Gastroenterology Nursing

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Comparison of Quality of Life and Caregiving Burden of 2- to 4-Year-Old Children Post Liver Transplant and Their Parents

imageA literature search determined there are no studies on children between 2 and 4 years of age who have had a liver transplant and their parents. For this reason, this study aimed to compare the quality of life of children between 2 and 4 years of age who have had a liver transplant, and the caregiving burden of their parents. The study was carried out as a descriptive cross-sectional study on 47 children who visited Inonu University Liver Transplant Institute outpatient clinic between March 2017 and March 2018. This study found that 59.6% of the children with transplants were male and 38.3% had their organ donated by their mother. There was a positive relationship between the quality of life of the parents and the quality of life and subdimensions of the children. There was a negative relationship between parental quality of life and care burden. This study found that the quality of life of children with liver transplants and their parents was low and, as the quality of life of children was impaired, the caregiving burden of parents increased. Healthcare professionals' awareness of the effect of caregivers' care load on quality of life after liver transplantation can positively affect the healing process.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/07000/Comparison_of_Quality_of_Life_and_Caregiving.6.aspx

Nutritional Assessment and Malnutrition in Patients With Cirrhosis

imageWe sought to determine the incidence and outcomes of malnutrition in patients with cirrhosis. We performed a retrospective chart review of 134 patients listed for liver transplant (LT) to assess the presence and degree of malnutrition identified by the Subjective Global Assessment score at the time of initial transplant evaluation, follow-up nutrition visits, and at the time of transplant. Number of admissions/readmissions to the hospital, reason for hospitalization(s), and length of stay were determined. Malnutrition was prevalent at initial nutrition visit (51.9%) and underdiagnosed. By the time of transplant, 61% of the patients were identified as malnourished. Most patients (52%) were awaiting LT for more than 180 days. The change in Subjective Global Assessment score after the initial nutrition assessment was statistically significant (p ≤ .007), with worsening malnutrition severity. Seventy-one patients (53%) required hospitalization while awaiting transplant, with a median hospital stay of 9 days. Nutrition expertise is required for prompt and accurate diagnosis of malnutrition in patients with cirrhosis. Nurses caring for patients with advanced liver disease are in a prime position to provide guidance to optimize patient outcomes.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/07000/Nutritional_Assessment_and_Malnutrition_in.2.aspx

Achieving Hepatitis C Elimination By Using Person-Centered, Nurse-Led Models of Care: A Discussion of Four International Case Studies

Nurse-led models of care are an important strategy in the management of patients with chronic disease because of the person-centered approach that allows the needs of the individual to be prioritized and addressed in accessible settings. Hepatitis C is caused by a blood-borne virus that can cause liver disease and liver cancer; it predominantly affects marginalized populations, including people who inject drugs. Since 2013, all oral, direct-acting antiviral regimens have been available to cure hepatitis C. Nurses are well placed to be involved in the delivery of hepatitis C testing and treatment because of their extensive reach within marginalized communities and holistic approach to patient care. Four case studies of nurse-led models of care operating in Australia, Canada, the United Kingdom, and the United States are presented to illustrate the important role nurses have in delivering accessible, person-centered hepatitis C testing and treatment. Each case study demonstrates the success of overcoming barriers to hepatitis C testing and treatment such as geographic isolation, incarceration, social marginalization, and inflexible healthcare systems. Achieving the global target to eliminate hepatitis C by 2030 will require the nursing profession to embrace its role as the first point of contact to the healthcare system for many members of marginalized communities potentially at risk of hepatitis C. Nurses are well placed to reduce barriers and facilitate access to healthcare by scaling up activities focused on hepatitis C testing and treatment.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/07000/Achieving_Hepatitis_C_Elimination_By_Using.5.aspx

