validate this competency by taking a certification examination. The following
certifications are available through The American Board for Transplant
Coordination (ABTC) and the European Society for Transplantation (ESOT):

Certified Clinical Transplant Nurse

Certified Clinical Transplant Coordinator

Certified Procurement Transplant Coordinator

Certified Transplant Preservationist
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
Certificate of European Transplant Coordination
With certification, the transplant nurse must actively maintain his or her
knowledge and competence at the levels defined by certification. The nurse is
responsible for assessing daily practice to identify knowledge deficits or areas for
improvement. The nurse must work within the identified scopes of practice of his
or her role with daily practice guided by the standards of practice for the nursing
profession and the specialty area of transplant.
Educational Requirements for Transplant Nurses
A state, commonwealth, territory, government or other regulatory body provides
an established mechanism for recognition and authorization of adequately
educated and prepared individuals to practice nursing, including the specialty of
transplant nursing. The associated registration or licensing processes vary by
country. In the United States, a nurse is licensed by a state and is called a
registered nurse. The individual is educationally prepared for competent practice
at the beginning level upon graduation from an approved U.S. school of nursing
and then becomes qualified by examination for registered nurse licensure.
Outside of the United States, countries require graduation from an approved
school of nursing but may or may not require a registered nursing license. Other
countries, such as Germany, require a state examination after three years of
education for those pursuing a nursing degree.
Entry level nurses may begin their profession through a variety of
educational degrees and levels which vary internationally. Experienced nurses
become proficient in one or more practice areas or roles and may chose to focus
on patient care in clinical nursing practice specialties, such as transplant nursing.
As discussed previously, specialized transplant nursing knowledge and
experience may be acknowledged through an identified certification process, in
which specific nursing educational requirements and demonstration of knowledge
in transplant nursing practice have been delineated and validated.
Transplant nurses may choose to pursue advanced degrees to prepare for
transplant nursing practice specialization. Educational requirements vary by
specialty, role, educational institution and country. Upon graduation from an
advanced level academic program, transplant nurses may pursue additional
certification in direct and indirect care roles, such as a clinical nurse specialist or
nurse practitioner, based on educational preparation. In response to the
changing healthcare environment, educational programs, and requirements and
regulatory environments, new models for educational preparation continue to
evolve. An advanced certification examination in transplant nursing is a future
goal.
Transplant Nursing: Scope and Standards of Practice
2014 July Revision
16
Knowledge and Skills Base of Transplant Nursing
General transplant nursing care requires a broad knowledge base in anatomy,
physiology, immunology, pharmacology, pharmacogenomics,
pharmacotherapeutics, nutrition, psychology, sociology and developmental
theory. Clinical competencies beyond fundamental nursing preparation include
assessment and management of the deceased transplant donor, assessment
and management of the transplant candidate and recipient, assessment and
management of the potential or living donor and education and counseling for the
transplant recipient and living donor. An understanding of the patient’s self-care
management skills and healthy living and chronic health care complications and
needs is essential.
Competencies in serving the physiological, pathophysiological and
psychosocial needs of transplant patients, families and communities are critical.
Transplant nurses must possess the skills to support aging patients, and when
necessary assist them as they transition and prepare for death. Transplant
nurses must be knowledgeable of the principles of ethical practice and have
resources available to evaluate the merits, risks and social concerns of
transplantation. As transplantation becomes a treatment option for both older
and younger patients, transplant nurses must support and advocate for the more
vulnerable patient and family
The core of transplant nursing practice is the provision of care based on theory,
current evidence, best practices and consideration of patient preferences using
good clinical judgment and decision-making. In providing comprehensive transplant
nursing care across the age continuum, the transplant nurse uses the nursing
process to assess individual and group needs, formulate an appropriate nursing
diagnosis, design a mutually agreed upon plan of care, coordinate and provide
therapeutic interventions, document care, and evaluate the action plan using an
interprofessional case management approach.
Transplant nurses must possess a global perspective on patient and donor
long-term goals, understand the expected clinical course and outcomes in a
given transplant situation and alter plans accordingly. By conducting
comprehensive assessments and using analytical abilities the transplant nurse
operates from an in-depth understanding of transplant nursing, recognizes when
situations are outside the expected and investigates alternative transplant
perspectives. The transplant nurse promotes health and the prevention of injury
and disease; serves as an advocate and educator for the patient, their family and
support system; provides consultation and education to healthcare providers and
the community; and participates in research and quality improvement processes
to improve practice.
Sound assessment skills are the foundation of transplant nursing practice with
the assessment of rejection and infection being paramount. Further assessment
varies based on the organ that is transplanted. For example, if the patient has
Transplant Nursing: Scope and Standards of Practice
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17
received a kidney transplant, the transplant nurse will also assess signs and
symptoms of decreased urine output and a potential knowledge deficit related to
dietary and medication modifications post-transplant.
Advances in transplantation include new technologies to assist in evaluating
and monitoring end-stage organ disease and then extending treatment by
transplantation. For example, as fetal echocardiography becomes more accurate,
earlier diagnosis of high-risk cardiac lesions will be possible with earlier listing for
cardiac transplantation (i.e., 36 weeks gestation). Implantable artificial hearts are
available to prolong life for those waiting for a heart transplant and
transplantation across ABO blood groups is now possible. Transplant nurses will
need to acquire new knowledge and skills in order to successfully navigate the
technological advance on the horizon.
Transplant nurses acquire advanced knowledge and skills from technology
that is used to monitor data, plan care and improve patient outcome; for example,
becoming skilled in caring for patients with implantable artificial hearts or utilizing
gene expression profiling blood tests to monitor and assess for rejection.
Transplant nurses use expertise with advanced technologies to assess the
patient’s response to treatment; diagnose the patient, family, and support
systems response to new technology; provide education and support to assist
the patient their family and support system as they to adapt to the new
technology; and to monitor quality and safety and outcomes. A solid knowledge
base in transplantation is essential for transplant nurses, administrators,
researchers, case managers, transplant coordinators, advanced practice nurses,
quality specialists and educators to ensure optimal care for the transplant
recipient and donor and their families within a dynamic healthcare delivery
system.
Globalization of Transplant Nursing
Transplant nursing is an international specialization. The transplant nurse
delivers culturally sensitive care when caring for donors, transplant candidates,
recipients, families, and communities. These issues are many and varied and
also may involve providing transplant nursing care in collaboration with nurses
with varied levels of nursing educational preparation. Cultural influences impact
transplantation policies and procedures, availability, and transplant care
practices. Providing transplant nursing care in countries with limited financial
resources or those involved in organ trafficking or marketing will present
challenging social and ethical issues for the transplant nurse.
Palliative Care and Transplant Nursing
Palliative care is both a philosophy of care and a system or model for providing
care. The goal of palliative care is to prevent or relieve suffering and to focus on
helping patients achieve the best possible quality of life throughout their lifelimiting or life-threatening illness (National Consensus Project for Quality
Palliative Care 2009). The eight recognized domains of palliative care are:
Transplant Nursing: Scope and Standards of Practice
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
Structure and process of care

