S3-E9 - Are We Taking Full Advantage of the Skills and Knowledge that Liver Nurses and Advanced Nurse Practitioners Bring To NASH Education and Patient Care?

Send us Fan MailLouise Campbell convenes  liver nursing and nurse educator experts Kathryn Jack, Michele Clayton, Pam O'Donoghue and Patrizia Kunzler to consider where liver nurses and advanced nursing practitioners should fit into treatment and communication paradigms and what support they will need. Stephen Harrison joined to offer a different viewpoint.Timestamps:2:42 – Roger introduces session4:07 – Louise starts discussion5:37 – Stephen reviews patient case12:10 – Panel introductions 22:33 – FIRST QUESTION: health discrimination and quality of care24:58 – Michele: 2012-3 report stated that patients admitted with alcohol-related liver disease lacked HEP access, received poor treatment. We have made some progress but see similar issues today with COVID-1927:59 – Patrizia: in Switzerland, liver patients come to care late in disease.  Nurses provide excellent care but are not involved in prevention. Doctors drive the entire decision hierarchy29:24 – Michele: Similar issue in UK;  where nurses need decision input and greater investment in specialists, particularly in rural areas31:47 – Kate: Agreed. We lose too many opportunities for nurses to inform and educate32:40 – Pam: HCC patients on wards present "extremely unwell", in late stages. Nursing “short-staffed.” Not enough time to coach patients. 33:43 – Pam: I did recordings so I could work with one patient while another consumed recording. We also worked with patients in groups 36:06 – Stephen: We’re getting closer to our first NASH drug, which will reduce frequency of NASH-HCC if we can treat early enough in disease progression. Also, we need to create a communication model that combines nurses and doctors37:33 – Stephen: Another target: podiatrists. They  check patients' liver enzymes before Lamisil therapy,  see dysfunction and don’t know what to do. And  which other specialties? Obesity? Cardiology? ENDO? GYN? KEY: two “foundational pillars of education” - doctors and nurses - working collectively to develop and share content39:38 – Pam: This requires trust between doctors and nurses. Trust takes time41:24 – Kate: In prisons, once patients are diagnosed, we arrange conversations in person or video. Harder to build rapport without in person. With rapport, everything flows smoothly43:15 – Kate: We have a system for GPs to refer patients for FibroScan, which is an excellent communication opportunity for nurses44:58 – Michele: Some UK universities offer liver education, most do not. This is a global challenge47:07 – Pam:  We should invest some of this billions we spend on HCC systemic therapies in education before and early in  disease progression48:43 – Michele: Liver "blindsided" countries and planners who focused on renal,  CV and cancer49:34 – Louise: We spend heavily on expensive late-stage drugs but lack funds to locate and educate at-risk people early in  process or steer them to clinical trials50:39 – Louise: How can we use the Lancet Commission's  competency documents better?51:15 – Michele: Others have local competency documents in their own languages53:25 – Patrizia: Not certain about Swiss association 54:15 – Stephen: Not aware of a common framework in US57:48 – FINAL QUESTION: something you would like to see in next 2 years58:46 – Michele: More global action from/for nurses58:58 – Kate: Engage other specialties. New UK competency criteria around Fatty Liver1:00:07 – Kate: More inclusive trial recruitment based on communication in patients' own languages1:03:14 – Patrizia: Collaboration matters, but support/fund nurses today in research  and publication1:04:18 – Pam: Encourage British Liver Trust to be more aggressive;  they can be quite effective1:05:10 – Louise: Bring all the liver disease competencies we have to bear on NAFLD1:06:53 - Business report