Specialist Screening Practitioner: Sedation in Endoscopy Reflection

This report presents a reflective account on the learning experience of sedation in endoscopy, focusing on the perspective of a Specialist Screening Practitioner within the Bowel Cancer Screening Programme. The reflection utilizes the Driscoll model (What, So What, Now What) to analyze the experience. The 'What' stage describes the practitioner's responsibilities, observations of patient preparation, sedation procedures, and patient responses, including both positive and negative aspects of the experience. The 'So What' stage evaluates the practitioner's gained knowledge of sedation under PGD (Patient Group Direction), the importance of pre-assessment, medication management, and the role of communication in managing patient anxiety and safety. The 'Now What' stage outlines areas for skill and knowledge improvement, including the application of clear instructions, identifying contraindications, and ensuring high-quality patient care. The account emphasizes the importance of patient safety, trust, and adherence to the NMC Code of Conduct, with references to relevant literature supporting the practices discussed.

Reflective account : Learning experience on sedation in endoscopy
Utilizing a reflective model critically reflect on an aspect of professional development.
Main purpose of this reflection is to show the skills and learning experience on
sedation on endoscopy that was gained at the time when I visited clinic. I have worked
there as a Specialist Screening Practitioner in Bowel Cancer Screening Programme. In
order to show my reflection, I have made use of Driscoll model. This is a type of model
that divides the experience by asking question: What, So what and now what.
‘What?’ stage: Description of the chosen experience
As per the induction program (SSP), it is my responsibility to make sure that all the patients
are properly instructed. More specifically, patients are given Bowel prep at the time of
Colonoscopy preparation. I noticed that only trained and competent doctors are allowed for
examining and sedating the patients. The role of operator is to check that the clinical
conditions of patient's is observed by registered nurse or qualified doctor. I analysed that
sufficient assistants with at least one qualified nurse is meant to be present during the
procedure. I explained patient the meaning of sedation which is the action of administering
a sedative drug to generate a state of calm or sleep. As a nurse, I have described the various
side effect of sedation such as depression, anxiety, aggression, restlessness, hallucination
and loss of personality. I describe these effects and after effects to the family member so
that they will get to know when to bring patient hospital for endoscopy for clonoscopy as a
part of bowel cancer screening. Patient was experiencing viloentness in following sedation
and frequently become restless. I was trying to develop my skills by observing other and
performing certain tasks and activities. The good experience about the whole process is the
patient recovery, and the bad experience is to watch them in pain. I observe that recovery
should be monitor by trained staff. Before conducting the procedure, patients are required
to fast at least 12 hours before. Patients should only be discharged when fit and this should
be recorded in the patient. As a nurse it is my responsibility to know th properties of
medication to be provided to patient.
Record. Ideally, formal nurse led discharge criteria should be used and documented.
Further, there are conditions in which patients are given laxatives previous night before
procedure take place in order to clean the system.
‘So what?’ This stage of the model prompts us to analyse, evaluate feelings and
discuss effects of actions
Whilst undergoing the patient group direction (PGD) training for sedation I have gained
more knowledge and understanding of issues surrounding the supply and or administration
of sedation under PGD. It is important to make sure that there is proper interaction with
patients so that they share their issues. As new specialist screening practitioner, I have
recognised the importance of pre-assessment before the procedure and how accurately it
has to be recorded in the nursing records. Before conducting endoscopy, as a nurse it is
essential to make sure that patients were taking any type of medication (Zakeri, Webster
and Thillainayagam, 2013). If an incorrect medicine is supplied to the patient in the process
of sedation than it is my duty to inform the ward pharmacist. The importance of sedations
is that it minimises anxiety and stress. If the patient become too drowsy, a drug will be
provided to reverse the effects. Further, there are certain set of risk that are involved in
which it includes bleeding, infection and other rare complication like chest pain, fever, etc.
All these depend upon the procedure that is being followed. For example, when there is
difficulty in swallowing or conditions that causes vomiting occurs after colonoscopy, then
it can be stated that the procedure is not properly followed. Interaction is helpful for me to
understand the trust policy and guidelines regarding the PGD.
The final stage ‘Now What?’ guides to apply, synthesise and consider implications

and actions.
From the training that I will help me to give clear instruction to my patients about sedation
and supply the medication according to the PGD protocol. I need to improve my skills and
knowledge regarding sedation and endoscopy so that I can able to assist my fellow nurses.
It also enables me to identify the contraindications correctly during the assessment of
patients in the clinic (Alghamry, Ponnuswamy and HODGSON, 2014). The training has
given me insight into how communication is helpful in develop trust and confidence among
patients. When patient comes for this process they become anxious and feel discomfort. It
is my responsibility towards patient who feel depressed, demotivated and anxious to have
communication with them. My role is to make them understand the whole process and
bring them to mental calmness and serenity. After all it’s all about patient safety and health.
I explained them that the doctor will provide midazolam 2mg and pethidine 25mg as pain
killer to minimise their pain. This is known as conscious sedation. Further, at the time of
any emergency situation, it is essential to seek help so that situation can be controlled. I
need to learn about various drugs such as propofol, ketamine and analogous compounds so
that I will able to serve patients. I need to learn to ensure high quality patient care which
reduce the risk of cardio-pulmonary events. The areas of learning include the use of
monitoring machines, pulse oximetry, alarms, ECG monitoring, etc. By having proper
knowledge and skill I might be able to serve patient effectively and efficiently.
How is this relevant to the NMC Code?
Select one or more themes:
Preserve safety: As a nurse, it is important for me to make sure that patients develop trust
and confidence so that they share all the issues that are faced by them. As NMC Code, it is
essential for me to maintain and consider proper steps so that proper safety can be me
maintained.
References
Jover, R., Zapater, P., & Pellisé, M. (2013). Modifiable endoscopic factors that influence the
adenoma detection rate in colorectal cancer screening
colonoscopies. Gastrointestinal endoscopy. 77(3). 381-389.
Zakeri, N., Webster, S., & Thillainayagam, A. V. (2013). PWE-071 Safe Sedation in
Endoscopy: Time for a New Approach?. Gut. 62(Suppl 1). A159-A159.
Alghamry, A., Ponnuswamy, S., & HODGSON, R. (2014). Reduced time to endoscopy
performed under propofol sedation after split-dose bowel preparation does not
increase residual gastric volume (RGV) or risk of
aspiration. Gastroenterology. 146. 736.
.