Matching Hearts.

This short memoir conveys a special relationship between a nurse and her patient, a 13-year-old girl who had a liver transplant.

Relationship of Nurse-Led Education Interventions to Liver Transplant Early Readmission.

INTRODUCTION: Early hospital readmission following liver transplantation is associated with lower survival and worse long-term graft function. Language, cultural practices, and health literacy influence patient understanding of posttransplant care education. Complex medication regimes, changes in metabolism and nutrition absorption, and infection/rejection further complicate the prevention of readmission. PURPOSE: The purpose of this study was to compare the 30-day readmissions of single-organ liver transplant recipients for 1-year prior and 1-year following the implementation of nurse-led education. The study examined the demographics, clinical characteristics, and 30-day readmissions of 35 liver transplant recipients who participated in the newly designed nurse-led education and 51 liver transplant recipients who experienced the prior post-liver transplant education. DESIGN: A single-center, correlational study with a convenience sample was conducted at a Hispanic-serving South Texas hospital. The new education intervention maintained the standard education and added twice-daily mutual patient-focused goal setting between the nurse and the recipient that aligned with readiness for discharge activities/goals, structured education using abbreviated handouts written at a second-grade level available in both English and Spanish, and the use of repetition through multimodal methods. RESULTS: The odds for 30-day readmissions the year prior to the nurse-led patient education intervention were 2.088 times greater than the year following the implementation. Thirty-day readmissions were reduced by 16.3% from the 2017 cohort to the 2018 cohort. DISCUSSION: Understanding unique risk factors facilitates structured patient education which can be individualized to the patient and caregiver including collaborative nurse-patient goals.

Critical Care Management of Living Donor Liver Transplants.

This article represents a review of the postoperative management of donors and recipients after living donor liver transplant, including monitoring, liberation from mechanical ventilation, nutritional support, and pain control. Vascular complications, such as biliary and sepsis, and bleeding are also discussed. Finally, commonly used immunosuppression and antimicrobial prophylaxes are reviewed.

Graft Dysfunction and Management in Liver Transplantation.

Graft dysfunction of the liver allograft manifests across a spectrum in both timing posttransplantation and clinical presentation. This can range from mild transient abnormalities of liver tests to acute liver failure potentially leading to graft failure. The causes of graft dysfunction can be divided into those resulting in early and late graft dysfunction. Although nonspecific, liver biochemistry abnormalities are still the mainstay investigation used in monitoring for dysfunction. This article provides a summary of the main causes and management strategies for liver graft dysfunction in the early through late posttransplant stages.

Perioperative Management of the Liver Transplant Recipient.

Perioperative management of the liver transplant recipient is a team effort that requires close collaboration between intensivist, surgeon, anesthesiologist, hepatologist, nephrologist, other specialists, and hospital staff before and after surgery. Transplant viability must be reassessed regularly and particularly with each donor organ. Regular discussions with patient and family facilitate realistic determinations of goals based on patient aspirations and clinical realities. Early attention to hemodynamics with optimal resuscitation and judicious vasopressor support, respiratory care designed to minimize iatrogenic injury, and early renal support is key. Preoperative and postoperative nutritional support and physical rehabilitation should remain a focus.

Registered nurse intent to promote physical activity for hospitalised liver transplant recipients.

AIM: To describe how registered nurse work motivation, attitudes, subjective norm and perceived behavioural control influence intention to promote physical activity in hospitalised adult liver transplant recipients. DESIGN: Descriptive study of clinical registered nurses caring for recipients of liver transplant at a tertiary medical centre. METHODS: Intent to Mobilise Liver Transplant Recipient Scale, Work Extrinsic and Intrinsic Motivation Scale, and demographics were used to explore registered nurses' work motivation, attitudes, subjective norms, perceived behavioural control and intention to promote physical activity of hospitalised adult liver transplant recipients during the acute postoperative phase. Data analysis included demographics, comparison between scale items and analysis of factors predicting intent to mobilise. RESULTS: Factors predictive of intention to promote physical activity after liver transplant included appropriate knowledge to mobilise patients (R2  = .40) and identification of physical activity as nursing staff priority (R2  = .15) and responsibility (R2  = .03). DISCUSSION/IMPLICATIONS FOR NURSING MANAGEMENT: When implementing an early mobilisation protocol after the liver transplant, education on effects of physical activity in the immediate postoperative period are essential to promote implementation in practice. Nursing care environment and leadership must be supportive to ensure mobility is a registered nurse priority and responsibility. Nursing managers can leverage results to implement a mobility protocol.

