© 2020 The Authors. Journal for Specialists in Pediatric Nursing Published by Wiley Periodicals, Inc.
J Spec Pediatr Nurs. 2020;e12290. wileyonlinelibrary.com/journal/jspn
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1 of 8https://doi.org/10.1111/jspn.12290 DOI: 10.1111/jspn.12290
O R I G I N A L A R T I C L E
Undergoing colonoscopy as experienced by adolescents
Vedrana Vejzovic PhD, MNSc, RN, RSCN
| Karin Örmon PhD, MNSc, RN, PRN
Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
Correspondence
Vedrana Vejzovic, PhD, MNSc, RN, RSCN, Department of Care Science, Faculty of Health and Society, Malmö University, SE‐205 06 Malmö, Sweden.
Email:vedrana.vejzovic@mau.se
Abstract
Purpose: The aim of this study was to describe the phenomenon of undergoing
colonoscopy as experienced by adolescents.
Design: This study was a qualitative study in which data were collected and analyzed
in accordance with the methodological principles of Reflective Lifeworld Research with
a phenomenological approach.
Methods: Face
‐to‐face interviews were performed with 17 adolescents after
un-dergoing the first colonoscopy.
Results: The phenomenon of undergoing colonoscopy as experienced by adolescents
can be described as a collision between emotions and a desire to obtain answers to
questions about the examination, as well as concerns about its result and the meaning of
undergoing colonoscopy. The essential meaning is additionally described through its
constituents: a sense of vulnerability, an opportunity for symptom explanation, and
sensibility regarding information.
Conclusions: The results can be concluded in terms of the knowledge that for
adolescents a colonoscopy means more than an examination. Although colonoscopy
is not experienced as painful, it evokes different emotions that affect adolescents.
Therefore, a psychological preparation, on an individual level, is required before the
colonoscopy. Our results showed that adolescents need to understand the
con-nection between their symptoms, their body, and the colonoscopy.
K E Y W O R D S
adolescent, colonoscopy, experience, Merleau‐Ponty, reflective lifeworld research
1 | W H A T I S C U R R E N T L Y K N O W N ?
Colonoscopy is a procedure that is experienced as difficult for patients of all ages. Adult patients have reported difficulties such as anxiety, anticipation of pain, and feelings of embarrassment and vulnerability. Adolescents have their own way of experiencing things, and research‐ based knowledge of their experiences of colonoscopy may further help healthcare professionals to better understand their needs.
2 | W H A T D O E S T H I S A R T I C L E A D D ?
This study describes the phenomenon of undergoing colonoscopy as experienced by adolescents. The study confirms the need for psychological interventions aimed at optimizing this complicated investigation for adolescents who need to undergo a colonoscopy.
-This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
3 | I N T R O D U C T I O N
Colonoscopy is a medical examination where the rectum and lower bowel are examined for abnormalities and disease, and it has been shown to be effective in the diagnosis and follow‐up treatment of pediatric inflammatory bowel disease (IBD; IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition,2005). IBD, including Crohn's disease and ulcerative colitis, is a common chronic illness among children and adolescents. In addition to standard diagnostic laboratory testing, it is recommended that the children undergo both an upper endoscopy and a colonoscopy at the time of the initial investigation to determine the diagnosis of IBD (IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition,2005). According to the literature, approximately 25% of all IBD cases are diagnosed during adolescence (Kugathasan et al., 2003), which means that many adolescents must undergo a colonoscopy several times in their life. Adolescents who need to undergo a colonoscopy often endure long periods of gastrointestinal (GI) symptoms, such as abdominal pain, diarrhea, weight loss, GI bleeding, growth failure, and anemia, which can have negative impacts on their daily lives and well‐being (Mackner, Sisson, & Crandall,2004; Mamula, Markowitz, & Baldassano, 2003; Rabizadeh & Dubinsky, 2013). Due to those symptoms of IBD, and/or following an initial evaluation for IBD, adolescents are often subjected to a series of diagnostic tests, including a colonoscopy with biopsies (IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition,2005).
