Relationship of Nurse-Led Education Interventions to Liver Transplant Early Readmission

Abstract

Introduction: Early hospital readmission following liver transplantation is associated with lower survival and worse long-term graft function. Language, cultural practices, and health literacy influence patient understanding of posttransplant care education. Complex medication regimes, changes in metabolism and nutrition absorption, and infection/rejection further complicate the prevention of readmission. Purpose: The purpose of this study was to compare the 30-day readmissions of single-organ liver transplant recipients for 1-year prior and 1-year following the implementation of nurse-led education. The study examined the demographics, clinical characteristics, and 30-day readmissions of 35 liver transplant recipients who participated in the newly designed nurse-led education and 51 liver transplant recipients who experienced the prior post-liver transplant education. Design: A single-center, correlational study with a convenience sample was conducted at a Hispanic-serving South Texas hospital. The new education intervention maintained the standard education and added twice-daily mutual patient-focused goal setting between the nurse and the recipient that aligned with readiness for discharge activities/goals, structured education using abbreviated handouts written at a second-grade level available in both English and Spanish, and the use of repetition through multimodal methods. Results: The odds for 30-day readmissions the year prior to the nurse-led patient education intervention were 2.088 times greater than the year following the implementation. Thirty-day readmissions were reduced by 16.3% from the 2017 cohort to the 2018 cohort. Discussion: Understanding unique risk factors facilitates structured patient education which can be individualized to the patient and caregiver including collaborative nurse–patient goals.

Educational Strategies for Liver Transplant Candidates and Recipients: An Integrative Literature Review

“…Among the seven selected studies, three were cross-sectional studies, >23-25 one of quality improvement, 26 one of prospective cohort, 27 one of descriptive correlation 4 and one of qualitative approach. 28 Five studies originated from the United States of America, 4,24,26-28 one from Thailand 23 and one from Brazil.…”

“…25 With regard to postoperative complications, three studies produced in the United States have addressed educational strategies. 4,24,27 The first evaluated the effect of an educational tool in improving knowledge in liver transplant recipients who have developed chronic kidney disease (CKD). A questionnaire on knowledge of CKD after liver transplantation was administered before and after an educational intervention focusing on CKD.…”

“…There are studies that point to several benefits for patients submitted to the health education process, including increased satisfaction and quality of life, improved continuity of care at home, reduced anxiety, promotion of and adherence to the proposed treatment, and the achievement of independence. 4 The nurse's role involves not only giving directions to the patient when they are absent; it includes assisting the patient to increase skills for self-care. According to international literature, there are several barriers to teaching for nurses, including: lack of competence or confidence in their educational skills; low prioritization of teaching activities by administrators and other staff; environmental infrastructure problems, such as lack of space, privacy, and frequent interruptions; and questioning the effectiveness of education, making it less valued.…”

Estrategias Educativas para Candidatos y Receptores de Transplante de Hígado: Revisión Integrativa de la Literatura

“…25 En lo que se refiere a las complicaciones postoperatorias, tres estudios producidos en los Estados Unidos de América abordaron estrategias educativas. 4,24,27 El primero evaluó el efecto de una herramienta educativa en la mejoría del conocimiento en receptores de transplante de hígado que desarrollaron enfermedad renal crónica (DRC). Un cuestionario sobre conocimiento de la DRC después del transplante de hígado fue aplicado antes y después de una intervención educativa con enfoque en la DRC.…”

“…Los resultados no demostraron diferencia estadística significante en las readmisiones de 30 días (antes y después de la nueva intervención educativa), a pesar de que haya habido una disminución del 16,3% en las admisiones, sin embargo los enfermeros crearon un proceso que mejoró la estructura y la consistencia de la enseñanza de los pacientes. 4 En lo que se refiere a aspectos nutricionales, un estudio americano investigó los beneficios de la enseñanza en la suplementación nutricional en candidatos a transplante de hígado gravemente desnutridos, por medio de una iniciativa de mejoría continua de la calidad (metodología plan-do-study-ask). Los pacientes incluidos fueron seguidos por llamadas telefónicas para enseñanza nutricional, hechas dos, seis y ocho semanas después de la inclusión en la lista de espera.…”