Complicações pós-operatórias do transplante hepático: evidências para otimização da assistência de enfermagem / Las complicaciones postoperatorio de trasplante de hígado: evidencias parala optimización de la asistencia de enfermería / Postoperative complications of liver transplant: evidence for the optimization of nursing care

Objetivo: investigar as principais complicações mais frequentes no pós-operatório do transplante hepático e apontar as evidencias para a detecção precoce e otimização da assistência de enfermagem. Método: Trata-se de um estudo com abordagem quantitativa do tipo descritiva. Foram analisados todos os prontuários eletrônicos disponíveis no sistema MvPep no período de janeiro de 2012 a dezembro de 2014. Os dados foram coletados por meio de um formulário esquematizado, e, para a analise, foram transferidos para o Microsoft Office Excel 2007, transcritos em forma de tabelas e transformado em gráficos para melhor visualização dos dados. Resultados: Destacaram-se diversas complicações como as neurológicas, pulmonares, respiratórias, cardíacas, hematológicas, vasculares, biliares, as do próprio enxerto, intestinais, peritoneais, cirúrgicas, infecciosas e renais. Conclusão: Evidenciou-se a necessidade de uma assistência diferenciada e individualizada aos transplantados, com um olhar aguçado e minucioso, sendo o enfermeiro o responsável por planejá-la.

Objective: to investigate the main and most frequent complications in postoperative liver transplantation and to point out the evidence for early detection and optimization of nursing care. Method: This is a study with a quantitative approach of a descriptive type. All electronic records available in MvPep system from January 2012 to December 2014. Were analyzed. The data were collected through a schematic form, and for the analysis, they were transferred to Microsoft Office Excel 2007, transcribed in the form of tables and graphs were made for better visualization of data. Results: Several complications were noteworthy such as neurological, pulmonary, respiratory, cardiac, hematologic, vascular, biliary, the graft itself, intestinal, peritoneal, surgical, infectious and kidney related. Conclusion: The need for a differentiated and individualized assistance to the transplant patient, with a keen and thorough look, was made evident, and the nurse is responsible for planning it.

Objetivo: investigar las principales complicaciones mas frecuentes em el postoperatorio del trasplante hepatico y senalar las pruebas para La deteccion temprana y la optimizacion de los cuidados de enfermeria. Método: Se trata de un estudio con un enfoque cuantitativo descriptivo, se analizaron todos los registros electronicos disponibles en el sistema MvPep desde enero de 2012 hasta diciembre de 2014. Los datos fueron recogidos a traves de una forma esquematica, y para la analisis fueron transferidos a Microsoft Office Excel 2007, transcritos en forma de tablas y graficos fueran realizados para una mejor visualizacion de datos. Resultados: Se destacaron varias complicaciones como neurologica, pulmonar, respiratorias, cardiacas, hematologicas, vasculares, biliares, el propio injerto, intestinal, peritoneal, quirurgica, infecciosas y en el rinon. Conclusión: Se demostro la necesidad de uma atencion diferenciada e individualizada al paciente de trasplante, com una mirada penetrante y profunda, y el enfermero responsable de La planificacion de la misma.

[Risk factors for delirium in intensive care unitin liver transplant patients]. / Fattori di rischio per l'insorgenza di delirium in terapia intensiva nei pazienti sottoposti a trapianto di fegato.

