Report of Nurse Colposcopy Training Programme to the Royal Shrewsbury Hospital NHS Trust May 2011

Transcription

1 Report of Nurse Colposcopy Training Programme to the Royal Shrewsbury Hospital NHS Trust May 2011 Two nurses were recruited by NNCTR (Nepal Network for the Cancer Treatment and Research), Miss Sita Pariyer and Miss Mamata Shrestha. The selection of candidates by NNCTR was excellent. Both nurses were highly motivated with good verbal and written communication skills. Flights were funded, accommodation and lunches were provided. All transport costs were met. A lively social programme was put together and a grant of 120 per nurse was awarded. Following last minute flight changes they arrived on Thursday 18 May into London Heathrow. They were greeted by Colin How and driven to Shropshire to Sister Sheryl Goodall s house for the weekend. The day after their arrival their contracts and paperwork were processed and they underwent a corporate induction day including infection control and manual handling. Shrewsbury and Telford NHS Hospital Trust (SATH) is made up of Royal Shrewsbury Hospital (RSH) and The Princess Royal Hospital (PRH). Colposcopy clinics and outpatient gynaecology takes place in both hospitals. There are colposcopy offices with admin back-up at both sites. In-patient gynaecology is delivered only at the RSH site. SATH provided accommodation free of charge on PRH hospital site. This resulted in a potential loss of revenue to the Trust. The accommodation was basic (doctor s resident house) with no WiFi. This was found to be challenging for host staff and less pleasant for visitors. The nurses had access to libraries and IT suites in both hospitals with free internet access. For 3 weeks they followed a set training timetable. They attended colposcopy clinics in both sites. They were trained as colposcopy nurses. This involved setting up the clinics, preparing the trolleys and cleaning them and taking care of the patients. They were instructed on the use of the colposcope. The colposcopy nurses all were involved in the training. JP, SG, MR and JB taught colposcopy. They observed colposcopy examinations and by the second week were performing colposcopy under direct supervision of JP and SG. Additional colposcopy experience was gained in JP day surgery lists. They were instructed on scrub techniques, setting up equipment, assisted and performed colposcopy under direct supervision. In addition they set up trolleys, assisted the

2 scrub nurses and assisted in hysteroscopy and other minor gynaecological surgery. They observed major gynaecological surgery with Dr Oates and Mr Reed. Administration is essential if screening and colposcopy are to be successful and training was targeted at this. They spent time completing administrative tasks and data collection with the colposcopists and spent time with the colposcopy administrators. They had library and IT training. They were able to attend a departmental audit morning. They attended a gynaecology/pathology MDT meeting in addition to colposcopy MDT. They also had the opportunity to join a pressure sore workshop. Both nurses spent a day in the cytology laboratory with SB. They had a session in the histology lab and observed analysis of cervical specimens including LLETZ biopsies with the Professor of pathology. Formal teaching and lectures were shared with the medical undergraduates of Keele University including practical skills with pelvic models. They watched a video on cervical sampling and attended lectures on the cervix and the malignant potential of CIN. They also attended JP gynaecology clinics and were supervised by the gynaecological nurses. They chaperoned the doctors, set up trolleys and assisted in patient care throughout. They were also interested in other aspects of women s heath and observed the breast clinic, the urodynamic clinic and the perineal clinic. On Sunday 12 June a colposcopy examination was undertaken by both nurses. This consisted of both a theory and practical examination (appendix 3). JP and SG examined and Mr David Fenton and Dr Esther Moss were external examiners. Dr Gerda Pohl observed. This was followed by a social gathering at JP s home with the rest of the team. Both nurses were successful and were awarded certificates for completing the training programme and passing the exam (appendix 1). The nurses were very keen on the English food. They particularly enjoyed visiting the hospital canteen on a daily basis and were very experimental with the local cuisine! Socially both visitors and hosts were kept busy. SG looked after them in her own home the weekend they arrived. They visited Birmingham and had an opportunity to join in a traditional family Sunday lunch with SG extended family. There were visits to a local curry restaurant and a fish and chip restaurant. They enjoyed meals at SG home, JB s home (BBQ) and JP home. The nurses also spent one evening hosting their own dinner party and cooking Nepali food at SG house. At the end of their first week was a bank-holiday weekend and this gave them an opportunity to visit London by train and join up with Nepali friends who are living in

