Flexible cystoscopy is the cornerstone of non-muscle invasive bladder cancer (NMIBC) surveillance. The literature reports that nurse cystoscopists provide safe and competent services, improve waiting times, and have high patient satisfaction rates. Additional important patient benefits include; continuity of care and the provision of psychological support, however, the nurse cystoscopy role has not yet been developed in the Republic of Ireland.
This service development provides a tentative framework for urology nurses to establish this role, and reports on the provisional audit results of the preliminary introduction of what is believed to be the first nurse-led cystoscopy service in Ireland.
Concept analysis confirmed congruence of nurse cystoscopy with the principles of advanced nursing practice as defined by the Nursing and Midwifery Board of Ireland. Next, multidisciplinary stakeholder meetings collaboratively agreed on the job description and the patient caseload. Policies, procedures, protocols and guideline documents were developed to articulate the governance for delivering a safe and quality service. Formal mentorship and clinical supervision arrangements were agreed. A structured program of training and competency assessment followed an internationally recognised flexible cystoscopy training and assessment guideline. On completion, the following aspects of safety and quality were audited against local, national and international guidelines.
|National Standard||Area of service|
|Effective care and support||Send urine for cytology in all high grade (HG) cancers|
|Safe care and support||Documented antimicrobial stewardship|
|Use of resources||Time to complete an entire episode of care safely|
Effective care and support
Target: 100% samples sent
Result: 20 consecutive records of patients attending the candidate ANP (cANP) for surveillance of HG NMIBC demonstrated a 90% compliance rate (2 patients unable to void an appropriate sample).
Safe care and support
Target: 100% documentary evidence of the reason for antimicrobial prophylaxis.
Result: 100% of patients who received a prophylactic antibiotic (18% of all patients attending) had a documented valid reason for administration.
Use of resources
Target: Complete an entire episode of care in equivalent time to urology colleagues.
Result: The cANP completed (supervised) 57% of all cystoscopys without a perceivable increase in the average time to complete an entire episode of care (26:27 versus 26:12 minutes:seconds).
Preparing for the nurse cystoscopist role requires a commitment from all of the multidisciplinary stakeholders to successfully deliver the initiative.
The demonstration and evaluation of the preliminary introduction of the role in the context of advanced nursing practice in Ireland outlined here provide a tentative framework for its adoption in other centres.
Patients with an ostomy have to face great challenges, not only just on physical, but also on emotional, psychological, and social level. Health professionals have a key role, supporting adaptation, encouraging patients to be involved in stoma care directly, and creating the best conditions to promote an effective self-management. The aim of this study is to describe the self-care’s (SC) levels in ostomy patients and their caregivers using two new tools: the Ostomy Self-Care Index (OSCI), and Caregiver Contribution to Self-Care in Ostomy Patient Index (CC-OSCI).
A descriptive study was conducted on a sample of adult ostomy patients and caregivers in the Dept. of Urology, San Raffaele Hospital (Milan, Italy), from Jan. to Sept. 2018. The patient questionnaire was composed of a sociodemographic-clinical data form, to collect information about demographics, living, family and work conditions, clinical information about ostomy, the OSCI, and the Stoma Care Quality of Life scale (Stoma-QoL). The caregiver questionnaire was composed of a sociodemographic-clinical data form, to collect information about demographics, living, family and work conditions, and the CC-OSCI.
The considered sample of patients was composed of 105 subjects (74.29% men; mean age: 68.77 yrs, SD 12.41). In almost the 82% of cases, patients did not live alone; the 46.67% had a colostomy. The predominant causes of stoma creation were oncological (90.48%). The mean time of stoma creation was 22.35 months (range 1-60). Almost half of the sample declared to be autonomous in stoma management (48.57%). The 31.43% of patients’ sample had one or more complications and the 25.71% had readmissions. The mean OSCI scores were: SC maintenance 34.76 (SD 11.47), SC monitoring 30.45 (SD 9.42), SC management 16.99 (SD 3.69), SC confidence 36.40 (SD 10.29). The mean Stoma-QoL score was 57.30 (SD 17.72).
The considered sample of caregivers was composed of 75 subjects (76% women; mean age: 59.09 yrs, SD 13.91), mainly husbands/wives/partners (65.33%), the 73.33% living with the patient. The average time spent on caregiving was about 19 hours/week. The mean CC-OSCI scores were: SC maintenance 32.44 (SD 13.32), SC monitoring 22.89 (SD 13.75), SC management 12.69 (SD 6.96).