. Risk factors for delirium in intensive care unit in liver transplant patients. INTRODUCTION: Delirium is a disorder of the state of consciousness characterized by acute onset and temporal variability of cognitive abilities. It is frequent in intensive care unit (ICU) and it is associated with worst outcomes. AIM: To identify risk factors for the development of delirium in patients in intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS: Observational retrospective study on all the patients undergoing OLTx between January 2014 and December 2015. The daily assessment for delirium was performed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), by nemed nurses. RESULTS: Of the 123 patients included, 15 (12.2%) developed post-operative delirium. The main risk factor was preoperative hepatic encephalopathy (OR = 8.80, 95% CI 2.70-28.59): the deterioration of the state of consciousness (GCS pre-OLTx score < 15) increased the risk of developing delirium (OR 6.18; IC 95% 1.51 - 25.31). A high Acute Physiologic and Health Evaluation (APACHE II) score (OR=1.29, IC 95%: 1.12-1.47) showed how patients with a more severe clinical situation at ICU admission were more likely to develop delirium. CONCLUSIONS: The risk factors identified predict the development of delirium in ICU. Its prevention with the implementation of pharmacological or other strategies may reduce the onset of delirium and improve the quality of care.

Multi-professional team's perception of nurses' competences in liver transplantations.

Objective describe the multi-professional team's perception of nurses' competences in liver transplantation programs. METHOD: descriptive study with a qualitative approach. Data were collected through a questionnaire. Participants were 12 professionals of the liver transplantation team of a reference hospital. For result interpretation, the thematic analysis technique was employed. RESULTS: the professionals assessed the competences employed by nurses as proactive, autonomous, creative, humanized, capable of teamwork, decision-making and conflict management. CONCLUSION: this study made it possible to demonstrate that members of the multi-professional team perceived nurses as professionals capable of coordinating and integrating the skills "knowing, doing, being and co-existing", enabling quality care for candidates and receivers of liver transplants, as well as for their families and/or caregivers in all perioperative phases.

Multi-professional team's perception of nurses' competences in liver transplantations / Percepción del equipo multiprofesional sobre las competencias del enfermero en el trasplante hepático / Percepção da equipe multiprofissional sobre as competências do enfermeiro no transplante hepático

ABSTRACT Objective describe the multi-professional team's perception of nurses' competences in liver transplantation programs. Method: descriptive study with a qualitative approach. Data were collected through a questionnaire. Participants were 12 professionals of the liver transplantation team of a reference hospital. For result interpretation, the thematic analysis technique was employed. Results: the professionals assessed the competences employed by nurses as proactive, autonomous, creative, humanized, capable of teamwork, decision-making and conflict management. Conclusion: this study made it possible to demonstrate that members of the multi-professional team perceived nurses as professionals capable of coordinating and integrating the skills "knowing, doing, being and co-existing", enabling quality care for candidates and receivers of liver transplants, as well as for their families and/or caregivers in all perioperative phases.

RESUMEN Objetivo: describir la percepción del equipo multiprofesional sobre las competencias del enfermero en el programa de trasplante hepático. Método: estudio descriptivo, con abordaje cualitativo. Datos recolectados mediante cuestionario, con la participación de 12 profesionales del equipo de trasplante hepático de un hospital de referencia. Para la interpretación de resultados, se utilizó técnica de análisis temático. Resultados: los profesionales evaluaron las competencias desarrolladas por el enfermero como proactiva, autónoma, creativa, humanizada, que sabe trabajar en equipo, tomar decisiones y administrar conflictos. Conclusión: este estudio permitió revelar que los miembros del equipo multiprofesional percibían al enfermero como un profesional capaz de articular e integrar los saberes "conocer, hacer, ser y convivir", permitiendo una atención de calidad al candidato y al receptor de trasplante hepático, así como también a sus familiares y/o cuidadores en todas las fases del perioperatorio.

