ESGENA Core Curriculum for Endoscopy

Nursing

European Society of Gastroenterology and

Endoscopy
Nurses and Associates (ESGENA)

ESGENA Education Working Group (EEWG)

Planning Group

September 2008

published by:

European Society of Gastroenterology and Endoscopy Nurses and

Associates
ESGENA Secretariat
Medconnect Ltd.
Brünnsteinstrasse 10
81541 Munich, Germany
Tel.: +49 89 4141 9450
Fax: +49 89 4141 9245
Email: info@[Link]
[Link]

© European Society of Gastroenterology and Endoscopy Nurses and

Associates, 2008
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Contents

1 Introduction 3
1.1 Background 3
1.2 Aims of the ESGENA Core Curriculum 5
2 Educational philosophy 5
3 The teaching and learning environment 6
4 Teaching staff 7
4.1 Internal assessor/mentor 7
4.2 External assessor of clinical practice 7
4.3 Academic tutor/course leader 9
5 Structure of courses and modules 10
5.1 Introduction 10
5.2 Length of courses 11
5.3 Outline of modules 11
6 Content of modules 1–4 12
6.1 Module 1: fundamentals of endoscopic nursing 12
6.2 Module 2: clinical modules with obligatory units 15
6.3 Module 3: clinical modules with optional units 17
6.4 Module 4: optimizing nursing 20
7 Assessment 21
7.1 Assessment levels 21
7.2 Suggested assessment methods 23
7.3 Criteria for failed practice 24
8 Guidelines for implementing and using the core curriculum 24
8.1 Cooperation with official bodies 26
8.2 Local implementation group 26
8.3 Three phases of implementation 27
8.4 Key members 29
8.5 Academic levels: equivalence of educational courses
through the Bologna process 29
9 Review date 30
10 Appendix 31
10.1 European Job Profile for endoscopy nurses 31
10.2 Recommendations for a European framework
for specialist nursing education 39
10.3 References 42
10.4 Glossary 43
10.5 Authors involved in the development of the
Job Profile and the Core Curriculum 47

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1 Introduction

1.1 Background
Over the last 30 years, endoscopy has become an essential tool for medical
diagnosis and treatment. In parallel with technological developments and
increasing specialization among physicians, endoscopy nursing has
developed into a discipline that involves highly qualified nursing and
assistance tasks alongside the endoscopist. Endoscopy nurses work within a
multidisciplinary team both in hospitals and in general practice and primary
care.

The scope of endoscopy nurses’ practice varies from country to country. In

some countries, for example, the field of endoscopy nursing includes not only
gastroenterological endoscopy, but also thoracic medicine, urology, surgery,
gynaecology, etc. In another group of countries in Europe, the focus in
endoscopy nursing is on gastroenterology. Consequently, the work of the
nurses concerned involves not only endoscopy, but also stoma care,
percutaneous endoscopic gastrotomy (PEG), nutrition, inflammatory bowel
disease (IBD), in-patient and outpatient care in the field of gastroenterology,
and other areas.

In 1998, the European Society of Gastroenterology and Endoscopy

Nurses and Associates (ESGENA) initiated the setting up of a European
Endoscopy Nurses’ Forum (EENF) in order to work towards harmonizing the
training provided for endoscopy nurses throughout Europe and to promote
recognition at European level for this nursing specialty. The group consisted
of national representatives – one from each of ESGENA’s group members –
with considerable experience in training endoscopy staff.

At the first EENF meeting in May 1998, a great deal of information about the
training and education provided for endoscopy nurses all over Europe was
collected. Various aspects involving specialist nursing education, continuing
education and short-term training needs in the field of endoscopy nursing
were discussed. The data collected showed that there is wide variation in the
education and training provided for endoscopy nurses in Europe. Training
courses for endoscopy nursing have been established in the majority of
European countries, but they vary in length, content, academic level and level
of official qualification obtained. Courses lasting from one to six weeks can be
described as representing continuing education, whilst courses lasting from
one to two years are designed to provide post-basic nurse education. Short
courses usually concentrate on gastroenterological endoscopy, while longer
courses also cover endoscopy in the fields of thoracic medicine, urology and
some parts of surgery, orthopedics and gynaecology. A few courses available
at university level offer combinations of all aspects of gastroenterology, with
the option of obtaining a master’s degree.

At the end of the first EENF meeting, it was agreed that one of the group’s
initial aims should be to define the job of an endoscopy nurse in Europe (in
the European Job Profile) as the foundation for working towards a European
core curriculum for endoscopy nurse education.

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Between September 1998 and October 2001, the EENF met twice a year to
develop the European Job Profile for endoscopy nurses. The final version of
the document was adopted in October 2002. The job profile includes
recommendations on the qualifications, skills, knowledge and responsibilities
of endoscopy nurses, and it is intended as a general statement that defines
the profession’s role and philosophy. The European Job Profile provided the
basis for the content of the Core Curriculum, while the framework for the Core
Curriculum was based on the results of collaboration with the European
Federation of Nurses’ Associations (EFN) – formerly the Comité Permanent
des Infirmiers de l’UE/Standing Committee of Nurses of the EU (PCN).

Since 1998, ESGENA has represented the interests of its members at the
annual meeting of the European Network of Nurses’ Organizations (ENNO).
At these meetings, various European specialist nursing groups discuss issues
that affect their position within the larger field of nursing together with
members of the PCN (representing national nursing organizations). An ENNO
steering group (of which ESGENA was a member) developed a European
Framework for Post-Basic Nurse Education (adopted in 2000), featuring
quality criteria such as the length and academic level of courses, the balance
between theory and practice, qualifications of teaching staff and the
organization of courses. The aim of the framework was to harmonize the
specialist training provided in different countries. The framework makes it
possible to establish equivalent training qualifications and will consequently
allow nurses to move freely within their profession to different countries within
the European Union (EU).

At its eighth meeting in May 2002, the EENF Working Group changed its
name to ESGENA Education Working Group (EEWG) and started to work on
the European Core Curriculum, with the ESGENA European Job Profile
indicating the content of the curriculum and the ENNO Framework providing
the minimum quality criteria. Different European core curricula from other
European specialist nursing societies and groups were reviewed. Based on
this evaluation, a structure for the ESGENA Core Curriculum was developed.
A nominated subgroup (the Core Curriculum Working Group) developed the
details of the document, with the EEWG continuously reviewing and
complementing the work at twice-yearly meetings.

The final version of the ESGENA European Core Curriculum for endoscopy
was adopted in October 2007.

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1.2 Aims of the ESGENA Core Curriculum

The aims of this Core Curriculum are:

• To empower nurses to:

– Optimize patients’ experiences (improving patient care, services,
environment, etc.)
– Advance evidence-based practice
– Look at the profession critically in order to encourage research
– Promote the professional status of endoscopy nursing
– Promote lifelong learning through reflective practice
• To support national nursing societies and official bodies within Europe to:

– Provide educational opportunities for staff working in gastroenterology

and endoscopy nursing
– Promote a recognized qualification in gastroenterology and endoscopy
nursing
– Promote cooperation with other relevant professional groups
– Advance the professional status of gastroenterology and endoscopy
nursing
• To implement the ENNO Framework in order to establish equivalence of
training and consequently allow nurses to move freely within their
profession to different countries within the EU
• To promote the specialty within Europe
• To promote equivalent high standards of endoscopy care for patients
throughout the EU (Rome Criteria)

2 Educational philosophy
The Core Curriculum was developed with an awareness of the principles
involved in adult education and in order to develop the required skills among
practitioners involved in endoscopy nursing.

It is recognized that adult students have individual expectations based on their

previous experience. They expect to be treated as adults and to work hard, to
be taught and to learn in topics related to their chosen vocation.

Reece and Walker (2006) state that adults do best:

• When they are involved in negotiation of their learning
• When they devise their own goals after diagnosing their own learning
needs
• When they accept learning as an internal process
• When they become autonomous and take responsibility for their own
learning
• When they learn and think together with others, sharing ideas and
feelings
• In a climate that is conducive to learning in which there is openness, trust,
respect and commitment
• When they are focused on the present, but can use past experience
• When they are able to learn from problems, rather than subjects

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• When they are willing to alter their way of thinking and accept change
• When learning is activity-based
• When they can focus on principles
• When they value transitions and have the feeling that they are making
progress
• When they think in an integrated way, using both reflective and critical
approaches

Theory and practice are equally important in the Core Curriculum. The
acquisition of skills, as described by Benner (1984) in an approach that is still
accepted in nursing today, is described as a five-stage process: from novice,
to advanced beginner, to competent, proficient and finally expert practitioner.
The competent practitioner can be described as ‘having the ability to perform
actions/procedures proficiently in the workplace’ (Reece and Walker, 2006).
Benner (1984) expands on this by stating that the competent nurse ‘has a
feeling of mastery and the ability to cope with and manage the many
contingencies of clinical nursing. The conscious, deliberate planning that is
characteristic of this skill level helps achieve efficiency and organization.’

