1. Section Editor(s): Adams, Ellise D. PhD, CNM
  2. Professor

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The science of organ transplantation and obstetrics rarely crosses paths. However, as the science of transplantation evolves, we see these 2 fields of study beginning to overlap more frequently. Currently, ovarian transplants can be done to restore reproductive function. For women who had ovarian damage due to cancer treatment by radiation or chemotherapy, an ovarian transplant may prove to be a pathway to parenthood. Women with previous liver or kidney transplants can give birth once recovered as well.


Women who have uterine factor infertility may be eligible for uterine transplantation. The University of Pennsylvania is conducting a unique trial of uterine transplants using living and deceased donors. Eligible donors were between the age of 30 and 50 years, had a body mass index of less than 30, were cancer-free for 5 years, had no history of diabetes, and were negative for HIV, hepatitis, gonorrhea, Chlamydia, and herpes. In 2019, the first couple to give birth following a uterine transplant of a deceased donor occurred at Penn Medicine's program.


I have been thinking about transplants recently because my husband underwent a liver transplant this summer. One day I will write about this full experience, but for this column, I would like to give you some insights I gleaned while walking this path of liver transplantation.


I always hesitate to tell medical and nursing professionals that I am a nurse when I am in a personal medical situation. I do not want to be deprived of simple explanations, and I do not want it to be assumed that I understand a situation when I do not. In this situation, I shared hesitantly that I was a nurse and that most of my experience was as a perinatal nurse and nurse educator. But just saying these words out loud made me have a sudden rush of lack of confidence. I felt suddenly out of my scope of practice and vulnerable. What could a nurse who knew about caring for a woman and newborn during labor and birth know about caring for a liver transplant patient? I shared this emotion with my friend and colleague Haley, a PhD-prepared lung transplant nurse practitioner. She encouraged me to consider that "nursing is nursing" and that I knew what I needed to get through this situation and care for my husband. And Haley was right! Here are a few examples of how I experienced the wisdom that "nursing is nursing."


Nursing is focused on patient safety. In my 40-year career, I have helped many a postpartum woman take her first walk after labor and birth. Preventing falls is about a safe environment, proper body mechanics, adequate personnel, and the knowledge of what to do when the patient cannot bear their own weight. My husband is not a small man at 6 ft 4 in. The ravages of nonalcoholic fatty liver disease had left him with muscle wasting in his arms and legs. I frequently was the one who helped him from the bed to the bathroom in the wee hours of the morning. On one faithful trip, his energy and body gave way, my nursing knowledge kicked in, and I was able to ease him carefully to the floor and avoid his injury and mine. Nursing is nursing.


Caring for patients includes the promotion of rest. Teaching childbirth classes to hundreds of families was a highlight of my career as a perinatal nurse. I typically reserved one session to discuss newborn expectations and how best to communicate with a crying infant who cannot specifically communicate their needs. Much of this discussion encouraged new mothers to lower their expectations, reduce their commitments, and rest and sleep when the newborn sleeps. The liver transplant patient requires large dosages of antirejection drugs, including steroids. Steroids at high doses can cause newborn-like qualities of restlessness, anxiety due to the inability to express needs, and frequent wakefulness. I heard my childbirth educator's voice encourage rest when he rests. This saved me and helped manage my fatigue. Nursing is nursing.


The mother of modern nursing, Florence Nightingale, purported the importance of proper ventilation, air quality, and light to encourage wellness and healing. These principles have been confirmed frequently by research. Natural light, as compared with artificial light, can slow the heart rate, decrease blood pressure, and have a positive effect on depression and anxiety.


How many perinatal nurses have encouraged new mothers to place their jaundiced newborns in a sunlit window to alter the negative effects of bilirubin? So too, light is important for the liver transplant patient. They experience 6 to 10 hours of surgery, 48 to 72 hours in intensive care, and 1 to 2 weeks in postoperative units. These experiences strip them of the ability to breathe fresh air and feel the warmth of natural light. I found myself adjusting blinds, moving the surgical chair closer to the window, and rerouting the physical therapy walks to large plate glass windows with a view of the hospital atrium. Nursing is nursing.


Excellent nursing care includes the careful, correct administration of medication. Those who care for high-risk obstetric patients provide intensive care, including the careful titration of intravenous medications. In one hospital I worked in, during the era of paper charting, the care of a patient with pregnancy-induced hypertension on magnesium sulfate required careful surveillance and intensive charting on 11 x 14 pages and a specialty clipboard. The careful and correct administration of medication is serious business.


The postoperative liver transplant patient requires more than 20 medications daily to support the new organ and prevent rejection. I have been reveling in the fact that I am a nurse as I seek to manage this mass of medications. Many of the medications have frequent dosage changes based on laboratory findings. Effectively managing these medications requires the basic nursing skills of organization, a methodical approach, and accurate documentation of new orders and administration. Nursing is nursing.


As I fell into the groove of private duty nursing while caring for my husband, my confidence gradually returned. By applying principles of basic nursing, mixed with patience and kindness, and transferring skills learned as a perinatal nurse, I worried less about my abilities in caring for a type of patient who I had never cared for before.


Sometimes in nursing we pride ourselves in specialization. It is not a bad thing to become an expert in our fields, but perhaps we should not forget that our basic nursing skills are applicable to all types of patients. We can have confidence that any nursing challenge we are given, we already have the skills to overcome it. Nursing is nursing after all!


-Ellise D. Adams, PhD, CNM




College of Nursing


University of Alabama-Huntsville


Huntsville, Alabama