Nursing care of patients with chronic liver diseases: Time for action
Chronic liver diseases are very common worldwide and represent a major healthcare issue (GBD 2013 Mortality and Causes of Death Collaborators, 2015). Chronic liver diseases are characterized by inflammation of the liver, which may be secondary to distinct aetiological factors, including hepatitis C or B infection, increased alcohol consumption or non‐alcoholic fatty liver disease (NAFLD). Chronic liver inflammation leads to unrelenting fibrosis deposition with formation of scars that progressively disrupt the normal liver architecture and function, eventually leading in some cases to cirrhosis unless the cause of injury is removed (ie, elimination of hepatitis C virus by antiviral drugs) (Schuppan & Afdhal, 2008). Cirrhosis is a progressive disease that causes many complications, has a negative impact on patient health‐related quality of life, is a major cause of years of life lost, and hospital readmissions, and ultimately leads to death unless liver transplantation is performed (Schuppan & Afdhal, 2008). In Europe, chronic liver diseases are estimated to affect approximately 25% of the population and cirrhosis is responsible for around 170,000 deaths per year (Blachier, Leleu, Peck‐Radosavljevic, Valla, & Roudot‐Thoraval, 2012; Younossi et al., 2016). In USA, the prevalence of chronic liver diseases is like that in Europe and cirrhosis is estimated to affect 0.27% of the population and accounts for more than 70,000 deaths each year (Asrani, Larson, Yawn, Therneau, & Kim, 2013; Scaglione et al., 2015).
Despite the importance of chronic liver diseases as global health issue, the nursing community has paid little attention to liver diseases compared with other chronic diseases, particularly diabetes, chronic pulmonary diseases, cardiovascular diseases and neurological diseases. Nursing training in hepatology has been remarkably low compared with training in other chronic diseases. Moreover, incorporation of nurses into multidisciplinary teams for hospital care of patients with liver diseases has been very slow in comparison with other chronic conditions, particularly diabetes, cardiovascular diseases, and neurological diseases. Furthermore, nursing role in liver diseases in primary care is not present in most primary care systems. Consequently, nursing research in liver diseases has been markedly lower compared with that in other chronic disorders (Figure 1). The importance of incorporation of nurses to care of patients with chronic liver diseases has been emphasized in the context of Liver Campaign Addressing Liver Diseases in the UK (Williams et al., 2014). One of the 10 key recommendations that the commission asked for strong endorsement and urgent implementation was to improve the education and training of nurses in hepatology and increase the number of nurses caring for patients with liver diseases in hospitals and primary care.