3 The teaching and learning environment

The setting in which specialist education courses take place varies from
country to country depending on the national health and education systems.
The following criteria need to be met (ENNO Framework, 2000):
• Theory should be provided at institutes of higher education (at the
university level or equivalent).
• Theory must be applied to clinical practice in a supervised clinical
environment, which must include support from a mentor.
• The educational setting (both the institution and the clinical area) must be
conducive to learning and encourage critical thinking and discussion.
• The educational setting should follow the principles involved in adult
education (e.g., constructivism).
• Both the institution and the clinical area must be able to provide
appropriate and up-to-date educational resources (e.g., library, seminar
rooms, information technology, etc.)

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4 Teaching staff
In addition to the appointed teaching staff, other professionals with recognized
expertise (e.g., doctors, dieticians, hygiene experts, etc.) can also make a
valuable contribution to the delivery of the Core Curriculum (ENNO
Framework, 2000). The roles outlined below are essential.

4.1 Internal assessor/mentor

4.1.1 Definition
An internal assessor or mentor is a professional member of the health-care
team who facilitates learning, supervises students and carries out continuous
assessment of the students in the practice setting.

4.1.2 Role
• To play an essential part in facilitating students to enhance their
knowledge and skills in the clinical setting in which endoscopic
procedures are undertaken.
• To work alongside students in the practice environment and judge their
abilities to achieve determined learning outcomes by undertaking
continuous assessment of their practice. The external assessor and
academic tutor provide support for the mentor in carrying out this
responsibility.

4.1.3 Qualifications
• Current nursing qualification
• Wide experience in endoscopy nursing practice
• Completion of an approved programme in mentorship

4.2 External assessor of clinical practice

4.2.1 Definition
A recognized expert in endoscopy nursing, appointed by the academic
provider of the course to undertake summative assessment of practice in the
clinical area (Figs. 1 and 2).

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Fig. 1 Example of the implementation of assessment procedures.

Institute of higher Clinical area

education

Academic tutor Internal

(= course leader) assessor
(= local mentor)

Cooperation Continuing
assessment

External assessor formative and Student

summative
assessment

4.2.2 Role
To assess the student’s ability to practice at the required standard. This is
achieved through a relationship involving the student, the mentor and the
external assessor. The external assessor has the key responsibility in
determining whether the student is fit for practice by carrying out summative
and final assessment of his or her practice. The academic tutor provides
support for the assessor in carrying out this responsibility.

4.2.3 Qualifications
• Current nursing qualification
• Wide experience in endoscopy nursing practice
• Completion of an approved programme in teaching and assessing in
clinical practice

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Fig. 2 Relationship between educators, assessors, management and the

student.

ASSESSMENT

EXTERNAL CLINICAL
FACILITATOR FACILITATOR
(Mentor) (Mentor)
(Assessor)
(to be apptd. by univ.)

STUDENT

ACADEMIC CLINICAL
TUTOR (NURSING)
MANAGER

DIAGRAM KEY
ADMINISTRATION COURSE DELIVERY SITES
COURSE
COURSE PERSONNEL
STUDENT

4.3 Academic tutor/course leader

4.3.1 Definition
A member of the teaching staff employed by the academic institution
delivering the course, with responsibility for ensuring that agreed quality
standards for all aspects of the course are met.

4.3.2 Role
This is a key academic role designed to meet the specific needs of the
course. The holder of the post will:

• Provide advice on the course content and structure

• Develop and lead a range of teaching strategies
• Take responsibility for implementing and coordinating the course
• Provide links between the clinical teaching team and the academic
institution

4.3.3 Qualifications
• Current nursing qualification
• Subject expertise:
academic – e.g., post-qualifying course, postgraduate study, research;

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practical – e.g. experience in the field, involvement in practice, links with

an endoscopy service
• Appropriate teaching qualification and experience in education

The infrastructure for learning and assessment involves many elements and
people. The theoretical part of the course brings the student into contact with
the institute of higher education concerned and with the academic tutor, as
well as the appointed external assessor.

In addition, students need support from their own employers for the practical
part of the course. Management has to support the student attending a
course, and to agree to provide an expert member of staff in the endoscopy
unit who provide mentoring and formative internal assessment during the
course.

The higher education institute and the staff members it appoints will also
need to collaborate with staff involved in the clinical area and with
management in order to ensure an environment that is conducive to learning.

5 Structure of courses and modules

5.1 Introduction
Specialist training courses in endoscopy nursing have been available in many
European countries since the 1980s. Due to considerable differences in
national training structures and political factors, these courses vary in length,
content and academic level, as well as in the official recognition given to
them.

Many countries are currently in the process of developing new courses for
endoscopy specialist nursing, in line with European recommendations and EU
directives.

In response to the need to promote equivalent training qualifications

throughout Europe, ESGENA has developed a flexible, modular course that is
consistent with the recommendations of various ongoing EU working groups
and EU directives. The ESGENA Core Curriculum will give countries enough
flexibility to adapt the content and length of national courses that already
exist. In addition, it’s comprehensive and clear structure will also help
countries develop new programmes and courses.

The scope of endoscopy nursing practice varies from country to country.

The flexible course structure enables countries to include different fields of
endoscopy as well as of gastroenterology, either as part of the core course
(with optional modules) or in additional modules for longer courses.

The flexible course structure is an open and forward-looking system, and

new techniques and new areas of work in nursing can easily be incorporated.

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5.2 Length of courses

Based on the ENNO framework, ESGENA has developed a course that
covers 720 theoretical hours (classroom and study), with a minimum of 50%
of the total duration being dedicated to clinical and/or practice training (ENNO
framework, 2000). The course must be equivalent to at least one calendar
year.

5.3 Outline of modules

The Core Curriculum consists of four modules of equal length. Each module
covers 180 hours (two units per module) (Fig. 3).

Fig. 3 Structure of the Core Curriculum modules.

5.3.1 Obligatory modules

The three obligatory modules (1, 2 and 4) impart e cessential knowledge and
skills .

• Module 1 covers the fundamentals of endoscopy nursing. In this module,

general nursing knowledge is transferred into the field of endoscopy and
basic endoscopy knowledge is taught. This knowledge provides the basis
for modules 2–4.
• Module 2 consists of two obligatory clinical units focusing on basic
endoscopy procedures.
• Module 4 covers advanced material that optimizes patients’ experience of
endoscopy (management, education, research, ethics).

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These modules cannot be replaced by optional modules, as they provide the

basis for making basic endoscopy training equivalent and interchangeable
throughout Europe.

• Module 3 focuses on clinical issues and includes two optional units. The
focus can be selected in accordance with national and local requirements.

5.3.2 Optional modules

To allow the curriculum to be adapted to the different educational formats that
exist all over Europe, the curriculum includes a choice of at least one optional
module involving two units of 90 hours each.

The scope of endoscopy nursing practice varies from country to country. In

some countries, the field of endoscopy nursing includes not only
gastroenterological endoscopy, but also endoscopy in fields such as thoracic
medicine, urology, surgery, gynaecology, etc. In other European countries,
the focus is on gastroenterology, and therefore includes not only endoscopy
topics, but also aspects such as stoma care, percutaneous endoscopic
gastrostomy (PEG), nutrition, inflammatory bowel disease (IBD), in-patient
care in gastroenterology, etc.

The optional modules can therefore be focused on endoscopic techniques

or on specific areas of patient care. Optional modules may vary not only from
country to country, but also within countries, depending on the local
educational system. The ESGENA Core Curriculum provides the flexibility
needed to comply with individual local needs and structures.

5.3.3 Implementation into a local curriculum

Learning outcomes and the course content are defined for each module and
have to be incorporated into and implemented into local core curricula and
course plans (see also section 8 below).

6 Content of modules 1–4

6.1 Module 1: Fundamentals of Endoscopic Nursing

Module 1 includes the basic knowledge required for endoscopy nursing. The
module contains two units:
• Unit A: an introduction to basics that serves as the foundation for the
more advanced information and applications included in module 4.
• Unit B: an introduction to basics that serves as the foundation for the
more advanced information and applications included in modules 2 and 3,
adapted to specific endoscopic procedures and issues in
gastroenterology.

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6.1.1 Aims
The aim is to provide an introduction to the principles underlying endoscopy
nursing practice and to develop basic skills and knowledge and an
understanding of the role of the professional nurse in providing high-quality,
evidence-based and individualized care for patients undergoing endoscopic
procedures.

6.1.2 Learning outcomes

On completing the module, students should:
1 Demonstrate an understanding of the history and development of
endoscopy nursing and appreciate the way in which an individual
develops to become a professionally accountable nurse in the context of
current trends and activities in nursing.
2 Be able to demonstrate knowledge of current views and attitudes towards
health, society and the individual patient.
3 Be aware of the way in which endoscopy care is organized in their own
country and throughout Europe, and of the relevant legislation affecting it.
4 Have respect for human beings and be able to act in accordance with
acknowledged ethical norms and legal requirements, recognizing the way
in which norms, values, cultures and attitudes influence legislation and
society.
5 5. Demonstrate aspects of accountability towards self, patient, profession
and employer .
6 Understand health and safety issues relating to the work environment.
7 Understand and be able to apply the principles of asepsis and sterilization
in managing infection control in the endoscopy environment.
8 Demonstrate knowledge of the principles of safe endoscopy care for
everyone in the endoscopy unit – including patients and their relatives and
partners.
9 Correctly document the nursing care given, using a recognized nursing
framework to assess, plan, implement and evaluate it.
10 Apply good communication skills and be able to use them to work well in
a multidisciplinary team, recognizing the needs of others in the team, and
to support patients’ relatives and partners in the endoscopy environment.
11 Be able to use computers and appreciate the role of information science
as a resource in endoscopy nursing.

