The Experiences and Perceptions of Organ and Tissue Donation Coordinators Participating in a Team Cohesion and Communication Workshop: An Exploratory Descriptive Qualitative Study

ABSTRACT

Background/Purpose: Organ and tissue donation coordinators are usually registered nurses with intensive care background that work in highly specialized and complex environments that can lead them to experience work-related issues, such as burnout and compassion fatigue. To help tackle these issues, organ donation organizations need to take preventive measures to improve coordinators’ work-related well-being. Therefore, the purpose of this study was to explore the perceptions of coordinators following participation in a workshop aimed at improving team cohesion, communication strategies, and work-related well-being.

Methods/Procedures: We conducted individual descriptive qualitative interviews using a semi-structured interview guide with coordinators in an organ donation organization in Canada. The data were analyzed using an inductive thematic analysis process.

Results: Seven coordinators participated in the study. Most participants reported improvements in inclusiveness and cohesiveness among their team after the workshop. Some coordinators reported apprehension about role-playing but found it to be a valuable aspect of the intervention. Participants reported a positive experience and indicated they would participate in future workshops. Still, coordinators mentioned that future interventions should have an additional focus on the donation work and how to become a better communicator.

Discussion: The findings from this study brought new insight into the coordinators’ team dynamics and their experience in a workshop intervention. The expertise and experience of the facilitators, role-playing, group interaction, and feedback were perceived as valuable components of the workshop.

Conclusion: OTDCs in this study perceived positive impacts on their team cohesiveness, communication skills and work-related well-being following the workshop initiative. The findings from this study highlight that workshop interventions can be effective in fostering work-related well-being among OTDCs.

Keywords: organ and tissue donation coordinator, workshop, team cohesion, communication

Implications for Nursing

1. The discussion presented in this paper offers insights into nurses’ perception with intensive care backgrounds that work in organ donation, on their attendance on a workshop grounded in a relationship-centred care model.
2. The findings from this paper highlight the importance of implementing focused interventions to improve Organ and Tissue Donation Coordinators (OTDCs) nurses’ work-related well-being.
3. This paper presents the starting point to further develop interventions to prevent burnout and compassion fatigue among nurses that work in organ donation directly (OTDCs) or indirectly (intensive care nurses).

Background & Purpose

Organ and tissue donation coordinators (OTDC) are key to effective deceased organ donation programs. Their work and dedication are recognized by donor families (Sarlo et al., 2016; Sarti et al., 2018; Silva e Silva et al., 2016), intensive care nurses, and physicians (Silva e Silva et al., 2020). However, OTDCs deal with highly stressful and emotional scenarios daily, which can negatively impact their mental health and work-related well-being (e Silva et al., 2020; e Silva et al., 2022). OTDCs are usually registered nurses with experience in intensive care units (ICU) and/or specific training in organ donation and transplantation, who manage the organ donation process from donor identification to organ retrieval surgery (Silva e Silva et al., 2020). Balancing all activities related to their role daily can potentially contribute to the incidence of work-related issues such as burnout and compassion fatigue, which are both conditions linked to mental, emotional and physical exhaustion (Mao et al., 2018; Silva e Silva et al., 2020).

A recent scoping review of the literature conducted by our research team highlighted that there is a lack of publication in this area despite the evidence that work-related issues are common among OTDCs (Silva e Silva et al., 2020). This is in addition to evidence that there is a lack of interventional studies applying tailored interventions to help improve work-related well-being among OTDCs (Chuang et al., 2016; Van-Mol et al., 2015). Interestingly, despite being susceptible to work-related issues, OTDCs also frequently report having high levels of job satisfaction, which is usually linked with higher levels of resilience and lower incidence of work-related issues (Silva e Silva et al., 2020).  