3 London. In addition to Shrewsbury they were taken to Birmingham, Iron Bridge Gorge and the Blists Hill Museum, Attingham Park and ventured also into Wales and Powys Castle. SATH kindly provided hospital transport to Heathrow for their return journey. The visit was deemed to be successful. It involved close co-operation with many staff. The BSCCP awarded a grant of Fundraising had been going on for over 6 months to raise the monies required to fund the training. A charity cheese & wine evening with lectures on women s health in Nepal (including David Nunns and Patrick Beresford was a great success). The HR department and Occupational Health were instrumental in the visit taking place. The visit was supported by the Trust and thanks are owed to Adam Cairns the CEO, Helen Coleman the chief nurse, Dave Fitton the facilities manager, Chris Fisher the catering manager and many more. The entire department was involved and support from the CD Mr Andrew Tapp, the managers Tina Wood and Cathy Smith with support from Rachael Hanmer. Training was undertaken by JP, SG with help from Jill Blackmore, Marilyn Reah, Nick Reed, Martyn Underwood and Sharon Oates, Tina Jones, Sarah Beardsley, Steph Roberts and Helen Reece and many more. The visits to the labs were greatly appreciated by the nurses and the expertise of Sue Blundell, Steve Bird and the cytology team and Professor Malcolm was essential to this success. The Trust seemed to really encompass ownership of the training. Andy Rogers assisted with the publicity within the trust and the local newspapers ran several stories. Learning points The selection of candidates by NNCTR is vital. The candidates need to be involved in screening programme and be in a position on return to Nepal to carry on work started in UK. They need a high level of verbal and written English to benefit from programme Fundraising is essential. The cost of the training is around It was a very generous of SATH to provide accommodation. If high quality rented accommodation is to be provided this would increase significantly the cost of the training and unlikely to be viable. Realistic expectations regarding accommodation should be given. Access to the internet is vital. We could consider the possibility of host families.

4 On this occasion the flight details changed at last minute. This was challenging as Shrewsbury is not located near Heathrow airport. It is obviously important to be met by one of the team but needs advance planning. In addition to airport transfer arrangements local transport arrangements with split site units needs organisation. The timetable was very useful. It gave structure to the training and allowed advance planning. This enabled maximum training within such a short period of time. Some flexibility is important to allow for sickness and areas of other interest.. The British food was surprisingly appreciated. The free canteen food was a great success. The social side of the programme was important. Having opportunities to visit local places of interest was a great success. Free time was also necessary. How the programme could be improved? More information prior to arriving. Write manual. Provide info re what to expect in UK-weather, food, local tourist guide, buses, trains More opportunities to be independent Hard work but rewarding for hosts 4 weeks in one institution seemed to be good for training Multidisciplinary approach to training and socialising Finally plan to return journey and begin to raise more funds. Thanks to all who were involved in making the training programme a success.

5 APPENDIX 1 Theory Examination This question is about Cervix Cancer How might a patient with cancer of the cervix present to the nurse or doctor? What are the risks associated with cancer of the cervix? What may you see on speculum examination? What are the colposcopy findings in a case of early cervix cancer?

6 This question is about CIN3 What is CIN3? Can you draw a picture of the pathology/histology findings of CIN3? What symptoms do patients with CIN3 have? What are the colposcopy findings of CIN3? Why is CIN3 important? What is the natural history of CIN3?

7 This question is about Cervical Screening Below are different types of cervix screening Can you tell us about them? What are the advantages of each one? What are the disadvantages of each one? 1. VIA/VILI screening 2. HPV screening 3. Cytology screening Pap smears LBC samples

8 This question is about HPV What is HPV Why is it important? What are Gardasil and Cerverix? What is the difference between the 2 products?

9 This question is about Treatment of CIN Can you describe? 1. Cryotherapy (what is the disadvantage?) 2. Cold coagulation (thermocoagulation) 3. LLETZ/LEEP 4. Knife Cone Biopsy 5. Hysterectomy What treatments would be suitable for CIN3 in a women age 30 years with no children? Why? What are the advantages of each method? What are the disadvantages of each method? What treatments would be suitable for CIN3 in a women age 40 years with heavy periods and a large fibroid who has completed her family? Why? What are the advantages of each method? What are the disadvantages of each method?

10 Practical Examination Can you show me the colposcope Can you plug it in? Can you turn on the light and show me how to turn up the light? Can show me the green filter? Why would you use the green filter? Can you show me how to alter the focal length? Can you show me how to increase the magnification? Can you now put the colposcope back to where you would put in after finishing a clinic?

11 Can you set up a trolley for me in order for me to perform a colposcopy What is more important for diagnostic colposcopy-cleanliness and reduction of cross-contamination or sterility? How can you reduce cross-contamination?

12 Here is a picture of a normal colposcopy Can you tell me about the findings Here is a picture of low grade CIN (CIN1) Can you tell me about the findings Here is a picture of high grade CIN (CIN3) Can you tell me about the findings

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