6.1.3 Content of Unit A

• History and development of endoscopy nursing
• Guidelines, regulations, laws relevant to:
– General nursing
– Endoscopy nursing
• Documentation in endoscopy nursing:
– Different formats and systems
– Legal regulations
• Professional development in the context of endoscopy nursing
• Communication skills

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• Multidisciplinary teamwork
• Psychology
• Sociology
• Pedagogy & Andragogy (Educational and adult learning processes)
• Health education and disease processes specific to conditions requiring
diagnostic and therapeutic endoscopy
• Public health:
– National trends in public health
– International trends in public health
• Quality process and management
• Risk management
• Accountability
• Advocacy
• Information management:
– Information technology (IT)
– Research/appreciation
– Evidence-based practice
• Ethics
– Ethical and professional standards

6.1.4 Content of Unit B

• History and development of endoscopy techniques
• Guidelines, regulations, laws, manufacturers’ instructions for each item of
equipment
• Nursing process applicable to endoscopic procedures
• Standards of practice in endoscopy
• Pharmacology, sedation, anaesthesiology, resuscitation
• Emergency management
• Handling of specimens, histology, cytology
• Care of equipment (endoscopes and accessories); familiarity with
endoscopic equipment with regard to:
– Construction
– Functioning
– Intended usage
– Potential malfunctions
– Potential hazards
• Hygiene and infection control:
– Infection risks in endoscopy
– Transmission of infections in endoscopy
– The decontamination process with special attention to the complex
construction of endoscopic equipment and the methods and agents used
– Potential risks associated with the methods and agents used
– Potential risks to staff and patients during decontamination/reprocessing
of equipment

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• Occupational health/health and safety for patients and staff in endoscopy:

– Chemicals, hazardous agents, latex, etc.

– Ergonomics; lifting and positioning of the patient
– Radiology
– Electrotherapy and thermotherapy
– Lasers
– Argon plasma coagulation (APC)

6.1.5 Reference
European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA).
European job profile for endoscopy nurses – August 2004. Endoscopy 2004;36:1025–
30 [downloadable at [Link]
Sections 2, 5, 6, 8–10, 13.

6.2 Module 2: clinical modules with obligatory units

Module 2 focuses on clinical issues and contains two obligatory units
concerned with procedures of the:
• Upper gastrointestinal tract
• Lower gastrointestinal tract

In each unit the subjects / teaching units are taught focused on the respective
procedures:

• The basic aspects of some subjects have already been introduced in

Module 1. The corresponding applications and procedure-specific
information are taught in modules 2 and 3.
• The basic information in other subjects is taught in Modules 2 and 3, and
the relevant advanced information and applications are covered in module
4.

6.2.1 Aim
The aim of the module is to enable the student to develop the knowledge,
skills and attitudes that underpin safe practice in diagnostic and therapeutic
upper and lower gastrointestinal endoscopy.

Basic information on the topics listed below has already been dealt with in
module 1. Advanced and procedure-specific information and the ways in
which it is applied are taught in this module.

6.2.2 Learning Outcomes

On completing the module, students should:
1 Be able to use nursing procedures to provide safe and holistic care for
patients and their significant others for a range of upper and lower
gastrointestinal endoscopic procedures.

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2 Be able to provide effective technical assistance for a range of upper and

lower gastrointestinal endoscopic procedures.
3 Be able to demonstrate safe care of endoscopic and supplemental
equipment.
4 Be able to apply knowledge of anatomy, physiology and pathophysiology
relevant to the diagnostic and therapeutic procedures used in upper and
lower gastrointestinal endoscopy.
5 Be able to assess the risks and apply the principles of health and safety
and of infection control in upper and lower gastrointestinal procedures.
6 Be able to identify potential and actual complications related to upper and
lower gastrointestinal endoscopic procedures and take the appropriate
action in emergency situations.
7 Be familiar with the mode of action, indications for and administration of
common pharmacological agents used in upper and lower gastrointestinal
diseases and during upper and lower gastrointestinal endoscopic
procedures.
8 Be able to assess and monitor the patient’s physiological and
psychological responses before, during and after the procedure.
9 Be familiar with health education and able to use it to provide discharge
advice and information to patients and carers.
10 Be able to plan the patient’s discharge and communicate effectively in
order to ensure safe continuity of care.

6.2.2 Content of Units C and D (upper and lower gastrointestinal endoscopy)

• History and development of endoscopy techniques
• Guidelines, regulations, laws, manufacturers’ instructions for each item of
equipment
• Background knowledge
– Anatomy, physiology, pathophysiology
– Indications, contraindications, potential complications
– Comorbidities
– Risk factors
– Alternatives to endoscopy
• Standards of practice in endoscopy
– Procedural information and consent
– Staffing
• Nursing process applicable to endoscopic procedures
• Pharmacology, sedation, anaesthesiology, resuscitation
• Pain management
• Emergency management
• Handling of specimens, histology, cytology
• Care of equipment and familiarity with endoscopic equipment in relation
to:
– Construction
– Functioning
– Application
– Potential malfunction
– Potential hazards

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• Hygiene and infection control:

– Principles of the decontamination process with special considerations
ƒ of the complex construction of endoscopic equipment
ƒ of the methods and agents used (incl. automated
systems)
– Potential risks to staff and patients during decontamination/reprocessing
of equipment
• Occupational health/health and safety for patients and staff in endoscopy:

– Chemicals, hazardous agents, latex, etc.

– Ergonomics, lifting, positioning of patient
– Radiology
– Electro-thermotherapy
– Occupational health
• Patient education, specifically adapted to special procedures
• Health education and disease processes specific to conditions requiring
diagnostic and therapeutic endoscopy

6.2.3 Reference
European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA).
European job profile for endoscopy nurses – August 2004. Endoscopy 2004;36:1025–
30 [downloadable at [Link]
Sections 1–7, 9–11, 13.

6.3 Module 3: clinical modules with optional units

Module 3 focuses on clinical issues and contains two optional units. The focus
can be selected in accordance with national and local requirements.

Endoscopy-focused options may include, for example:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiography (PTC)
• Capsule endoscopy
• Thoracic medicine
• Urology
• Ear, nose and throat (ENT) medicine
• Paediatric endoscopy
• Surgery
• Gynaecology
• etc

Gastroenterology-focused units may include, for example:

• Nutrition
• Percutaneous endoscopic gastrostomy (PEG)
• Stoma care/colorectal cancer
• Inflammatory bowel disease (IBD)
• Liver diseases
• Oncology
• Gastroenterology for in-patients and outpatients

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• etc

Basic aspects of some of these topics have already been provided in module
1. The corresponding applications and procedure-specific information are
included in module 3.

Basic information about other subjects is included in module 3, while the

corresponding advanced information and applications are covered in module
4.

6.3.1 Learning outcomes for an ERCP module

On completing the module, the student should:
1 Be able to provide safe, holistic care for the patient and his/her significant
other for ERCP applying the nursing process
2 Be able to provide effective technical assistance during ERCP.
3 Be able to demonstrate safe care of endoscopic and supplemental
equipment .
4 Be able to Apply knowledge of anatomy, physiology and pathophysiology
relevant to ERCP.
5 Be able to assess risks and apply the principles of health and safety and
infection control to ERCP.
6 Be able to identify potential and actual complications related to ERCP and
take the appropriate action in emergency situations.
7 Be familiar with the mode of action, indications for and administration of
common pharmacological agents used in biliary and pancreatic diseases
during ERCP.
8 Be able to assess and monitor the patient’s physiological and
psychological response before, during and after the procedure.
9 Be able to Integrate knowledge of Health Education into discharge advice
and information to patients and carers.
10 Be able to plan the patient’s discharge and communicate effectively in
order to ensure safe continuity of care.

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6.3.2 Content of Unit E: ERCP

• History and development of endoscopy techniques
• Guidelines, regulations, laws, manufacturers’ instructions for each item of
equipment
• Background knowledge:
– Anatomy, physiology, pathophysiology
– Indications and contraindications
– Comorbidities
– Risk factors
– Alternatives to endoscopy
• Standards of practice in endoscopy:
– Procedural information and consent
– Staffing
• Nursing process applicable to endoscopic procedures
• Pharmacology, sedation, anaesthesiology, resuscitation and pain
management
• Emergency management
• Handling of specimens, histology, cytology
• Care of equipment and familiarity with endoscopic equipment in relation
to:
– Construction
– Functioni
– Application
– Potential malfunction
– Potential hazards
• Hygiene and infection control:
– principles of decontamination process with special considerations
ƒ of the complex construction of endoscopic equipment
ƒ of the methods and agents used
– Potential risks to staff and patients during decontamination /
reprocessing of equipment
• Occupational health/health and safety for patients and staff in endoscopy:

– Chemicals, hazardous agents, latex, etc.

