الفهرس 
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Abstract
Summary
T
he care of the liver transplant (LT) patients presents the critical care team with one of the more complex and challenging endeavors. The primary goal of LT is to relieve limitations resulting from liver disease or failure. However, active participation in the care of patients post LT must be taken in action. Proper management and early recognition of complications and communication of these findings allow for prompt intervention and progress toward optimal outcomes for these patients who underwent LT (Good & Kirkwood, 2018).
Length of stay in intensive care unit (ICU) post LT is influenced by a number of factors as the patient’s underlying pathology, disease severity, comorbidities, quality of donor graft, the intraoperative course, quality of pre and post LT medical and nursing management. Also, Liver transplant recipients with acute liver failure experience longer ICU lengths of stay with increased morbidity and mortality. Also, Adverse psychological changes may result in a loss of confidence in the treatment and, thus, slow recovery, further resulting in mental illness. Due to LT special environment, the ICU is secluded, with reduced communication between physicians and patients, which causes great difficulties in disease recovery (Clayton & Greenslade, 2020
Aim of study: -
Assess factors influencing length of stay for patients post liver transplantation through the following:
1. Assess patients related factors influencing length of stay for patients post liver transplantation.
2. Assess health team workers related factors influencing length of stay for patients post liver transplantation.
3. Assess environmental and safety related factors influencing length of stay for patients post liver transplantation.
Research question:
1. What are the factors influencing length of stay for patients post liver transplantation in critical care unit?
Research designs: -
A descriptive exploratory design was conducted to achieve the aim of this study.
Research settings: -
This study was conducted in in critical care unit at Ain Shams Specialized Hospital at Cairo in Egypt.
Research subject:
There two convenience sample were be recruited in the current study through one year from beginning of March 2021 to the end of March 2022 as following:
All available Patients underwent liver transplantation at Ain Shams Specialized Hospital included 30 patients.
All available health team members providing care for such group of patients in critical care unit post liver transplantation included (15 physicians – 10 nurses – 5 physiotherapists – 5 workers) were be recruited in the current study.
Tools of data collection: -
Data were collected using the following three tools:
I: Patients assessment tool: this tool was designed by the investigator with Arabic language, included the following three parts:
Part I: Demographic data.
Part II: Hemodynamic stability.
Part III: Medical & surgical data.
II: Health team members structured interviewing questionnaire: It was included three parts as following:
Part I: it was concerning with assessing demographic data of health team member.
Part II: It concerned with assessing: (physician, nurses, physiotherapist & worker) knowledge regarding liver transplantation.
Part III: it was concerning with assessing Health care providers’ practice observational checklists.
Part IIII:: it was concerning with assessing Attitude of the studied.
III: Environmental and safety related factors: it was used to assess environmental and safety factors influencing length of stay for patients post liver transplantation
The main findings of this study revealed that:
• Regarding demographic data of studied patients showed that 100% of studied patients their age ≥40 years with mean &SD 49.69±7.29, 60% of them were male, 43.3% of them were illiterate.
• Regarding length of stay in critical care post liver transplant of studied patients showed that, 70% of studied patients their length of stay in critical care post liver transplant were 8-9 days. While, 30% of them their length of stay in critical care post liver transplant were 5-7 days.
• Regarding of demographic data of studied health team revealed that, 100% of studied physicians had master degree, had from 5 years to below 10 years experiences and attending liver transplant courses. 80% of studied physiotherapists had bachelor, 60% of them had more than 10 years’ experience and 100% of them attending liver transplant courses. 50% of studied nurses had high education, 40% of them had years of experiences from 5 years to 10 years and more and 90% of them were attending liver transplant courses. 60%, of studied workers had secondary education, 40% of them had below than 5 years and more than 10 years experience, 60% of them were attending liver transplant courses.
• Concerning of health team members knowledge regarding liver transplantation showed that, 88.6% of studied health team had satisfactory level of knowledge. While, 11.4% of them had unsatisfactory level of knowledge about managing patient post liver transplantation in critical care unit.
• An analysis of the studied health team members level of practice regarding caring patients post liver transplantation revealed that, 85.7% of studied health team had satisfactory level of practice. While, 14.3% of them had unsatisfactory level of practice about managing patient post liver transplantation in critical care unit.
• Concerning total positive and negative attitude among studied health team members showed that, 65.7% of studied team had positive attitude and 34.3% of them had negative attitude regarding managing patient post liver transplantation in critical care unit
• Regarding total environmental and safety factors affecting the length of stay for patients post liver transplantation revealed that, 66.7%, of studied patients had suitable environment. While, 33.3% of them had unsuitable environment.
• Concerning relation between length of stay in critical care post liver transplant of studied patients according to their environmental and safety factors showed that, there was statistically significant difference between environmental and safety factors and length of stay in critical care post liver transplant.
• Regarding Correlation between patients Length of stay in critical care post liver transplantation and total knowledge, practice & attitude of health team members revealed, there was negative correlation between knowledge, observational checklist ant attitude of physicians, physiotherapists, nurses, workers and overall team and length of stay in critical care post liver transplant.
Conclusion:
Based on findings of the present study, it can be concluded that:
There are many factors affecting length of stay for patients post liver transplantation in critical care unit including patients related factors the majority of them had viral c hepatitis. Regarding health team member related factors, it was found that majority of them had satisfactory level of knowledge and level of practice. Also, about two thirds of studied team had positive attitude regarding management provided for the patients post liver transplantation. In addition to, more than two thirds of studied patients had suitable environment that may be result of new SICU after a renovation.
The important recommendations inferred from the study results were:
Recommendations:
• Continuous implementation training programs for improving knowledge, attitude and practice of physicians, physiotherapist, nurses and workers regarding management of patient post liver transplantation in critical care unit.
• Further studied should be conducted about another factors that prolonged length of stay in critical care post liver transplant and methods to overcome.
• Replication of the same study on larger probability subject at different geographical locations for data generalizability.