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The Role of the Nurse Colposcopist

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In 1996 the BSCCP introduced formal training for all colposcopists. ... one week in the histopathology and cytopathology modules as opposed to one day ... – PowerPoint PPT presentation

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Title: The Role of the Nurse Colposcopist


1
The Role of the Nurse Colposcopist
  • Carmel Flynn
  • Nurse Colposcopist
  • Royal Free Hospital

2
Topics to be considered
  • Background to role
  • Training
  • Implementation
  • Audit

3
Background
  • Traditionally colposcopy has been a consultant
    led service
  • There was no formal training programme
  • Junior doctors were trained on an ad hoc basis

4
Background
  • In 1996 the BSCCP introduced formal training for
    all colposcopists.
  • In combination with NMCS Code of professional
    Conduct (2002) this allows nurses working in an
    extended role within colposcopy to access
    colposcopy training and accreditation

5
Nursing roles in Colposcopy
  • Colposcopy clinic nurse
  • Lead nurse for colposcopy
  • Nurse colposcopist

6
Colposcopy Clinic Nurse
  • Trained nurse, assisting the colposcopist in
    the day to day colposcopy clinics (D /E grade)
  • Care and support of the patient

7
Colposcopy Lead Nurse
  • Senior nurse co-ordinating clinics and nursing
    staff (F/G grade)
  • Nurse led smear clinics
  • Nurse counsellor for women attending clinic
  • Involved in clinic audit and protocols

8
The Nurse Colposcopist
  • A nurse who is trained, competent and certified
    to perform colposcopy in accordance with the
    training standards laid down by the BSCCP (H/I
    grade)
  • Currently there are 74 accredited Nurse
    Colposcopists in the UK

9
The Nurse Colposcopist
  • Not entirely a new role first pioneered in the
    1970s in America
  • First nurse colposcopist accredited in Birmingham
    in 1997.

10
The Nurse Colposcopist
  • Colposcopy nurses have for many years worked
    closely with consultants gaining an in depth
    knowledge of colposcopy practice
  • It is logical then that training of Nurse
    Colposcopists should come to the fore

11
Justification
  • Why train nurse colposcopists?

12
Justification
  • Currently there are in excess of 120,000 women
    who require colposcopy in the UK each year

13
Advantages of the Nurse Colposcopist
  • Embraces a multidisciplinary approach to care
  • Increases patient choice
  • Continuity of care
  • Flexibility of clinic times
  • More skilled colposcopists
  • Personal satisfaction

14
Essential qualifications to train as a Nurse
Colposcopist
  • RGN- First level registration
  • Teaching and assessors course
  • 2 years experience in womens health at E grade
    or above
  • Able to demonstrate an in depth knowledge of the
    colposcopy service .

15
Essential qualifications to train as a Nurse
Colposcopist
  • Evidence of good organisation, communication and
    leadership skills
  • Demonstrate a supportive, sensitive and
  • approachable manner
  • Membership of a professional organisation for
    indemnity

16
Desirable qualifications
  • Basic counselling skills
  • Basic knowledge of GU medicine and sexually
    transmitted disease

17
Local agreements
  • The support of a lead consultant in the
    colposcopy unit
  • Support of the Trust and nursing management
  • To be trained in a unit which has been accredited
    for training by the BSCCP
  • Strict protocols

18
Training requirements
  • It is essential that nurses acquire the same
  • skills and standards as their medical
    colleagues
  • To be trained by a recognised preceptor
    registered with the BSCCP
  • Access to a smear takers course

19
Training
  • Training of the Nurse Colposcopist is identical
    to that of her medical colleague
  • However, nurses are required to spend one week in
    the histopathology and cytopathology modules as
    opposed to one day for medical staff

20
Levels of training
  • Level 1
  • Undertakes basic colposcopy assessment and
    diagnosis (D)
  • Level 2
  • As level 1 but undertakes treatment (T)

21
Nurses and Treatment
  • Some nurses wish to perform the complete role as
    diagnostic and theraputic colposcopist
  • Some nurses are reluctant to undertake treatment
    as it may seem one step beyond the role in which
    they wish to practice

22
Maintaining Registration
  • Nurse colposcopists undergo the same audit
    requirements as their medical colleagues.
  • All colposcopists require to see a minimum of 50
    new patients each year.
  • All colposcopists must attend a colposcopy
    related postgraduate meeting every three years.
    (Usually BSCCP annual meeting).

