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Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You’re listening to The Scope.

Interviewer: Nurses Week is just such a great opportunity to celebrate nursing and the individual nurses that work so hard to make sure that patients in hospitals and clinics and any medical situation around the world get the best care possible. To help celebrate is David Entwistle, the CEO of University of Utah hospitals and clinics. David, tell me about a particular instance that a nurse has had an impact on your career or maybe even the way that nurses make you think of your job a little bit differently or change how you think about what it is you do.

David: I have to tell you, that’s a great question because part of what I think about, when you think about the CEO's role in this organization, being able to provide resources to make sure you’ve got focus as an organization. But at the end of the day, when you look at the care that our patients receive when they are in our in-patient facility at the bed side, it’s the nurses that provide that care. So I am taught every day, again, the perspective that they bring to the patients and what they value and the fact that we can provide that great care at their hands and at their caring and at their attention. The fact that we have them here in our organization, I have a great level of respect and empathy for the work that they do. I just appreciate all that they have done every day and I continue to learn from what their examples are to me.

Interviewer: It's kind of cliché but they really, truly are on the front line, and if your front line is not strong and providing excellent care, that makes your job impossible.

David: Absolutely. I mean, when you look at what they're doing on a day to day basis, and they are the patient advocate, they are making sure that that patient gets the care that they need. They are there at the bed side when that patient has concerns when they, again, need that help.

Interviewer: They are with them more often than any other person on staff.

David: They are.

Interviewer: Yeah. National Nurses Week theme is ethical practice, quality care, and quality has been an important initiative for University of Utah Healthcare. How do you see nurses affecting the quality of care at the U?

David Well, let me give you a great example. One of the things that our nurses have got around is how do you prevent infections at the bed side? We are now over a year in being able to prevent those infections at the beside in such a way that they have met of, what I think, has exceeded the national standard.
Certainly if you look at the value that our patients have received from that, that's an initiative that they took themselves. It's something that, again, they have owned, and I'm very proud of them for what they've been able to accomplish, but more importantly what our patients been able to gain by that.
Again, having hospital acquired infections when they get into the hospital is certainly not . . . we don't want to give anything else to them while they’re here and the fact that our nurses have just done such an outstanding job in preventing that is just truly exceptional.

Interviewer: I love it that it was an initiative led by them and almost they demanded more out of it than anybody else did. They were like, “We can offer better than what we're offering now.”

David: Well, you look at how busy we have been as an organization and, again, our in-patient capacity is certainly exceeding levels. We're having, again, to make sure that we’re juggling a lot of patient at their bedside and a lot of work in having to move patients around to make sure that all patients need to get in here. Despite all of that, their concern is how do we create a better experience and better quality care for those patients. It truly is remarkable.

Interviewer: You've touched on this in answering a couple of other questions, but maybe we can drill down a little bit more. What role do the nurses play in this institution? Describe their importance.

David: Well, again, back to the advocacy role that they play, but the caring role and, again, what they are able to do to provide and carry out the care plans for our patients to make sure that they get, again, the treatments they need to get recovered.
Now, we get patients from all around this area. We get patients that have been treated in other hospitals that are transferred to us in many different circumstances. As so we think about that and what they’re getting when they come into the organization, these nurses become their advocates. They become the ones that are many times taking care of patients that are away from home, that are away from family, that feel nervous, they feel scared, and we are able to provide that comfort through them.
Our nurses do such an exceptional job at doing that. I continually hear from our customers, whether that be our patients themselves, to their family members that are here visiting with them, the truly exceptional, caring work that our nurses give us. In fact, it's hard to get negative feedback sometimes as we try to go out and learn, what we can do to improve because the individuals we ask spend so much time telling us how great our staff are and how great the nurses are that cared for them. It truly is amazing to think about the exceptional folks we have at this organization.

Interviewer: What advice would you have to nurses just getting started in our organization? I am sensing a theme with patient advocate, like that should be one of the things that frames just about all the decisions they make. Do you have any other advice?

David: You know, I have the fortunate fact that I just had a niece, and the niece in my family that just started here is a nurse. One of the the things that she talked about, and she had the opportunity to work as a nurse in another organization and she said, “It is amazing how many things you have the opportunity to work with and deal with here.” She goes, “Sometimes that can be overwhelming.”
What I would give advice to our new nurses is take advantage of the great experience of those individuals that they get to work with here, those other nurses that can be great colleague, that can be great mentors, and really help them think through how do they balance all of the myriad of different tasks that they have to make sure that they're successful coming into this organization. We do a great job of wrapping our arms around these new nurses and giving them the ability to succeed, and I want to make sure that they’re taking advantage of the myriad of things that we’re providing.

Interviewer: More than ever now, beyond just the bedside which we've talked about a lot, nurses are filling positions throughout the organization away from the bedside. How do you see that as impacting the success of the University of Utah Healthcare?

David: Well, I think certainly here you've got a great skill set and the individuals that are providing great care to our patients and, again, they have a lot of talents that they can bring to other aspects of care. So when you're talking about the quality area, whether you're talking about case management, whether you talk about value engineering, there is so many different areas that they can provide value back to our patients, the organization. By bringing those clinical skills, we as administrators don't always have that focus about how do we create experience that's about the patient.

Interviewer: We are celebrating National Nurses Week so I want to give you an opportunity to wrap this up by taking a chance to say something to the nurses that provide such excellent care here and that are the patient advocates and are helping in ways beyond the bedside.

