Background
Objective
Methods
Design
Participants and setting
Data collection
Colonoscopy participant | Nurse |
---|---|
Could you please describe the experience of this colonoscopy? | Could you please tell me about your general awareness of quality indicators for colonoscopy? |
Could you please tell me what impressed you most during your colonoscopy? Why? | Could you please tell me the difficulities you meet in your work? How were these difficulties resolved? |
What makes you feel satisfied/unsatisfied? Were all your needs responded by the nurses? | Could you please tell me what key points need to be included in a colonoscopy care indicator system with reference to the structure, process and outcome models? Why? |
Could you please tell me what else the nurse can do to resolve your inconvenience during the colonoscopy? | Is there anything else you would like to complete regarding the quality of colonoscopic care indicators? |
From your personal perspective, what do you think a excellent colonoscopy nurse looks like? How can the quality of colonoscopic care be evaluated? |
Data analysis
Ethical considerations
Results
Variable | Frequency (%) | Variable | Frequency (%) |
---|---|---|---|
Participants’ characteristics (P = 11) | Nurses’ characteristics (N = 7) | ||
Age (years) | Age (years) | ||
≤ 30 | 1 (9.1) | 26 ~ 35 | 2 (28.6) |
31 ~ 40 | 4 (36.4) | 36 ~ 45 | 3 (42.9) |
41 ~ 50 | 3 (27.3) | 46 ~ 55 | 2 (28.6) |
> 50 | 3 (27.3) | Gender | |
Gender | Men | 1 (14.3) | |
Men | 6 (54.5) | Women | 6 (85.7) |
Women | 5 (45.5) | Education | |
Occupational status | Below bachelor's degree | 3 (42.9) | |
Employed | 10 (90.9) | Bachelor degree | 3 (42.9) |
Unemployed | 1 (9.1) | Master degree | 1 (14.3) |
Marital status | Years in profession (years) | ||
Single/divorced | 1 (60.2) | 6 ~ 10 | 1 (14.3) |
Married | 10 (30.6) | 11 ~ 15 | 4 (57.1) |
Education | > 15 | 2 (28.6) | |
Below bachelor's degree | 3 (27.3) | ||
Bachelor degree or above | 8 (72.7) | ||
Examination reason | |||
With symptoms | 3 (27.3) | ||
No symptoms | 8 (72.7) | ||
Examination results | |||
All is well | 4 (36.4) | ||
Intestinal adenoma/ulcer | 7 (63.6) |
Workforce structure
Nursing staffing
“It might be better to restructure staffing in the future. Having a dedicated position for everyone will ensure a smooth workflow. In fact, the higher the workload, the higher the risk of making mistakes.” (N4).
Quality requirements
Professional responsibility
“My understanding is that nurses should carry out their duties; responsibility is both noble and mundane and needs to be consciously obeyed by the nurses.” (P6)
Humanitarian spirit
“I think the attitude of nurses is quite essential, because I feel more relaxed when nurses have a better attitude.” (P1)
Teamwork
“Work becomes efficient because of timely cooperation.” (N1)
Professional competence
“Professionalism of the medical team comes first in my list of importance.” (P6)
Proactive care
“I had no idea about what to do afterwards, and no one told me. I felt a little confused about the process. The nurse just called out my name and told me to change and keep lying down. I would have shared my queries with the nurse, but I didn't bother when I noticed that they were busy.” (P6)
“I believe it might be better if the nurses explained everything before being asked for clarifications by the participants.” (N1)
Unit facilities
Physical environment of waiting areas.
“I think it's important for everyone to have a nice environment, whether it's the staff or the patients. It makes a person comfortable and is less irritating.” (N1)
Nursing tools
Educational tools
“An appointment form with various notes is necessary.” (N2)
Anesthesia and resuscitation monitoring criteria
“As soon as a participant finishes medical examination, we will record it on the resuscitation record sheet, including the participant's blood oxygen, heart rate level, as well as the participant's departure time.” (N1)
Nursing quality control system
Infection control strategies
“Our infection control requirements are strict and rigorous as cleaning and disinfection are important for patient safety.” (N6)
Dynamic assessment and intervention
Participants’ psychological state
“I feel embarrassed because wearing the given pants will reveal my buttocks if I'm not careful as the colonoscope has to go in through the anus.” (P5)
Pre-examination care
Using identification measures
“It is necessary to check a patient's name and other information because calling a patient directly and asking for the name are two different things, and the latter prevents confusion about the patient's identity. Thus, we must ask the patient's name rhetorically in clinical practice.” (N1)
Determining extent of pre-examination preparation
“It's hard to figure out whether the patient's bowel is completely prepared. Thus, we have to ask the following questions: ‘What time did you finish taking the morning medicine? Did you have watery stools after taking the medicine? Did you drink and eat again after taking the medicine?’” (N2)
Flexible examination schedule to shorten queuing time
“I took note of the time. I went in at 3:10 p.m., and the examination took a total of 45 minutes. It didn't seem to take as long as I thought it would.” (P2)
Strengthening education
Pre-examination education
“This could have occurred because of a poor response to the medication. I am uncertain regarding the frequency and extent of defecation that is needed prior to the colonoscopy.” (P1)“I woke up at 4 am and remained awake until the next morning because I had to defecate. The medicine was so unpleasant that I vomited. Moreover, I had a bloating sensation because of drinking an excessive amount of water.” (P5)
Anesthesia education
“I wasn't quite sure what the effect of the ingested throat anesthetic would be; I thought it would make me unconscious like a general anesthetic, but that didn't actually seem to be the case.” (P4)
Post-examination education
“Yes, I was confused and checked the related information yesterday because I could not remember the nurse’s instruction regarding the time of eating and drinking.” (P6)
Feedback on education
“I think it is important that the education is interactive. The nurses should confirm our understanding of the instructions. I think it is probably better for the nurses to repeat the instructions for our better understanding.” (P7).
Colonoscopy Outcomes
Prevention of anesthesia-related safety hazards.
“In these patients, falls are considered serious and dangerous nursing accidents.” (N4)