The characteristics of our sample appear similar to ostomy patients described in literature. Each scale reaches a similar average score towards patients; the scores indicated a good level of SC and an average level of quality of life. The OSCI and CC-OSCI are two important tools for support nurses in their practice. An objective assessment of ostomy patients’ and caregiver’s SC levels is an essential starting point willing to guarantee an evidence-based educational support. This might contribute a significant reduction of readmissions and ostomy complications.
There is a growing body of literature that addresses the scope of APN roles and despite the growing demand for advanced practice nurses, there are limited data to conduct the successful implementation and optimal utilisation of these roles. Switzerland, however, have only just begun to scratch the surface of ANP role development and agreement among key stakeholders. Although been a middle size rural provider trust, the care for patients with urological problems (benign or malign incidences) are on the rise.
The aim of this project is to identify priority problems and goals for the implementation of the Advanced Practice Nurse (APN) role focusing on urological in-patients within the regional hospital Uster in Switzerland.
The Delphi technique is used to review systematically the value of an urological APN implementation for the regional hospital Uster using the PEPPA Nine-Step Framework as a guidance (Bryant-Lukosius and DiCenso, 2004). However, as the aim of this project was to identify priority problems and goals for the implementation of the ANP role, we focused only on the first four steps of the PEPPA Framework.
A panel of 9 experts were established the review implementation scenarios within a regional hospital. The participants were recruited from metropolitan and regional health services. Data were collected via a semi structured individual interview in round one and two following on-line questionnaires in round two and three. The more detailed topic summary of the semi-structured interview was recorded by the researcher and evaluated by the experts in round two and three using a Likert scale. Feedback and statistical summaries of responses were distributed to the panel until the 70% consensus cut-off was obtained.
Three rounds of Delphi were required to reach consensus on the answers and discussions provided.
A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles are essential during the implementation process of new APN’s.
Recommendations for the future introduction of APN roles can be derived from this paper. These include the need for a collaborative, systematic and evidence-based process that provides data to support the need and objectives of a clearly defined APN role, support a nursing orientation to advanced practice, promote the full use of different role areas, create settings that support role development, and a continuous evaluation of these roles shall be carried out on the basis of predefined objectives. However, various aspects of the implementation process that were not dealt with in depth in this study, such as the strategic orientation of the hospital, the willingness of internal and external experts to cooperate and the political, economic and social orientation in the regional context, should not be neglected
Simulation-based training has become an integral part of medical education. The purpose of this study was to evaluate the improvement in knowledge and skills of participants after introduction of a new training methodology namely Simulation Based Workshop.
-To improve knowledge and hands on skills of Urology nurses in managing Urosepsis
-To evaluate the attitude of the participants towards simulation based training.
Cause and Effect Tool (fish bone diagram method) was used to identify issues in patient care faced by urology nurses. Management of urosepsis was identified as a learning topic. Timeline was set and PDSA (Plan Do Study Act) tool was applied to improve services provided by urology nurses and improve outcomes. Biannual traditional training course for urology nurses at our tertiary care university hospital was revamped into Simulation Based Workshop. Nursing staff was acquainted with sepsis protocol and performed focused assessment of patients having Urosepsis and its initial management on high fidelity SimMan 3G simulator. Each participant had skills signed off at the end of simulation based training session. In order to identify improvement in knowledge, Multiple Choice Questions (MCQs) based pre and post tests were conducted. An evaluation form was filled by each participant to assess effectiveness of workshop and Strengths, Weaknesses Opportunities, Threats (SWOT) Analysis was done.
Overall 29 out of 34 nurses working in Nephrology-Urology service line participated in simulation based workshop. Pre-test average score of participants was 48%, whereas, on completion of this workshop average post-test score was 82% indicating significant improvement in knowledge domain. All participants had successful skill sign off with at least satisfactory performance. At the end of workshop evaluation form, most of the participants found this training useful. Verbatim as per participants’ feedback: “Simulation-based training has opened up a new educational aspect, moreover it has provided us a valuable platform that enriches our learning in all specialties”. On SWOT analysis the main strength of project was that participants learned hands-on skills to identify early warning signs of sepsis and to manage them timely and efficiently
Simulation based workshop significantly improved knowledge and skills of urology nurses. Participants have shown positive attitude toward this new method of training and enthusiasm to practice these concepts in patient care based on workshop evaluation. With these findings we further look towards measuring the clinical outcomes in patient care management.