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New Zealand Nurses Organisation
P O Box 2128
Wellington
Copyright© 2000
Published 24-02-2000

INTRODUCTION

These standards represent the Section's views on what constitutes the requirements for the delivery of safe and effective nursing services. They underpin and guide best nursing practice and have practical application for the novice through to the expert practitioner.

The revised standards of practice for gastroenterology and endoscopy nurses are based on the generic NZNO Standards of Practice (1993) and are to be read in conjunction with them. These standards represent the outcomes against which gastroenterology and endoscopic nursing practice will be measured by consumers, employers, colleagues and nurses themselves.

Guidelines for auditing the standards are included and will assist you to measure actual performance against the standards.

At the 1999 Gastroenterology Nurses Section NZNO Annual General Meeting members not only agreed to the revision of the Section Standards of Practice they also revalidated the Sections endorsement of the Gastroenterology Nurses Society of Australia (GENSA) and the Gastroenterological Society of Australia guidelines for infection control and standards for endoscopic facilities and services. These two publications will remain the gold standard for New Zealand nurses until NZ guidelines are published and approved. The publications maybe accessed on Internet (website code). They are Cowan A (Ed) Reference Guidelines: Infection Control in Endoscopy 4th Edition and Cowan A (Ed) Standards for Endoscopic Facilities and Services 2nd Edition.

The Section supports the Society of Gastroenterological Nurses and Endoscopy Associate (SIGNEA) mission and goals which facilitates the establishment of international Standards to ensure quality patient care.

The working party involved in the review of the Section's standards of practice comprised of Raewyn Paviour, Karen Clarke, Jayne Davies, Jo Lester, Mary Ann Peetz, Rosemary Tonkin, Susanne Trim (facilitator). Their work, enthusiasm and commitment is acknowledged.

Raewyn Paviour
National Chairperson
Gastroenterology Nurses Section
New Zealand Nurses Organisation

PHILOSOPHY

Gastroenterology and Endoscopy nurses support the New Zealand Nurses' Organisation statement that

"Nursing is a specialised expression of caring concerned primarily with enhancing the abilities of individuals and groups to achieve their health potential within the realities of their life situations"

(NZNO Social Policy Statement 1993, p130)

Gastroenterology and Endoscopy nursing is a speciality within nursing practice which provides quality care to those patients and their families utilising gastroenterology and endoscopy services. It occurs in a variety of settings and incorporates nursing practice for those undergoing screening procedures, diagnostic and therapeutic interventions and treatment modalities.

Gastroenterology and Endoscopy nurses

  • Provide holistic patient-centred care utilising speciality nursing knowledge
  • Respect the patient's cultural identity, values, customs, traditions, sexuality and spirituality
  • Incorporate the principles of the Treaty of Waitangi (protection, partnership, participation) into their practice
  • Are accountable for their own nursing practice and provide safe, quality care
  • Maintain professional and personal development based on credible, relevant research
  • Participate in research and utilise evidence based practice
  • Work within a quality health framework and are open to change and improving standards for better patient outcomes
  • Practice within legal and ethical frameworks
  • Work in collaboration with patients, their families, those close to them, and members of the health team. S/he practices the principles of advocacy
  • Balance the use of technology with human qualities such as sensitivity, understanding and caring.
  • Participate and contribute to national gastroenterology endoscopy activities and international networking
  • Individually and collectively have a responsibility to be socio/politically aware and to use their power to bring about social, political and organisation change.

SCOPE OF PRACTICE

Gastroenterology and Endoscopy nurses work within legislative, professional, organisational and unit requirements and guidelines. Nursing is delivered in both private and public health facilities.

The scope of practice is diverse and varies dependent on the practise setting. The skill mix is appropriate for

  • Providing optimal patient care
  • The work requirements
  • Supporting those of differing levels of practice

Gastroenterology and Endoscopy nurses work within multidisciplinary teams, act as patient advocates and are accountable for all aspects of nursing care.

Gastroenterology and Endoscopy nurses educate patients and/or their families, prevent health problems, maintain current health and intervene in acute and chronic illness.

STANDARD ONE

Gastroenterology and Endoscopy nurses are accountable for their practice.

OUTCOMES

  • Nursing practice is safe, legal, effective and responds to the holistic changing needs of clients
  • Individual rights are protected and enhanced
  • Ethical problems are addressed and resolved. Ethical principles are evident in the nurse's practice
  • Nursing's contribution to gastroenterology and endoscopy services is visible, appropriate and accepted
  • Nursing research is made available for professional and public scrutiny.