Physical aspects of care

Psychological aspects of care

Social aspects of care

Spiritual aspects of care

Cultural aspects of care

Care of the imminently dying

Ethical or legal aspects of care
Transplant nursing naturally encompasses many of the palliative care domains,
which are reflected in these standards.
Ideally, palliative care is implemented at diagnosis and is provided in conjunction
with curative efforts. By incorporating a palliative care philosophy, the goals and
preferences of the patient, their family and support system are clarified;
aggressive pain and symptom management is provided, psychosocial and
spiritual support is offered, and ethical issues are addressed.
Transplant nurses are uniquely qualified to care for transplant candidates and
recipients within the palliative care philosophy, integrating palliative care domains
with the management of patients pre- or post-transplant. If transplantation is not
a viable option of care or if post-transplant complications become life-threatening,
palliative care measure can be actively implemented. Palliative care will ensure
that patients are physically comfortable, their desired goals are being met, and
that end-of-life wishes will be fulfilled
Ethics and Informed Decisions
The transplant nurse is concerned about the availability and accessibility of the
specialized care required for donors, transplant candidates, recipients, families,
and communities. Transplant nursing is based on the belief that patients and
families have the right and responsibility to make informed decisions about their
care. The transplant nurse may be faced with caring for patients whose quality of
life can be compromised by unanticipated consequences of technological
advances in health care. Even as transplant procedures and technologies
mature and become more reliable, the potential remains for serious and enduring
unanticipated side-effects. Patients, their families, and their communities need to
know of such issues.
Ethical issues unique to the conflicts inherent in transplant nursing often arise.
Transplant candidates and their families face life-threatening illnesses, where
survival is dependent on the availability of viable, healthy organs. Conflicts may arise
between the rights of the individual, the rights of families, available accepted
Transplant Nursing: Scope and Standards of Practice
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scientific and technological treatments, and economic realities. The rights and needs
of the potential transplant recipient must be balanced with the rights and needs of
the potential donors and their families, whether the donor is living or deceased.
Because the need for organs greatly exceeds availability, it is imperative that
ethical principles be followed to help ensure the fair and equitable distribution of
organs. The transplant nurse should be aware of unethical activities such as
payment for organs and organ trafficking. When caring for transplant recipients,
donors, and families, the transplant nurse should always consider the principles of
autonomy, beneficence, confidentiality, equality, and justice. The transplant nurse
may participate in discussions and the decision-making processes with other
support staff, such as Social Workers, psychiatrists, patient advocates, and
members of ethics boards and hospital committees to resolve such dilemmas.
The transplant nurse recognizes that each patient is a unique human being, and
must protect the individual’s basic rights during every phase of the transplant
process. The transplant nurse is responsible for reporting incidents of abuse of
patients’ rights and practices that are incompetent, unethical, or illegal. In the United
States, the transplant nurse should approach ethical decisions as guided by Code of
Ethics for Nurses with Interpretive Statements (ANA, 2005). This resource may be
helpful for transplant nurses in countries where a code of ethics has not yet been
established.
Future Considerations
The specialty of transplant nursing will continue to develop and expand as new
technologies and transplant procedures are created to provide healthy tissue and
organs. Efforts to increase the numbers of transplantable organs will remain at the
forefront in transplantation. Xenotransplantation, the organ transplantation across
species, continues to be explored as a way to expand the organ donor pool. Stem
cell research will continue to advance the science of creating organs from cells.
Composite transplantation, the transplantation of hand or face tissue from one
individual to another, has been successful in early trials. The emergence of 3-D
printing of strips of cells harvested from biopsies or stem cells provides an
exciting glimpse into the future where entire organs may be able to be created
using a framework that allows cells to adhere to the appropriate structure.
Using genomics, including pharmocogenomics, to identify patients who would most
benefit from transplantation and associated therapies may contribute to improved
transplant outcomes in the future. Advances in computer technology will provide
readily accessible information to help the transplant process progress more
effectively and efficiently. Advances in technology allow for changes in assessment,
monitoring and patient support and includes the use of mobile applications and
remote monitoring via online programs. As solid organ transplantation has become
more successful, recipient age criteria have already expanded and with an
Transplant Nursing: Scope and Standards of Practice
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increasing emphasis on long-term graft survival recipients can be expected to live
longer with their transplanted organs. A growing interest in gero-transplantation is
emerging and the National Institutes of Health already actively supports research
focused on older transplant recipients (NIH, 2012).
The need for transplant nurses is expanding across the world. The aging nursing
workforce, coupled with the aging world population, complicates the issue. As the
number of specialty nursing areas increases and demand for transplant services
escalates, transplant administrators are finding it more difficult to attract and retain
qualified transplant nurses. Experienced and competent transplant nurses are
critical to maintaining and improving transplant patient outcomes. As the acuity of
transplant patients intensifies, the skills, knowledge, and abilities of transplant
nurses must meet the corresponding care and education demands of the patients,
family, community, and institution. In addition to educational programs provided by
local institutions, several organizations host conferences and provide workshops
which provide opportunities for transplant professionals to remain current with
advances in the field. In addition, certification programs are available for transplant
nurses and coordinators which attest to the individuals’ achievement of a defined set
of competencies.
Transplant nurses must be active participants in developing, implementing, and
evaluating innovative patient care systems and models of care to improve transplant
patient care delivery and outcomes. Nursing education curricula should continue to
develop qualified undergraduate and graduate nurses who can specialize in
transplantation. As healthcare undergraduate curricula move toward integrated
education across professions, transplantation provides a unique opportunity for
students and faculty alike to experience integrated teams providing care to patients,
families, and communities. Appropriate funding for undergraduate and graduate
education must be provided.
The worldwide shortage of physicians provides an opportunity for advanced
