Pilot of an advanced liver disease nurse education programme and its intersection with emerging models of advanced hepatology nursing practice

Abstract

INTRODUCTION: Advanced liver disease (ALD) and liver cancer are a growing public health issue. Burdensome treatments for Hepatitis C once consumed nursing resources. However, as new treatments shift Hepatitis C care from specialist to generalist practice, hepatology nurses are freed to diversify their skills to meet the growing burden of ALD and liver cancer. Internationally, there are limited examples of hepatology education programmes to address and assess core ALD nurse capability. AIM: To explore acceptability and feasibility of a pilot ALD education and mentoring programme, and its impact on nurse capability and emerging models of advanced hepatology nurse practice. METHODS: Phase 1 surveyed nurses’ attitudes towards ALD training and identified learning needs. This informed curriculum and assessments comprising 9-months of formal hepatologist mentoring, face-to-face and online learning, hands-on skill development and clinical placement. Phase 2, through survey and interview, evaluated relevance of, and satisfaction with curriculum, nurse/hepatologist experience of mentorship, and local issues impacting course participation. In Phase 3, Schuler’s model of advanced practice guided semi-structured interviews with nurses and hepatologists, and descriptive, qualitative analysis was grounded in Fawcett’s nursing metaparadigm. RESULTS: There was great interest in the programme, it was rated highly acceptable, feasible and relevant to ALD practice. Under mentorship, nurses developed educational initiatives and local policies, and gave examples of nurse-led, patient-centered, holistic models of advanced ALD practice. Participants revealed the person with ALD as socially disadvantaged, with substance use disorders and communication challenges. Their health embodied complex body needs. Their environment lacked ALD services, particularly in rural/regional settings, heightening stigma and discrimination. Emerging models of ALD nursing practice responded by listening to the whole story, being non-judgmental, being a lynch pin and building networks and lines of referral. CONCLUSION: The programme was acceptable, feasible and effective in building capability for advanced nursing practice. Future work may confirm the impact of education and advanced practice on ALD service access and outcomes.