CLINICAL

Gastroenterology and Endoscopy nurses

1.1 work within their scope of practice based on current knowledge, judgement, experience and competence.

1.2 plan and document holistic nursing practice which is appropriate for the setting.

1.3 practise according to authorised ethical codes including NZNO Code of Ethics, the Health and Disability Code of Patient Rights, the Privacy Act and the Nursing Council of NZ Code of Conduct.

1.4 advocate for patients in situations where their ability to advocate for themselves is compromised.

1.5 address ethical problems using an appropriate nursing ethical framework eg. NZNO Flowchart: How to resolve difficult professional/ethical issues.

1.6 function within legislative, professional, organisational and unit guidelines eg. Nurses Act, Medicines Act and Amendments.

1.7 participate in the development and regular review of unit standing orders, policies, protocols, guidelines, job descriptions and utilisation reviews.

1.8 actively promote professional nursing by presenting a positive nursing image and participating in professional debate.

EDUCATION

Gastroenterology and Endoscopy nurses

1.1 maintain an up-to-date knowledge base through ongoing evidence-based education

MANAGEMENT

1.1 ethical and legal practice is supported by the availability of appropriate resources and professional development opportunities.

RESEARCH

1.1. any research undertaken by gastroenterology and endoscopy nurses should by ethically and methodically sound, supervised and reviewed by an appropriate ethics committee.

1.2 the researcher ensures the availability of his/her research findings.

STANDARD TWO

Within their scope of practice Gastroenterology and Endoscopy nurses are responsible for the safety and well-being of their client group.

OUTCOMES

  • Nursing practice protects clients from physical and psychological danger and avoidable risk
  • Nursing practice is appropriate and acceptable to identified client needs
  • Clients' decisions and choices are respected and facilitated
  • Nursing practice enhances the spiritual and emotional well-being of clients
  • The three principles of the Treaty of Waitangi, participation, protection and partnership are reflected in nursing practice
  • Clients feel culturally and spiritually respected
  • Nurses promote wellness and prevent further ill health

CLINICAL

Gastroenterology and Endoscopy nurses

2.1 apply current nursing knowledge using a documented systematic approach to meet the stated and implied needs of clients, including physical, physiological and psycho-social assessment.

2.2. accurately monitor and assess clinical situations and intervene appropriately.

2.3 participate in the development and implementation of standards of nursing practice and quality assurance activities.

2.4 participate in infection control in accordance with the GESA & GENSA Reference Guidelines: Infection control in Endoscopy.

2.5 identify risks and participate in developing and practice risk management.

2.6 understand and document competence of clinical equipment.

2.7 demonstrate respect for patients' spiritual and cultural beliefs and values.

2.8 practise within the principles of the Treaty of Waitangi, protection, partnership, participation.

2.9 collect data in a purposeful manner and maintain patient confidentiality. Data is easily retrievable for future reference.

EDUCATION

2.1 education and resources are provided to enable the nurse to practise in a safe and effective manner.

MANAGEMENT

2.1 gastroenterology and Endoscopy nurses participate in the development and implementation of quality assurance activities.

2.2 risk management policies are in place eg. Nursing care standards and protocols, infection control policies, monitoring of environment health and safety for staff and patients.

RESEARCH

2.1 any research undertaken by gastroenterology and endoscopy nurses should be ethically sound, supervised and reviewed by an appropriate ethics committee and research findings are accessible.

STANDARD THREE

Gastroenterology and Endoscopy nurses are responsible for entering into and maintaining a partnership with clients, community, colleagues and employers.

OUTCOMES

  • Clients benefit from nursing expertise and nurses' specialised expression of caring
  • Nursing practice develops within the context of a negotiated relationship with clients
  • Nursing practice has an integrated approach to individual and community health awareness
  • Clients benefit from valued-added partnership between health professionals
  • Health service delivery to clients and community is shaped by nursing input.

CLINICAL

Gastroenterology and Endoscopy nurses

3.1 enable opportunities for families to be present during nursing care activity, with the patients consent.

3.2 actively consult with the client in the planning and delivery of nursing care.

3.3 regularly and actively liaise with other health professionals and departments, eg laboratory, diagnostic services, other patient care areas.

