Gastroenterology nursing practice is most often associated with either in-patient or out-patient settings focused on endoscopic and gastrointestinal diagnostic and therapeutic procedures. Nursing care involves assessment, education, and support of the patient during and following diagnostic or therapeutic endoscopy and other invasive gastroenterology procedures. But gastroenterology nurses cannot afford to just be procedure-oriented. I was recently reminded by a World Health Organization colleague that addressing primary care needs is a desired competency for all healthcare workers internationally. Addressing primary care with our gastroenterology patients is part of our responsibility beyond the focus of delivering procedural care.
Primary care needs for gastroenterology patients typically include a focus on screening, prevention, and early referral for treatment. Primary care is seen to be commonly delivered in office or clinical settings with primary care referrals for gastroenterology specialty care. The time during pre-procedure assessment is an ideal opportunity for the gastroenterology nurse to address the importance of other primary care needs with each patient.
A focus on immunization's can be an important aspect of primary care in the gastroenterology setting. For some patients, immunizations specific to gastroenterology practice such as hepatitis A and B may be indicated. But all adult patients should be encouraged to obtain measles, mumps, rubella (MMR), varicella (VAR), and tetanus, diphtheria, pertussis (Tdap or TD) vaccinations as recommended by the Centers for Disease Control (CDC) (https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html). Influenza immunization is critical for public health reasons (during the fall and winter in the United States). Depending on the patient's age and risk factors, immunizations such as zoster, human papillomavirus (females), pneumococcal, and meningococcal vaccines are other preventive measures that gastroenterology nurses should be prepared to discuss with patients. And tetanus should be administered every 10 years.
Attending to health care literacy is another aspect of primary care that gastroenterology nurses should incorporate into their daily practice. Health care literacy involves an individual's ability to understand basic health information in order to make appropriate health decisions (IOM, 2004). Research shows that "patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs compared to those with adequate health literacy skills" (Cawthon, Mion, Willens, Roumie, & Kripalani, 2014, p. 68). Explaining procedures, nursing care, and clinical recommendations so that patients can understand and act on this information is a critical aspect of achieving desired patient outcomes.
Be aware that the health literacy tools referenced in the literature are not intended for clinical practice. They are appropriate for quantifying health literacy for research purposes but are not useful for clinical practice (Weiss, 2018). The best approach for clinicians to promote health literacy is to provide information at an appropriate level for each individual patient. Don't assume that educational brochures and pamphlets are appropriate for the patient's level of understanding. Assess for their understanding and provide a phone number for patients to call if they have questions about their experience. Inability to read, stress or confusion, or lack of English proficiency are not always easy to assess, yet critical to consider in relation to health literacy. Time spent building a trusting relationship with the patient can be helpful in contributing to an accurate assessment of the patient's health literacy needs.
Addressing healthy lifestyle choices is also a valid application of primary care in the gastroenterology setting. Assessing patient lifestyle choices and providing alternative choices alongside individualized education can impact not only gastroenterology issues, but general health for each patient. Evidence suggests that using a patient-centered, conversational style is more effective than an advice-giving communication style. Motivational interviewing approaches such as asking open-ended questions ("What activity do you think you could do each day for just 5 or 10 minutes?"), offering affirmations ("You are making progress."), reflective listening ("It sounds as if you have set personal goals but are finding them difficult to achieve."), and summarizing ("Let me summarize what we have talked about today."). Additionally, assess each lifestyle domain separately (i.e. activity, eating, emotional well-being, readiness to change) to avoid overwhelming the patient (McAndrews, McMullen, & Wilson, 2011). Planting small seeds for a healthy lifestyle can add up to significant patient outcomes, even though you may not personally see the results of your efforts.
Gastroenterology nurses cannot be just procedure-oriented if we are to play a significant part in promoting individual and public health. Consider incorporating primary care practices in your daily care. Work with other departments or community partners to promote easy access for patients to receive immunizations, preferably conveniently while they are receiving their gastroenterology care. Be attentive to health literacy issues in both your written materials as well as your professional communication with patients and their families. Finally, develop a comfortable, non-judgmental approach to discussing health lifestyle choices with your patients and motivating them to make small, achievable changes. I hope you agree; gastroenterology nursing care is not just procedure-focused. Primary care is every healthcare provider's responsibility.
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