David: Well, what I wish I could do is individually meet with every nurse in this organization and say, “Thank you for the work that you're doing,” so that that would be a personal touch. Unfortunately, I can't always get out and do that. I have many opportunities, but I just want to say thank you them. We don't often stop and say thank you enough for the care that's being provided. To be able to tell them now that we appreciate what you do, we know what your time that you’re spending with us, we thank you for doing that and we appreciate that you advocate for our patients every day and provide truly an exceptional experience.

Announcer: We are your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: You've been diagnosed with liver disease. How is that going to affect your diet? We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: After you've been diagnosed with liver disease, dietary changes can make a difference. We're going to find out what you should be eating and what you should be avoiding right now, with Doctor Juan Gallegos. He's a liver expert at the University of Utah hospital. Tell us about diet and the importance of diet with liver disease.

Dr. Juan Gallegos: Thank you, Scot. It is very important because the liver receives most of the nutrition that you get through your mouth. It actually makes it into the blood from the small bowel and, then, that blood has to go and get through the liver. The liver cells, basically, detoxify your blood, and are very important in making proteins, making cholesterol, and it's basically like a chemical factory.

Interviewer: So, very important diet.

Dr. Juan Gallegos: Yes. Most of the time when I see patients in my clinic who have chronic liver disease, my main recommendation for them is, first, abstain from alcohol because we know alcohol has a direct toxic effect on the liver. So, if somebody already has liver disease, we strongly recommend that they abstain from alcohol so as not to damage the liver even further. In regards to any particular change in their diet, I do recommend that they try to eat healthy. Meaning, have adequate portions of fruits and vegetables, trying to limit their simple sugars, like a lot of flour, and bread, things of that nature. The other main thing, especially in patients that have very advanced liver disease, something we call cirrhosis, is to limit their salt intake because increased salt intake can lead to complications of liver disease or worsening of those complications, such as fluid build up in the abdomen, which we call ascites, or swelling of the legs and arms.

Interviewer: And why does that happen?

Dr. Juan Gallegos: Well, it happens because the liver is important in maintaining the amount of protein in our blood and, also, in maintaining the adequate amount of salt in our blood. So, when the liver isn't working well, there is an imbalance in those things that lead to people having low levels of protein in their blood, and that makes it easier for the water part of our blood to filter out, or go out of, the blood vessels and stay in the tissues and that causes ascites and swelling.

Interviewer: Is it the same thing with sugar, as well?

Dr. Juan Gallegos: It's a little bit different, but yes, the liver is very involved in sugar and metabolism. So people that have advanced liver disease can have sugar problems similar to diabetics.

Interviewer: So it sounds to me, essentially, the liver is just not doing its job the way it should be and you just have to be really careful because a normal functioning liver might be able to take the overload.

Dr. Juan Gallegos: Correct, that is true. It's just that the liver is so noble that it takes a lot of injury before it actually manifests itself as having problems. So, normally, people, when they get diagnosed, it tends to be later on in their disease course and that's where nutrition is so important.

Interviewer: All right. So we hear these things a lot. We hear nutrition is important. We hear that you should stop drinking because it can affect your liver. How important is it? It's like we hear it so often that I think a lot of people ignore it, so give us some context.

Dr. Juan Gallegos: Well, it is very important because we are what we eat, basically, and when you have a liver that's already damaged, or faulty, then, you don't want to increase the damage to that liver or make things worse and some of the symptoms that have to do with liver disease. The other important part is the alcohol issue. Even patients that have liver disease not related to alcohol, we know that the liver will be damaged by the alcohol intake, so that's why we recommend, in those cases, not to drink alcohol.
But, in those patients that have had injury to their liver because of significant alcohol intake, or now have what we call liver cirrhosis from alcohol, it is extremely important for them to stop their behavior and stop drinking alcohol because what is going to happen, if they continue to drink alcohol, is that their liver is going to get worse and their going to reach a point where their liver fails them and there's no way we can treat them anymore.

Interviewer: But one drink a day, that's not that big of a deal is it?

Dr. Juan Gallegos: Well, that's not big of a deal for a healthy person, that is true. In general, the recommendations are, for men, not to drink more than three or four drinks per day, and in women, as they are more sensitive to the effects of alcohol, the recommendation is not more than two drinks per day, but that's only for healthy people. In patients that have already liver disease, our recommendation is that there's really no minimal safe amount of alcohol and, hence, we tend to be more strict and say "No alcohol for you."

Interviewer: So when it comes to diet and alcohol, when you have liver disease, it makes a huge difference?

Dr. Juan Gallegos: It does. It makes a big difference. Of course, the other important part of it is making sure that you are being taken care of by the adequate medical provider and that you follow the recommendations, not only from a diet standpoint, but also if you're already on medications, to make sure that you follow those as well.

Interviewer: Like the difference of living and dying, living a great life and living a mediocre life; I mean how important are these things that we're talking about.

Dr. Juan Gallegos: It can be, especially in those patients with alcoholic liver disease. Continued use of alcohol will definitely result in, not only a very bad life quality, but, also, a shortened life and those people look forward to, basically, being in the hospital and dying in a very short period of time. And patients that have their types of liver disease, it might not be as dramatic, but, certainly, anything we can do to prolong their life and improve their quality of life, I think, is very important.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.