3.4 implement client and family health education programmes.

3.5 enter into and maintain value added partnerships with colleagues.

3.6 participate in decision making regarding health care delivery.

EDUCATION

Gastroenterology and Endoscopy nurses

3.1 use their knowledge of learning behaviours related to age, culture, and context of the situation to deliver relevant information to the patient and family. A mechanism is in place to evaluate learning, eg regarding options and choices

3.2 liaise with departments of nursing education so that there is a practice/education interface.

3.3 actively share and promote their knowledge and skills.

3.4 actively seek and utilise knowledge from nursing colleagues from within and outside gastroenterology and endoscopy units.

MANAGEMENT

3.1 charge nurse/nurse managers are present and visible in the workplace.

3.2 charge nurse/nurse managers facilitate participation of nurses in policy and planning decisions.

3.3. gastroenterology and endoscopy nurses develop individual and peer group support networks

3.4 gastroenterology and endoscopy nurses have a responsibility to promote nurse participation in decision-making regarding health care delivery

RESEARCH

Gastroenterology and Endoscopy nurses

3.1 use expertise and the specialised expression of caring unique in all interactions with clients.

3.2 review patient surveys and informal feedback and consider the relevance to their practice and make amendments accordingly.

3.3. participate in peer review and reflection.

3.4 participate in quality assurance programmes and quality initiatives.

3.5 participate in microbiological testing of endoscopes and reprocessing machines as set out in the GESA and GENSA reference guidelines.

3.6 enter into and maintain partnerships with colleagues.

STANDARD FOUR

Gastroenterology and endoscopy nurses are committed to nursing professional development.

OUTCOMES

  • Nursing practice is based on current nursing knowledge and expertise within changing environments
  • Research is an integral part of nursing practice
  • Nursing practice is influenced by discussion of professional issues through professional networking
  • Improvements in nursing practice and client care are made as a result of regular evaluation by nurses

CLINICAL

Gastroenterology and Endoscopy nurses

4.1 identify their own learning needs and participate in professional development which is supported by documented evidence.

4.2 pursue new knowledge in relation to practice

4.3 demonstrate proficiency in specific unit defined skills, at specified intervals and these are documented

4.4 control and participate in the regular evaluation of nursing practice and challenge deficits.

4.5 participate in professional bodies/networks pertaining to gastroenterology and endoscopy nursing, eg Gastroenterology Section, NZNO, GENSA, SIGNEA.

EDUCATION

Gastroenterology and Endoscopy nurses

4.1 invest time, effort and other resources into maintaining and expanding knowledge and skills required for competent practice.

4.2 contribute to the education of colleagues and students, both formally and informally.

4.3 are active members of relevant professional organisations.

4.4 implement and support a formal orientation programme for new staff.

4.5 have access to inservice education

MANAGEMENT

4.1 an annual performance assessment occurs and professional goals are set, identifying training needs and resources.

4.2 systems are in place for acknowledging excellence in nursing practice and these are promoted.

4.3 documentation pertaining to orientation, competence and inservice education is reviewed and updated annually.

4.4. a process is in place to manage poor performance.

4.5 new equipment is accompanied with an education programme on its application and all other appropriate technical information made readily available.

4.6 resource allocation is available for professional development.

RESEARCH

4.1 there is evidence of a research culture in the unit, eg

  • critique of research fundings
  • availability of resource people to assist with the research process
  • nursing research occurring
  • relevant research findings implemented

4.2 requirements for change in nursing practice are identified and proposed changes to nursing practice are planned, implemented and evaluated in a systematic way

4.3 Active, deliberate QA processes critically evaluate nursing practices, eg

  • orientation programme
  • training check lists/peer review
  • infection control
  • family need
  • OSH

4.4 the perceptions and experience of patients and families form a component of the QA process measuring the quality of nursing practices

STANDARD FIVE

Gastroenterology and Endoscopy nurses manage resources efficiently and effectively to meet client health care needs.

OUTCOMES

  • Nursing practice reflects appropriate nursing skills and numbers
  • Resources are provided at the right time, quality and quantity to meet clients needs
  • Nursing practice influences decisions regarding the use of technology in health care
  • Inadequate resources are identified and corrective action taken

CLINICAL

Gastroenterology and Endoscopy nurses

5.1 participate in the ongoing measurement of nursing workload in relation to staffing levels and skill mix

5.2 identify inadequate staffing and other resources and immediately relay this information to the charge nurse/nurse manager or equivalent verbally and with follow up documentation.

