Duthie G S, Drew P J, Hughes M A, Farouk R, Hodson R, Wedgwood K R, Monson J R
University of Hull Academic Surgical Unit, Castle Hill Hospital, Hull, UK.
Gut. 1998 Nov;43(5):711-4. doi: 10.1136/gut.43.5.711.
Flexible sigmoidoscopy is a technical skill that has been successfully performed by suitably trained colorectal nurse practitioners in the USA. However, no recognised training course exists for nurse practitioners in the UK.
To design and evaluate a training programme for nurse endoscopists.
A multidisciplinary committee of nurses and clinicians developed a structured programme of study and practice. This involved a staged process of observations, withdrawals, and ultimately, full procedures. Once training had been completed the nurse practitioner was permitted to practice independently. Patients with colorectal symptoms referred for flexible sigmoidoscopy were examined for the final stages of training and independent practice. A prospective evaluation of the training and practice of the first trained nurse flexible sigmoidoscopist was performed. Barium enema, video, clinical follow up, and histology were used to validate the results of the flexible sigmoidoscopies.
The training programme required that 35 observations, 35 withdrawals, and 35 supervised full procedures were performed prior to the development of independent practice. Subsequent to the completion of this programme 215 patients have been examined independently by the nurse practitioner. Ninety three per cent of the examinations were judged successful and pathology was identified in 51%. The nurse endoscopist successfully identified all "significant" pathology whereas barium enema failed to identify pathology in 12.5%. There were no complications.
With suitable training nurse endoscopists are able to perform flexible sigmoidoscopy safely and effectively.
在美国，经过适当培训的结直肠执业护士已成功掌握了乙状结肠镜检查这项技术。然而，英国尚无针对执业护士的公认培训课程。
设计并评估一项针对护士内镜医师的培训计划。
由护士和临床医生组成的多学科委员会制定了一个结构化的学习与实践计划。这包括一个分阶段的观察、退出操作，最终进行完整操作的过程。培训完成后，执业护士被允许独立操作。将有结直肠症状并被转诊进行乙状结肠镜检查的患者用于培训的最后阶段及独立操作检查。对首位接受培训的护士乙状结肠镜检查医师的培训及操作进行了前瞻性评估。使用钡剂灌肠、视频、临床随访及组织学检查来验证乙状结肠镜检查的结果。
培训计划要求在开展独立操作前进行35次观察、35次退出操作以及35次有监督的完整操作。该计划完成后，执业护士已独立检查了215例患者。93%的检查被判定成功，51%的患者发现了病理情况。护士内镜医师成功识别了所有“重大”病理情况，而钡剂灌肠有12.5%未能识别出病理情况。未出现并发症。
经过适当培训，护士内镜医师能够安全有效地进行乙状结肠镜检查。