– Ergonomics, lifting, positioning of patient
– Radiology
– Electro-Thermotherapy,
– Occupational health
• Patient education, specifically adapted to special procedures
• Health education and disease processes specific to conditions requiring
diagnostic and therapeutic endoscopy

6.3.3 Reference
European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA).
European job profile for endoscopy nurses – August 2004. Endoscopy 2004;36:1025–
30 [downloadable at [Link]
Sections 1–7, 9–11, 13.

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6.4 Module 4: Optimizing Nursing

Module 4 takes up basic knowledge and applications from Modules 1–3 and
develops advanced knowledge and application. It also introduces new and
more advanced topics such as management, education, research, and
ethics,etc.

6.4.1 Aim
The aim of the module is to enable the student to integrate the knowledge
gained in the previous modules and apply it to personal professional
development and enhancement of endoscopy nursing.

Basic knowledge on the topics listed has already been dealt with in module
1. Advanced and procedure specific knowledge and its application are taught
in this module .

6.4.2 Learning outcomes

On completing the module, students should:
• Demonstrate effective interpersonal skills in dealing with all levels of staff,
the patient, and the public at large.
• Be able to coordinate the workload involved in caring for a group of
patients undergoing endoscopic procedures.
• Be able to analyse and critically appraise published research studies
relevant to endoscopy nursing and to suggest possible applications of the
findings.
• Be able to apply the teaching and learning process to training colleagues
and the public at large.
• Be able to apply and participate in the quality assurance process.
• Be able to analyse an ethical dilemma in endoscopy nursing and consider
the advantages and disadvantages of possible modes of action.
• Be able to use computer facilities to enhance and develop the
management of the endoscopy service.
• Show evidence of professional development by initiating and managing
change in practice.
• Be able to adapt practice in the light of new developments.
• Be aware of current national and international public health issues.

6.4.3 Content
• Evidence-based practice
• Professional development in the context of endoscopy nursing:
– Personnel development
– Political developments in nursing
– Development of the discipline
– Risk management
– Accountability
– Advocacy

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ESGENA Core Curriculum
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• Nursing frameworks:
– Clinical pathways
– Nursing diagnosis, interventions and outcomes
– Nursing classifications
• Information management in endoscopy nursing
– Different formats and systems
– Legal regulations
• Communications skills
• Multidisciplinary teamwork, including staff management
• Psychology
• Sociology in health care
• Pedagogy & Andragogy
• Public health:
–prevention and education
– National trends in public health
– International trends in public health
• Quality assurance and management
• Research:
– Application
– Research analysis
• Ethics
– Ethical and professional standards
• Evaluation:
– Review of practice
– Reflective practice
– Audit practice
– Problem-solving methods
• Learning methods
• Teaching and learning skills and methods
• Management issues in endoscopy, including staffing
• Emerging new developments

6.4.4 Reference
European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA).
European job profile for endoscopy nurses – August 2004. Endoscopy 2004;36:1025–
30 [downloadable at [Link]
Sections 2, 6–13.

7 Assessment

7.1 Assessment levels

The overall aim of assessment is to promote good practice in the specialist
nursing field of gastroenterology and endoscopy. Assessment of learning
should be continuous throughout the course, with prescribed assessments for
each module.

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22

Aims of assessment are:

• To stimulate an enquiring, analytical and creative approach, encouraging
independent judgement and critical self-awareness.
• To encourage the skills needed for clear communication and logical
argument.
• To encourage students to transfer what they have learned into actual
patient care situations.
• To develop students’ skills in reflecting on practice, in order to ensure that
nursing practice is constantly reviewed and evaluated.
• To encourage research appreciation and the value of nursing research,
and the application of theory and valid research findings in the clinical
setting.

Objectives of assessment:
• To provide students with information about their educational progression
and personal progress.
• To assure society that students are competent and qualified to work in
endoscopy.

In addition to other factors, constructive evaluation will be a basis for adjusting

the form and content of the programme. Assessment of theory and practice
should reflect the ‘50% theory, 50% practice’ split recommended in the ENNO
framework.

The design of the learning outcomes, teaching and assessment methods

should be based on a constructivist approach to adult learning (Bloom 1956,
Atherton 2005). Assessment should therefore be (Reference: Plymouth Uni.
Assessment in Practice):
• Theoretical and practical for each module
• Reliable
• Ongoing (formative)
• Cumulative, through each module and final assessment (summative)
• Valid
• Explicitly and accessibly presented with sufficient information
• Relevant to the teaching content and methods, with adequate and varied
tools
• Using a balanced proportion of formative and summative assessments
• Followed systematically with feedback
• Documented (with a portfolio of evidence)
• Conducted by qualified assessors

Students can be assessed using a variety of methods, which may vary in

different European countries. Table 1 is designed to help in the selection of
the most appropriate methods in different situations.

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ESGENA Core Curriculum
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7.2 Suggested assessment methods

Table 1 Suggested assessment methods. These can be used for
formative and summative assessment.

Area Students

Theory Practice Group Individual

(oral or written)

Case study X X X

Debate (pros and contras) X X

Direct observation of practice (DOP) X X X

Discussion X X

Interviews X X

Literature-based research projects X X X

Multiple-choice questionnaires (MCQ) X X X

Oral examination X X

Patient care plan and rationale X X

Patient education X X

Portfolio X X X

Poster presentation X X X

Practical examination X X X

Presentation to peer group X X X

Production of learning package X X X

Production of patient information (sheets and X X X

booklets)

Quizzes and games X X

Reflective writing X X

Self-assessment X X X

Short and long essays X X

Simulation (e.g., dummies, simulators, models, X X X

role play)

Statement of competence from authorized X X

persons

Video-recorded performance X X X

Written assignment X X

Written examination X X X

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7.3 Criteria for failed practice

Failed practice can mean that the student has failed in one or more of the
following areas.

Clinical practice:
• Lack of compliance with national regulations.
• Wrong assessment of the patient’s condition and holistic needs. The
student does not gather information from available sources, does not see
problems or potential risks, is not realistic in his or her assessments.
• Lacks underpinning knowledge and expected experience.
• General failure in the planning and performance of nursing care and/or
technical assistance.
• Failure of or inadequate record-keeping. The student does not include
important information, or includes erroneous information.
• Lack of theoretical understanding to support clinical actions.

Personal attributes:
• Lack of responsibility for personal professional development. The student
does not acknowledge personal weaknesses in abilities and skills. The
student does not consider how to improve problem areas or accept help
or guidance.
• Lack of initiative in the learning situation.
• Functional failure in teamwork.
• Lack of ability and willingness to take on problematic tasks, difficult
procedures or patients, or acute situations.
• Functional failure in new or high-pressure situations.
• Lack of ethical judgement. The student does not consider the patient’s
explicit wants and needs, does not preserve the patient’s autonomy,
undermines the trust/confidence of colleagues, or does not observe
confidentiality, considerations of fairness, or the need to avoid racial
discrimination.

8 Guidelines for implementing and using the core

curriculum
The following sections may help individuals or societies in establishing a new
course or changing the format of established ones in order to meet European
recommendations. Figure 4 provides an overview of the official bodies
involved at the European, national and local levels.

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ESGENA Core Curriculum
 25

Fig. 4 Official working groups and their tasks in relation to implementing the
core curriculum.

Level Official bodies Development/

responsibilities

ESGENA Education
Working Group
 European Core
Curriculum

European 

Key members
 Consultation


Consultation requirements group
(examples), with representatives from:

Endoscopy Appropriate Universities

nursing national
National recognition/
societies nursing
regulatory
Educational
institutions
 acceptance
bodies

Medical Government
societies officials
National


National implementation group
(example), with representatives from:

Endoscopy Appropriate Universities  National core curriculum

nursing national
societies nursing Educational
regulatory institutions
bodies


Local implementation group (if
required), with representatives from: Running a course:
– Organization
Local Clinical area Universities  – Evaluation
Educational
institutions

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26

8.1 Cooperation with official bodies

If a national or local course in endoscopy nursing is not available in a given
country, national teams should be set up in order to plan potential courses
and to implement and monitor them.

If endoscopy courses are already available in the country concerned, national

or local teams should evaluate the extent to which the existing courses are in
accordance with the European recommendations.

The national teams should be multidisciplinary working groups of experts,

educators and representatives of the relevant official bodies and should
include, for example:

• Endoscopy nurses’ societies

• National nursing associations
• Nursing registration bodies and/or regulatory bodies
• Relevant medical societies
• Universities and institutes involved in endoscopy education programmes
• Government officials concerned with nursing education (e.g., official
bodies or ministries of health, culture and education)

These representatives may be:

• Experts with broad experience in the relevant field (e.g., gastroenterology)
• Educators
• Representatives of regulatory bodies

The working groups should develop and update:

• National guidelines for specialist education in endoscopy
• A national core curriculum for endoscopy nursing

8.2 Local implementation group

Local implementation groups should include experts from the clinical area,
educators and tutors from the relevant educational institutes or universities.