5.3 make the best use of resources available in the provision of client care.

5.4 participate in ongoing resource utilisation reviews

5.5 refer where appropriate to others with expert knowledge

5.6 practice within the guidelines of universal precautions and other specific safety standards.

EDUCATION

Gastroenterology and Endoscopy nurses

5.1 participate in the ongoing measurement of nursing workload.

5.2 act to improve inadequate or unsafe resources.

5.3 participate in technology assessment and review.

5.4 participate in the training of product knowledge, trials and technological advancements.

5.5 participate in occupational safety and health inservice.

MANAGEMENT

Gastroenterology and Endoscopy nurses

5.1 have greater than two years full time post registration experience in a medical/surgical setting before employment into the endoscopy unit.

5.2 potential staff are interviewed and employed by the charge nurse/nurse manager.

5.3 there is an appropriate experience mix of gastroenterology and endoscopy nurses on all shifts.

5.4 the appointed nursing leader provides professional leadership, practices with a participatory style and advocates for nurses and nursing: i.e. a transformational leader.

5.5. student nurses and those undergoing orientation are supernumerary and under the direct supervision of a registered gastroenterology/endoscopy nurse.

5.6 a pool of appropriately experienced nurses is desirable for utilisation during peak workloads.

5.8 participate in maintenance, review and repair of equipment and recommend capital replacements.

5.7 the charge nurse submits proposals for capital expenditure for nursing/patient needs.

RESEARCH

5.1 Gastroenterology and Endoscopy nurses participate in assessment and review of equipment on trial.

GUIDELINES FOR THE AUDITING OF STANDARDS

STANDARD ONE

  • Evidence of a current practising certificate
  • Evidence that statutory requirements are met
  • Evidence of reporting and monitoring of all incidents to the appropriate bodies
  • Evidence of clients being informed in situations where their health status has or may be compromised
  • Evidence of the availability of current practice protocols and that these are known to the nurses and complied with
  • Evidence that the Code of Health and Disability Services Consumers' Rights Regulations 1996 and the Privacy Code are being complied with
  • Evidence that nurses are undertaking critical reflection of their own practice
  • Evidence of community feedback indicating nursing is valued and understood
  • Evidence of the use of an ethical nursing framework
  • Evidence of competency based certification
  • Evidence that gastroenterology and endoscopy nurses are not undertaking duties outside their competence and registration

STANDARD TWO

  • Evidence of practice guidelines to ensure adequate assessment of client need is facilitated
  • Evidence of nursing participation in risk management
  • Evidence of risk management audits which result in improvements
  • Evidence of client feedback which indicates the nurses practice cultural safety and show respect for a client's spiritual beliefs
  • Evidence that nurses understand the principles of the Treaty of Waitangi
  • Evidence of nurses facilitating informed choice in health care, delivery from client feedback and direct observation
  • Evidence of nurses participating in quality assurance programmes
  • Evidence that evaluation of incident reports occurs with remedial action taken as required
  • Evidence that the environment for practice is adequate in the areas of:
    • safety
    • privacy
    • equipment
    • resources (including adequate staffing levels)

STANDARD THREE

  • Evidence of nursing records/research showing client/other involvement in care planning delivery and evaluation
  • Evidence of interactions with clients, colleagues and the health, care team
  • Evidence of client feedback on quality of nurse/client relationships e.g. client questionnaires
  • Evidence of gastroenterology and endoscopy nurse representation on relevant nursing and health planning committees
  • Evidence that patient information sheets are current
  • Evidence of consumer input into service development where appropriate
  • Evidence that informed consent is obtained from client for all nursing interactions
  • Evidence of networks established with other organisations
    • Ministry of Health
    • Patient Support Groups
    • District Nursing Services
    • Practice Nurses
    • GENSA
    • SIGNEA
    • NZ Society of Gastroenterology
    • NZMA
  • Evidence that the client and a support person understands and participates in nursing actions undertaken

STANDARD FOUR

  • Evidence of evaluation of ongoing education needs
    • eg certificates
    • degrees
    • diplomas
    • conferences attended
    • professional journals
    • meetings
    • workshops and seminars
  • Evidence of personal development planning
  • Evidence of participation in performance appraisal
  • Evidence of improvements made as a result of performance appraisal
  • Evidence of peer review of competence
  • Evidence that the nurse participates in nursing networks and membership of groups
  • Evidence of research critique and application to practice

