The liver is the second largest body organ coming only after the skin. The liver is approximately three pounds in weight, making it the second heaviest organ of the body. It performs very crucial functions in the body. These include; it is responsible for the storage of nutrients such as vitamins in the body, it is involved in the process of digestion, it detoxifies foreign substances, and it provides immunity to the body among other functions. Sometimes people suffer from acute liver which is caused by some conditions (Nursing Centre, 2014). The causes of liver failure include liver cancer, too much use of some chemicals such as felbamate and acetaminophen, inborn errors e.g. Wilson’s disease and hepaticellular diseases.
A liver transplant is the only way to treat liver failure. Simply defined, a liver transplant is a surgery that involves removing all or part of a patient’s liver and replacing it with a healthy liver from a donor. If the liver is totally damaged, the patient has to be fitted with a liver from a donor. In cases where only part of the liver is damaged, a patient can receive a portion of a healthy liver from a living donor who is mostly a close relative because of compatibility. Liver transplants are the second most common transplants coming only after kidney transplants. However, the liver transplant remains one of the most complex surgical procedures. It calls for special equipment and experience. This being the case, liver transplants take place only in a few hospitals that are fully equipped with the special medical equipment needed and also have the medical personnel to carry out the procedure. The length of the surgery varies from four to eighteen hours depending on the outcome. The surgery normally requires three surgeons, two anesthesiologists and about four supporting nurses.
The surgical procedure demands efficient team work by all the parties involved. Nurses are actively involved in the surgical procedure of a liver transplant before, during and after the surgery. Before the surgery, nurses are trusted with role of preparing the patient both psychologically and physiologically (Dal et al, 2009). Every patient reacts differently to the news that they need a liver transplant. Some patients wait for long periods before a compatible liver is available. This period varies with some patients waiting for as long as three years. It is the nurse’s role to assure and encourage the patient during the waiting period. The nurse also helps the patients avoid practices that could make liver worse, such as intake of alcohol. The patient is also advised to avoid sodium (Benner et al, 2009). The nurse also prepares the patients psychologically when a liver is finally available for transplant. The nurses are also responsible to prepare the patient physiologically e.g by conducting urinary tests and carrying out the required blood tests.
The evidence based problem identified during the research is the use of nurses as secondary member of the multidisciplinary team. This problem is even worse if the nurse is has no specialized training in the care of a liver transplant patient. According to Grogan (2011), a nurses role in both the preoperative and postoperative care of a liver transplant patient is crucial and should be treated with the seriousness deserves. The solution developed to this problem in this paper is the use of nurses as primary members of the multidisciplinary team. In addition to this, these nurses should also be specially trained to handle and efficiently care for liver transplant patients during both the preoperative and postoperative periods.
Change Plan Overview
According to Rosswum & Larrabee (2009), the change plan overview will involve a six step plan. In the first step a focus group will be conducted in order to help identify the best model for the solution. This will involve the teams presenting their preferred model and its pros and cons. The second step will involve selecting the best model among all the presented models. The selected model is the one which is most effective and has the most benefits. The third step will involve communicating to the other members of staff concerning the impending change. The fourth step will be educating the concerned staff on the new model. The fifth step is implementing the model or putting it to use. The last step of this model is evaluating the solution to determine whether it is working or not.
Implementation of the Solution
Implementation of the solution will require a lot of commitment from both the nurses and also health care facilities. To start with, nurses should be encouraged to take part in specialized training. The benefits of the training should be clearly spelt out and analyzed to the nurses. Health care facilities should enhance these trainings by providing the required support to the nurses. Such support include making the nurses’ shifts shorter so they can have time to attend the training. Also, the health care facilities should give incentives to the nurses who are willing to undergo the special training. This tactic will encourage their counterparts to join them in the training. Salary raises should also be awarded to the nurses who undergo the special training.
Needless to say, this process will not be easy for any of parties involved. Nurses for example will have less free time to themselves while the hospital might suffer from shortages. The best plan to implement the situation so as to many the work easier for all parties involved will require health facilities to coordinate with special trainers who will train the nurses within the hospital premises. This will make it easier for nurses to attend the training after their work shifts.
The training will be thorough and all nurses will require to take tests to confirm their newly acquired skills and expertise. Moreover, carrying out the training in the hospital; facility will give the nurses a unique opportunity to practice what they have learnt. The time frame of the training should take about four weeks to ensure that nurses get all the training they require in order to improve their skills as far as preoperative and postoperative caring for liver transplant patients is concerned.
