Capsule endoscopy nursing: small camera, big role

1 July 2012

After more than two decades of nursing, enrolled nurse Kay Bone has recently stepped up into a new time-saving role for West Coast capsule endoscopy patients and has been endorsed at an “accomplished” level of practice. FIONA CASSIE finds out more.

Back in 2008, Kay Bone “crossed the floor” to work in outpatients after nearly 20 years working in mental health.

“It’s the best thing I’ve ever done – the opportunities have just come my way.”

By 2010, she was the West Coast’s first and only capsule endoscopy nurse, and last year, when she applied to gain her proficient level PDRP (professional development recognition programme), she was pleasantly shocked to be upgraded to “accomplished”.

Bone started her training as an enrolled nurse at Greymouth Hospital back in 1988 before working at the then-Seaview Psychiatric Hospital near Hokitika, and later, on-call work at the Greymouth acute mental health unit.

Crossing the floor to outpatients saw her nursing horizons widen, and one of her new roles was to work with visiting Christchurch gastroenterologist Judith Collett during her six-weekly clinics at Greymouth. Collett would sometimes bring with her the compact suitcase containing the high-tech equipment needed for a capsule endoscopy.

Capsule endoscopy involves swallowing a tiny disposable camera that takes two images a second as it passes through the small bowel – or about 60,000 images of every kink, bend, and centimetre of the bowel over an eight-hour period.

Collett told Bone she would be an ideal candidate for a capsule endoscopy nurse, allowing more people to have the study done on the Coast without having to travel over the Alps to the weekly capsule endoscopy clinic in Christchurch. Bone decided to embrace the challenge and ask her nurse manager, Julie Lucas, whether as an EN she could take on the role.

Lucas says she thought Bone was more than capable, and after discussing it further with then-director of nursing Jane O’Malley, it was decided Bone should take up the opportunity for two days training in Christchurch.

Bone is proud of taking on a role that allows her patients – who are often elderly – to be able to relax at home while the camera does its work, rather than have the worry and expense of an overnight trip to Christchurch.

Now the endoscopy “briefcase” is couriered back and forth across the main divide as Bone carries out about six to ten capsule endoscopy studies on the Coast each year for the Christchurch Hospital Gastroenterology Department. With the disposable cameras costing $1300 a pop, the expensive small bowel study is not common and is usually reserved for patients who have already had clear colonoscopy and gastroscopy examinations but continue to have positive FOB (faecal occult blood tests).

She contacts each patient prior to the endoscopy date to introduce herself, take a patient history, and explain the process. The patient then turns up at 7.30am on the day so she can go through the paperwork with them, administer medication (signed off by an RN), and attach the sensors across the abdomen and the leads to the small data recorder that is slung over the patient’s shoulder for the day.

At 8am, the camera is swallowed.

“When they first look at it (the camera), their eyes are saying, ‘oh goodness’… but after they swallow it, they have a big smile on their face,” says Bone.

The patient then heads home to relax and Bone returns to her other outpatient clinic work before the patient returns at 5pm to have the sensors, leads, and data recorder removed and sent to Christchurch to be read and interpreted by the gastroenterology department.

The next step for Bone is to wait for news that the expensive camera has successfully passed through the bowel, which can take up to two days, depending on the patient’s peristalsis rate.

“The worst case scenario is if the camera gets lodged in the bowel somewhere”.

To date, all cameras have been happily sighted and then flushed away.

“Though I had a patient last week who retrieved it so he could show the children,” laughs Bone.

Bone says the role has not been daunting as an experienced EN, and it was a matter of ensuring the t’s are crossed and the i’s dotted.

Lucas also points out that Bone is a very professional and proactive nurse for her clients, including an elderly man who told Bone during the patient interview that his bowel hadn’t evacuated properly for his previous colonoscopy. After consulting with the gastroenterologist, it was decided he should have two rather than the normal one Pico Prep solutions to clean out his bowel. Bone was then concerned about the risk of dehydration, and after talking with Lucas, she took extra steps to encourage him to keep hydrated and to fully inform ED about the man’s history in case he presented during the night.

Transition fear prompted leap into PDRP

It is extra steps like this that saw Lucas ready to “bat” for Bone being sent to a capsule endoscopy conference in Sydney last year and also to write the policy and procedure guidelines for capsule endoscopy (with the support of Lucas and the existing Christchurch policy as a starting point).

Lucas acknowledges it is unusual to have an EN writing policy and procedures.

“For me, because a nurse is an EN doesn’t mean they haven’t got the education or the ability. Kay was the best person to be doing that, in conjunction with us, as she had knowledge I didn’t have on capsule endoscopy.”

It was Lucas, who in 2008, carried out Bone’s first annual appraisal in nearly 20 years of nursing and asked her to set a goal a bit more ambitious than her initial “to turn up to work each day”.

Bone agreed to aim to do her PDRP. A year later, she hadn’t started, but the transition process to the new EN scope of practice panicked her into action.

“I thought to myself ‘I really need to get on with this otherwise I mightn’t have a job’. I really got paranoid about it. It was a good thing in hindsight.”

She sought advice from the board’s nurse educator and was initially stumped at having to write three reflections but “then the light went on, and I thought, ‘Kay you’ve already done half of this’.”

She pulled out reports she had already written from a wound care conference, an EN study day that she had entered downhearted about the EN role’s future but left with a smiling face, and of course, the Sydney conference. Along with the work she had done for her annual appraisal, a patient case study, and material she had gathered in her capsule endoscopy role, she put together a PDRP portfolio that included transitioning to the new scope and sent it to Christchurch with the aim of reading a ‘proficient’ level of practice.

“The two people marking me upgraded me to ‘accomplished’, and I thought, ‘oh bugger, now I have to do an interview’, but I did it and passed ‘accomplished’ last year.”

Her advice to other ENs wanting to take on new or non-traditional roles?

“Just take opportunities that come their way and go with it.”