Contributors – Hugo Miguel de Oliveira Castro and
Beatriz Coelho Pereira

Digestive Endoscopy has evolved significantly in recent decades, regarding diagnosis and therapeutics (Sena et al, 2015). This progress has made procedures increasingly complex and invasive, placing the Endoscopy nurse in a prominent position due to the growing demand for knowledge and technical skills. This advancement has focused on providing specialized, safe, and high-quality care. The nursing team faces complex situations that often reside in the specificity of the techniques and the management of space, human resources, and materials to provide the best care to the individuals seeking our help. Real et al (2022) state that nurses must develop competencies in knowledge and skills to deliver excellent care alongside all these advancements. According to Cotton & Williams (2003), trained gastroenterologists can access the digestive system. Maximizing benefits and minimizing risks is crucial, requiring correctly trained physicians and nurses using specialized equipment.

As referenced by Rey (2011), Gastroenterology procedures are closely related to surgical procedures, despite the specific considerations that must be considered. Therefore, excellent nursing care is tested with a higher number of examinations and their complexity, increasing the need for safety measures while maintaining technical and human precision.
According to the Practical Guide for Healthcare Professionals – Nursing in Digestive Endoscopy, Real et al. (2022) state that those starting their professional journey in the field of Endoscopy, are faced not only with the specificity of the performed techniques but also with a wide range of accessories, software, and possible procedures, demanding knowledge and training from these professionals. According to the authors, a nurse entering this field experiences the challenges of novelty, differences, and specificities, while also being exposed to various available techniques, devices, and accessories, requiring considerable integration and sharing knowledge and experience from colleagues.

Cotton & Williams (2003) argue that specially trained Endoscopy nurses are essential. The literature supports that one of the most critical roles of the Endoscopy nurse is understanding and knowing the materials/instruments used, their specificities, mechanics and anatomy. Increasing the nurse’s knowledge about the equipment is crucial in reducing immediate complications and promoting complementary collaboration between the physician and nurse in challenging and complex procedures. Endoscopy nurses should comprehensively understand the procedure beyond person monitoring and equipment handling. With each technique, the nurse must verify and test all the necessary equipment and materials to ensure proper functioning, easy access and smooth procedure flow. Physicians and nurses must learn to work as a team in addition to their experience in performing complex techniques.

Due to the level of specialization required for these techniques and the large number of available materials, the Endoscopy nurse must know all the procedural steps, potential materials to be used, and how to act in cases of complications and emergencies. The Endoscopy nurse must meet all the requirements to execute complex and time-consuming techniques sucessfully. Given the limited number of complex procedures, the learning and specialization process entails a longer and more precise learning curve. Due to the specificity of these techniques, more experienced and trained nurses must pass on their knowledge and invest in integrating other nurses. As referenced in William Glasser’s pyramid (2001), teaching is the most effective active learning method. In other words, by transmitting their knowledge and actively training other nurses, the nurse is also evolving in their continuous learning process, improving and developing their technical abilities. To teach and to be prepared.

Considering these insights, the concept known as ‘From Novice to Expert’ by Patricia Benner applies to the educational path and professional trajectory of nurses in Digestive Endoscopy. This concept explains how nurses develop skills and understanding of caring for people over time, combining solid academic foundations and personal experiences. It also describes how knowledge development in nursing stems from research and learning through clinical experience.
Benner (1982) proposed that in skill development, learners go through 5 stages – Novice, Advanced Beginner, Competent, Proficient and Expert. Progressing from novice to expert is a circular and non-linear process. According to the author, learners do not need to move systematically from one stage to another; they can alternate between stages repeatedly as they acquire new knowledge and develop new skills.

Benner’s theory has changed the understanding of what it means to be an expert in nursing and how developing these capabilities is a long and progressive process. The expert nurse is the one who provides the best possible nursing care, i.e., excellent care. They have a deep background of experience and an intuitive understanding of clinical situations. Their performances are fluid, flexible, and highly proficient. Benner argues and explains that experience-based nursing competencies are a prerequisite for becoming an expert nurse. Each step in this process of development and improvement is built upon the previous step and is enhanced and expanded through experience and clinical expertise.
Given the current context, it was crucial to structure and define the profile of the Digestive Endoscopy Nurse in a logic of specialization and competency development. For this purpose, the “Certification of Additional Differentiated Competence in Nursing in Digestive Endoscopy” by the Order of Nurses in Portugal was essential. It recognized, validated, and certified the knowledge, skills, and attitudes in various domains of intervention, aimed at attesting to the nurse’s training, experience, and qualification in this area. The “Training Process” is fundamental, defining the path of development and learning resulting from formal and informal training, relevant to the nurse’s professional journey, including continuing professional education, action, and experience. The underlying principles of the process are based on acquired knowledge and competencies, in conjunction with personal and professional projects, maximizing learning and emphasizing professional empowerment.