STANDARD FIVE

  • Evidence of the appropriate use of a workload measurement system
  • Evidence of a plan for nursing workforce development which demonstrates appropriate numbers and mix of staff are available
  • Evidence of participation in systematic review of resource utilisation for key resources in the practice setting
  • Evidence of gastroenterology and endoscopy nurse representation on product evaluation committees and decision making bodies
  • Evidence of equipment, safety audits
  • Evidence that instructions and guidelines are current and available for major items of equipment and key processes
  • Evidence that there is a current nursing procedure manual which is used to guide nursing practice
  • Evidence of knowledge and compliance with occupational health and safety guidelines

GLOSSARY OF TERMS

ACCOUNTABILITY
The acceptance of rights and responsibilities of conduct and behaviour. It is the acceptance of responsibility to self, profession, client, employer and the community as a whole.

ADVOCATE
A person who stands alongside, enables and/or removes barriers to the client being able to self-determine their own health outcomes.

AUDIT
The process whereby the results of an activity are evaluated to see if the expected level has been achieved as set out by present rules, guidelines or standards. It is the process of determining what is happening against what should be happening, of establishing whether what you think or say you are doing is actually what you do. Is a concrete measurement, or evidence of achievement in relation to standards.

CULTURAL VALUES
Morals, beliefs, attitudes and standards that derive from a particular cultural group. Culture is not only seen as ethnic-specific but must include groups from within cultures e.g cultures of class, socialisation, age, sexual orientation etc.

ENDOSCOPY SERVICES
These services involve the scoping patients for screening, diagnostic and therapeutic purposes. Initially this was limited to the gastrointestinal tract but now includes scoping many other areas.

ETHICAL PROBLEMS
Fall into two distinct categories: ethical violations and ethical dilemmas. An ethical violation involves the neglect of a moral obligation, eg A nurse who fails to provide care to a client because of the client's race. An ethical dilemma arises when ethical reasons both for and against a course of action are present e.g. resuscitation of a client.

GENSA
The Gastroenterology Nurses Society of Australia.

RESOURCE UNTILISATION REVIEWS
A systematic process for reviewing the way resources are allocated and used with efficiency and effectiveness being the main criteria.

RISK MANAGEMENT
A systematic approach to identifying monitoring and reducing risks in health care provision.

SIGNEA
The Society of International Gastroenterological Nurses and Endoscopy Associates is a multinational network of nurses and technicians who work in the fields of endoscopy and gastroenterology.

Its goals are

  • to provide a channel for communication among GE nurses and Endoscopy associates internationally
  • to provide an international forum for presenting and publishing nursing research and achievements in gastroenterology and endoscopy
  • to advance professional practice of gastroenterology and endoscopy nurses and endoscopy associates internationally
  • to provide educational opportunities for gastroenterology and endoscopy nurses and endoscopy associates

SKILL MIX
This relates to both the mix of those with differing qualifications ie registered and enrolled nurses and unregulated assistants, and to the levels of experience, knowledge and expertise within each of these groups.

TREATY OF WAITANGI
Bi-culturalism in Aotearoa has its roots in Te Tiriti o Waitangi and has the potential to be the driving force behind the aspirations of national solidarity. However bi-culturalism requires systems of relationships which promote power sharing, understanding mutual respect of language, lifestyles and beliefs, which could lead to beneficial interaction between the two major and interdependent cultures.

REFERENCES

Cowan A, Jones D, King B, Rayner T (1998) Standards for Endoscopic Facilities and Services. 2nd Edition
Gastroenterological Society of Australia, Sydney

Cowan A, Jones D, King B, Rayner T (1999) Reference Guidelines: Infection Control in Endoscopy 4th Edition
Gastroenterological Society of Australia, Sydney

NZNO (1993) Standards for Nursing Practice
NZNO, Wellington

NZNO Intensive Therapy Section (1996) Philosophy and Standards for Nursing Practice in Intensive Care
NZNO, Wellington

NZNO Practice Nurse Section (1997) Standards of Practice for Practice Nurses
NZNO, Wellington

SIGNEA (1993) Society of Gastroenterological Nurses and Endoscopic Associates Mission Statement and Goals

SIGNEA News Vol 12 No 1 2000.

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