practice registered nurses to meet the needs of those most vulnerable and in need
of care. Advanced practice registered nurses in transplantation can provide the
knowledge, experience, and skills to efficiently and effectively fill these healthcare
gaps. These nurses are particularly well positioned to provide chronic illness care to
transplant patients, families, and communities and promote effective, preventive
self-care and positive outcomes.
Healthcare delivery systems have been designed to support acute episodes of care
rather than improved long-term patient outcomes. Refocusing the healthcare system
on transitional care, chronic illness, and patient self-management is likely to
enhance long-term outcomes. Transplant nurses, across educational levels, are well
positioned to lead the movement in expanding chronic illness management which
includes patient self-management and preventative care. Advanced practice
registered nurses must continue to educate transplant professionals regarding the
positive patient outcomes associated with transplant care. They must also work with
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transplant administrators and regulators to integrate advanced practice registered
nurse services into routine transplant health care. With these changes in health care
comes a continued need to emphasize patient safety.
Transplant nurses are charged to remain current through lifelong learning and
provide evidenced-based care in a dynamic global healthcare environment.
Transplant nurses must promote patient, family, and community safety through
evidence-based practice and quality improvement efforts. Only through a continuous
quest for new knowledge and excellence will transplant nursing excel as a nursing
specialty.
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STANDARDS OF TRANSPLANT NURSING PRACTICE
Function of the Standards
The standards of transplant nursing, which are comprised of the standards of
practice and the standards of professional performance, are authoritative
statements by which nurses practicing within the role, population, and specialty
governed by this document (Nursing: Scope and Standards of Practice) that
describe the duties transplant nurses are expected to competently perform. These
standards may be utilized as evidence of the legal standard of care governing
nurses practicing within the role, population, and specialty governed by this
document. The standards are subject to change with the dynamics of the nursing
profession and as new patterns of professional practice are developed and
accepted by the nursing profession and the community. In addition, specific
conditions and clinical circumstances may also affect the application of the
standards at a given time such as during a natural disaster. The standards are
subject to formal periodic review and revision.
The measurement criteria that discussed within each standard (pages xxxx)
are not all-inclusive and do not establish the legal standard of care. Measurement
criteria are specific, assessable elements that can be used by transplant nursing
professionals to measure professional performance. Nurses practicing within the
specialty of transplant nursing should identify opportunities for development and
improvement based on performance as outlined by these standards.
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STANDARDS OF PRACTICE
STANDARD 1. ASSESSMENT
The transplant nurse collects comprehensive data pertinent to the patient’s
health status or situation.
Measurement Criteria:
The Transplant Nurse:
 Collects clinical data in a systematic and ongoing process
 Includes the patient, their family and support system, and interprofessional
healthcare team members in holistic data collection
 Involves assessment of patients of all ages across the continuum of care
from acute to community care to end of life care
 Prioritizes data collection based on the patient’s immediate condition or
anticipated needs
 Uses developmentally appropriate evidence-based assessment
techniques and instruments in data collection
 Uses analytical models and problem-solving tools
 Documents relevant data in a comprehensive and retrievable format
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Initiates diagnostic tests and procedures relative to the transplant patient’s
current status based on established protocols and procedures
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Initiates and interprets diagnostic tests and procedures relative to the
transplant patient’s current status
 Assists staff and the interprofessional team in developing and maintaining
competency in transplant assessment
 Synthesizes data, information, and knowledge relevant to the situation to
identify patterns and variances
Transplant Nursing: Scope and Standards of Practice
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
STANDARD 2. DIAGNOSIS
The transplant nurse analyzes assessment data to determine nursing
diagnoses or health-related problems or needs.
Measurement Criteria:
The Transplant Nurse:
 Derives diagnoses, problems, or needs based on assessment data
that reflect the patient’s current clinical condition.
 Derives diagnoses encompassing:
o Identified or potential age-related physical, psychological, social, or
developmental problems
o Need for rehabilitation care post-transplant based on comorbidities,
developmental level and psychosocial status
o Support and educational needs of care givers
o Any present, or potential, physical or psychosocial environmental
problem
 Discusses diagnoses, problem, or needs with the patient, their family
and support system, members of the interprofessional team, and other
healthcare providers when possible and appropriate
 Documents diagnoses or issues in a manner that facilitates the
determination of the expected outcomes and plan
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Refines and revises diagnoses based on ongoing assessment data
 Systematically compares clinical findings with normal variations
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Systematically compares clinical findings with normal in formulating a
differential diagnosis
 Utilizes complex data and information obtained during interview,
examination, and diagnostic procedures in identifying diagnoses
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STANDARD 3. OUTCOMES IDENTIFICATION
The transplant nurse identifies expected outcomes for a plan individualized
to the patient or the situation.
Measurement Criteria:
The Transplant Nurse:
 Identifies expected outcomes mutually with the patient, family and
support system, and other healthcare providers. Expected outcomes are
patient-oriented, developmentally appropriate, evidence-based,
attainable, and realistic in relation to the patient’s, caregiver’s, and their
support system’s present and potential abilities

Derives culturally and age-appropriate expected outcomes from the
diagnoses

Considers associated risks, benefits, costs, current scientific evidence,
and clinical expertise when formulating expected outcomes

Defines expected outcomes in terms of the patient, patient values,
ethical considerations, environment or situation with consideration of
associated risks, benefits and costs, and current scientific evidence

Includes a time estimate for attainment of expected outcomes

Develops expected outcomes that provide direction for continuity of care

Documents expected outcomes as measurable goals

Implements consensus-driven clinical guidelines
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Identifies expected outcomes that incorporate scientific evidence and
are achievable through evidence-based practices

Modifies expected outcomes based on patient changes and evaluation
of the situation.

