Develop a new role of nurse bronchoscopy in chronic cough | Nursing time

2021-12-15 00:22:59 By : Ms. Dolly Chen

This article discusses the development of new clinical nurse specialist roles, including performing bronchoscopy to help diagnose, manage, and treat patients with chronic cough

The number of referrals for chronic cough patients from the University of Manchester NHS Foundation Trust Fund has increased significantly in recent years, leading to delays in the diagnosis and treatment of this group. The role of the clinical nurse specialist for chronic cough is designed to meet service needs, including bronchoscopy. The existing plan was revised to comply with current standards. Clinical outcome measurement and review are being conducted on patient satisfaction, safety and technical capabilities throughout the training process. After the training, a more detailed analysis of the role of the expert and its cost-benefit will be completed.

Citation: Martin J, Hennessey S (2021) Develop a new role of nurse bronchoscopy in chronic cough. Nursing time [online]; 117: 8, 51-53.

Authors: Julie Martin is a consultant nurse for bronchoscopy, Sarah Hennessey is a clinical nurse specialist for chronic cough; both in the University of Manchester NHS Foundation Trust.

Bronchoscopy is an endoscopic assessment of the bronchial tree from the nasal cavity to the fifth generation bronchus using a standard size bronchoscope. Hybrid, smaller bronchoscopes can now be used, whose range can exceed that of the fifth-generation bronchus. The main function of the program is diagnosis and sampling, but it also has a wide range of treatments for malignant and benign diseases.

Fiberoptic bronchoscopy is traditionally performed by respiratory physicians and their registrars. In 2000, after completing a detailed training program, I became a bronchoscopy nurse at the South Manchester University Hospital NHS Foundation (UHSM) (Martin, 2003). To date, there are no other trained bronchoscopy nurses known in the UK or Ireland, but some nurses and trust agencies have shown interest in developing this role (Box 1).

Box 1. MFT's role of nurse bronchoscopy to date

Chronic cough is defined as a persistent cough with no clear diagnosis and lasts for eight weeks or more (Morice et al., 2006). Systematic investigation methods to rule out common causes of cough include pulmonary function assessment, radiography, treatment trials, and bronchoscopy assessment (Morice et al., 2019). Coughs that last three to eight weeks are considered acute or subacute (NICE, 2019) and follow different diagnostic methods.

In 2018, there is an opportunity to play a unique role as a chronic cough nurse specialist in UHSM, now the University of Manchester NHS Foundation Trust Fund (MFT). MFT's chronic cough service is a tertiary service-one of the largest in the UK-attracting patients from all over the country.

A retrospective audit of new patients referred to the MFT cough service showed that each year increased from 136 in 2014 to 384 in 2019; the average number of new patients referred per month increased from 19 to 38. This leads to long waiting times for clinical review and investigation procedures (including bronchoscopy), leading to delays in diagnosis and treatment. The data emphasizes the need to improve clinic capacity and bronchoscopy accessibility for these patients. The purpose is that the role of the chronic cough nurse specialist will:

Currently, bronchoscopy is used as part of the diagnostic investigation approach for patients with chronic cough for a variety of reasons, including recurrent chest infections and the presence of hemoptysis and other red flag symptoms. The indications for bronchoscopy in patients with chronic cough are shown in Box 2.

Box 2. Chronic cough: Causes of bronchoscopy

The authorization to develop this role was obtained from the trust and all relevant stakeholders, as well as my support and consent guidance as the current bronchoscopy examiner and chief cough consultant. Prescribes the necessary knowledge and skills of the trainees (Box 3).

Box 3. Essential practical and theoretical skills

Chronic cough specialist nurses need to complete the same practical and theoretical training program as medical bronchoscopy physicians, and comply with the British Thoracic Society (2013) Bronchoscopy Guidelines. This includes being assessed as competent in all areas of the program before being approved for independent practice.

The initial bronchoscopy nurse training was developed to meet the needs of the original position holders in 2000, and was updated according to current evidence-based guidelines and protocols related to bronchoscopy procedures and training (Martin and Hennessey, 2019; Martin, 2003) and submitted the trust for approval. These programs are not publicly available, but the author is willing to share this information upon request.