The absence of effective coping strategies to sustain work-related well-being among OTDCs can negatively impact retention, turnover, and the organization’s ability to optimize organ donation (Mao et al., 2018). Losing experienced OTDCs may also harm the performance of organizations across multiple domains (e.g., reallocation of resources to train new people, and activities to foster team dynamics with new professionals). In addition to educating hospital staff about the importance of organ donation and promoting a culture of donation locally, OTDCs work synergistically with the members of the ICU and the care team to manage organ donation cases and provide care for donors and their families, (Silva e Silva et al., 2020). In a recent mixed-method social network analysis study mapping the communication during organ donation cases, ICU nurses and physicians described their routine as intense and emotionally charged and having specialized help, such as OTDCs supporting families emotionally, and responding to technical questions about the donor maintenance alleviates some of their workload, which also relates to increased rates of donor identification and donation (Silva e Silva, 2020). Thus, the identification and development of appropriate coping and preventative strategies to improve the well-being of OTDCs are necessary to ensure both continuity and quality in the donation process, and the mental health of those healthcare professionals.

An organ donation organization in a province of Canada hired consultant experts in resilience and interpersonal communication to facilitate a workshop to improve team dynamics and work-related well-being among OTDCs. The workshop used a relationship-centred care framework to strengthen approaches and communication with donor families in order to decrease family decision regret, increase team cohesion, and improve work-related well-being, conversion rates and donor numbers (Suchman, 2006). The relationship-centred care approach promotes team cohesion, support, collegiality, and personhood of patients, families, and staff (Suchman, 2006). Nearly a year after the workshop, it was determined that it would be valuable to evaluate the impact on OTDCs. Therefore, the purpose of this study was to explore the experiences and perceptions of OTDCs following participation in that workshop.

Methods & Procedures

We used an exploratory-descriptive qualitative approach, with a constructivist paradigm to investigate the experiences and perceptions of OTDCs following a relationship-centred care workshop (Hunter et al., 2019). The qualitative descriptive approach allows participants to share their experience with a lower level of researcher interpretation when compared to other qualitative methodologies (e.g., grounded theory), which allows researchers to get closer to the data and the events surrounding it (Colorafi & Evans, 2016). Constructivist qualitative research studies emphasize data generated by participants either through observations or interviews, allowing the researcher to understand the phenomenon of interest from the perspective of those experiencing it (Chandler et al., 2017).  We also used the COREQ (Consolidated criteria for Reporting Qualitative research) to guide the description of the methods used in this study (Tong et al., 2007). This study was approved by the Ottawa Health Sciences Network Research Ethics Board (OHSN-REB #20190716-01H).

Setting

            The target population for the study was OTDCs working in a Canadian organ donation organization who participated in the relationship-centred care workshop.

The workshop

A consultant expert group that had previously administered a workshop with the Canadian organ donation organization was invited to deliver a second workshop to expand on the significant foundational work regarding the relationship-centred care approach completed during the first workshop (provided two years prior in 2017).

The workshop was delivered over 2.5 days was and built on the foundation of a health care model of service grounded in relationship-centred care, with the perspective that the quality of the workplace in health care largely affects quality and satisfaction across the patient, staff, and organizational domains and consequently can influence the work-related well-being. The intent was that as participants improve their understanding of the complexities and impacts of relationships (for self and others), they would enhance their coping strategies and improve their work-related well-being (Hunter et al., 2019). In addition, the workshop sought to address issues related to suffering, vicarious trauma, moral distress, grief, and burnout that OTDCs may experience since these can impair team cohesion, function, and relationships.

The workshop was designed to have participants engaging in experiential group-based learning and included teaching sessions, individual reflection, and group exercises. These activities were used as building blocks towards role rehearsal (playing) which was employed as a process to promote refinement of skills so the OTDCs were better prepared to have challenging conversations. During role rehearsal, participants could pause at any time and request feedback and have the opportunity to incorporate that feedback and approach the scenario differently. The scenarios used were provided by a physician from the organization who used composites of real experiences to ensure they were relevant and useful learning tools for the team.