Supports the use of clinical guidelines linked to positive patient
outcomes
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Identifies expected outcomes that incorporate cost and clinical
effectiveness, patient satisfaction, and continuity and consistency
among providers
 Develops clinical guidelines that are linked to optimal patient outcomes
 Provides leadership in the coordination of the interprofessional healthcare
services to identify patient outcomes.
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

Synthesizes data and information to facilitate necessary system and
community support measures, including environmental modifications that
will affect patient outcomes.
Leads the multidisciplinary team at a systems level to identify outcomes
Transplant Nursing: Scope and Standards of Practice
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STANDARD 4. PLANNING
The transplant nurse develops a plan of care that prescribes strategies and
alternatives to attain expected outcomes.
Measurement Criteria:
The Transplant Nurse:
 Develops an individualized plan of care that considers patient
characteristics and developmental level, and is culturally appropriate
and environmentally sensitive
 Participates in the design and development of interprofessional
processes to address the situation or issue
 Contributes to the development and continuous improvement of
organizational systems that support the planning process.
 Supports the integration of clinical, human, and financial resources to
enhance and complete the decision-making process
 Develops a plan of care with the patient, their family and support
system, and others, with an understanding and appreciation of the
patient’s values and beliefs, developmental level, and coping style
 Includes strategies in the plan that addresses each of the identified
diagnoses or issues, which may include strategies for promotion and
restoration of health and prevention of illness, injury, and disease.
 Provides for continuity in the plan of care
 Incorporates a clinical pathway or timeline in the plan.
 Establishes priorities with the patient and their support system to meet
the goals of the plan of care
 Has an awareness of current trends and research affecting care in
planning
 Considers the economic impact of the plan on the patient, their family
and support system
 Uses standardized language or recognized terminology to document
the plan
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Collaborates with interprofessionals to carry out the plan
 Identifies assessment, diagnostic strategies, and therapeutic
interventions in the plan that reflect current evidence, including data,
research, and literature
 Reviews the plan to make sure it reflects current statues, rules, and
regulations, and standards of transplant nursing practice
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
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



Utilizes the plan to provide direction to other members of the
healthcare team
Modifies the plan to reflect current evidence, including data, research,
literature, and expert clinical knowledge
Selects and designs strategies that meet the multifaceted needs of
complex transplant patients
Includes the synthesis of the patient’s values and beliefs regarding
nursing and medical therapies in the plan
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STANDARD 5. IMPLEMENTATION
The transplant nurse implements the identified plan.
Measurement criteria:
The Transplant Nurse:
 Implements the plan in a safe and timely manner.
 Implements the plan using the fundamentals of project or systems
management
 Documents implementation and modifications of the identified plan.
 Utilizes knowledge of evidence-based practices specific to the
diagnosis or problem
 Assists the multidisciplinary team in working with community resources
that are consulted to help implement the plan of care
 Collaborates with nursing colleagues, the multidisciplinary team and
other disciplines to implement the plan
Additional measurement criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Facilitates utilization of systems and community resources to
implement the plan
 Supports collaboration with nurses and the interprofessional team to
implement the plan
 Incorporates new knowledge and strategies to initiate change in
nursing care practices to achieve the desired outcomes
Additional measurement criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Appraises initiates and facilitates the utilization of systems and community
resources to implement the plan
 Leads collaboration with organizational systems that support the
implementation of the plan
 Facilitates and monitors implementation of the plan, adjusting strategies
as needed based on the desired outcome
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STANDARD 5A. COORDINATION OF CARE
The transplant nurse coordinates care delivery.
Measurement criteria:
The Transplant Nurse:
 Provides direct care that implements the plan
 Documents implementation of care.
 Documents and reports any unexpected outcomes in implementing
care.
 Assists in developing modifications in care delivery.
Additional measurement criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Coordinates system and community resources that enhance delivery of
care across the continuum

Monitors the coordination of care delivery to achieve the desired
outcomes
Additional measurement criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:



Provides leadership in the coordination of the interprofessional healthcare
services for the integrated delivery of patient care
Synthesizes data and information to facilitate necessary system and
community support measures, including environmental modifications.
Leads the multidisciplinary team at a systems level to monitor care
delivery and assess outcomes
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STANDARD 5B. HEALTH TEACHING AND HEALTH PROMOTION
The transplant nurse employs strategies to promote health and a safe
environment.
Measurement criteria:
The Transplant Nurse:
 Provides health teaching that addresses patient self-monitoring,
developmental needs, healthy behaviors, activities of daily living and
preventive self-care

Uses health promotion and teaching methods appropriate to the
situation and the patient’s developmental level, learning needs,
readiness, ability to learn, literacy level, language preference and
culture

Seeks opportunities for feedback and evaluation of the effectiveness of
the strategies used
Additional measurement criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Designs transplant patient education appropriate to the patient’s
developmental level, learning needs, readiness to learn, cultural values
and beliefs

Designs community education programs about organ donation,
transplantation and the treatment of end-stage organ diseases
Additional measurement criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Synthesizes empirical evidence regarding risk behaviors, learning
theories, behavioral change and motivational theories, epidemiology
and other related theories when designing health information and
patient education

Designs transplant education resources that are appropriate to the
patient’s developmental level, learning needs, readiness to learn,
cultural values and beliefs

Evaluates health information resources in the field of transplantation
for accuracy, readability and comprehensibility to help patients access
quality health care information
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STANDARD 5C. CONSULTATION
The transplant nurse coordinator or advanced practice registered nurse
provides consultation to influence the plan of care, enhance the abilities of
others and effect change.
Measurement criteria:
The Transplant Nurse Coordinator:

Facilitates the effectiveness of consultation by involving the patient in
decision-making and negotiating role responsibilities

Communicates consultation recommendations to facilitate change
Additional measurement criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Synthesizes clinical data, theoretical frameworks and evidence when
providing consultation