These working groups should:

• translate national guidelines and core currucula into a local course
concept.
• Plan, organize, deliver and evaluate the local courses.

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8.3 Three phases of implementation

The implementation of a curriculum has three phases (Fig. 5).

Phase I:
• European and general national frameworks for post-basic education
influence the structure, content, academic level and recognition of
national courses. Both European and national recommendations need to
be taken into account when new courses are being developed. European
and national recommendations for post-basic nursing education have to
be complied with for courses to receive official recognition.

Phase II:
• National guidelines for specialist education in endoscopy should be
developed by a multidisciplinary working group.
• National guidelines describe the focal points, duration and structure of the
courses (Fig. 5). They should follow the recommendations given in this
document, e.g.:
– Minimum time allocated for each module: 90 hours
– Academic qualifications required for teachers and tutors
Despite this, there is still considerable scope for flexibility in implementing
national-specific recommendations.
• The national core curriculum should be developed by a team of educators
and experts in the field of endoscopy.

Phase III:
• Each institute of higher education has to translate the national Core
Curriculum into a course model. Although the content and minimum
number of hours are fixed by the curriculum, there is sufficient flexibility
for differently structured courses to be set up in each country.

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Fig. 5 The three phases of implementation.

Phase Official documentation Details to be clarified

European
recommendations
• EU directives
! • ENNO framework
• ESGENA Core
Phase Curriculum
I

National guidelines/
framework for post-
basic nursing
education

 
• Focal points/target group
• Duration of course
National guidelines for • Theoretical/practical hours
specialized endoscopy education  • Teaching staff
• Education level/location
Phase • Recognition
II

• Implementation
Development of core curriculum • Content of course
for endoscopy nursing  • Aims and learning outcomes
• Evaluation and assessment


• Local management team
• Structure of course (single days,
weeks, distance learning, practical
parts)
• Location for theory and practice,
equipment, etc.
• Reference centres for practice
• Selection of teachers, tutors,
assessors
Phase
III
Development and organization of local courses  •
•
Dates, timetable of course
Advertising and recruitment
• Selection of students
• Definition of catchment area
• Study material
• Documentation
• Assessment and evaluation
• Costs
• Funds and sponsorship
• Etc.

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8.4 Key members

ESGENA can provide support from key members who can be contacted
during the process of establishing a new course or evaluating existing
courses. Key members have wide experience in:
• Endoscopy/gastroenterology
• Organizing courses
• Teaching
• Working at the European level

The key members include those who were involved in the development of the
European Core Curriculum.

Key members are nominated by the ESGENA Education Working Group.

Their tasks are:
• To serve as contact persons for national groups.
• To provide advice during the process of establishing a new course or
evaluating existing courses.
• To distribute information.
• To establish contacts between different countries.
• To report back to ESGENA Education Working Group.

A list of key members who have been nominated is available on the

ESGENA web site ([Link]).

8.5 Academic levels: equivalence of educational courses through the

Bologna process
As a result of local traditions, EU countries have had different ways of
expressing and measuring study programmes, including time requirements
(numbers of years of study required), credit points, identification of learning
outcomes and skills, qualifications and level indicators, and subject
benchmarks. The existence of different national measures and levels for
(academic) qualifications make it difficult to obtain EU-wide recognition of
qualifications, and this restricts practitioners’ freedom of movement from
country to country.

The Bologna Declaration of June 1999 on the creation of a Europe-wide

framework for higher education was a pledge taken initially by 29 countries to
reform their own higher education systems. The aim of the Bologna
Declaration is overall convergence at the European level, resulting in a
system of easily comprehensible and comparable university degrees. The
system was initially based on the adoption of two main levels of university
education – undergraduate and graduate (Bologna Declaration, 1999).

The aims formulated in the Bologna Declaration relate to the undergraduate

(bachelor’s degree) and graduate levels (master’s degree); these have been
supplemented by the Berlin Communiqué, which added the doctoral degree
as a third level (Bologna Declaration, 1999).

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In addition, over the last decade, the European Credit Transfer System
(ECTS) has been successfully introduced through the European
Commission’s Socrates ERASMUS programme, which was initially designed
as a tool to facilitate European student mobility. The ECTS has now become a
generalized course credit system for the emerging European Higher
Education Area, as university degrees throughout Europe have converged
through the implementation of the Bologna process.

This has made it possible to develop shorter higher education “short cycle”
courses (within the first degree level/cycle). These are awards that are made
to students who have completed a programme of study of 1year, for example,
within the first degree level in the Bologna scheme, but which do not
represent the full extent of this level (i.e., 3 years). These awards can prepare
the student for employment while also providing preparation for and access to
studies leading to completion of the first degree level. National systems may
include various qualifications within the first degree level.

In addition, the EU also recognizes a ‘Diploma certifying successful

completion of training at post-secondary level of a duration of at least one
year, or professional training which is comparable in terms of responsibilities
and functions’ (Directive 2005/36/EC of the European Parliament and of the
Council of 7 September 2005 on the recognition of professional
qualifications).

The present Core Curriculum will be in accordance with the shorter higher
education courses (higher education short cycle within the first degree level - )
as defined in A Framework for Qualifications of the European Higher
Education Area (Bologna Working Group on Qualifications Frameworks,
2005) and Directive 2005/36/EC.

9 Review date
This document is to be reviewed 5 years after its publication date.

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ESGENA Core Curriculum
 31

10 Appendix

10.1 European Job Profile for endoscopy nurses

The European Job Profile was developed by the ESGENA Education Working
group in 2002. It was published in Endoscopy 2004;36:1025–30. [Minor
changes to the text have been made here to correct the English.]

10.1.1 Introduction
Over the last 30 years, endoscopy has become an essential tool for medical
diagnosis and treatment. In parallel with technological developments and
increasing specialization among physicians, endoscopy nursing has
developed into a discipline that involves highly qualified nursing and
assistance tasks alongside the endoscopist. Endoscopy nurses work within a
multidisciplinary team both in hospitals and in general practice and primary
care. The scope of endoscopy nurses’ practice varies from country to country.
In some countries, for example, the field of endoscopy nursing includes not
only gastroenterological endoscopy, but also thoracic medicine, urology,
surgery, gynaecology, etc. In another group of countries in Europe, the focus
in endoscopy nursing is on gastroenterology. Consequently, the work of the
nurses concerned involves not only endoscopy, but also stoma care,
percutaneous endoscopic gastrotomy (PEG), nutrition, inflammatory bowel
disease (IBD), in-patient and outpatient care in the field of gastroenterology,
and other areas. Whereas job profiles have been established in some
European countries, the structure and content of the jobs concerned varies
from one country to another. The European Society of Gastroenterology and
Endoscopy Nurses and Associates (ESGENA) has therefore developed this
European Job Profile for endoscopy nursing, in order:
• To offer clear and structured information about the endoscopy nursing.
• To promote discussions in member countries concerning endoscopy
nursing as a recognized specialty.
• To offer a structure for developing country-specific job profiles.
In addition, the European Job Profile will serve as a basis for developing a
European Core Curriculum.

10.1.2 Philosophy
• The endoscopy nurse is a specialist nurse whose goal is to provide
optimal care and thereby enhance the quality of life of patients undergoing
diagnostic or therapeutic endoscopy procedures. This is accomplished by
a nurse who is a member of a multidisciplinary health-care team whose
practice is governed by ethics and professional codes of conduct, the
patient’s needs being the primary focus of all concerns (Bottrill 1991).
• Every patient undergoing a diagnostic or therapeutic endoscopic
procedure has the right to be treated by a qualified nurse trained in the
field of endoscopy care.
• The endoscopy nurse is responsible for ensuring individualized and
comprehensive patient care.

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• Health education is an integral part of the endoscopy nurse’s role, with the
emphasis on prevention, screening, education and support.
• Endoscopy nurses have a responsibility to update their knowledge by
undertaking continuing education in order to be able to provide evidence-
based practice.
• Endoscopy nurses are professionals who are accountable for their
actions.
• Endoscopy nurses are members of a multidisciplinary team and they act
as the patient’s advocate within that team.

10.1.3 Qualification and competencies (Table 2)

Table 2 A specialist nurse is a nurse formally educated and practically
trained beyond the level of a general nurse, who is authorized to practice as a
specialist nurse with advanced expertise in a specialized branch of nursing
(Advisory Committee for Training in Nursing, 1994). The specialized practice
includes advanced nursing and/or clinical skills and related tasks and
advisory, research, teaching and administrative activities in the specialized
field concerned.