Colonoscopy for adolescent patients must be safe, informative, effective, and performed in an adolescent‐friendly atmosphere with minimal distress (IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, 2005). It is generally a safe examination; however, it also carries the potential of complications, such as perforation. Thus, bowel cleansing before a co-lonoscopy is a very important part of the precoco-lonoscopy procedure (Thakkar et al.,2016). Inadequate preparation for the colonoscopy is associated with a number of poor outcomes, including missed diagnoses and avoidable repeat procedures (Chokshi, Hovis, Hollander, Early, & Wang,2012). However, this part of the procedure has been reported as difficult by both adults (Lee et al., 2019; Thakkar et al.,2016) and children (Vejzovic,2017; Vejzovic, Bramhagen, Idvall, & Wennick,2015; Vejzovic, Wennick, Idvall, & Bramhagen,2015), regardless of age. It is therefore widely recognized that children undergoing medical proce-dures need to be well prepared, the goal of this preparation is to minimize their level of anxiety (Coyne,2006; Coyne & Gallagher,2011; Karlsson, Englund, Enskar, & Rydstrom,2014).
Colonoscopy is a procedure that is difficult for patients of all ages. Adult patients have reported difficulties such as anxiety, the anticipation of pain, and feelings of embarrassment and vulnerability (McLachlan, Clements, & Austoker,2012). Anxiety has in fact been reported to be a major barrier to the acceptance of a colonoscopy procedure in adults, and reduced anxiety may lead to better accep-tance of and preparation for the procedure (Lee et al.,2019). The best way to understand why a medical procedure can cause anxiety
in patients is to directly ask the patients about their experience (Svenaeus,2011), which is especially important for adolescents.
Adolescence is a transitional stage from childhood to adulthood during which an individual undergoes many physiological, psychological, cognitive, and social changes. During this period, healthy adolescents are under constant development, including biological and sexual maturity, the development of personal identity, the development of intimate sexual relations, and the establishment of independence and continued independence (Christie & Viner, 2005). It is not surprising that the symptoms of IBD, in combination with unpredictable activities, can have a negative impact on adolescents’ daily lives and well‐being (Nicholas et al.2007; Vejzovic, Bramhagen, Idvall, & Wennick,2018). Thus, it is important to try to minimize stress during the investigations before diagnosis. Adolescents have their own way of experiencing things, and research‐based knowledge of their experiences of different medical procedures can further help healthcare professionals to better understand their needs (Coyne, 2006; Coyne & Gallagher, 2011). Previous studies have examined patients' experiences of precolonoscopy procedures (di Nardo et al.,2014; Turner et al.,2009), but these studies did not specifically focus on adolescents' experiences of colonoscopy. The literature suggests that understanding the patient's experiences of colonoscopy and precolonoscopy procedures is important (Vejzovic,2019; Vejzovic, Wennick et al.,2015); however, studies about adolescents’ experiences are still scarce, despite the high number of adolescents who undergo colonoscopy.
To gain a deeper understanding of the phenomenon of undergoing colonoscopy as experienced by adolescents, this study was carried out in accordance with reflective lifeworld research (RLR). RLR is grounded in the philosophy of Merleau‐Ponty (1945/1962, 1968/1964) and Husserl (1970/1936,1977/1929), and the focal point of RLR is the subjective meaning of experiences with a focus on the lived phenomena of humans. Merleau‐Ponty described the lifeworld as the lived world. The body is not solely a biological object but also our access to the world, and it is thereby meaningful to us (Dahlberg, Dahlberg, & Nyström,2008). According to the philosophy of Merleau‐Ponty, humans do not have a body, but we are our bodies (Dahlberg et al.,2008). Merleau‐Ponty (1945/1962,1968/1964) describes humans as creators of meaning, and as humans, we are curious and engaged with the world. We are constantly connected to and engaged in situations on different levels, where some situations are familiar and some situations are new or unknown to us. Our access to the world is through our bodies, which means that every bodily change is also a change of and to the world. The lived body is our anchor in the world and thereby our home. Thus, illness and disease could cause dramatic changes affecting a person's whole world (Merleau‐Ponty,1945/1962), an insight that informs the aim of this study, namely, to describe the phenomenon of undergoing colonoscopy as experienced by adolescents.