RESUMO Objetivo: descrever a percepção da equipe multiprofissional sobre as competências do enfermeiro no programa de transplante hepático. Método: estudo descritivo com abordagem qualitativa. Os dados foram coletados por meio de questionário com participação de 12 profissionais da equipe do transplante hepático de um hospital de referência. Para interpretação dos resultados, utilizou-se a técnica de análise temática. Resultados: os profissionais avaliaram as competências desenvolvidas pelo enfermeiro como proativa, autônoma, criativa, humanizada, que sabe trabalhar em equipe, tomar decisões e administrar conflitos. Conclusão: este estudo possibilitou revelar que os membros da equipe multiprofissional percebiam o enfermeiro como um profissional capaz de articular e integrar os saberes "conhecer, fazer, ser e conviver", possibilitando uma assistência com qualidade ao candidato e ao receptor de transplante hepático, como também aos seus familiares e/ou cuidadores em todas as fases do perioperatório.

Assistance continuity from primary care in an inter-level nursing plan for a case of pediatric liver transplant. / Continuidad asistencial desde atención primaria en un plan de cuidados interniveles para un caso de trasplante hepático pediátrico.

Spain is one of the countries where most solid organ transplants are performed each year, in the year 2014 a 2.7% of them were given in childhood. Given the complexity and severity of this disease it is necessary to establish a care plan that covers both pre-transplant and post-transplant, with close cooperation between different levels of care, to approach the several problems that can appear and assure continuum of care. In the following example, a Gambian teen with risk of social exclusion fostered a collaboration between the primary care nurse and transplant nurse that was the key to continuum care. Multiple strategies were used in the care plan to ensure better adherence and compliance of the treatment. However, the knowledge of the culture of origin must be deepened to establish more individualized care plans and thus improve results. The care plan included problems according to the NANDA, NOC, NIC taxonomy.

Mastering Together the Highs and Lows: Patients' and Caregivers' Perceptions of Self-Management in the Course of Liver Transplantation.

CONTEXT: Self-management in chronic illness involves complex medical, role-related, and emotional tasks. Still, while self-management support of patients and their families has become a cornerstone of chronic illness care, information is limited as to how liver transplant (LTx) patients and close caregivers perceive self-management before and after transplantation. OBJECTIVE: To explore self-management tasks in view of medical, role-related, and emotional tasks in LTx candidates and recipients and their respective close caregivers. DESIGN AND PARTICIPANTS: For this qualitative study, focus group interviews were conducted and analyzed using knowledge mapping according to the 3 above-noted self-management categories. German-speaking adults who were wait-listed for or had received LTx and who were being treated in University Hospital Zurich or who were close caregivers to such patients were eligible for participation. As patients' data were closely related to those of the caregivers, the 2 groups' data sets were merged during the final development of themes. RESULTS: Thirty participants comprised 7 focus groups. The main theme was "The current state of health determines the daily rhythm." The essence of how patients and caregivers described their self-management tasks is compiled in "Mastering together the highs and lows" which comprises 3 core themes: mastering medical management, managing roles together, and managing the highs and lows of emotion. CONCLUSION: Patients and close caregivers prioritized self-management tasks as follows: first medical, then role-related, and finally emotional management. Over the course of LTx, health-care professionals should acknowledge this ranking while providing individualized support to both patients and caregivers.

Pediatric Liver Transplantation: Unique Concerns for the Critical Care Team.

Liver transplantation originated in children more than 50 years ago, and these youngest patients, while comprising the minority of liver transplant recipients nationwide, can have some of the best and most rewarding outcomes. The indications for liver transplantation in children are generally more diverse than those seen in adult patients. This diversity in underlying cause of disease brings with it increased complexity for all who care for these patients. Children, still being completely dependent on others for survival, also require a care team that is able and ready to work with parents and family in addition to the patient at the center of the process. In this review, we aim to discuss diagnoses of particular uniqueness or importance to pediatric liver transplantation. We also discuss the evaluation of a pediatric patient for liver transplant, the system for allocating them a new liver, and also touch on postoperative concerns that are unique to the pediatric population.