In the future, even more, fruits are projected from the marriage between endoscopy and informatics with new tools, equipment, and computer simulation. Nanotechnology, robotics, more hybrid procedures combining surgery and endoscopy, and new surgical procedures through endoscopy are just a few steps away. In this way, we are evolving towards an Advanced Nursing practice where experience is not merely a passage of time and career longevity but an understanding of existing notions, concepts, and theories. According to the International Council of Nurses (2012), this implies specialized knowledge, complex decision-making skills, and clinical competencies for nursing practice.
Schober (2016) states that Advanced Nursing practice is the solution to these new challenges in healthcare, not only due to technological advancements and increasing complexity in healthcare, but also a response to the population’s changing needs. A nurse with specialized knowledge, the ability to make complex decisions and clinical competencies are required for experienced practice.

In conclusion, the Endoscopy nurse must meet all the mentioned requirements to perform the most complex and time-consuming techniques successfully. Due to the limited number of complex procedures, learning and specialization require a longer, more assertive learning curve. Given the specificity of these techniques, it becomes imperative for experienced and trained nurses to pass on their knowledge and invest in the integration of other nurses. By transmitting their knowledge and actively training other nurses, the nurse is also evolving in their continuous learning process, improving and developing their technical abilities. With the recognition of the enhanced competencies of the Endoscopy nurse and demonstrating the evolution of the nurse’s role in this field, it is crucial not to forget the Nursing Theories of the past that have led us to the present day and prepared us for the future, achieving a balance between Benner’s legacy and Advanced Nursing Practice. Ultimately, with all the necessary conditions and resources available, it boils down to the willingness of each individual to become the best version of the nurse they aspire to be and dream of.

References

Benner, P. (1982). From Novice to Expert. American Journal of Nursing , Vol. 82 No.3 pp. 402-407. Acedido em http://www.jstor.org/stable/3462928.

Benner, Patricia. From novice to expert: excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley. 1984 (De principiante a perito. Coimbra: Quarteto Editora, 2001)

Cotton, P. B., Williams, C. B. (2003). Practical Gastrointestinal Endoscopy – The Fundamentals. Blackwell Publishing Ltd.
Glasser, W. (2001). Teoria da Escolha: uma Nova Psicologia de Liberdade Pessoal. Mercuryo.

Hesbeen, W. (2001). Qualidade em Enfermagem: Pensamento e acção na perspectiva do cuidar. Loures, Portugal: Lusociência.

Petiprin, A. (2020). Dr. Patricia Benner. Novice to Expert – Nursing Theorist. Nursing Theory. Acedido em Dezembro de 2022, em https://nursing-theory.org/nursing-theorists/Patricia -Benner.php

Real,L., Proença, P., Raposo, T.(2022) Guia Prático para Profissionais de Saúde – Enfermagem em Endoscopia Digestiva. Sabooks – Lusodidata.

Rey, Jean-Francois. (2011). Quality Control in Endoscopy Unit: Safety Considerations for the Patient. In Ivanov O. (Ed.), Applications and Experiences of Quality Control. Rijeka, Croatia: Intech.

Schober, M. (2016). Introduction to Advanced Nursing Practice An International Focus Madrean Schober Schober Global Healthcare Consulting Indianapolis Indiana USA Advanced Practice in Nursing ISBN 978-3-319-32203-2 ISBN 978-3-319-32204-9 (eBook) DOI 10.1007/978-3-319-32204-9 Library of Congress Control Number: 2016955805 © Springer International Publishing Switzerland 2016.

Sena, C., Castro, H., Pinto, M. J., Alvarez, P., Cannas, P. (2015). Técnicas Endoscópicas – Lista de Verificação de Segurança. Lisboa, Portugal: Ordem dos Enfermeiros. Disponível em https://www.ordemenfermeiros.pt/arquivo/projectos/Documents/Projetos_Melhoria_Qualidade_Cuidados_Enfermagem/HospitalLuz_Projeto_Lista_Verificacao_Seguranca_Tecnicas_Endoscopicas.pdf

About the Contributors

Hugo Miguel de Oliveira Castro

I have been a nurse since 1999, and am currently working in an digestive and respiratory endoscopy center of a university hospital in Lisbon, Portugal, for the last 15 years. I truly believe that teaching and passing knowledge is a responsibility and a duty of all but also the best way to grow as a professional and learning. I am attending the Master Nursing Course of the Health Sciences Institute of Universidade Católica Portuguesa (Lisbon). This post was created in the nursing theories curricular unit, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).

Beatriz Coelho Pereira

I am a third year nursing student at Health Sciences Institute of Universidade Católica Portuguesa (Lisbon).