Facilitates the effectiveness of a consultation by conducting research
and disseminating research findings to enhance psychosocial and
clinical outcomes
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STANDARD 5D. PRESCRIPTIVE AUTHORITY AND TREATMENT
The Advanced Practice Registered nurse uses prescriptive authority,
procedures, referrals, treatments and therapies in accordance with state and
national laws and regulations.
Measurement criteria for the Advanced Practice Registered Nurse:
 Prescribes evidence-based treatments, therapies and procedures
considering the patient’s comprehensive healthcare needs

Prescribes pharmacologic agents based on a current knowledge of
pharmacology and physiology

Prescribes specific pharmacological agents and treatments based on
clinical indicators, the patient’s status and needs and the results of
diagnostic and laboratory tests

Evaluates therapeutic effects of pharmacological and nonpharmacological treatments, monitors outcomes and adjusts care as
needed to obtain the desired outcomes

Evaluates potential adverse effects of pharmacological and nonpharmacological treatments and adjusts treatment to achieve the
desired results

Provides patients with information about intended effects and potential
adverse effects of proposed prescriptive therapies

Provides information about costs, the use of brand vs generic
medications and alternative treatments and procedures as appropriate
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STANDARD 6. EVALUATION
The transplant nurse evaluates progress toward attainment of outcomes.
Measurement criteria:
The Transplant Nurse:

Includes the patient and others involved in patient care during the
evaluation process

Documents results of the evaluation

Uses ongoing assessment data to revise the nursing diagnoses, the
plan of care, implementation and outcomes
Additional measurement criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Evaluates the accuracy of the diagnosis and effectiveness of the
interventions in relation to the patient’s attainment of expected
outcomes.
 Uses the results of the evaluation to recommend process or structure
changes, including policy, procedure or protocol documentation as
appropriate.
Additional measurement criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Leads a systematic, ongoing and criterion-based evaluation of the
outcomes in relation to the structure and processes prescribed by the
plan and the indicated timeline.

Synthesizes the results of the evaluation to determine the impact of the
plan on the affected patients, families, groups, communities,
institutions, networks and organizations.

Disseminates the results to the patient and others involved in the care
or situation, as appropriate, in accordance with country and state laws
and regulations.

Uses the results of the evaluation to make or recommend process or
structure changes, including policy, procedure, or protocol
documentation, as appropriate
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STANDARD 7. QUALITY OF PRACTICE
The transplant nurse systematically enhances the quality and effectiveness
of nursing practice.
Measurement Criteria:
The Transplant Nurse:

Obtains and maintains professional certification

Functions in accordance with legislative and common law affecting
nursing practice

Protects the rights of individuals and groups

Provides age- and developmentally appropriate care in a manner that
demonstrates an understanding of cultural norms and influence

Documents the application of the nursing process in a responsible,
accountable and ethical manner

Understands the role of consultants and other referrals that contribute
to continuity of care and is aware of their recommendations

Documents plan-of-care communications, rationales for plan-of-care
changes, and collaborative discussions to support and advance patient
care and the well-being of their family and support system.

Uses the results of quality improvement activities to initiate change,
and monitor effectiveness in nursing practice and the healthcare
delivery system

Uses creativity and innovation in nursing practice to improve care
delivery

Evaluates the practice environment in relation to existing evidence,
identifying opportunities for the generation and use of research

Incorporates new knowledge and evidenced based findings to initiate
changes in nursing practice to achieve desired outcomes

Supports efforts of transitional care modalities for patients and families,
e.g., acute nursing care is one link in the chain of all healthcare
components which can include hospitalizations, home and community,
to ensure optimal care delivery

Participates in quality improvement activities. Such activities may
include:
o Collecting data to monitor quality and effectiveness of nursing
practice
o Integrating technological advances to support, maximize, and ensure
safe nursing care delivery modalities
Transplant Nursing: Scope and Standards of Practice
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o Participating in efforts to minimize costs and unnecessary duplication
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:
 Designs quality improvement initiatives.



Develops, implements, and evaluates policies, procedures and
guidelines to improve the quality of practice. .
Participates in interprofessional transplant team-based care to
evaluate clinical care or healthcare delivery services. (AACN, 2011)
Implements processes to remove or decrease barriers within
organizational systems
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:
 Applies quality improvement processes in designing, implementing,
evaluating, and recommending change to improve healthcare
outcomes
 Provides leadership in the coordination of the interprofessional
healthcare services to attain quality in nursing practice
 Synthesizes data and information to facilitate necessary system and
community support measures, including environmental modifications to
attain quality in nursing practice
 Analyzes organizational systems for barriers, facilitators and potential
strategies for change
 Analyzes outcomes related to safety, satisfaction, effectiveness and
cost to design program innovations that promote quality
 Integrates technological advances to optimize quality in nursing care
delivery systems
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STANDARD 8. EDUCATION:
The transplant nurse attains knowledge and competency that reflects
current nursing practice.
Measurement Criteria:
The Transplant Nurse:

Participates in ongoing educational activities related to the appropriate
knowledge base and professional issues in transplant nursing

Demonstrates a commitment to lifelong learning through self-reflection
and inquiry to identify learning needs

Seeks experiences that reflect current practice in order to maintain
skills and competence in clinical practice or role performance

Acquires knowledge and skills appropriate to the specialty area,
practice setting, role, or situation

Seeks formal and independent learning experiences and activities to
maintain and develop proficient clinical skills and knowledge.

Uses current healthcare research findings and other evidence to
expand clinical knowledge, enhance role performance, and increase
knowledge of professional issues.

Participates in ongoing interprofessional educational activities to
ensure high quality interprofessional collaborative practice and
interprofessional team-based care

Is aware of and may consider additional professional and educational
advancement through graduate level education
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Promotes a climate of research and inquiry through collaboration with
nurse-scientists and mentoring transplant nurses in evaluating and
basing practice on evidence generated through research

Provides leadership in the design, implementation, and dissemination
of quality assessment studies to promote evidence based nursing
practice

Assesses and analyzes the educational needs of the transplant
nursing team and formulates a plan for ongoing education and
assessment
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STANDARD 9. PROFESSIONAL PRACTICE EVALUATION
The transplant nurse evaluates self-practice in regard to professional
practice standards and guidelines, relevant statutes, rules, and regulations.
Measurement Criteria:
The Transplant Nurse:

Applies knowledge of current practice standards, guidelines, statutes,
rules, and regulations into practice.

