Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Developing the Australasian Hepatology Association's Consensus-Based Guidelines for the Nursing Care of Patients with Liver Disease

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Developing the Australasian Hepatology Association's Consensus-Based Guidelines for the Nursing Care of Patients with Liver Disease

Article excerpt

The Australasian Hepatology Association (AHA) is a membership-based organisation representing and supporting nurses and allied health professionals caring for patients with liver disease. The AHA aims to build and promote the expertise of hepatology nurses; contribute to pol- icy; and advocate for improved care for patients with liver disease (Australasian Hepatology Association [AHA], 2008). In 2008, the AHA released the Competency Standards for the Hepatology Nurse, which documents the funda- mental principles of hepatology nursing practice and provides guidance for advanced hepatology nursing practice (AHA, 2008). Integral to the implementation of the Competency Standards is the definition of an Australian hepatology nurse: A registered nurse who applies advanced knowl- edge, expertise and skills in the testing, manage- ment and treatment of liver disease to optimise the health and wellbeing of patients across the continuum of care (AHA, 2008).

Similar to other nursing specialities, the clini- cal evidence guiding hepatology nursing practice is embedded in the medical model of healthcare delivery. However, many elements of hepatol- ogy nursing are not identifiable in the existing medical evidence base. In Australia, the major- ity of the hepatology nursing workforce care for patients with hepatitis C, a role that is well described (Ehsani, Vu, & Karvelas, 2006; Grogan & Timmins, 2010; Larrey et al., 2011; Leone, 2002). The AHA recognises that for a sustain- able role, hepatology nursing needs to evolve to encompass the care of patients with hepatitis B, advanced liver disease (ALD) and hepatocellular carcinoma (HCC). These emerging areas of nurs- ing practice are yet to be clearly articulated in the literature.

Healthcare in Australia is provided by both private and government funded institutions. The current Australian government funded health- care system, known as Medicare, coexists with a private health system. Medicare is funded by Australian taxpayers and general revenue. Access to prescription medications is significantly subsi- dised by the Pharmaceutical Benefits Scheme. A point of difference from international practice is that Australian hepatology nurses do not prescribe specialist pharmaceutical treatment, such as anti- viral therapy for hepatitis B and C, which remains the domain of medical practitioners. However, the emergence of Hepatology Nurse Practitioners will expand the mandate of the nursing profes- sion in the care of patients with liver disease (Nazareth, Piercey, Tibbet, & Cheng, 2008). Currently hepatology nurses in Australia work in a diverse range of clinical and community settings including: Tertiary hospitals within gastroenter- ology/hepatology, infectious diseases (ID), liver transplant, oncology and medical imaging depart- ments; community health services; primary care settings; alcohol and other drugs services; sexual health clinics; mental health services; Aboriginal and Torres Strait Islander health services; refugee health services; haemophilia services; rural ser- vices; and custodial settings. It is estimated there are approximately 200 nurses working princi- pally in the field of hepatology. The workforce is expected to grow over the next decade, in order to meet the demand of caring for an increasing number of patients with ALD and HCC.

To establish a benchmark for current and future hepatology nursing practice the AHA com- missioned the development of nursing guidelines. Considering the lack of relevant and rigorous evidence to support hepatology nursing prac- tice, developing evidence-based guidelines was not a feasible option. In this context, guidelines based on a consensus of experts are regarded as an appropriate and suitable substitute (National Health Service Executive, 1996; Scottish Intercollegiate Guidelines Network [SIGN], 2011). Across many specialities in medicine and nursing, consensus- based methods are increasingly being used to capture expert opinion and inform therapeutic and management guidelines (Nair, Aggarwal, & Khanna, 2011; Omata et al. …

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