Theoretical training will start in 2019, and the practical elements will start in January 2020. There is no fixed completion date, as participation in the bronchoscopy checklist and contact sampling techniques are variable; however, this capability is expected to be realized within three years.

The training program includes assessment tools designed around 14 core areas, including risk management, informed consent, surgical preparation and execution, safe sedation, local anesthesia techniques, complication management, and postoperative care. The theory involves attending lectures and bronchoscopy courses, as well as knowledge and understanding of related protocols and guidelines. Practical skills are taught in planned bronchoscopy checklists, simulation training, and manikin demonstrations; they include:

This assessment tool brings together a combination of personal evidence, as well as assessments of competence by medical and nurse supervisors.

At the beginning of the training, an initial assessment of the baseline knowledge and skills required to execute the procedures is carried out to help measure the progress during the training. The progress will be reassessed in the mid-term and after the training is completed.

After the role is determined, the clinical nurse specialist (CNS) spends time observing the bronchoscopy and begins the theoretical part of the bronchoscopy plan for the trainee nurse. Practical training begins with skills training that is fully authorized and supported, such as operating a bronchoscope and traversing the airway, initially using a mannequin, and then developing to patients who have agreed. With the accumulation of experience, the trainee nurse bronchoscopy examiner will take on different aspects of the procedure, so as to be competent for a complete bronchoscopy.

The patients were asked to complete a satisfaction survey to explore their experience of involving the trainee nurse in the bronchoscopy procedure. The survey includes questions and feedback about the consent process, any discomfort experienced, and whether the patient is willing to agree to the practice nurse bronchoscopy examiner to perform the procedure again in the future.

To avoid deviations in the results, the bronchoscopy nursing team, not the bronchoscopy trainee nurse, completes the questionnaire with the patient for explanation after the patient recovers from the operation.

To date, 46 patients have been asked to complete the questionnaire; these six patients have rejected it. Two other patients refused to allow the nurse to perform the procedure and were therefore excluded from the questionnaire. Of the 40 interviewees, all were satisfied with the role of the nurse and were happy that the trainee nurse bronchoscopy examiner performed the procedure again.

Nurses’ bronchoscopy training started in January 2020, but was interrupted due to the coronavirus pandemic; however, the clinical outcome measurement and review outlined in Box 4 will be conducted throughout the training process and performed independently when nurses are qualified to perform bronchoscopy Continue after inspection. Once the nurse has acquired the overall ability to perform the procedure, the economic benefits of a list led by a nurse bronchoscopy examiner rather than a medical bronchoscopy examiner will be explored.

Box 4. Clinical outcome measurement and audit

Requirements for consultant input during bronchoscopy

As an additional member of the cough team, it is expected that CNS will free up the time of medical consultants to focus on more complex patient needs. The nurse-led bronchoscopy list will allow more advanced procedures in the medical bronchoscopy list. As part of the cost-benefit analysis, the number of patients scheduled on the bronchoscopy checklist will be compared to determine whether the bronchoscopy nurse provides a patient quota list that is ambiguous with the patient quota list for medical bronchoscopy examiners.

This role provides nurses with advanced clinical skills and theoretical knowledge with greater autonomy, and improves their ability to diagnose, treat, and support patients with chronic cough. It also facilitates decision-making about investigations and treatment plans. Chronic cough CNS will be able to provide continuous care throughout the diagnosis and treatment pathways of individual patients. In addition, the addition of this new bronchoscopy nurse role will enable greater integration with a wider multidisciplinary team and network involved in the care of these patients. Shifting from a generalist to a more professional role will bring greater responsibilities and should improve personal job satisfaction among nurses.

In consultation with patients before bronchoscopy, nurses can better rely on the core values ​​of nursing by empathizing with patients and reducing their fear and anxiety related to surgery. The nurses will provide high-quality holistic care in the technical aspects of performing the surgery. Nurses need good communication and interpersonal skills to bring a calm and reassuring impact to the patient and the bronchoscopy nursing team during the entire operation and recovery period.

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