Engages in self-evaluation of practice on a regular basis, identifying
areas of strength as well as areas in which professional development
would be beneficial.

Obtains informal feedback regarding self-practice from patients, peers,
professional colleagues, and others.

Participates in systematic peer review as appropriate.

Takes action to achieve goals identified during the evaluation process.

Provides rationales for practice beliefs, decisions, and actions as part
of the informal and formal evaluation processes.

Engage in a formal process seeking feedback regarding role
performance from individuals, professional colleagues,
representatives, administrators of corporate entities, and others.
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Advocates for health policy, financing, regulation, healthcare delivery
systems and political processes that advance the safe and effective
care of patients, families, and caregivers.

Evaluate and interpret the effectiveness of evidenced base health
promotion and risk reduction strategies to patient, families and support
systems.
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STANDARD 10. COLLEGIALITY
The transplant nurse interacts with, and contributes to the professional
development of the interprofessional team
Measurement Criteria:
The Transplant Nurse:








Actively participates on interprofessional teams that contribute to role
development and advances the practice of nursing
Shares knowledge and skills with peers and colleagues as evidenced
by such activities as patient care conferences or presentations at
formal or informal meetings.
Provides peers with feedback regarding their practice or role
performance.
Interacts with peers and colleagues to enhance one’s own professional
nursing practice and role performance.
Supports and facilitates education of students in healthcare
professions.
Contributes to a supportive and healthy work environment.
Mentors novice nurses and other allied health professionals as
appropriate.
Models proficient practice within the interprofessional team and with
healthcare consumers.
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Engage other healthcare professionals appropriate to specific care
situations in understanding the unique contributions, scope of practice and
educational preparation of all members of the health care team.
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STANDARD 11.COLLABORATION AND COMMUNICATION
The transplant nurse collaborates with patients, their family and support
system, and others in the conduct of nursing practice.
Measurement Criteria:
The Transplant Nurse:

Communicates with the patient, their family and support system, and
healthcare providers regarding patient care and the nurse’s role in
providing that care.

Collaborates in creating a documented plan focused on outcomes and
decisions related to care and delivery of services that indicates
communication with patients, families, and others.

Uses communication practices that minimize risks associated with
handoffs among providers and across transitions of care

Communicates with the patient and their support system to ensure
access and optimize adherence to necessary follow-up care

Participates with other disciplines to optimize patient care and care
delivery through interprofessional activities such as education,
management, technological development, or research opportunities

Partners with others to effect change and generate positive outcomes
through knowledge of the patient or situation

Documents plan-of-care communications, rationales for plan-of-care
changes, and collaborative discussions to support and advance patient
care and the well-being of their family and support system
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:

Facilitates communication among the interprofessional

Partners with other disciplines to enhance patient care through
interprofessional education, consultation, management, technology
development, or research activities.

Assesses the effectiveness of the collaborative and communicative
processes across systems that are involved in the overall care of the
patient, their family and support system.
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Provides leadership within the transplant interprofessional team to
improve patient care through education, consultation, management,
technology development, and research
Transplant Nursing: Scope and Standards of Practice
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
Engage other healthcare professionals appropriate to the specific care
situation in shared patient and family centered problem solving

Analyzes the outcomes of collaborative and communicative processes
of the interprofessional teams in regard to patient outcomes.

Based on this analysis, strategizes and develops programs to optimize
the effectiveness of interprofessional collaboration and communication.
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STANDARD 12. ETHICS
The transplant nurse integrates ethical principles in all areas of practice.
Measurement Criteria:
The Transplant Nurse:

Uses Code of Ethics for Nurses with Interpretive Statements (ANA,
2001) to guide practice.

Delivers care in a manner that preserves and protects patient
autonomy, dignity, rights, values, beliefs and diversity

Recognizes the patient, their family and support system as core
members of the healthcare team

Maintains appropriate therapeutic and professional patient nurse
relationship with appropriate boundaries

Maintains patient confidentiality within legal and regulatory parameters

Serves as a patient advocate by promoting patient self-advocacy

Demonstrates a commitment to practicing self-car and stress
management

Understands that ethical dilemmas may arise within the transplant
specialty related to organ allocation, transplant candidacy, and
available technologies

Participates in committees or in care conferences with the
interprofessional team to help resolve ethical issues involving patients,
the healthcare tem, or healthcare system

Takes appropriate action at the transplant nurse level to report illegal,
incompetent, or impaired practices.

Demonstrates an understanding of diversity awareness and cultural
humility in working with patients, families and the interprofessional
team.
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Provides leadership within the interprofessional team to address ethical
issues that impact the patient, family and healthcare team.

Synthesizes data and information to facilitate strategies to operationalize
ethical principles in nursing practice
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
Uses the results of an evaluation to make or recommend process or
structure changes, including policy, procedure, or protocol documentation,
as appropriate to optimize ethical practice.
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STANDARD 13. EVIDENCED BASED PRACTICE AND RESEARCH
The transplant nurse integrates evidence and research findings to inform
best practice.
Measurement Criteria: Evidence-Based Practice
The Transplant Nurse:

Utilizes findings from evidence-based research to implement best
nursing practice and guide clinical judgment

Participates in research activities as a transplant nurse by: Identifying
practice issues that are problematic
o Assessing current evidence about specific topics
o Implementing evidence-based practice guidelines to influence or
change current practice
o Participating in data collection for research purposes
o Participating in an institution-based research committee or program
o Incorporating research as a basis for learning.
 Ensures the protection of human subjects, understanding that patients
and families who are involved in research studies should experience
minimal risk and potential for harm.
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
Research
The Advanced Practice Registered Nurse:


Provides leadership within the interprofessional team to promote
evidence based practices that impact the patient, family and healthcare
team.
Uses scholarly evidence to improve healthcare outcomes and advance
nursing practice.