Competences Essential

Qualification Qualified nurse after a formal period of education and training

(including 3 years, 4600 hours; EU Directive 77/452/EEC)

1 The qualified nurse is able to work in endoscopy after

Entrance into/employment in completing basic nursing education. It is recommended that
endoscopy nursing she/he should have a minimum of 1 year’s experience in
general nursing (ENNO Framework 2000)

Technical skills on entrance Endoscopy nurses require a high level of technical skills. New
into/employment in recruits require the aptitude and ability to understand and
endoscopy nursing undertake complex technical tasks

Interpersonal skills on Endoscopy nursing is characterized by short but intensive

entrance into/employment in contact with patients. Endoscopy nurses work in an outpatient
endoscopy nursing setting. They should therefore:
– Be able to work independently or as part of a
multidisciplinary team
– Have a high level of communicative and organizational skills

2 The requirements for entering specialist nursing education in

Entrance into specialist endoscopy are:
training in endoscopy – A minimum of 1 year’s experience after passing basic
nursing education (ENNO Framework 2000)
– A minimum of 6 months’ experience in the field of endoscopy

10.1.4 Knowledge and responsibilities (Table 3)

Endoscopy nurses perform a variety of functions. Their tasks and
responsibilities cover the following areas:
• Comprehensive patient care
• Technical assistance during diagnostic and therapeutic procedures

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• Care of endoscopic equipment

• Hygiene and infection control and prevention including reprocessing of
endoscopic equipment
• Documentation and record-keeping
• Organization and clinical management
• Health and safety
• Legal and ethical aspects
• Research
• Providing patients and carers with information about health and disease
• Education and training of staff
• Quality control

Outcome quality:
• The endoscopy nurse is responsible for providing professional and
comprehensive patient care in order to ensure the patient’s physical
safety and psychological well-being before, during and after endoscopic
procedures and to prevent any hazards or avoidable complications.
• The endoscopy nurse is responsible for professional and highly qualified
technical assistance during endoscopic procedures.
• The endoscopy nurse is responsible for enhancing cooperation within a
multidisciplinary team in the endoscopy department and in the institution
in which they are employed.
• Endoscopy nurses are responsible for facilitating a safe environment for
their own benefit and that of patients, colleagues and carers.
• Endoscopy nurses are responsible for maintaining a learning environment
for their own benefit and that of patients, colleagues and carers.
• The endoscopy nurse is responsible for contributing to accurate and
relevant record-keeping.

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Table 3 The specialist knowledge, tasks and responsibilities of a trained

endoscopy nurse.

Tasks and responsibilities Knowledge Application

Underpinning knowledge Anatomy, physiology, Thorough understanding of

pathophysiology relevant to the endoscopic procedure,
endoscopic diagnostic and including indication,
therapeutic procedures performance, risks and
complications

Distinguishing normal and

abnormal structures and
functions of the organs
examined

Comprehensive patient care Nursing process applicable to Assessment, identification

in endoscopy endoscopic procedures of individual problems,
planning, delivery and
evaluation of nursing care
appropriate to patients
undergoing endoscopic
procedures

Optimal preprocedure,
intraprocedural and
postprocedure care for each
patient undergoing
endoscopic procedures

Standards of practice in Physical preparation of the

endoscopy patient for endoscopic
diagnostic or therapy,
specific intraprocedural and
postprocedure care

Psychology Providing psychological

support before, during and
after endoscopic procedures

Pharmacology, intravenous Monitoring of vital signs and

therapy, anaesthesiology, assessment of patient’s
resuscitation response to sedation
before, during and after the
procedure

Identification of potential
and actual complications
related to an endoscopic
procedure

Appropriate response to the

emergency situation

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ESGENA Core Curriculum
 35

Tasks and responsibilities Knowledge Application

Health education and disease Patient information and

processes specific to education, counselling
conditions requiring about follow-up care
diagnostic and therapeutic
endoscopy

Technical assistance Knowledge about the Preparation and handling of

construction, function and instruments, equipment,
application of endoscopes including function testing
and endoscopic accessories, and problem solving during
thorough understanding of use
the procedures

Knowledge of diagnostic and Technical assistance during

therapeutic endoscopic diagnostic and therapeutic
procedures including procedures
purpose, indications,
contraindications,
performance, risks and
complications

Care of endoscopic Knowledge about the Competence in equipment

equipment construction, function, care ; maintenance and
application and potential storage of endoscopic
malfunction and hazards of equipment
endoscopic equipment

Knowledge about guidelines, Maintenance, care, use and

regulations, law, disposal of endoscopic
manufacturers’ instructions equipment in accordance
for respective equipment with guidelines, regulations,
laws and manufacturers’
instructions

Hygiene and infection control Principles of the Decontamination and

decontamination process, reprocessing of endoscopic
with special consideration of: equipment
– The complex construction
of endoscopic equipment
– The methods and agents
used

Infection risks in endoscopy Protection measures for

staff, patients and
environment

Transmission of infection in
endoscopy

Potential risks to staff and

patients during
decontamination/reprocessin
g of equipment

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Tasks and responsibilities Knowledge Application

Documentation and record- Nursing process applicable in Patient documentation:

keeping endoscopic procedures accurate documentation and
record of patient’s activities
and individual patient care

Legal requirements for Equipment documentation:

documentation accurate documentation and
record of use, reprocessing,
maintenance and
traceability

Different formats and systems Department documentation:

for documentation taking part in accurate
documentation of
departmental audit

Organization, clinical Basic principles of clinical Time management of

management management specific to allocated workload,
endoscopy scheduling procedures,
setting clinical priorities

Appropriate use of initiative

Professional accountability Conforming with quality

relevant to endoscopic standards set locally,
practice nationally and by
professional nursing bodies

Working within the

boundaries of education,
training and experience

Professional development Continuous update in the Remaining clinically

endoscopy field, general effective in practice
nursing and health care

Health and safety Health and safety concerns Taking appropriate action to
for patients and staff in protect patients, self and
endoscopy (chemicals, other members of the team
ergonomics, latex, radiology, from potential harm
electrical/diathermy, lifting,
hazardous substances, etc.)

Legal, ethical aspects Ethical, professional Providing patient care within

standards legal and ethical limits

Guidelines, regulations, laws Acting within boundaries of

relevant to general nursing code of nursing conduct
and endoscopy nursing

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 37

Tasks and responsibilities Knowledge Application

Research Data collection, Providing evidence-based

documentation, analysis, practice
interpretation, critical
evaluation of publications Maintaining and evaluating
professional standards

Participation in clinical
research (trial study, testing
new instruments, evaluation
of effectiveness of care and
treatment)

Education and teaching of Basic educational theory, Maintaining clinical

staff learning and teaching competencies through
methods ongoing education

Teaching and training of

new staff in the endoscopy
setting

Health and disease education Principles of health education Provision of appropriate

of patients and carers health and disease
education to patients, their
relatives and families and
health-care providers

Disease process relevant to

conditions requiring
endoscopy

N.B. This Job Profile does not address the specific needs, knowledge and skills required for
department leaders in endoscopy.

Job description
National wage and salary agreements do not always require a written
formulation of a job profile in every European country. Nevertheless, a job
profile is an important instrument for quality assurance in the nursing process,
along with nursing standards and nursing documentation. It provides the
employee with clear and structured information about the tasks and
responsibilities of endoscopy nurses. This clarity increases job satisfaction
and enhances efficiency and motivation. It also means that an unnecessary
lack of information and confusion over responsibilities can be avoided.

A national job profile is the basis for department-specific job descriptions. It

describes the smallest unit of a department/company: the employment
position/job. It varies according to the practice setting and its organizational

© European Society of Gastroenterology and Endoscopy Nurses and Associates, 2008

38

structures. The duties vary depending on the size of the department and
number of procedures performed.

Job descriptions should include a number of common elements:

• Title of the position
• Job qualifications (essential and desirable qualifications, experience
required)
• Personal qualities and characteristics required
• The person to whom the individual will be responsible
• The position of the employment position within the hospital’s hierarchy
• Connections and associations with other jobs in the department and the
hospital

The job description provides detailed information about tasks and

responsibilities with regard to:
• Comprehensive patient care
• Technical assistance during diagnostic and therapeutic procedures
• Care of endoscopic equipment
• Hygiene and infection control and prevention, including reprocessing of
endoscopic equipment
• Documentation and record-keeping
• Organization and clinical management
• Health and safety
• Legal and ethical aspects
• Research
• Providing patients and carers with information about health and disease
• Education and training of staff
• The job description should include a statement of lines of
responsibility/communication

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ESGENA Core Curriculum
 39

10.2. Recommendations for a European framework for specialist nursing

education

Developed by the European Network of Nurses’ Organizations (ENNO) in

November 2000 in Paris.

Purpose
Since in many countries in the European Union, specialist nursing practice
requires post-basic nursing education that varies from one country to another,
the European Network of Nurses’ Organizations has developed a framework
for specialist nursing education in order to harmonize post-basic nursing
education and thereby facilitate the free movement of specialist nurses
throughout Europe.

Preamble
The field of nursing knowledge and its associated skills has become too vast
and complex for any one person to master in full, and it must therefore be
acknowledged that specialization within nursing has now become necessary
in order to provide quality care and ensure the safety and well-being of
patients and consumers.

