Nurses Integral to Face Transplant Procedure, Care
Jim Maki and Lorrie MacDonald prior to a press conference at BWH about Maki’s face transplant.
Caring for the hospital’s first face transplant patient was a learning experience for everyone involved—but especially for Tami R. Robitsek, ANP, APRN-BC. She had been a nurse practitioner only two weeks when she learned that she would be part of the team providing post-operative care for recipient Jim Maki.
“I was still learning the NP role itself when this happened,” said Robitsek, who previously had been a nurse here for four years prior to pursuing education as a nurse practitioner and beginning in Plastic Surgery. “The other nurses mentored and guided me through it, and they really helped me rise to the occasion.”
Stephanie Ahmed, DNP, FNP-BC, a nurse practitioner of 10 years, had called Robitsek to see if she wanted to come in early on April 9, when BWH made international headlines by performing the first face transplant in New England and the seventh in the world. Bohdan Pomahac, MD, director of the BWH Burn Center, led a multidisciplinary team in the operation. Ahmed, who witnessed the procedure, described how the skills of OR nurses shined during the operation.
After the 17-hour procedure, Ahmed, Robitsek, staff nurse Lorrie MacDonald, RN, and the other nurses involved rose to the challenge of caring for Maki post-operatively and did what they do best: put patient needs first.
Tami Robitsek, left, is one of the nurse practitioners caring for Maki.
“This was one of the most complex challenges I’ve faced in my career,” said Ahmed, who coordinated Maki’s multi-disciplinary care, which involved staff from 12 departments. “Even though there were so many of us, we acted as a team during this experience.”
Inpatient primary nurse MacDonald played a central role bringing her nursing expertise to the care team.
Nursing’s role was so important on the multidisciplinary care team, with Ahmed leading morning rounds and MacDonald and other clinical nurses actively participating.
“I found myself speaking up more during rounds,” said MacDonald. “I felt like I was part of the team.”
Initially though, MacDonald said she was anxious about caring for Maki. “What if I missed a drug level or didn’t do his oral care correctly?” she said. “The simplest tasks became stressful—even blowing his nose.”
But MacDonald, with her 19 years of experience including the past seven on the Plastic Surgery/Urology unit, has a specialized body of knowledge that she brought to this patient’s care. She used this knowledge, with her general nursing skills to shape his care, anticipate Maki’s needs and to communicate them to other members on the care team.
Stephanie Ahmed, a nurse practitioner who cared for Maki, was featured on the cover of Nursing Spectrum’s fall 2009 specialty guide to med/surg. Ahmed, Lorrie MacDonald and Tami Robitsek were interviewed for the magazine’s story about the first face transplant at BWH.
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“I thought extensively about what was going on with him holistically, especially the emotions he was going through,” she said. “We developed charts and plans to manage every detail of his care and attended to his psychosocial needs at the same time.”
Basic nursing care proved crucial. “He required very meticulous suture and oral care,” MacDonald said. “This is critical to making sure his incision line heals well. Basic nursing care makes a tremendous difference.”
Having reflected on those weeks in April and May, Ahmed and MacDonald both feel this experience has advanced their practice.
Ahmed was involved in Maki’s care during his initial injury a few years ago. “Having seen him then and what a devastating deformity he suffered, it’s really exciting for me to see where he is today,” she said.
Robitsek, who was still learning about the plastic surgery specialty at the time of the procedure, is grateful for the experience. “It forced me to attend to the details in a more complex way and build on the baseline of knowledge I had,” she said. “I needed to work closely with many disciplines, especially Transplant Surgery, and learn about the medications and labs that were involved. It was a whole different realm.”
Having this experience so early in her NP career contributed to her growth as a care provider. “It helped me build confidence,” she said. “I’m still new in my role, but I think the hardest part of a new role is gaining confidence, and that’s what helps you get to the next level in your practice. This helped me to do that more quickly.”
Now, nurses involved in the care of Maki are beginning to pen an article that will help all nurses involved in this ground-breaking, new procedure. MacDonald noted that she couldn’t find any research or article that discussed nursing care in face transplant literature.
“It’s so important that these things we did don’t get lost but passed on,” Ahmed said. “It’s an opportunity for us to be leaders.”
Robitsek agreed. “This is not only a new frontier for surgery, but also for nursing,” she said. “We have a new place to go in practice and to add to the literature by articulating a protocol in nursing to care for these patients.” The experience caused Ahmed to recall a nursing theory class she took as an undergrad, where she studied a theorist who encourages thinking out of the box.
“It takes courage to do that,” Ahmed said. “I’m sure there was a time when no one could imagine taking the face of one person and transplanting it to another person—it makes me think about the future and where we’re heading. This represents amazing possibility.”