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.

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.

A prospective audit of preprocedural fasting practices on a transplant ward: when fasting becomes starving.

AIMS AND OBJECTIVES: To investigate the prevalence and duration of preprocedural medically ordered fasting during a period of hospitalisation in an Australian population of patients with hepatic cirrhosis or following liver transplantation and to identify potential solutions to reduce fasting times. BACKGROUND: Protein-energy malnutrition is a common finding in patients with hepatic cirrhosis and can impact significantly on survival and quality of life. Protein and energy requirements in patients with cirrhosis are higher than those of healthy individuals. A significant feature of cirrhosis is the induction of starvation metabolism following seven to eight hours of food deprivation. Many investigative and interventional procedures for patients with cirrhosis necessitate a period of fasting to comply with anaesthesia guidelines. DESIGN: An observational study of the fasting episodes for 34 hospitalised patients with hepatic cirrhosis or following liver transplantation. METHODS: Nutritional status was estimated using subjective global assessment and handgrip strength. The prevalence and duration of fasting practices for diagnostic or investigational procedures were estimated using electronic records and patient notes. RESULTS: Thirty-three patients (97%) were malnourished. Twenty-two patients (65%) were fasted during the observation period. There were 43 occasions of fasting with a median fasting time of 13·5 hours. On 40 occasions fasting times exceeded the maximum six-hour guideline recommended prior to the administration of anaesthesia by the majority of Anaesthesiology Societies. The majority of procedures (77%) requiring fasting occurred after midday. Eating breakfast on the day of the procedure reduced fasting time by 45%. CONCLUSIONS: Medically ordered preprocedural fasting times almost always exceed existing guidelines in this nutritionally compromised group. RELEVANCE TO CLINICAL PRACTICE: Adherence to fasting guidelines and eating breakfast before the procedure can reduce fasting times significantly and avoid the potential induction of starvation metabolism in this nutritionally at risk group.

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.

Diseases of the Liver.

IMPAIRED LIVER function affects every aspect of the body's physiology. Diseases of the liver have more widespread and life-threatening impacts than malfunctioning of any of the body's other conditions. accessory organs. Non-alcoholic fatty Liver disease rates are soaring, concurrent with the obesity epidemic and increasing rates of type 2 diabetes. Alcoholic liver disease and viral hepatitis also contribute to high rates of liver damage in the population, making liver disease one of the commonest causes premature death. Liver transplants, hepatocellular carcinomas, and deaths from Liver disease are increasingly due to preventable or treatable liver conditions. Understanding normal liver function allows nurses to predict the impact of Liver disease on their patients' health and well-being. Knowledge of underlying causes of impaired liver function enhances our ability to support and counsel those who are at risk of, or have been diagnosed with liver disease.

Vulnerability and chronic illness management in pediatric kidney and liver transplant recipients.

CONTEXT: Solid-organ transplant is the treatment of choice for end-stage organ failure and requires a transition from management of a life-threatening condition to a chronic illness. Despite research focusing on quality of life after transplant, there is a gap addressing the role of managing a chronic illness focusing on vulnerability and impact on family. OBJECTIVE: Identify patient and family patterns of adaptation among kidney and liver transplant recipients in regard to (1) vulnerability, (2) impact of illness on the family, (3) family functioning, and (4) quality of life (parent and child report). DESIGN: Cross-sectional study enrolling children 5 to 18 years old and their parent at a single time point after kidney or liver transplant. Validated self-report tools were completed. RESULTS: In all, 47 participants (24 kidney and 23 liver) were recruited. Mean age at transplant was 4.0 (kidney) and 2.1 (liver) years. Mean age at report was 12.1 (kidney) and 7.1 (liver) years. Child vulnerability correlated negatively with (1) family impact in the kidney (P < .05) and liver (P < .05) transplant groups, (2) PedsQL subscales including Parent Emotional (P< .05), Parent Social (P< .01), Parent Psychosocial (P < .01), Parent Physical (P < .05), Parent School (P < .05), and Child Social (P < .01) in the kidney transplant group, (3) PedsQL Parent Emotional subscale (P< .01) in the liver transplant group, and (4) Functional status (P < .01) in the liver transplant group. CONCLUSIONS: Child vulnerability provides insight into quality of life and the impact of illness on the family and family functioning.

