I have worked within hepatology for almost 20 years and am passionate about enhancing the care of hepatology patients. Currently I am working in North Bristol NHS Trust, at Southmead Hospital. I have helped set up the hepatology nursing service in both this trust and in my previous trust.
My role as the Hepatology Clinical Nurse Specialist requires practice that is informed by high levels of judgement, decision-making and discretion. I am involved with all aspects of hepatology, assessing, planning and caring for acute, chronic and palliative hepatology patients, in the outpatient setting.
Patient support
I aim to provide a better standard of care for patients who are often marginalised by their disease process and symptoms—to offer support and palliation to hepatocellular cancer and decompensated liver patients and their carers, and function as a patient advocate to negotiate and mediate to work with the system to ensure optimum care for patients.
A key aspect of my role is to smooth the patients' experience of living with chronic illness, particularly when they reach the end of their life. I am a point of contact for patients and accessible by telephone for patients and relatives, clinical teams in and out of the hospital, palliative care services and GPs. I provide specialist nursing advice and support to patients, their families and carers from the time of diagnosis and throughout treatment and follow-up phases of treatment and care, ensuring an optimum level of service to patients and their carers.
Clinics
The COVID-19 pandemic has increased our reliance on virtual clinics and patients are often offered a telephone appointment instead of a physical clinic appointment. Now more than ever the communication and trust between myself and my patients is essential in order to fully assess their needs and changes to their health.
My clinics are nurse-led and run independently of the consultants. I run a stable cirrhosis clinic and a hepatocellular cancer screening clinic. I also run viral hepatitis B clinics and FibroScan testing for liver fibrosis and steatosis. Each clinic appointment is consolidated so that the patient has their appointment scan, blood test and prescription in one appointment.
‘In my role I use clinical, communication and interpersonal skills to identify the needs of patients and advocate for them.’
I provide a rapid response clinic to assess and direct best care for patients who become unwell and decompensate, and monitor and help control symptoms and distress. I provide an outpatient paracentesis (large volume ascites drainage) service for two patients a day in order to prevent an ad hoc inpatient stay and to enable patients to manage their illness, giving them a better quality of life. I optimise their diuretic therapy alongside this and am happy to advise GPs to prevent admission. Another aspect of my work is instructing and assessing the junior doctors within hepatology, the medical admissions unit and oncology on the paracentesis within the trust—I teach it as part of the South West clinical skills days. This requires clinical examination, non-medical prescribing and ultrasound skills.
Other aspects of the role
As a clinical nurse specialist I play a significant role in setting standards and guidelines, undertaking audit and research, educating others and disseminating best practice. I develop, implement, monitor and review standards/policies/guidelines and service improvements for the hepatology nursing service, informing and collaborating with other colleagues as appropriate. I am an integral member of the multidisciplinary team within the hospital and across other NHS trusts for hepatocellular cancer and end-of-life care. I work closely with community and network teams, other hospital and community staff to ensure an effective seamless service.
In my role I use clinical, communication and interpersonal skills to identify the needs of patients and advocate for them. I am particularly driven to care for patients who are at the end of life. I am a Macmillan nurse and am developing pathways alongside the palliative services in the community and within my hospital trust, to enhance the patient journey by developing effective communication and support systems for patients and their families.
I aim to ensure a coordinated quality service and will be actively involved in education, audit and research. This is to provide advice, support and information from the time of diagnosis and throughout the care pathway and establish links with other organisations providing support and information and make use of these additional resources where necessary. I collaborate with transplant centres to smooth the patient journey during their work-up and assessment for liver transplant, and develop a hub centre for transplant work-up.
Overall, I try to lead the development, improvement, management and promotion of the service, ensuring the delivery of high quality, cost-effective care, as well as the implementation and monitoring of adherence to relevant clinical guidelines.