Sampling

            We used convenience sampling as the target population was very specific (Jager et al., 2017). Fifteen OTDCs participated in the workshop in April 2019. At the time of data collection, in March 2020, ten of those coordinators were still working for the organization and we invited all the accessible population to participate in the study (Thacker, 2020). An email was sent to the organ donation organization manager to request permission to contact the OTDCs directly to invite them to participate in the study. An email invitation was sent to the OTDCs employed by the organization at the time of the study. The invitation included information about the study, the purpose, and an informed consent form for each participant to sign. A virtual interview was scheduled once the participants returned their signed consent form. The organization manager did not receive information about which OTDCs consented or declined to participate. Eight OTDCs responded to the invitation and signed the informed consent; however, one individual could not participate due to an unexpected change in workload, resulting in interviewing seven participants (participation rate=87.5%) in March 2020.

Data Collection

             Interviews were conducted using a semi-structured interview guide eleven months after the workshop. This model of interview gives guidance and allows participants to insert their perceptions on the discussed topic (Finlayson et al., 2019; Van-Devanter et al., 2018). When using this type of interview, the main goal is to understand the respondent’s views on the topic instead of making generalizations about behaviour (Barrett & Twycross, 2018; Roulston & Choi, 2018).

            The semi-structured interview guide was reviewed by the primary investigator (V.S.S.), the senior research (A.S.) and the research assistant (A.R.) prior to beginning the interviews. The interview guide was piloted during the first interview, and no major revisions were required. The interviews were conducted by a female research assistant, (A.R., RN, MScN), who has experience co-facilitating focus groups and collecting qualitative data virtually using Zoom©, an online video- and teleconferencing platform with recording capabilities. The participants were provided with an overview of the study and introduced to the research assistant prior to the interview. Each interview lasted between 45 and 60 minutes, was recorded, and no interview was repeated.

The interviewer used descriptive and reflective field notes to record thoughts and observations during and immediately following each interview (Phillippi & Lauderdale, 2018). The field notes were used to foster self-reflection during the data collection and analysis process, and to help identify emerging themes in the data analysis along with the qualitative thematic analysis conducted (Emerson et al., 2011). The interviewer and the primary investigator also connected throughout the interview process to discuss data saturation. Data saturation was determined based on the repetition of findings among the different interviews.

Data Analysis

            We conducted a thematic analysis of the data as this method is not attached to a particular paradigmatic orientation, and it can be used within post-positivist,

constructivist, or critical realist research approaches(Chandler et al., 2017). Analysis was conducted using an iterative process, with interviews, transcription, and analysis occurring concurrently. This process provided opportunities to monitor for data saturation, comprehensiveness of the interview guides, and any issues that emerged during data collection. The digital recordings were transcribed verbatim and anonymized. The data was imported into NVivo®12 (a qualitative data management software) to organize, manage and facilitate the data analysis.

The research team (V.S.S., A.R., A.R.S., A.S.) read the transcripts exhaustively to identify key pieces of relevant data within the text before inductively assigning codes to segments of text (Green et al., 2007). Team members iteratively and collaboratively discussed the codes and created a codebook, identified the most appropriate links between them and created coherent categories (Green et al., 2007). Overarching themes were identified from the descriptive patterns that emerged from the formation of categories (Green et al., 2007). This process of detailed independent analysis of data, followed by collective meaning-making and discussion until consensus is reached, ensure the analytic rigour and dependability of the study findings (Graneheim & Lundman, 2004). The transcripts and findings were not returned to participants.

Results

Seven coordinators participated in this study. All seven participants were women, registered nurses with education and experience in critical care. Three of the participants worked full-time in the multi-organ donor coordinator role, while four of the participants worked full-time in the transplant coordinator role. All the coordinators did on call for the multi-organ donor program. The data analysis resulted in six categories that were combined into two themes: (1) Team dynamics; (2) The workshop (reason for participation, expectations of the workshop, experience participating in the workshop, impact and recommendations following the workshop).

Team Dynamics

The majority of OTDCs described feeling a sense of inclusiveness and cohesiveness within the team. There was a perceived positive atmosphere with good communication, trust, and peer support. They also described confiding in each other about difficult cases and a perception that their peers are the only ones who can truly understand their role and feelings related to OTDCs’ work.