[Liver transplantation]. / La transplantation hépatique.

The liver transplant procedure has advanced significantly since the 1960s. It is the only curative treatment for severe chronic liver disease including cirrhosis. In collaboration with the French Biomedicine Agency, a complex protocol is put in place by a multi-disciplinary team. The patient's commitment to the treatment project is essential.

Neonatal liver cell donation: a case report.

Traditional organ transplant options for newborns have been rare. There continues to be an increasing need for organs for transplant and a limited number of available organs, especially for small children. Liver cell transplantation is a promising alternative to orthotopic liver transplantation to treat liver-based inborn errors of metabolism.1 The procedure is minimally invasive and can be performed repeatedly. The safety of the procedure has been well established, and the clinical results are encouraging.1 The liver cell donation process is an option for families who experience the loss of a newborn and offers them a legacy for their child by providing life for others. The purpose of this article is to discuss the neonatal liver cell donation process and present a case report of an anencephalic infant whose parents chose to participate in this unique program.

Compassion fatigue in liver and kidney transplant nurse coordinators: a descriptive research study.

CONTEXT: Because of the nature of the helping professions, nurses are at high risk for compassion fatigue and burnout. In the past, many researchers have studied compassion fatigue and burnout in nurses. However, reports of research assessing liver and kidney transplant nurse coordinators' compassion fatigue and burnout are rare. OBJECTIVE: To assess liver and kidney transplant nurse coordinators' levels of compassion fatigue and burnout. DESIGN: A nonexperimental, exploratory descriptive study was conducted using the Professional Quality of Life Scale Version 5 (ProQOL-V), a 30-item self-report instrument to measure participants' level of compassion satisfaction, burnout, and secondary traumatic stress. SETTING AND PARTICIPANTS: This study sampled 14 liver and kidney transplant nurse coordinators from a large multiorgan transplant center in the Southeast region. RESULTS: Transplant nurse coordinators had an average level of compassion satisfaction, an average level of burnout, and an average level of secondary traumatic stress. Within liver and kidney transplant nurse coordinators, a statistically significant relationship was found between education levels of transplant nurse coordinators and the level of burnout, suggesting that education levels may influence burnout.

Investigation of adaptation after liver transplantation using Roy's Adaptation Model.

In this study we explored the adaptation of transplant recipients in Turkey using the Roy Adaptation Model. A descriptive qualitative design was used with data collected from liver transplant recipients in either individual or group interviews between May 2009 and February 2010. Using deductive content analysis, four themes were identified in the data: physiological mode, self-concept mode, role function mode, and interdependence mode. Each theme included both adaptive and ineffective behaviors of liver transplant recipients. The findings of this study indicate that liver transplant recipients need information and support about their ineffective behaviors in all modes of the Roy Adaptation Model. The findings also support the use of a nursing model in the delivery of nursing care for liver transplantation recipients.

Photoeducation and photoprotection among liver transplant candidates: a cross-sectional study.

The incidence of skin cancer after liver transplant ranges from 3% to 16%, considerably higher than that observed in the general population. Skin cancer causes 25% of deaths in patients who have survived more than 3 years after liver transplant. The objective of this study was to identify differences regarding the level of sun exposure, knowledge of potential risk factors, and photoprotection measures among liver transplant candidates and recipients. We carried out a prospective cross-sectional study with 100 patients enrolled at a liver transplant program in a Brazilian center. The patients were interviewed and received oral information regarding skin care and sun exposure. Results reveal that measures of photoprotection and photoeducation are more prevalent among recipients than among candidates. High degrees of solar exposure were observed more frequently among candidates, although recipients showed better knowledge about the risks of sun exposure. Educational actions concerning skin cancer prevention should be part of the guidelines given by the multidisciplinary team to the liver transplant patients, in particular, by the nursing team.