Risks and Safety of Advanced Therapies and Biologics in Inflammatory Bowel Disease: A Review for Nurses

imageAdvanced therapies, including biologics, are a core component of managing inflammatory bowel disease, which is increasing in prevalence. These therapies may offer an improved safety and tolerability profile compared with conventional treatments. However, they can interact with a patient's immune system via different mechanisms. Healthcare providers need to be aware of the possible adverse effects, such as infection and immune-mediated reactions, as well as risk management methods, such as patient screening and vaccination. As central members of the multidisciplinary team, nurses have an important role in educating patients with inflammatory bowel disease on disease course, treatment options, monitoring patient adherence, and response to treatment. This narrative review summarizes key safety considerations for the treatment of inflammatory bowel disease with advanced therapies, including risk of infection and malignancy; immunologic, metabolic, and hematologic complications; and what nurses can do to manage these risks. Special considerations for pediatric, elderly, and pregnant populations are also discussed.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/07000/Risks_and_Safety_of_Advanced_Therapies_and.11.aspx

A Balancing Act: Managing Workload While Improving Nurse and Patient Satisfaction

imageHigh workload and unpredictable shift end times can contribute to employee turnover, dissatisfaction, and low staff engagement. The aim of this project was to improve nurse and patient satisfaction within a hospital-based outpatient gastrointestinal endoscopy unit while moving from an existing three-shift procedure staffing model to a two-shift model with defined expectations and predictable shift end times. The shift modification led to an 82% decrease in nurse turnover rates after the first 6 months. There was a 12% decrease in the number of nurses calling in ill to work. Nurse satisfaction, compared to 2 years prior, demonstrated 21% improvement related to “having a sense of achievement”; 39% improvement with “being involved in work unit decisions”; 62% decrease in burnout; and 7% improvement in overall satisfaction. The number of nurses attending and presenting at national, regional, and local conferences increased. Furthermore, overall unit patient satisfaction improved by 1.94% (p = .063) between first-quarter 2014 preimplementation data (n = 183) and first-quarter 2015 postimplementation survey data (n = 140). The created shared governance environment supported nurses' involvement in decision-making and creating a new shift model that led to greater staff and patient satisfaction.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/07000/A_Balancing_Act__Managing_Workload_While_Improving.4.aspx

Peer-Led Education Expedites Deprescribing Proton Pump Inhibitors for Appropriate Veterans

imageCostly proton pump inhibitors have been widely prescribed since the 1990s for prevention and treatment of ulcers and gastroesophageal reflux disease. Evidence published since 2012 demonstrates risks associated with taking proton pump inhibitors for longer than 8 weeks. Primary care providers mostly deprescribe proton pump inhibitors for persons not meeting criteria for long-term use. Many patients resist discontinuation.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/05000/Peer_Led_Education_Expedites_Deprescribing_Proton.2.aspx

Differences in Factors Affecting the Quality of Life Over Time After the Gastrectomy in Patients With Stage I Gastric Cancer

imagePatients with Stage I gastric cancer experience decreased postgastrectomy quality of life (QoL) despite the excellent surgical outcomes. We need to find foundational data required to develop effective nursing care plans designed to improve their QoL. This study examined QoL of patients with Stage I gastric cancer over time following gastrectomy and the effects of QoL subdomains on the patients' overall QoL over time after surgery. Data were collected from 138 patients with Stage I gastric cancer who had undergone gastrectomy within the previous 3 years. Data were classified into 3 groups according to the length of postsurgery time: 12 months or less (Group 1), 13–24 months (Group 2), and 25–36 months (Group 3). A confirmatory factor analysis was performed to examine the effects of QoL subdomains. Quality of life of patients with Stage I gastric cancer improves over time following gastrectomy. Postoperative physical symptoms influenced QoL most in Group 1 patients, whereas physical well-being and emotional well-being were the highest contributors to QoL in Groups 2 and 3, respectively. Nursing interventions must be tailored to meet the particular needs of patients at each period of recovery in order to improve QoL of patients with Stage I gastric cancer after a gastrectomy.

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https://journals.lww.com/gastroenterologynursing/Fulltext/2020/05000/Differences_in_Factors_Affecting_the_Quality_of.5.aspx

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