Early in its development, professional nursing recognized that certain

population needs and particular settings for nursing practice require
practitioners with more specific and specialized knowledge and skills than can
effectively and efficiently be obtained in educational programs for general
practice.

The benefits of specialization in any occupation are considered to accrue to

the recipients (patients, clients and consumers), to the profession, to the
practice, and to the practitioners. The development of nursing specialties is
believed to be critical in stimulating the growth of nursing knowledge and
expertise so that the quality of care provided to the population can be
improved. The International Council of Nurses (ICN) definition, stating that
specialization ‘implies a level of knowledge and skill in a particular aspect of
nursing which is greater than that acquired during the course of basic nursing
education’ acknowledges that specialization is a path in which nursing
practice is deepened and refined.

The regulation concerning the nursing profession and free movement within
Europe is EU Directive 77/452/EEC, which takes into account equivalences
for the practice and education of nurses responsible for general care but does
not take account of nurses with specialist and post-basic education. Directive
89/48/EEC and Directive 92/51/EEC, as amended in 1997 and supplemented
by the Directive 1999/42/EC on the general system for the recognition of
professional qualifications, are the only directives appropriate for specialist
nurses. They are based on consideration of the education, training and
professional experience of practitioners.

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Specialist nurse
A specialist nurse is a nurse who has received formal education and practical
training beyond the level of a general nurse and who is authorized to practice
as a specialist nurse with advanced expertise in a branch of nursing.

Specialized practice includes advanced nursing and/or clinical skills and

related tasks, and advisory, research, teaching and administrative activities in
the field of the specialty.

Specialist nursing education is a formally recognized post-basic program of

study that follows on from general nursing education and training and
provides the knowledge and experience needed to ensure competence in the
specialization concerned.

Further education, training and authorization are determined in the light of

the tasks, training, education, and activities of post-basic specialists in other
branches of the profession and in the light of the rules and regulations
applicable to them.

Titles for specialist nurses mostly include the designation ‘specialist nurse’
combined with the name of the specialization.

Recommendations and principles

• The specialty defines itself as nursing and subscribes to the overall
purpose, functions, and ethical standards of nursing.
• The specialty practice is sufficiently complex and advanced that it is
beyond the scope of general nursing practice.
• There is both a demand for and a need for the specialty service.
• The focus of the specialty is a defined population that demonstrates
recurrent problems and phenomena that lie within the discipline and
practice of nursing.
• The specialty practice is based on a core body of nursing knowledge that
is being continually expanded, updated and refined by research and
experience.
• The specialty has established educational and practice standards that are
congruent with those of the profession and are set by a recognized
nursing body or bodies.
• The specialty adheres to the licensing/registration requirements for the
general nurse.
• Specialty expertise is obtained through a professionally approved
advanced education program that leads to a recognized qualification. The
program is administered by, or in collaboration with, a specialist nurse.
• The specialty has a credentialing process determined by the profession or
in accordance with the national practice for other professions. Sufficient
human and financial resources are available to support this process.
• Specialist nurses are organized and represented within a specialty
association or a branch of the national nurses’ association and/or nursing

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Specialist nursing education

Specialist nursing education is a formally recognized post-basic program for
nurses previously recognized as registered nurses under EU regulations
(Directive 77/452/EEC), with a minimum of 1 year of nursing experience. The
program:
• Takes place in an institute of higher education (university or equivalent)
while assuring adequate access to practice and/or clinical resources for
clinical practice.
• Continues from year to year (i.e., it is not a refresher course or seminar)
and is regularly updated.
• Is recognized by an appropriate authority.
• Has specified admission requirements.
• Has a full-time teaching staff or faculty, including nurses qualified by
education and experience (preferably with a master’s degree or doctoral
degree) and, on request, other professionals recognized for their
expertise.
• Is developed, controlled and administered by or in collaboration with the
nursing profession, including specialists.

Length of the program

This will vary depending on the content of basic nursing education, but may
be equivalent to at least 1 year, with a minimum of 720 theoretical hours
(classroom and study) and a minimum of 50% of the total duration dedicated
to clinical and/or practice training.

Qualification/graduation
On qualifying, the nurse will be provided with a certificate, diploma, or degree
appropriate to the education designating him/her as a specialist nurse.

This proposal was developed by the appointed ENNO steering group:

• International Federation of Nurse Anaesthetists (IFNA): Pascal Rod
(Chairperson)
• European Dialysis and Transplantation Nurses Association (EDTNA-
ERCA): Anna Marti i Moros, Waltraud Küntzle)
• European Society of Gastroenterology and Endoscopy (ESGENA):
Christiane Neumann
• Irish Nurses’ Organization (INO): Annette Kennedy
• National Nurses’ Association of the Netherlands (NU’91): Ted Kraakman,
Pieter Jochems
• Swedish Association of Health Professionals: Ella Danielson

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10.3 References/Bibliography
Advisory Committee for Training in Nursing. Recommendations on continuing and specialist
education and training (III/F/5004/4/93-EN). Brussels: Commission of the European
Communities, 1994.
Atherton JS. Learning and teaching: Bloom’s taxonomy [2005].
[Link] (accessed 5 January 2008).
Benner PE. From novice to expert: excellence and power in clinical nursing practice. Menlo
Park, CA: Addison-Wesley, 1984.
Bloom BS, ed. Taxonomy of educational objectives: the classification of educational goals.
New York: Longmans, Green, 1956.
Bologna Declaration of 19 June 1999: joint declaration of the European Ministers of
Education. Available at:
[Link] and
[Link] (accessed 5 January 2008).
Brussels: Commission of the European Communities, 1999.
Bologna Working Group on Qualifications Frameworks. A framework for qualifications of the
European Higher Education Area. Copenhagen: Ministry of Science, Technology and
Innovation, 2005. Available at: [Link]
Main_doc/050218_QF_EHEA.pdf (accessed 5 January 2008).
Bottrill P. Gastrointestinal endoscopy – guidelines for safe clinical practice: a British
perspective. United Kingdom Central Council. Gastroenterol Nurs 1991;13:234–8.
Council of Europe: Committee of Ministers. Recommendation no. R (83) 5 of the Committee
of Ministers to member states on further training for nurses. Available at:
[Link]
DocId=679416&SecMode=1&Admin=0&Usage=4&InstranetImage=45381 (accessed 5
January 2008).
Council of the European Union. Council Directive 77/452/EEC of 27 June 1977 concerning
the mutual recognition of diplomas, certificates and other evidence of the formal
qualifications of nurses responsible for general care, including measures to facilitate the
effective exercise of this right of establishment and freedom to provide services.
Available at: [Link]
[Link]/LexUriServ/[Link]?uri=CELEX:31977L0452:EN:HTML (accessed
5 January 2008).
Council of the European Union. Council Directive 89/48/EEC of 21 December 1988 on a
general system for the recognition of higher-education diplomas awarded on completion
of professional education and training of at least three years’ duration. Available at:
[Link]
(accessed 5 January 2008).
Council of the European Union. Council Directive 92/51/EEC of 18 June 1992 on a second
general system for the recognition of professional education and training to supplement
Directive 89/48/EEC. Available at: [Link]
[Link]/LexUriServ/[Link]?uri=CELEX:31992L0051:EN:HTML (accessed
5 January 2008).
European Parliament and Council of the European Union. Directive 1999/42/EC of the
European Parliament and of the Council of 7 June 1999 establishing a mechanism for
the recognition of qualifications in respect of the professional activities covered by the
Directives on liberalisation and transitional measures and supplementing the general
systems for the recognition of qualifications. Brussels: European Parliament and
Council, 1999.
International Council of Nurses. Nursing regulation guidebook: from principles to power.
Geneva: International Council of Nurses, 1992.
Reece I, Walker S. Teaching, training and learning: a practical guide. 6th ed. Sunderland, UK:
Business Education Publishers, 2006.
Russell RL, Gething L, Convery P. National review of specialist nurse education [EIP 97/2].
Canberra: Australian Government Department of Education, Employment and
Workplace Relations, 1997.

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10.4 Glossary

10.4.1 Practice
Accountability is the acknowledgement and assumption of responsibility for
actions and decisions, including an obligation to report, explain and be
answerable for the resulting consequences.

Benchmark. Benchmarking (the terms ‘best-practice benchmarking’ and

‘process benchmarking’ are also used) is a process used in management,
in which organizations evaluate various aspects of their processes in
relation to the best practice in their own sector. This then allows
organizations to develop plans on how to adopt such best practice,
usually with the aim of improving some aspect of performance.
Benchmarking opens organizations up to new methods, ideas and tools
as ways of improving their effectiveness.

Ergonomics. The applied science of equipment and workplace design

intended to maximize productivity by reducing operator fatigue and
discomfort.

Nursing process. The nursing process is a process, often supported by

nursing models or philosophies, by which nurses deliver care to patients.
It is a cyclical and ongoing process using assessment, care planning and
implementation and evaluation of care. The nursing process focuses on
ways of improving not only the patient’s physical needs but also his or her
social and emotional needs.

