Hepatology Education

Course team

Andrena Mierkalns	Rao Z Ahmad
Course Lead	Education Coordinator

 

Background

“Management of the care of patients suffering from Hepatobiliary disorder” was a stand-alone module, led by the Liver specialist nurse at the University of Nottingham. When the UON discontinued this module, the Liver specialist nurse after liaising with the senior nursing staff, continued to deliver the course in-house. So, a liver course at this level has been delivered every year since 2000 (since 2012 to in-house nursing staff only).

Nurses of Band 5, 6, and 7 including specialist nurses, nurse practitioners and ward managers have attended this course from the following clinical areas:

Clinical areas

Hepatology Wards	Gastroenterology Wards	Endoscopy Unit
Oncology Wards	Daycase Unit	HPB surgical ward
Theatre	Alcohol Liaison team	Drug & Alcohol support
Virology	Outpatient areas	Research & Innovation

 

This shows a broad representation of areas from within the Trust. Nurses working in similar clinical areas in other trusts across the region, would benefit from access to this course. In addition, nurses working in community settings, e.g. GP practice, Mental health, and prison services would also benefit as early diagnosis of Liver disease is part of their service delivery and management of Liver disease would be part of the management of care.

Aim of the Course

The overall aim of this course is to provide the opportunity for the learners to gain an in-depth knowledge of the anatomy, physiology and function of the liver. They can then apply this knowledge to disordered pathophysiology and the clinical presentations of Hepato-Biliary patients. This course will allow the learners to gain insight into the disease process, including the investigations and management pathways for HPB patients.

The course will cover acute and chronic liver conditions, virology, genetic diseases, auto-immune disease, malignancy, and transplantation. The course would wish to produce a learner, who can transfer the knowledge gained to the clinical setting. This could achieve a confident professional, who with improved understanding and engagement, could positively affect the quality of care delivery.

Course Design

This course consists of six sessions in total. The first five sessions are taught sessions, followed by an assessment day, where the learners will deliver a presentation as part of their assessment to their fellow learners. Their line managers will also be invited on this assessment day to observe the presentations.

All of the sessions are held in the Post-grad centre at QMC-NUH and led by the course leader (Andrena Mierkalns), with input from the Hepatology medical team, HPB surgical team, Specialist nurses, Liver pharmacist, Liver dietician, and Health professionals. Patients with lived-in experience of liver conditions may be invited into the course to share their experiences with the learners. This way our learners will also have a better understanding of the impact of the disease looking at the patient’s perspective. At the start of the course the learners will be given refresher pre-course learning material, and will be expected to complete homework between the taught sessions. Throughout the course, the learners will also be provided with topic-relevant documents and material for their learning reference. At the end of the fifth session, topics relevant to the course will be distributed among the learners for them to research, prepare and deliver a presentation on the final day.

COURSE CONTENTS

Course contents

DAY-1 Introduction to the course Icebreaker exercise Anatomy and Physiology of Liver Function Disordered Pathophysiology Development of cirrhosis Compensated and Decompensated cirrhosis Hepatorenal failure Introduction to the Final day assignment Homework: Genetic disease   Day-2 Recap of the knowledge Homework Feedback: Genetic disease Blood tests used in Liver disease Overview of virology Nursing care of in-patients with failing liver Homework: Autoimmune disease   Day-3 Recap of the knowledge Homework Feedback Autoimmune liver disease Medications used in liver disease Primary liver cancer Neuroendocrine cancer Assessment Planning   Homework:

Day-4 Recap of the Knowledge Homework Feedback Gallstone disease Liver surgery National Cancer guidelines   Pancreatic cancer Homework: Effects of alcohol   Day-5 Recap of the knowledge Homework Feedback Alcohol Liaison Services at NUH Theory of Liver Transplantation Moral and Ethical issues surrounding Transplantation Patient story sharing experiences Evaluation of the course Distribution of the Assessment subjects and organisation of presentation order for Day-6   Day-6 Each learner will present their individual teaching session in front of the Course mates and their managers The learners will receive a written evaluation from peers, managers, and the Course Lead

 

Nottingham liver patients are finding out that KELP is good for them, as this is the name chosen for the new Education and Surveillance programme being delivered by Andrena “Andy” Mierkalns (Advanced Liver Specialist Nurse) and Dr. Emilie Wilkes (Consultant Hepatologist) here at NUH.

The burden of liver disease is ever-increasing in the UK, liver disease deaths have doubled in the last 20 years, and primary liver cancer is the fastest-rising cause of cancer death in the UK. The number of patients with substantial liver scarring and cirrhosis continues to grow. The NUH Hepatology team have addressed this demand in part by facilitating a Nurse-led approach to this patient group. Andy has taken a step further by developing the KELP programme to support liver patients with stable cirrhosis.

KELP is a 18 months structured education and surveillance programme for patients with stable cirrhosis, which incorporates knowledge, support, and ongoing management/surveillance of their condition. This is delivered through Four planned taught sessions in a group setting covering Liver anatomy & function, development & management of cirrhosis, Understanding of Blood tests & medications used in the management of cirrhosis, nutrition & dietary advice, and exercise sessions. The course culminates in a final session where the patients are invited to bring their family/carers to join us, to discuss their progress, and ongoing support. This session will facilitate both group and individual evaluation, and plan for their ongoing management.

The KELP course is led by Andy with the support of an Education coordinator and sessions delivered by the Consultants in the Hepatology team, Liver Dieticians, Liver Pharmacists, and Physio/Yoga therapists. The course provides the patients with a robust system of communication, and prompt information relating to their surveillance investigations. After this 18-month programme, the patient’s surveillance and communication will be managed via a digital platform called DrDoctor.

Currently, we have successfully recruited two groups into the KELP programme. The first group started in May 2023 and have attended two education sessions and are currently looking forward to their diet and exercise session. The second group commenced in October 2023, and the recruitment for the Third group is underway and is planned to start in March 2024. The evaluations and feedback so far, suggest the patients are enjoying the group setting, gaining knowledge, and appreciating the relaxed approach of the KELP team, which allows them to voice their queries in a safe environment.

The overall aim for this course is that the patients whilst gaining knowledge about the management of their condition, will also gain confidence and an awareness of when to initiate a follow-up from the healthcare team. The Hepatology team are hoping that the knowledge and confidence gained will lead these patients to make healthy lifestyle choices going forward.

For further information, please feel free to contact the KELP team at hep.edu@nuh.nhs.uk.

Information coming soon.