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Researchers find Serbian nurses inexperienced with hepatic encephalopathy

A majority of nurses from a clinical center in Serbia did not know how to differentiate hepatic encephalopathy from other diseases or have proper training to treat it, according to study data.

“Hepatic encephalopathy is progressive in terms of its clinical prognostic character,” the researchers wrote. “A nurse needs to know well the symptoms of encephalopathy thus being able to react promptly and adequately in taking care of such a patient.”

Researchers, including Željko Vlaisavljević, RN, BScN, a PhD student of medical science at University of Mississippi Clinical Center of Serbia, performed a cross-sectional study of 70 nurses at a clinical center of Serbia between May 1, and December 15, 2011. They self-administered a questionnaire, which was divided into two parts: general questions such as professional education and sex; and 13 questions that were used to assess the knowledge of nurses about the specificities of hepatic encephalopathy (HE) health care.

Željko Vlaisavljević

The researchers sought “to observe specific nursing care rendered to hepatic encephalopathy patients and determining the significance of nurse education and employment length in [hepatic encephalopathy] patient health care,” the researchers wrote.

Results of the questionnaires showed that 88.6% of all the nurses (n = 62) had secondary medical school completed compared with the other eight nurses who had college or university degrees (11.4%). Thirty nurses reported having less than 20 years of experience (42.9%) and 40 reported having more than 20 years of working experience (57.1%). The average working experience was 17.3 years.

Over the course of the study period, 30 patients with grade 1 and 2 HE and 13 patients with grade 3 and 4 HE were seen and treated for HE during the study period. Of these, 69.2% had the most common cause of HE, ethylic cirrhosis, and 30.8% of patients with cirrhosis and HE died.

The nurses with 1 to 20 years of employment reported that they would recognize symptoms of HE (90%) compared with nurses with more than 20 years of experience (70%; P = .044). Additionally, 96.7% of those with up to 20 years of experience correctly identified HE as a “disturbance of consciousness” as compared with only 62.5% of those with more than 20 years’ experience (P = .001).

Among the nurses with up to 20 years of employment, 83% reported they would know how to read blood tests compared with 50% of nurses with more than 20 years of employment (P = .004).

Education level did not significantly affect these statistics.

A majority of the nurses (91.4%) stated on the questionnaire that they had “no adequate conditions to provide necessary HE patient health care,” the researchers wrote. In response to whether there are standards in health care procedures, 94.3% had negative replies.

“This paper has a universal meaning that should help the secondary staff education no matter in which medical institution or ward they are currently employed,” the researchers wrote. “The mentioned factors are in a direct correlation with each other and they can be only observed as a whole, where the failure to meet one of the factors is sufficient to make the algorithm of HE patient health care unsuccessful.”

“It can be concluded that, apart from the substantial level of staff education, further education process has to improve the other two factors of quality of work, which are: the interventional-therapeutic skills of nursing staff and the upgrade of equipment and improvement of general working conditions.” – by Melinda Stevens

Disclosures: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.