Conducts or synthesizing research that discovers, examines, and
evaluates knowledge, theories, criteria, and creative approaches to
improve health care.

Formally disseminates research findings through presentations and
publications

Promotes a climate of research and inquiry through mentoring
transplant nurses, reviewing the literature, participating in research
activities, and evaluating research findings

Uses research findings in the development of policies, procedures, and
standards of practice in patient care
STANDARD 14. RESOURCE UTILIZATION
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The transplant nurse considers factors related to regulation, legislation,
safety, effectiveness, cost, and impact on practice in the planning and
delivery of nursing services.
Measurement Criteria:
The Transplant Nurse:

Uses organizational and community resources to formulate
interprofessional plans of care.

Evaluates factors such as safety, effectiveness, availability, cost–
benefits, efficiencies, patient preference and impact on practice, when
choosing practice options with similar expected outcome.

Assists the patient their family and support system in identifying and
securing appropriate and available services to address health-related
needs.

Assigns or delegates tasks, based on the needs and condition of the
patient, potential for harm, stability of the patient’s condition,
complexity of the task, and predictability of the outcome.

Assists the patient their family and support system in becoming
informed consumers about the options, costs, risks, and benefits of
treatment and care.

Recognizes the importance of effective communication with the
patient, their family and their support system in achieving and ensuring
optimal care pre- and post-transplant.
Additional Measurement Criteria for the Transplant Nurse Coordinator:
The Transplant Nurse Coordinator:

Develops solutions for patient care problems that address effective
resource utilization and maintenance of quality.

Promotes interventions that assist others in becoming informed about
the goals of care, the strategies to achieve those goals, the risks and
benefits of care, and costs.
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Develops evaluation strategies and programs to demonstrate cost
effectiveness, cost benefit, and efficiency factors associated with
nursing practice.

Provides leadership within the interprofessional team to address
effective resource utilization.
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STANDARD 15. LEADERSHIP
The transplant nurse provides leadership in the professional practice
setting and the profession of transplant nursing.
Measurement Criteria:
The Transplant Nurse:

Engages positively with others on the transplant team as a team player
and in team-building strategies.

Demonstrates effective communication and conflict resolution skills.

Participates with the team in helping to maintain a healthy work
environment

Demonstrates the ability to set achievable goals through realistic
interventions that are measureable

Demonstrates an interest in continuing education

Promotes success through role modeling

Exhibits flexibility through times of change

Demonstrates leadership skills by contributing to a culture where safe
design principles are developed and implemented

Disseminates information and promotes the advancement of transplant
nursing through publications and presentations

Participates on committees, councils, and administrative teams within
the institution

Participates in professional nursing and transplant organizations to
promote the profession of transplant nursing
Additional Measurement Criteria for the Transplant Nurse Coordinator
The Transplant Nurse Coordinator:

Directs the coordination of care across settings and among caregivers
or providers, including oversight of licensed and unlicensed personnel
in any assigned or delegated tasks.

Provides direction to enhance the effectiveness of the healthcare team.

Describe strategies to integrate patients/families as primary members
of the health care team.

Reviews and revises protocols or guidelines to reflect evidence-based
practice, incorporates accepted changes in care management, and
solves emerging problems.
Transplant Nursing: Scope and Standards of Practice
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
Initiates and revises protocols or guidelines to reflect evidence-based
practice, incorporates accepted changes in care management, or
solves emerging problems.

Promotes advancement of the profession of nursing through attaining
leadership roles in professional organizations.

Advocates for the value and role of the professional nurse as a
member of, and leader within, the interdisciplinary healthcare team for
the provision of high quality and safe care to individuals and families
Additional Measurement Criteria for the Advanced Practice Registered Nurse:
The Advanced Practice Registered Nurse:

Creates a culture of innovation

Advances nursing’s autonomy and accountability through involvement
in healthcare policy making related to nursing roles.