23
Drawbacks
  • Feeling of isolation for nurses in a specialist
    role
  • Lack of support
  • Arranging medical cover

24
Impact of Nurse Colposcopists
  • A retrospective audit was performed to assess
    the impact of Nurse Colposcopists on service
    provision in Birminghan city Hospital over the
    last six years (Todd 2000)
  • During this period 8,880 colposcopies were
    performed

25
Inpact of Nurse Colposcopists
  • In 1993 8 of colposcopies were performed by
    nurses. By 1998 this had risen to 68.
  • Average waiting times to be seen has fallen from
    14 weeks in 1993 to 4 weeks in 1998.
  • Nurse Colposcopists were able to predict high
    grade disease in 75 of cases compared with 67
    of doctors

26
Impact of Nurse Colposcopists
  • Of patients referred with moderate or severe
    dyskaryosis and assessed by a nurse, histological
    diagnosis was obtained in 73 (79 doctors)
  • Evidence of CIN could be found in 82 of biopsies
    taken by nurses and 85 of those taken by doctors.

27
Current role in colposcopy
  • Registered as a Nurse Colposcopist in 1999
  • Perform two diagnostic clinics a week
  • Nurse led cytology clinic
  • Regularly supervise trainees undergoing
    Colposcopy training

28
Current role in Colposcopy
  • Nurse counsellor (colposcopy patients)
  • Clinical supervisor for the Womens Health and
    Screening course (PHC3133)
  • Able to see women with problems post treatment

29
Patient preference in the colposcopy clinic
  • Mrs Carmel Flynn
  • Nurse colposcopist
  • Mr Patrick Walker
  • Lead colposcopist

30
STUDY OBJECTIVES
  • To assess the acceptance by patients of the role
    of the nurse colposcopist.
  • To see if patients have a preference as to the
    gender of their colposcopist

31
Womens preference as to gender of their
gynaecologist
  • n 169
  • 59 preferred to see a female
  • 7 preferred to see a male
  • 34 expressed no preference
  • Ivins and
    Kent 1993

32
CERVICAL SCREENING
  • When asked what improvements in the cervical
    screening programme would encourage more women to
    attend
  • 25 of responders suggested the guaranteed
    availability of a female doctor

  • Schwartz 1989

33
RFH STUDY - METHOD
  • Prospective study
  • Questionnaire based
  • July 2000- October 2000
  • All new patients eligible
  • Two groups
  • Group A - Before consultation
  • Group B - After consultation

34
STUDY GROUP
  • Number of patients completing the questionnaire
    n 169
  • Randomized
  • Group A Prior to consultation 90
  • Group B Post consultation 79

35
RANDOMIZATION
  • Group A represents the pre-conceived views of
    women who have never undergone colposcopy.
  • Group B represents the views of women who have
    experienced the procedure

36
Gender of Colposcopist
  • Overall results n 169
  • Female 101 (
    60)
  • Male 2
    (1)
  • No preference 66 (39)

37
Status of the colposcopist
  • Overall results n 169
  • Doctor 72 (
    42)
  • Nurse 13 (
    8)
  • No preference 84 (50)

38
Gender of the colposcopist
  • Group A Group
    B
  • (pre)
    (post)
  • Female 63 55.5
  • Male 0.0 2.5
  • No pref. 37.0 42

39
Status of the colposcopist
  • Group A Group
    B
  • (pre)
    (post)
  • Doctor 47.0 38
  • Nurse 11.0 4.0
  • No Pref. 42.0 58

40
Seen by a nurse n20
  • No Pref. 17
    85
  • Doctor 3
    15
  • Nurse 1
    5

41
Seen by a male colposcopistn 30
  • No pref 21 (70 )
  • Female 9 ( 30)

42
CONCLUSIONS
  • There is an increasing acceptance of the role of
    the Nurse colposcopist
  • There is a continuing acceptance of the role of
    the male colposcopist

43
SUMMARY
  • There is a role for the nurse colposcopist
  • Training and assessment are essential
  • Audit of standards is paramount
  • Nurse colposcopists are not employed to replace
    doctors
  • A multidiscplinary approach will greatly enhance
    the service.
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