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The role of the nurse bronchoscopist

Nurse-led bronchoscopy, unlike other nurse endoscopy procedures, has not been developed in the UK. However, because of growing demand, it became clear that such a role was required in South Manchester University Hospital’s fibre-optic bronchoscopy department.

Abstract

VOL: 99, ISSUE: 41, PAGE NO: 60

Julie Martin, BSc, RGN, Dip(Respiratory), is nurse bronchoscopist, South Manchester University Hospital NHS Trust

 

Nurse-led bronchoscopy, unlike other nurse endoscopy procedures, has not been developed in the UK. However, because of growing demand, it became clear that such a role was required in South Manchester University Hospital’s fibre-optic bronchoscopy department.

 

 

Current bronchoscopy training of medical registrars, although excellent, lacks continuity due to the regular rotation of staff. It was proposed that a respiratory specialist nurse educated to degree level, who would work as part of the respiratory team, would be a suitable candidate for the role of bronchoscopist.

 

 

It was anticipated that this new role would help reduce waiting lists and free time for the consultant, who could then concentrate on interventional techniques.

 

 

Education and training
No training programme existed for nurse bronchoscopy, so the British Thoracic Society’s bronchoscopy guidelines (2001), current bronchoscopy training methods, and selected areas from nurse endoscopy training, were used to develop a programme. Legal and ethical issues were explored and a theoretical and practical training programme was developed (Box 1).

 

 

Gaining approval for the role
A nurse may perform extended roles, such as bronchoscopy, provided they have received appropriate training, have the support of the local health authority or trust, and are adequately supervised by a responsible practitioner (Nursing and Midwifery Council, 2002).

 

 

The role was initially agreed by consultant respiratory physicians and supported by the Heart/Lung directorate of the hospital’s trust. A proposal was submitted to the chief nurse and assistant chief nurse, which was agreed in principle. Then a service framework and training document were sent to the trust’s nursing and midwifery board, which agreed to the training programme and the development of a nurse-led bronchoscopy list.

 

 

Nurse bronchoscopy role
The nurse bronchoscopist offers a nurse-led, standardised, patient-centred service, and can ensure that patients receive a comprehensive plan of care when undergoing a bronchoscopy. The training programme provides nurses with the skills needed to inspect the respiratory tract, using a flexible bronchoscope, for diagnostic purposes and for retrieval of samples where indicated.

 

 

The nurse bronchoscopist must obtain informed consent from patients and be able to inform them of the risks, benefits and alternatives to the procedure. The role also involves the administration of conscious sedation and relevant drugs, using patient group directions.

 

 

Writing formal reports and communicating the results to patients, other than those awaiting pathology examination, are other vital parts of the role. Clear, concise descriptions of the areas of the lung being investigated, and documentation of samples taken, are required to enable other members of the multidisciplinary team to make decisions about disease management.

 

 

Evaluation
To ensure the service maintains a high standard, ongoing audit of procedures, adverse events and quality of specimens will take place, which will be compared with those taken by medical colleagues.

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