When first asked what the theme of my presidential year would be, I was at a loss for ideas. It seemed like all the recent themes about celebrating, building, connecting, and illuminating used all the good ideas. Then it hit me as I took a mental journey back through my times at the Society of Gastroenterology Nurses and Associates (SGNA) courses and my personal experiences in gastrointestinal (GI) nursing: why not explore our past, present, and future? This theme seemed especially appropriate as 2003 marks SGNA's 30th Annual Course.
Traditions
Since the early days of semiflexible gastroscopes and limited procedure options, the GI assistant has played a vital role in the safe performance of procedures. Most GI nurses have heard of Gabrielle Schindler and her work with her husband, Rudolph Schindler, the father of endoscopy. Gabrielle was responsible for patient education, calming the patient's anxiety and assuring the patient's cooperation, assisting with advancement of the scope, and cleaning of endoscopic equipment.
Rudolph Schindler gave great credit for his success to Gabrielle, who though not a nurse, served as his assistant for over 40 years. Gabrielle's detailed explanations of what would happen and how the patient could help in the process elicited excellent cooperation from patients. She administered the throat anesthetic, and taught the patient how to "swallow" the semirigid scope. Gabrielle held each patient's head with her left hand during the examination and, with her right hand, guided the scope and controlled the patient's hands. She also evaluated the patient's emotional and physical endurance before and during the procedure (Salmore, 1998). Assisting at the bedside, caring for the patient, and equipment care remain primary functions of the GI nurse and associate. Since 1985, at the SGNA Annual Course, Gabrielle's contributions to our specialty are commemorated by honoring a GI assistant who has been recognized by their peers for outstanding contributions to patient care, education, and training of other professionals.
Trends
Trends in endoscopy and GI nursing have evolved from simple diagnostic procedures to complex therapeutic treatments. Modern-day flexible fiberoptic endoscopes were first developed in the 1950s, but came of age in the mid-1960s and 1970s when a series of significant design changes assured their widespread acceptance among endoscopists (Edmonson, 1991). Early endoscopic retrograde cholangiopancreatography (ERCP) was developed to allow for better examination of the bile ducts and demonstrated usefulness in diagnosing malignancies of the biliary tract and pancreas. Now, most of the ERCPs performed have a therapeutic objective, such as stent placement or stone removal.
Other examples of therapeutic advances in endoscopy are percutaneous endoscopic gastrostomy (PEG), developed in 1979, and endoluminal gastroplication, an endoscopic treatment for gastroesophageal reflux, developed in 1994 and approved for general use by the FDA in 2000. The complexity of therapeutic procedures has compelled the utilization of two assistants in the procedure room: one dedicated to assisting the physician and one dedicated to monitoring the patient.
Along with the technical advances of the specialty, the role of the nurse in gastroenterology has changed. Virtual colonoscopy and capsule endoscopy, which are less invasive because they don't use a "conventional" endoscope and are not performed in the GI lab, have changed the traditional delivery of bedside care by GI nurses during procedures. Since the 1990s, nurse endoscopy has come to the forefront with nurses responsible for performing screening flexible sigmoidoscopy, screening colonoscopy, and transnasal unsedated esophagoscopy (Glenn, 2001). Thus in some settings, the nurse has progressed from the role of assistant to that of provider.
Tomorrow
What does the future hold for GI nurses and associates? That's the $1,000,000 question and I wish I knew the answer. Given the history and evolution of gastroenterology, it is probably safe to say that our technology will continue to change and new procedures will be developed. Will minimally invasive procedures decrease the number of patients seen in the endoscopy suite? What new therapeutic procedures will evolve to support these diagnostic tests?
We've heard a lot recently about the aging nursing population and the growing nursing shortage. SGNA has joined with 100 other nursing organizations to develop action plans for addressing and alleviating the nursing shortage, but it will take time before any success is apparent. Will the decreased number of available nurses along with the expanding roles of nurses, going from hand holder to scope manipulator, bring us full circle so that we once again use non-nurses in our units to deliver direct patient care? Some endoscopy units are already embracing this model.
Unfortunately, I have more questions than answers about tomorrow. I feel confident, however, that no matter what happens in gastroenterology and endoscopy nursing, SGNA will be there to provide education and support for everyone. SGNA was formed by a group of dedicated healthcare professionals employed in gastroenterology who recognized the need for support and education for persons working in this specialty. Through the years, SGNA has continued to grow and evolve, always striving to meet the needs of it's members. I am very honored to be serving with a dedicated group of volunteers as your President for this next year. Happy 30th, SGNA!
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