Patient experience. The patient experience is the experience from the

patient’s point of view when receiving health-care services.

Risk management is a human activity that integrates recognition of risk, risk

assessment, developing strategies to manage risk, and mitigating risk
using managerial resources. The strategies involved include avoiding the
risk, reducing the negative effect of the risk, and accepting some or all of
the consequences of a particular risk.

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10.4.2 Education
Academic year. The period of formal instruction, usually from late
August/early September to late May/early June. It may be divided into
terms or semesters of varying lengths.

Andragogy. ‘The art or science of teaching adults’ (Merriam-Webster’s Third

New International Dictionary, Unabridged; not in Oxford English
Dictionary). From Greek aner/andros, ‘man’ and -agogy on analogy with
‘pedagogy’. A term used by adult educators to describe the theory of adult
learning.

Bologna process. The purpose of the Bologna process is to create a

European higher education area by making academic degree standards
and quality assurance standards more comparable and compatible. This
is intended to facilitate the recognition of academic qualifications
throughout Europe. It is named after the University of Bologna in Italy,
where in 1999 the Bologna Declaration was signed by ministers of
education from 29 European countries.

Catchment area. A term defining the area and population from which an
individual service attracts potential students.

Contact time. The time students are expected to spend in lectures, tutorials,
seminars and workshops in which they have direct and organized contact
with staff and other students.

Credit points. The units which universities use to record the completion of
courses (with passing grades) that are required to complete the degree.
The university will define the amounts and types of credit required for
degrees and will state the value of each course offered in terms of ‘credit
hours’ or ‘units’.

Erasmus programme. The Erasmus programme was established in 1987 and

forms a major part of the European Union’s Lifelong Learning Programme
2007–2013. It is the operational framework for the European
Commission’s initiatives in higher education.

Institute of higher education. An educational institution that: 1) admits as

students only persons having a certificate of graduation from a school
providing secondary education, or the recognized equivalent of such a
certificate; 2) is legally authorized within such state to provide a program
of education beyond secondary education; 3) provides an educational
program for which it awards a bachelor’s degree or higher, or provides not
less than a two-year program (or its equivalent) which is acceptable for
full credit toward such a degree and/or certification; 4) is a public or other
non-profit institution; and 5) is accredited by a recognized body or bodies
approved for such purpose.

Pedagogy. ‘The art, science, or profession of teaching; esp. the study that
deals with principles and methods in formal education’ (Merriam-
Webster’s Third New International Dictionary, Unabridged).

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Portfolio. A collection of work (e.g., writings, reflections, etc.) that may be

used to demonstrate competency in an academic area.

Post-basic. Additional education beyond the level of general care nursing

education, considered as the basic one.

Practical hours. Clinical experience under individual or group supervision with

the aim of furthering practical skills.

Statement of competence from authorized persons. Statement of an

authorized person on the competence of performance observed.

Study hours. Includes all types of theoretical hours that are not classroom
hours (personal work, technical and laboratory training, library, research).

Study week/year. The period of time in which a unit or module of a course is

taught.

Theoretical hours. The study time taken to teach or learn the theory of
subjects.

Underpinning knowledge. The knowledge and understanding needed to

support performance as an essential component of competence.

10.4.3 Organizations
EFN. The European Federation of Nurses’ Associations ([Link]).
Formerly known as the ‘Standing Committee of Nurses of the EU’ (PCN).

ENNO. The European Network of Nursing Organizations. Holds an annual

meeting at which the various European specialist groups discuss issues
affecting their position in the larger field of nursing. ESGENA was member
of the ENNO Steering Group that developed the European framework for
post-basic nursing education.

ESNO. European Specialist Nurses’ Organization ([Link]).

EORNA. European Operating Room Nurses’ Association ([Link]).

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10.4.4 Abbreviations
APC Argon plasma coagulation

DOP Direct observation of procedural skills

ECTS European Credit Transfer System

ENNO European Network of Nursing Organizations

ENT Ear, nose and throat

ERCP Endoscopic retrograde cholangiopancreatography

ESGENA European Society of Gastroenterology and Endoscopy Nurses

and Associates

GI Gastro-intestinal

IBD Inflammatory bowel disease (e.g., ulcerative colitis, Crohn’s

disease)

MCQ Multiple-choice questions

PEG Percutaneous endoscopic gastrostomy

PTC Percutaneous transhepatic cholangiography

SOP Standard Operation procedures

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10.5 Authors involved in the development of the Job Profile and the
Core Curriculum

Country Name of society National representative on the

working party

Austria Austrian Society of Endoscopic Nurses Gerlinde Weilguny, Vienna

(Interessensverband Endoskopie-
personal Austria, IVEPA)

Belgium Association of Endoscopy Nurses in Willy Devriese, Bruges

Belgium (Association des Infirmier(e)s
d’Endoscopie/Verenigung van
Endoscopie-Verpleegkundigen, AIEVV)

Croatia Association of Nurses and Technicians Jadranka Brljak, Zagreb

in Gastroenterology and Endoscopy of
Croatia (GSC)

Czech Czech Nurses’ Group Working in Dana Kuchynkova , Prague; Ludmila

Republic Digestive Endoscopy (Sekce Sester Pavlatova, Hradec Kralove
Digestivni Endoskopie Pri Cges, SES)

Denmark Danish Society of Nurses in Mette Asbjørn Olesen, Copenhagen

Gastroenterology and Endoscopy
(Gastro-Endoskopi Forening for
Sygeplejersker, GEFS)

Finland Finnish Gastroenterological Nurses’ Eeva-Riitta Ylinen, Kuopio

Association (Suomen
Gastroenterologiahoitajat Ry, SGR)

France French Society of Endoscopy Nurses Dianelle Duforest-Rey, St. Laurent

and Associates (Groupement des du Var ; Ellen Herve, Paris; Stefane
Infirmiers et Infirmières pour la Bois, Toulon
Formation en Endoscopie, GIFE)

United British Society of Gastroenterology Christiane S. Neumann, Birmingham

Kingdom (BSG) – Endoscopy Associates Group
(EAG)

Greece Hellenic Society of Endoscopy Nurses Vassiliki Katsilaki, Alexandroupolis

(Hellenike Enose Noseleuton Monadon)

Germany German Society of Endoscopy Nurses Ulrike Beilenhoff, Ulm

and Associates (Deutsche Gesellschaft
für Endoskopieassistenzpersonal,
DEGEA), German nursing associations
(DBfK and DPV)

Iceland Icelandic Society of Endoscopy Nurses Herdis Astrasdottir, Reykjavik

(Innsýn)

Ireland Irish Society of Endoscopy Nurses Mary Fogarty, Dublin

(ISEN)

Israel Israeli Society of Gastroenterology Gwen Kreitzman, Tel Aviv

Nurses (ISGEN)

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Country Name of society National representative on the

working party

Italy Italian Society of Endoscopy Nurses Patricia Burga, Padua; Laura Rosa,
(Associatione Nazionale Operatori Ferrarotti
Techniche Endoscopiche, ANOTE)

Jordan Jordanian Association of Endoscopy and Lilishor Poponea, Amman

Gastroenterology Nurses and Associates
(JAGENA)

Luxembourg Luxembourg Association of Endoscopy Lorenz Rudkin, Luxembourg

Personnel (Association
Luxembourgeoise du Personnel en
Endoscopie, ALPE)

Netherlands Dutch Society of Gastroenterology Marjon de Pater, Amsterdam;

Endoscopy Assistants’ Section Christine Petersen, Amsterdam
(Nederlandse Verenigung voor Gastro-
Enterologie – Sectie Endoscopie
Assistenten, NVGE-SEVA)

Norway Norwegian Nursing Society/Nurses in Anita Jørgensen, Skien; Anne-Katrin

Gastroenterology Group (NSF/FSG) Hartz, Oslo

Monaco Society of Endoscopy Nurses in Monaco Dianelle Duforest-Rey, Monaco

Portugal National Association of Nurses in Rafael Luis dos Santos Oliveira

Gastrointestinal Endoscopy

Slovenia Nurses’ Association of Slovenia – Stanka Popovic, Ljubljana

Section of Endoscopy Nurses of
Slovenia (SES)

Spain Spanish Society of Endoscopy Nurses Pilar Pérez Rojo, Pamplona

and Associates (Asociación Española de
Enfermería Endoscópica Digestiva,
AEEED)

Sweden Swedish Association for Endoscopy and Solvig Ljungström, Stockholm

Gastroenterology Personnel (Svensk
Förening för Endoskopiassisterande
Personal, SEGP)

Switzerland Swiss Society of Endoscopy Nurses and Michael Ortmann, Basel

Associates (Schweizerische Vereinigung
für Endoskopiepersonal/Association
Suisse du Personnel en Endoscopie,
SVEP/ASPE)

Expert Diane Campbell, Torquay

consultant

For up-to-date information, please use the contact details listed on the ESGENA web site
([Link]).

© European Society of Gastroenterology and Endoscopy Nurses and Associates, 2008

ESGENA Core Curriculum