Role of the nurse endoscopist in colorectal practice

Abstract

Recent changes in the provision of colorectal services',2 have led the authors to train a nurse endoscopist in colorectal practice'. MethodsA registered general nurse was trained in flexible sigmoidoscopy and clinical coloproctology in accordance with an agreed protocol. The training took place during routine endoscopy lists in a medium-sized district general hospital. Under the direct supervision of a consultant (V.M.), the nurse (R.R.) was trained in the three main elements of colorectal endoscopy.First, theoretical training covered the anatomy, physiology, pathology and clinical aspects of gastrointestinal disease, with special emphasis on the colorectum. Second, general endoscopy equipment training covered the mechanisms, cleaning and maintenance of flexible sigmoidoscopes; the principles and practice of infection control and the function and organization of endoscopy units were also taught. Third, flexible sigmoidoscopy training consisted of observation, performance of supervised procedures and postsigmoidoscopy management in 200 cases.Fifty procedures were observed, during which continuous teaching of the clinical and technical aspects of endoscopy took place. The trainee then performed 50 supervised procedures. The first 25 were withdrawals and were part of colonoscopy in sedated patients. Following these, 50 flexible sigmoidoscopies were performed, with the trainer immediately available.The nurse also learnt to use the proctoscope and to inject haemorrhoids, following the practice of the consultant to perform injection at the time of flexible sigmoidoscopy. AssessmentBoth the consultant trainer and pupil were assessed by an independent consultant gastroenterologist (G.W.)Video recordings were made of 50 trainer and 50 pupil procedures. Data recorded included duration of procedure, depth of insertion, level of colon reached, quality of examination and diagnostic accuracy. The pupil performed 150 solo procedures in her training and assessment. The endoscopist was not identified on the pro forma or video recordings. The assessor scored each criterion and each procedure.Scores for the pupil and trainer were totalled and compared. The pupil was considered able to perform competent and safe Paper accepted 10 July 1996 flexible sigmoidoscopy when her scores were equal to or within 15 per cent of those of the trainer. ResultsTotal scores did not show any statistically significant difference between trainer and pupil. Quality and accuracy scores were all 94-97 per cent. Trainer and pupil achieved 60cm insertion in similar numbers of cases (72 and 71 per cent), and reached the descending colon in one-half (50 and 49 per cent) of cases.Competence in theoretical and endoscopy training was achieved in all areas with 'proficiency' marks awarded in all criteria in the training package.No complication occurred throughout the training or the assessment. DiscussionThe training protocol was stricter and more thorough than the training of medical personnel recommended by the British Society of Gastroenterology. Assessment by...

Nurse-led direct access endoscopy clinics: the future?

“…However, in contrast to other studies [6,16,21,22] the average length of insertion in our study was much higher. A few centers in the United Kingdom have started a nurseendoscopist service, and early results from these centers are promising [6,17]. In view of the predominance achieved by left-side pathology, several centres have reported their experience with OAFS [11,13,27,28].…”

Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study

“…Another advantage of FS is that it is a less complicated and less risky procedure than colonoscopy and can be carried out by an appropriately trained nurse specialist. 28 It has been suggested that there is scope within the NHS to reduce the diagnostic burden for patients and endoscopy services by implementing clinical protocols which incorporate the selective use of FS, in place of WCI, for the initial investigation of patients with symptoms suggestive of distal CRC. [29][30][31][32][33] For WCI to be avoided in favour of FS, diagnostic protocols using FS for first-line investigation must be able to demonstrate INTRODUCTION NIHR Journals Library www.journalslibrary.nihr.ac.uk favourable risk-benefit profiles, in which the benefits of this less invasive procedure are balanced against the risk of a missed diagnosis of proximal cancer.…”

Specialist nurses in gastroenterology

“…Many of the first nurse endoscopists received a more demanding and lengthy training in the procedure than existing doctor endoscopists 9 . The number of procedures required for competence, as judged by a trainer is, about the same 10 ; therefore, guidelines recommend the same training for a nurse as for a doctor-150 procedures under supervision 8 .…”

“…However, there was a possible selection bias in this study as symptomatic patients saw the doctor rather than the nurse 17 . Mashakis et al 9 found that an independent blinded assessor scored a specially trained nurse within 15% of her (doctor) trainer on various aspects of performance, with both achieving the aim of 60 cm insertion in over 70% of cases and reaching the descending colon in half, with no complications.…”