The Role of the GI Nurse Practitioner

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The Role of the GI Nurse Practitioner

• Angela Gardiner
• Senior Lecturer, Faculty of Health Social Care
• University of Hull

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• What is the role of the GI Nurse Practitioner /
  Colonoscopist?

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What determines the role?

• Patient care
• Gaps in service provision delivery
• Personal interest
• Personal motivation
• Healthcare targets

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GI aspects of care

• GI Cancer
• Inflammatory bowel disease
• Functional bowel disorders
• GI motility
• Hepatology
• Medical patient management
• Surgical patient management
• Endoscopy other GI investigations
• Stoma care
• Nutritional support dietics

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Care settings

• Helpline / advice
• Community
• Outpatient clinic
• Inpatient
• Medicine
• Surgery

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Aspects of patient journey
History taking
Counsel. / advisory
Informed consent
Pre-assessment
Meds. Managem.
Family history
Pre post op support
Investi-gations
Initial managem.
Health promotion
Education
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• UK Practitioner examples

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Nurse Endoscopist

• Upper GI endoscopy
• Diagnostic service
• GI Bleed service
• PEG insertion / management
• Lower GI Endoscopy
• Flexible sigmoidoscopy
• Colonoscopy
• Screen Colonoscopist

Endoscopy Training
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Other Practitioner roles

• Hepatology NP
• Inflammatory bowel disease NP
• BC Screen NP
• Colorectal or Upper GI cancer NP
• NP Nutrition
• PEG NP

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Continuity of Care
FBD
Referral Functional Bowel Disorder clinic
Seen FBD Practitioner clinic
Practitioner undertake investigation (s)
Results FBD Practitioner clinic
/- Practitioner led management
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Continuity of Care CRC
Referral 2 week wait suspected CRC
Seen 2 week wait CR NP clinic
CR NP undertake endoscopy organise
investigation (s)
Results CR NP, discharge or MDT mtg
/- CR NP led follow-up
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Continuity of Care BCSP
ive FOBt received BCSP
Telephone contact, Appt organised
BCSP guides through bowel prep, pre-colon
preparation
BCSP attends colon, discuss results /- referral
Telephone contact post-colon, follows onward
referral, completes documentation
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Continuity of Care anaemia
Referral anaemia outpatient clinic
Seen Anaemia NP led clinic
NP undertake investigation (s)
NP discuss results, commence management (where
approp.)
NP follow-up / review
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A closer look.

• Appointed 1995
• Clinical Measurement Technician
• Still fairly non-routine
• GI Physiological measurement
• Lower GI
• Upper GI

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A closer look. Contd.

• Endo-anal ultrasound
• Endo-rectal ultrasound
• Ano-rectal manometry
• Pudendal neurophysiology (PNTML)
• Oesophageal manometry pH
• Breath testing
• Biofeedback
• Patient advice counselling

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A closer look.

• GI Physiological measurement develops
• Development national courses
• National training centre
• Extended research
• Specialist centre investigations management

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Patient groups

• Faecal incontinence
• Constipation
• IBS
• Defaecatory disorders
• Surgical patients
• Gracilis neosphincter
• Sacral nerve stimulation
• ASR support

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Developments.

• Appointed department manager 1998
• Endoscopy training FSig, Colonoscopy 2003
• Consultant practitioner Coloproctology 2004/5
• Outpatient caseload 2004
• ½ time secondment UoH January 2005
• Full time UoH Sept 2006, clinical practice

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Why share this with you?

• Not on my radar
• Unexpected, not planned
• Interesting motivated
• En-debted Surgical Medical colleagues
• Not always plain-sailing
• Hard work
• Enjoyable, transformational, educational,
  satisfaction, personal professional
  relationships

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Challenges v benefits

• Professional jealousy
• Change resistors
• Hard work
• Time consuming
• Peaks troughs
• Confidence

• Highly rewarding
• Advancing patient care
• Advancing practice
• Personal development
• Job satisfaction
• Development of others

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• What is the role of the GI Nurse Practitioner /
  Colonoscopist?

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What determines the role?

• Patient care
• Gaps in service provision delivery
• Personal interest
• Personal motivation
• Healthcare targets

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Closing questions

• Where are the gaps in service?
• What really interests you?
• What do you want to do?
• Can you see how to get there?
• Who can help you get there?
• Who can support you?

Once you can answer some or all of these
questions, you are more than half way there..