Having carried out the first part of the solution, the second part will be quite simple. Involving a primary nurse in the multidisciplinary team will be easy with many specialized nurses to choose from. Primary nurses perform unique roles during the care of a liver transplant such as making decisions for individual patients depending on the nurse-patient relationship fostered during the period that the patient was under the nurse’s care, they carry out patient-based care also, they communicate directly with the patient and then relay the information to the team members and other colleagues (Liu &Niemann, 2011). Primary nurses have a unique relationship with patients as they remain the patient’s assigned nurse during the entire period.
Contribution to the Future of Health care
Carrying out specialized care for nurses will have enormous contributions to the future of healthcare. For one, it will improve the efficiency of the provision of health care services to liver transplant patients. Nurses with special training will now be in a position to even provide some medical care in case the doctor is absent. Also the training will equip nurses on the appropriate ways to handle liver transplant patients during both the preoperative and postoperative period. Some patients become depressed while some may even lose hope, especially if they have to wait for a long period before a compatible liver is available. The training will equip nurses with the skills to deal with such patients.
Healing after a liver transplant takes approximately two to three months, depending on the patient and also the expected outcome (DOI). During this period, having a nurse specially trained to care for liver transplant patients will be very advantageous. For one, a specially trained nurse will be more likely to notice odd or negative changes in a patient as compared to one who is not specially trained.
In addition to this, specially trained nurses will make work easier for the other parties, such physicians, involved. A nurse with special training will be extra resourceful to the team as compared to a nurse without special training. In addition to this, it will make the physician’s work easier as he can confidently rely on the nurse’s observations. This will provide the physician with more time to allocate to other liver transplant patient.
Lastly, having a primary nurse who is also a member of the multidisciplinary team builds a strong nurse-patient relationship. Due to the time spent with the patient before, during and after the surgery, the patient is most likely to become close to the nurse and even trust him/her. This makes it easier for the patient to easily communicate any problem to the nurse. Subsequently, the nurse is able to share this information with the team involved and other colleagues. This enhances communication and a solution to the problem is developed as soon as possible. This could save a lot of patients’ lives. The opposite is the result when the patient is used to seeing new faces of secondary nurses daily.
Assessment of the Need for Change
An assessment was carried out to evaluate whether the change is really necessary. It was found out that many liver transplant patients die after surgery due to poor postoperative care. This results from entrusting nurses without specialized training to care for the patients. Some of the causes can be avoided as some of them are as simple as malnutrition. Therefore, there is need to change the preoperative and postoperative care approach for liver transplant patients. Approximately three out a hundred liver transplants die after the surgery. Therefore, there is an urgent need for change to in order to save more lives.
The first expected outcome of this solution is less deaths from liver transplants. This will result due to the specialized care provided by the nurses after undergoing special training to equip them with the necessary skills. The efficiency of the provision of health care will also improve considerably. This is because nurses will now have more skills in dealing with emerging problems.
Reduced cases of death of liver transplant patients will encourage more patients suffering from acute liver failure to undergo liver transplant. This will lead to an even more decreased rate of liver transplants death.
The last outcome will be more surgical procedures for liver transplants. Having especially primary nurses who are members of the multidisciplinary team will increase the time liver specialists and surgeons have to see more patients. Consequently, more liver transplants will be carried out which will further reduce the number of deaths due to acute liver failure.
The sources used for this research mostly included scholarly sources. The reason these scholarly sources were chosen is because they present information on a firsthand basis. The information found in them was from nurses and other medical staff who have had firsthand experience with liver transplant cases.
Books were also used for the research as they provided important facts on the challenges faced during liver transplants and what can be done to save the lives of patients.
Evaluation of the Solution
Evaluation is important for various reasons. For once, it gives insights on whether the solution provided is working or not. It also makes it possible for the team involved with the implementation to identify with areas that require improvement.
Evaluation can be done qualitatively or quantatively. The first step in selecting an evaluation method is finding out the purpose or the solution and then finding out whether the solution is serving the purpose.
For the evaluation I would use a qualitative method. His would involve collecting statistics of deaths after liver transplants. A reduced number of deaths will be an indication that the solution is working. This would be carried out over a period of time, preferably monthly.
Integrate And Maintain Change
To maintain the plan, support and cooperation from the concerned parties would be required. Maintaining the plan will require constant and frequent special training of the nurses.
Next Steps to Maintain the Change
Maintaining the change will require emphasizing the importance of the change. New nurses joining the health facility will also undergo the training.
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