Primary caregiver stress in caring for a living-related liver transplantation recipient during the postoperative stage.

AIM: The aim of this study was to explore the stress experienced by the primary family caregiver of the living-related liver transplantation patient during the postoperative stage. BACKGROUND: Living-related liver transplantation is a treatment choice for end-stage liver disease patients who face a shortage of available donated livers. Research suggests that the caregiver of the liver transplant recipient experiences tremendous stress because a family member is on the waiting list. Nevertheless, there are limited studies that investigate the caregiver experience of stress during this surgery. METHOD: This qualitative study used face-to-face semi-structured interviews to understand the subjective experiences of study participants. The study participants were drawn from a tertiary medical centre in northern Taiwan. During the data collection period (October 2007 to May 2008), 6 of the 12 caregivers agreed to participate in this study (N = 6), all of whom were female and, except for one participant, were the wives of the recipients. RESULTS: Participant stress was caused by the gap between expectations and primary caregiving experiences. In particular, the five themes that were identified: (a) unstable sentiment towards liver transplantation; (b) entanglement of burden; (c) non-synchronized family interaction; (d) distance from the healthcare professional; and (e) concern about the protector role function. CONCLUSIONS: The stress of primary caregivers of living-related liver transplantation is related to the gap between expectations and primary caregiving experiences. The immediate postoperative stage is a critical one for health professionals to provide intervention and management.

[Therapeutic play in nursing care: one experience with a school-age liver transplant recipient].

This case report described an experience using therapeutic play in the care of a school-age living donor liver transplant recipient. A first intervention employed playing the patient's favorite game in order to create a therapeutic relationship. The author then introduced therapeutic play elements into the game to observe the patient's personal health behaviors, evaluate patient perception of hospitalization and assess the knowledge of self-care protocols. Therapeutic play was then used to raise patient familiarity with daily care specifics. The author found therapeutic play also helpful in persuading the patient to share deep feelings on the anxiety of separation from her parents while in the ICU. During the nursing process, the author recognized therapeutic play as an effective tool to communicate with children and improve treatment protocol compliance. The author recommends that nurses incorporate therapeutic play in clinical practice to reduce children's stress during hospitalization.

Quality improvement in the care of live liver donors: implementation of the Designated Donor Nurse Program.

Publications on living donor liver transplant have focused on the medical aspects of donor selection, postoperative management, surgical procedures, and outcomes, but little attention has been given to the nursing implications for care of live liver donors during their inpatient stay. Donor advocates from various disciplines are involved during the initial education and evaluation, but most care after surgery is delivered by an inpatient medical team and bedside nursing staff who are not as familiar with the donor and concepts related to donor advocacy. In an effort to improve the overall donor experience and provide safe, high-quality care to patients undergoing elective partial hepatectomy, our academic medical center began a quality improvement project focused on improving the inpatient stay. Inpatient nursing standards and policies and procedures were developed to ensure that consistent care is delivered. However, the infrequency of living donor liver transplantation makes it nearly impossible to have all transplant program staff on a nursing unit be "experts" on donor care. Therefore, our center determined that, similar to the Independent Donor Advocacy Team, a transplant program needs live donor champions on the nursing unit to mirror the goals of the team. To that end, we developed the concept of the Designated Donor Nurse to care for and advocate for live liver donors during the inpatient stay and also to serve as a resource to their colleagues.

Intra-operative hemodialysis during liver transplantation: an expanded role of the nephrology nurse.

Hemodialysis is widely acknowledged as a treatment option to stabilize acute medical conditions where biochemistry management is paramount. One of the most challenging situations is during liver transplantation, when patients with moderate renal dysfunction are likely to become acutely acidotic. For nephrology nurses, this extended role requires increased knowledge, advanced skills, and a high level of communication with unfamiliar team members. With appropriate procedures and a supportive environment, delivering such a service is feasible.