Despite participants’ reports of feeling that they are part of a team, they also mentioned having a lot of ‘solo’ work, particularly when working on an organ donation case. As one participant described it:

I feel like when I’m actually working as a deceased donor coordinator on a case, it’s very individual. You’re kind of on your own. But otherwise, when I’m at work every day, I feel like it’s very much like a team.

Participants also mentioned that their sense of team connection and interaction is not as strong with other members of the healthcare team as with the immediate coordinator team.

The Workshop

We explored various aspects of the workshop, such as the reasons for participating, expectations, experiences, impact, and recommendations following the workshop.

Reason for Participation

            Most participants reported that it was an expectation that they would attend the workshop, while one participant reported they had a positive experience during the previous workshop and they were keen to participate and “continue the momentum”. Because one of the coordinators always had to be on call, not all coordinators could attend to the full workshop. For those who reported that they were expected to participate in the workshop, the majority mentioned they would have chosen to participate regardless. One participant reported, “if it was an option, I would have either way, but it was the expectation that we’re a team and that the whole team participates because, it was the goal to improve team cohesiveness”, highlighting the importance of the entire team participating. It was the perception of one OTDC that “our team needed it…. I think afterwards, they may have seen the good it brought to the team”.    

Expectations of the Workshop

            Some of the OTDCs experienced the uncertainty of what to expect, and one participant reported feeling ‘afraid of participating’. One OTDC clearly articulated a certain apprehension provoked by the workshop among some team members. “I don’t really care for role-playing… I think a lot of us, we kind of knew that this was coming so it did provoke some pre-meeting anxiety knowing that this was potentially going to be happening.”

Some of the other participants who had exposure to similar training in the past reported different expectations. One participant reported they had a positive experience and was looking forward to furthering self-reflection. In addition, some of the participants acknowledged a desire to improve their knowledge and skills related to having difficult and complex conversations with families to discuss organ donation. For others, there was an incongruence between what they expected from the workshop and the content that was actually presented, demonstrating a lack of clarity around the workshop goals, with one transplant coordinator stating:

I really wanted to feel more comfortable having family conversations because we don’t do it that often and it really depends when you get (…) but at the end of the session, it ended up being a lot more about our team.

Experience Participating in the Workshop

            Overall, the participants reported a positive experience participating in the workshop. One coordinator reflected that it was a “good mix of information sharing, but also learning about our group dynamic… I felt safe to share information and I believe others did as well”.For many of the OTDCs, it was their second opportunity to participate in a session with the team of facilitators. There was difficulty for some discerning what they learned or experienced during the first, compared with the second workshop. Some of the OTDCs reported a shift in team dynamics after the first workshop following changes in staffing related to some significant interpersonal issues amongst the team and that, as a group, they were ‘in a better place’, as stated by one participant:

I think also we just got to really know each other better and I think spending that two days together, I know some of the coordinators who are more reserved or quiet that I didn’t know well, I felt like I knew them a little bit better after that. (…) I think it brought our team together because we were two days where we really got to get down to really knowing each other and what each other thought of the other person. So, I really think though that team cohesiveness did improve after that.

Also, since members of the leadership team were present during this workshop, some of the participants reported different dynamics and experiences. One OTDC reflected that they perceived the focus of the workshop to be more related to improving how they did their job in a more general sense. Although almost all of the OTDCs reported disliking role-playing, they found it to be a valuable and useful part of their learning experience, as one coordinator stated,

As much as I hate doing role-playing, I felt like I probably got the most out of that part. Like what we did in the second session, where we kind of put ourselves into situations. We played different roles, and he was able to give advice as to how to deal with that type of situation. I think I got the most out of that.

            There were triggers and interpersonal situations discussed during the workshop, which elicited strong emotions for some of the OTDCs. The participants described providing support to the individuals who were particularly impacted by the situations, and one participant reported that “even though you’re alone, you feel that support of your colleagues” and that sentiment was echoed by others.

