Methods
saving men and women having to make three trips to a hospital . It further supports the government agendas of diagnosing cancer early and improving patient outcomes . However , more research is needed over longer time periods to truly assess its effectiveness in the diagnostic uptake and reducing mortality from colorectal cancer .
Methods
It has been previously discussed that the increase in colorectal referrals and government push to diagnose cancers early means that changes in current practice are needed . It has been recognised that nurses with expert , specialist knowledge can be used in the assessment of patients and the role of the nurse is changing to meet the needs of services ( West , 2006 ; Hoffman et al , 2009 ). This is further supported by the Royal College of Nursing ( RCN ) ( 2012 ) who agree that nurses who have expert education to underpin their practice and the competencies to support , can make advanced clinical judgements and be effective Advanced Nurse Practitioners ( ANP ). Advanced nursing practice in colorectal speciality was previously seen in supporting patients following a cancer diagnosis or stoma as a specialist nurse but many are now being used to support colorectal consultants in clinics to assess patients in the 2WW clinics as ANP ’ s ( Barnwell , 2015 ). Nurses at this level need advanced assessment skills as set out by the RCN ( 2012 ). An ANP could run a one- stop rectal bleeding clinic if they have these outlined attributes and qualifications . They must also be trained in performing flexible sigmoidoscopy . Nurse endoscopists already perform 20 % of the workload in endoscopy which is estimated to increase to 40 % in the next few years ( Health Education England , 2017 ). They must be trained according to the Joint Advisory Group ( JAG ) prior to practicing independently and have been shown to be as safe and competent as that of medical endoscopists ( Swarbrick et al , 2005 ; JAG , 2012 ). Therefore , ANP ’ s or Advanced Clinical Practitioners ( ACP ’ s ) could be a safe and effective way of running these onestop clinics .
One possible variable for running a one- stop rectal bleeding clinic may be the endoscopy unit having the capacity to run this service . The demand for lower endoscopies has doubled between 2012- 2017 therefore putting added pressure on the endoscopy unit to cope with the increase in referrals ( Brown , 2015 ). If units don ’ t reach their quality standards , one of which is not meeting targets to scope patients in time , they put their Joint Advisory Group ( JAG ) accreditation at risk and may also be fined ( JAG , 2013 ). There is also the issues of staff shortages and lack of physical space in which to perform the procedures , as well to administer the enema preparations ( Brown , 2015 ; British National Formulary , 2017 ). Therefore , in order to set up the rectal bleeding clinic it must be taken in account the added work that the endoscopy units would have to absorb . There is limited research into how a rectal bleeder clinic will affect the endoscopy unit ; more research is needed on the impact of the service on endoscopy units .
Careful attention must be made to the history of the patient attending a one- stop rectal bleeding clinic . Questionnaires as that stated by Agaba et al ( 2006 ) and Toomey ( 1998 ) will determine what symptoms the patient is experiencing and help to triage these patients to the correct service . A consultation model , such as the medical model , can direct the questions and ensure that information is not missed ( Jarvis , 2016 ). It is important to establish whether the bleeding is bright red or dark red as dark red bleeding may warrant a colonoscopy to check for right sided pathology ( Burling et al , 2007 , Hibberts , 2011 ). Change in bowel habit or weight loss may need further investigation as it may indicate abnormalities in other areas ( Badger et al , 2005 ; Royal College of Surgeons , 2013 ). There is also the legal aspect of gaining consent for the procedure and patients must be given all the information to make an informed decision to whether they want to go forward for a procedure ( General Medical Council , 2008 ; DOH , 2009 ). They must include the risks of having a procedure which include perforation , bleeding , abdominal discomfort and missed pathology ( British Society of Gastroenterology , 2007 ). Healthcare professionals must follow the principle of nonmaleficence when looking after these patients ( Beauchamp & Childress , 1989 ; DOH , 2009 ). These raise the ethical implications around the