Nursing intensity and costs of nurse staffing demonstrated by the RAFAELA system: liver vs. kidney transplant recipients.

AIM: To compare nursing intensity and nurse staffing costs for liver transplant (LTx) vs. kidney transplant (KTx) patients through the use of the RAFAELA system (the OPCq instrument). BACKGROUND: High-quality patient care correlates with the correct allocation of nursing staff. Valid systems for obtaining data on nursing intensity, in relation to actual patient care needs, are needed to ensure correct staffing. METHODS: A prospective, comparative study of 85 liver and 85 kidney transplant patients. Nursing intensity was calculated using the Oulu Patient Classification (OPCq) instrument. The cost per nursing intensity point was calculated by dividing annual total nursing wage costs with annual total nursing intensity points. RESULTS: The results showed significantly higher nursing intensity per day for liver transplant patients compared to kidney transplant patients. The length of stay was the most important variable in relation to nursing intensity points per day. CONCLUSIONS: The study demonstrated differences in nursing intensity and nurse staffing costs between the two patient groups. IMPLICATIONS FOR NURSING MANAGEMENT: When defending nurse staffing decisions, it is essential that nurse managers have evidence-based knowledge of nursing intensity and nurse staffing costs.

Transplante hepático em hospital de referência: competências do enfermeiro no serviço ambulatorial / Liver transplant in reference hospital: nursing skills in outpatient service / Trasplante hepático en un hospital de referencia: competencias del enfermero en lo servicio de ambulatorio

Objetivo: descrever as competências do enfermeiro no serviço ambulatorial de transplante hepático.Método: estudo exploratório com abordagem qualitativa, com enfermeiros que atuam no ambulatório detransplante hepático de um hospital de referência, por meio de entrevista e observação não participante,com emprego da Técnica de Análise temática. Resultados: o período de espera envolve atividades relativasao acolhimento, triagem, consulta de enfermagem, procedimentos técnicos, educação em saúde, interaçãocom a equipe multiprofissional, ensino-pesquisa e gerenciamento de recursos humanos e materiais. Após otransplante, os cuidados estão direcionados para a prevenção de complicações e empoderamento para oautocuidado. Conclusão: é imprescindível a colaboração do enfermeiro na equipe multiprofissional, para umdesfecho positivo no processo do transplante hepático, pois precisa promover a assistência segura e efetiva,tanto aos clientes quanto aos seus familiares.(AU)

Objective: to describe the skills of nurses in outpatient liver transplant. Method: an exploratory study with a qualitative approach, with nurses working in liver transplantation clinic of a referral hospital through nonparticipant interviews and observation with use of thematic analysis technique. Results: the waiting period involves activities related to the reception, screening, nursing consultation, technical procedures, health education, interaction with the multidisciplinary team, teaching and research and management of human and material resources. After transplantation, care are directed to the prevention of complications and empowerment for self-care. Conclusion: the collaboration of the nurse in the multidisciplinary team is essential for a positive outcome in the process of liver transplantation, because they need to promote safe and effective care, both to clients and their families.(AU)

Objetivo: Describir las competencias del enfermero en lo servicio de ambulalorio de trasplante de hígado. Método: un estudio exploratorio con enfoque cualitativo, con las enfermeras que trabajan en el hígado clínica de trasplante de un hospital de referencia a través de entrevistas no participantes y la observación con el uso de la técnica de análisis temático. Resultados: el período de espera incluye actividades relacionadas con la recepción, selección, consulta de enfermería, procedimientos técnicos, la educación sanitaria, la interacción con el equipo multidisciplinario, la enseñanza y la investigación y la gestión de los recursos humanos y materiales. Después del trasplante, la atención se dirige a la prevención de las complicaciones y la habilitación para el autocuidado. Conclusión: la colaboración de la enfermera en el equipo multidisciplinario es esencial para un resultado positivo en el proceso de trasplante de hígado, debido a que necesita para promover una atención segura y eficaz, tanto a los clientes y sus familias.(AU)