Impact and Recommendations Following the Workshop

            There was consensus that the workshop was well received because the facilitators were effective, supportive, and knowledgeable. In addition, the workshop was perceived as improving different aspects of the work of coordinators, as one participant described it:

I would say I’ve heard others, and I know for myself, that I do feel more confident moving forward to speak to families in a challenging situation. I feel more equipped to empathize with strong emotion, which is a great thing, whether I’m doing this or other things in my life.

 While some of the OTDCs reported they were impacted by participating in the workshop, others reported they did not perceive any significant impact or “aha moment”, and another indicated they would have liked for the interviews to be conducted closer to the time of the workshop to improve recall because “so much happens in between…. And it’s hard to tell… what made the difference”. Reminders about some of the basic principles of team cohesiveness such as kindness and respect provided some positive and practical implications for communication in team meetings. One participant described their experience as “confidence-building” and recognized that they were supported during difficult situations.

            The majority of the participants reported they would be interested in additional workshops facilitated by the same team. The participants also provided some recommendations for future workshops regarding content, and opportunities to exchange experience with other organ donation programs. One OTDC expressed an interest in participating in a similar session in the future with “more focus on […] those difficult conversations and really getting to the grunt of how do we become better communicators”. One participant recommended more formal or structured training for novice OTDCs because of the specialty nature of the role, including approaches and conversations with families, while another indicated it might be beneficial to have someone speak to the team about burnout and compassion fatigue, and actually follow-up with them afterwards. The value in talking with other OTDCs across the country, an opportunity to ask questions, become familiar with what other organ donor programs are doing, and find out what they are doing to manage some of the challenges presented by difficult cases and the OTDC role in general were identified as being potentially beneficial.

Discussion

In this study, we explored the experiences of multi-organ donation and transplant coordinators and their experience of participating in a workshop based on relationship-centred care. Through a qualitative approach, we developed a better understanding of the collective perceptions of the coordinators about the impact and importance of participating.

Most of the coordinators reported that participation was an expectation from management. Although some were unsure about the workshop’s purpose, they believed it would help strengthen team dynamics, communication skills, and work-related well-being, which may be partially due to their previous positive experience participating in a workshop provided by the same team of facilitators. When people have a positive emotional experience in an event or meeting, their level of rationality relates it to the positive feeling; thus, individuals are more likely to participate in a similar event in the future (Hopkins et al., 2016).

While OTDCs often work independently on donor or transplant cases, participants reported strong communication, trust, and support among themselves and their peers. Despite the strong sense of team with their immediate colleagues, participants of this study reported their sense of team connection and interaction with other members of the healthcare team were lacking. In a recent study conducted in Spain, transplant coordinators, who were both nurses and physicians, reported a strong sense of inclusion and collaboration amongst the interdisciplinary team; arguably this could be as a result of the disciplines working together in the same role (Danet et al., 2020).

The workshop provided a safe place for participants to reflect, share experiences, and feelings. Participants identified that the expertise of the facilitators, role-playing, group interaction, and feedback were valuable components of the intervention. Most of the participants perceived improvements in team dynamics following the session because the workshop explored the relationships among the team members and improved cohesion. One study reported that team cohesiveness and support were fundamental for successful organ procurement among high-performing organizations (Thomas et al., 2017).

Overall, participants in this study were satisfied with the workshop. In a narrative synthesis of the literature, it was identified that team training interventions could improve performance, communication, cooperation among teams, and patient outcomes (Weaver et al., 2014). Ponzin et al. (2015) conducted a prospective survey to evaluate the effects of a team-building learning project on aspects related to the OTDC role, such as job satisfaction, psychological well-being and work performance and found that the team intervention, although demanding, positively influenced personal commitment and quality of the job in the organ donation/transplantation process (Ponzin et al., 2015). Similarly, the results from this study showed that, while the workshop elicited some strong emotions, it positively influenced team cohesion and work-related well-being. The participants provided recommendations for future workshops, including a greater focus on complex conversations to become a better communicator, address work-related issues, and specific training for novice OTDCs.