Provides leadership to influence decision-making bodies to improve
patient care

Applies quality improvement processes in designing, implementing and
evaluating change to improve healthcare outcomes.
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REFERENCES
American Nurses Association (ANA). (2005). Code of Ethics for Nurses with
Interpretive Statements.
Association of Pediatric Hematology/Oncology Nurses (APHON). (2009).
Pediatric Oncology Nursing: Scope and Standards of Practice.
Global Observatory on Donation & Transplantation (GODT). (2012). Retrieved
August 18, 2014 from http://www.transplant-observatory.org
Organ Procurement and Transplantation Network (OPTN) (2014) Retrieved
August 18, 2014 from http://optn.transplant.hrsa.gov
International Council of Nurses. Nurse Practitioner/Advanced Practice Nursing
Network. Definitions of the Role. Retrieved August 18, 2014 from
http://international.aanp.org/Practice/APNRoles
National Institutes of Health (NIH). (2012). Solid Organ Transplantation: Older
Donors and Recipients, PA 13-030, 13-037, and 13-038.
National Consensus Project for Quality Palliative Care. Clinical practice
guidelines for quality palliative care. 2nd ed. Pittsburgh (PA): National Consensus
Project for Quality Palliative Care; 2009.
J. Brant and R. Wickham (Eds.) Statement on the Scope and Standards of
Oncology Nursing Practice: Generalist and Advanced Practice. Pittsburg, PA:
Oncology Nursing Society (ONS). (2014).
.
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GLOSSARY
Assessment. A systematic, dynamic process by which the nurse, through
interaction with the patient, family and support systems, and interprofessional
team, collects and analyzes data about the patient. Data may include the
following dimensions: physical, psychological, sociocultural, spiritual, cognitive,
functional, developmental, economic, and lifestyle.
Caregiver. A person who provides direct care for another, such as a child,
dependent adult, the disabled, or the chronically ill.
Code of ethics. A list of provisions that makes explicit the primary goals, values,
and obligations of the profession.
Continuity of care. An interprofessional process that includes patients and
family and support systems in the development of a coordinated plan of care.
This process facilitates the patient’s transition between settings, based on
changing needs and available resources.
Criteria. Relevant, measurable indicators of the standards of clinical nursing
practice.
Data. Discrete entities that are described objectively without interpretation.
Diagnosis. A clinical judgment about the patient’s response to actual or potential
health conditions or needs. The diagnosis provides the basis for determination of
a plan of care to achieve expected outcomes. Transplant nurses utilize nursing or
medical diagnoses depending upon educational and clinical preparation and
legal authority.
Disease. A biological or psychosocial disorder of structure or function in a
patient, especially one that produces specific signs or symptoms or that affects a
specific part of the body, mind, or spirit.
Environment. The atmosphere, milieu, or conditions in which an individual lives,
works, or plays.
Evaluation. The process of determining both the patient’s progress toward the
attainment of expected outcomes and the effectiveness of nursing care.
Evidence-based practice. A process founded on the collection, interpretation,
and integration of valid, important, and applicable patient-reported, clinicianobserved, or research-derived evidence. The best available evidence, moderated
by patient circumstances and preferences, is applied to improve the quality of
clinical judgments.
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Expected outcomes. End results that are measurable, desirable, and
observable, and that translate into observable behaviors.
Family. Family of origin or significant others as identified by the patient.
Guidelines. Systematic statements, based on available scientific evidence and
expert opinion, that describe a process of patient care management which has
the potential to improve the quality of clinical and consumer decision-making.
Health. “The state of complete physical, mental and social wellbeing and not
merely the absence of disease or infirmity” (World Health Organization.
Retrieved August 18, 2014 from http://www.who.int
Healthcare provider. A person with special expertise who provides healthcare
services or assistance to patients. This may include nurses, physicians,
psychologists, social workers, nutritionist/dietitians, and various therapists.
Holistic. Based on an understanding that the patient is an interconnected unity,
a whole system that is greater than the sum of its parts, and that physical,
mental, social, and spiritual factors need to be included in any interventions.
Illness. An unhealthy condition due to an abnormal process in which aspects of
the social, physical, emotional, or intellectual condition and function of a person
are diminished or impaired compared with that person's previous condition.
(Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier).
Implementation. Activities such as teaching, monitoring, providing, counseling,
delegating, and coordinating. The patient, significant others, or healthcare
providers may be designated to implement interventions within the plan of care.
Information. Data that are interpreted, organized, or structured.
Interprofessional. Reliant on the overlapping knowledge, skills, and abilities of
each professional team member, resulting in synergistic effects where outcomes
are enhanced and more comprehensive than the simple aggregation of the team
members’ individual efforts.
Knowledge. Information that is synthesized so that relationships are identified
and formalized.
Registered Nurse. An adequately educated and prepared individual registered
or licensed by a state, commonwealth, territory, government, or other regulatory
body to practice as a registered nurse.
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Nursing. the protection, promotion, and optimization of health and abilities,
prevention of illness and injury, alleviation of suffering through the diagnosis and
treatment of human response, and advocacy in the care of individuals, families,
communities, and populations. (American Association of Nursing. Retrieved
August 18, 2014 from http://www.nursingworld.org.)
Outcomes. Measurable, expected, patient-focused goals that translate into
observable behaviors.
Palliative care. Patient and family-centered care that optimizes quality of life by
anticipating, preventing, and treating suffering. Care throughout the continuum of
illness involves addressing physical, intellectual, emotional, social, and spiritual
needs and to facilitate patient autonomy, access to information, and choice.
(National Consensus Project for Quality Palliative Care. Clinical Practice
Guidelines for Quality Palliative Care, Third Edition. 2013.)
Patient. The recipient of transplant nursing care, whether a potential donor,
transplant candidate, organ donor, or transplant recipient. When the patient is an
individual, the focus is on his or her health state, problems, or needs. When the
recipient of care is a family or group, the focus is on their health state as a whole,
and/or on the reciprocal effects on the health states group members. When the
patient is considered to be a community or population, the focus of care is on the
collective personal and environmental health and the health risks.
Peer review. A collegial, systematic, and periodic process by which registered
nurses are held accountable for practice and which fosters the refinement of
knowledge, skills, and decision-making at all levels and in all areas of practice.
Plan. A comprehensive outline of the steps that need to be undertaken to attain
expected outcomes.
Quality of life. An individual’s general perception of happiness and satisfaction
with life; domains include health, physical, psychological, financial, social, family,
economic, and spiritual areas. The transplant patient’ perception may focus on
health-related quality of life issues, and the impact on his or her normal
functioning by disease or illness.
Recipients of nursing care. See Patient
Self-care maintenance. Self-monitoring adherence behaviors used by patients
to maintain health.
Self-care management. The decision-making process that patients use when
conducting self-care maintenance.
Situation. A set of circumstances, conditions, or events that affect someone or
something at a particular time and in a particular place.
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Standard. An authoritative statement enunciated and publicized by the
profession, by which the quality of practice, service or education can be judged.
Standards of nursing care. Authoritative statements that describe a competent
level of clinical nursing practice demonstrated through assessment, diagnosis,
outcomes identification, planning, implementation, and evaluation.
Standards of practice. Authoritative statements that describe a level of care or
performance common to the profession of nursing by which the quality of nursing
practice can be judged. Standards of clinical nursing practice include both
standards of care and standards of professional performance.
Standards of professional performance. Authoritative statements that describe
a competent level of behavior in the professional role, including quality of care,
professional practice evaluation, education, collegiality, ethics, collaboration,
research, resource utilization, and leadership.
Strategy. A plan of action to achieve a major overall goal.
Transplant nursing. Specialized nursing care of the transplant recipient and
donor with these focuses:
 Protection, promotion, and optimization of health and abilities of the
transplant recipient and living donor across the life span. Includes
prevention, detection, and treatment of illness and injury related to
diseases treated by solid organ transplantation, and diseases that may
occur due to living donor donation in individuals, families, communities,
and populations of all ages.
 Protection, promotion, and optimization of the deceased donor organ
during the process of organ donation. Includes prevention, detection, and
treatment of illness and injury that may occur during the process of organ
donation and recovery in individuals and families of all ages.
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