Limitations

The small sample size limits the generalizability and transferability to OTDCs and organ donation organizations in other provinces or countries. In addition, the OTDCs who participated in the workshop and subsequently left the organization were not included in the study, which might have led to information bias from those who are still employed by the organization. We mitigated the risk of identifying individuals in the small group of participants by using quotes that highlighted the themes but would not identify an individual. The time between the workshop and the interviews may also have resulted in recall bias, as some OTDCs reported it was difficult to discern between what was learned during the first and second workshops.

Conclusion

Overall, OTDCs were satisfied with the workshop and perceived positive impacts on team cohesiveness and communication skills. Participants who had a previous positive experience with similar workshop interventions were more open to learning and actively engaging. Workshops for OTDC can be valuable interventions to improve their practical and interprofessional skills when delivered by expert facilitators, including role-playing, group interactions and feedback. Participants believed that future workshops should focus on complex conversations and specific training for novice OTDCs. The impact of workshops or similar interventions on team cohesiveness may also improve work-related well-being among OTDCs. This study provides insights for the nursing community, so more interventions using similar approaches can be developed in the future, not only focused on OTDC nurses but also other nursing specialties that may face similar work-related issues (e.g., intensive care nurses). Lastly, the study findings will inform the next phase of a national study investigating burnout and compassion fatigue that will culminate in the development of an intervention to mitigate these work-related issues among OTDCs.

Author Notes

Vanessa Silva e Silva, PhD, RN, Research Coordinator, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ontario – Canada

Laura Hornby, MSc, Research Manager, University of Ottawa, Ontario – Canada

Ken Lotherington, BSc., Project Manager, Canadian Blood Services, Ontario – Canada

Andrea Rochon, MN, RN, Research Assistant, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ontario – Canada

Amina Regina Silva, MN, RN, Research Assistant, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ontario – Canada

Hilary Pearson, PhD, MA, Consultant, Canadian Blood Services, Ontario – Canada

Linda MacNutt, MSW, RSW, Consultant, Canadian Blood Services, Ontario – Canada

Adrian Robertson, MD, Consultant, Canadian Blood Services, Ontario – Canada

Kim Werestiuk, BN, RN, Manager, Transplant Manitoba, Manitoba – Canada

David Kuhl, PhD, MHSc, MD, Professor, University of British Columbia, British Columbia – Canada

Peggy John, Acting Director Organ and Tissue Donation and Transplantation, Canadian

Blood Services, Ontario – Canada

Sonny Dhanani, BSc (Pharm), MD, FRCPC, Chief of Pediatric Intensive Care Unit, Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ontario – Canada

Aimee Sarti, MD, Professor Assistant, University of Ottawa, Ontario – Canada

Corresponding author:   Vanessa Silva e Silva, PhD, RN, CHEO Research Institute, 401 Smyth Rd., Ottawa, Ontario, K1H 5B2

Email: vsilvaesilva@cheo.on.ca

Acknowledgements

The authors would like to acknowledge our patient partners, Peter Wright and Diana Brodrecht, Canadian Blood Services, and the Canadian Donation and Transplantation Research Program.

Ethics Approval

All authors confirm where human patients are involved in the work covered by the manuscript, that ethical approval from all relevant ethical bodies has been received and this information is reflected and/or acknowledged (Research Ethics Board (REB) approval/approval numbers) within the manuscript.  All authors confirm when submitting quality improvement reports that ethical conduct and REB approval/exemption has been reported.

Funding and Conflict of Interest

The workshop and this study were funded by Canadian Blood Services.

Ms. Hornby is a paid part time consultant for Canadian Blood Services.

Ms. Rochon is a research assistant and receives a salary from Canadian Blood Services.

Ms. Silva is a research assistant and receives a salary from Canadian Blood Services.

Ms. Silva e Silva is a paid full-time research coordinator and receives salary from Canadian Blood Services.

Mr. Lotherington is a paid employee of Canadian Blood Services, and the program is a charitable organization funded by federal and provincial governments.

The consultant experts who facilitated the workshop could potentially benefit from the reporting about the results of this study which examined the impact of the workshop.

The other authors have no conflict of interest to declare.

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