4 | M E T H O D S
Face‐to‐face interviews were performed with 17 adolescents after undergoing the first colonoscopy. RLR with a phenomenological approach
was used to describe colonoscopy as experienced by adolescents. RLR implies the researcher's openness and sensitivity as well as a reflective attitude. The aim of RLR is to make the phenomenon that is the focus of the study present itself to the researcher. Within RLR, bridling is a method used to better understand a process; it is a method according to which the researcher should put their subjective experiences aside, slow down the process of understanding, and see what is clearly or not clearly presented. With this method, the preunderstanding of the researcher will not influence the understanding of the phenomena of interest (Dahlberg & Dahlberg,2003; Dahlberg et al.,2008).
5 | P A R T I C I P A N T S A N D P R O C E D U R E
All adolescents were recruited from a university hospital in southern Sweden that caters to approximately 1.2 million people—13% of the Swedish population. The overall inclusion criteria were suspected IBD, first colonoscopy, and ages 10–18 years. Twenty‐two adolescents were asked whether they wished to participate in the present study. A total of five adolescents declined to participate and 17 of both genders (12 girls and 5 boys), with an age range of 10–17 years, were included. The exclusion criteria were the following: patients requiring an urgent colo-noscopy and patients who did not speak Swedish. The adolescents and their caregivers were informed about the study, both in writing and verbally, by a nurse who was not involved in the procedure but was responsible for the patient registration. They were also informed that their responses would be treated confidentially. At the time of the in-terview, written informed consent was obtained from both the caregivers and adolescents older than 15 years. In families with younger adoles-cents, the parents gave written consent, and the adolescents gave their verbal assent.
Ethical approval for the present study was granted by the Re-gional Ethical Review Board in Lund (Ref. No. 2011/155).
6 | D A T A C O L L E C T I O N
The data collection was performed using face‐to‐face RLR interviews, conducted by the first author at a time and location decided on by the informants. Before the interviews began, the interviewer in-troduced herself and presented the study. In this way, the opportu-nity to ask questions was given to each individual. The first author performed all interviews, and they were audio‐recorded and tran-scribed, which minimized the risk of misinterpretation. The in-formants were not compensated for participating in the study.
7 | I N T E R V I E W S
This study was the second part of an interview study with adolescents who had undergone one elective colonoscopy, where the first part cov-ered the adolescents’ experiences of the precolonoscopy procedure by means of bowel cleansing (Vejzovic, Wennick et al.,2015). The interviews
started with an input question allowing the adolescent to describe the reason why the colonoscopy had been performed, followed by an open question about their experiences before the colonoscopy, and then by questions about their experiences of the colonoscopy examination. The main question to the adolescents was: “Can you describe how you experienced colonoscopy?” All interviews were conducted individually 1 week after each adolescent had undergone a colonoscopy. The first interview was a pilot interview. The idea was to see if an open question could get the adolescents to talk about their experience. After reviewing the pilot, it was decided that one closing question would be added. The closing question was, “If you had a friend who had to go through the same procedure, what would you tell them?” All interviews were audio‐recorded with a telephone without an internet connection. Most of the interviews (n = 14) took place in the adolescents’ home; however, three interviews were held at the hospital. No parents were present during the interviews. The median duration of the interviews was 29 min.
8 | D A T A A N A L Y S I S
The process of data analysis was conducted according to RLR (Dahlberg et al., 2008). The interviews were transcribed verbatim and read separately by the authors to become familiar with the material as a whole. The authors read the text repeatedly and si-multaneously searched for the meaning of the phenomena, and to capture the phenomenon of adolescents undergoing a colonoscopy, the question“Is this how adolescents experience colonoscopy?” was asked of the text during the whole analysis process. To identify the structural essence and meaning of the phenomenon, clusters de-scribing related meanings were identified and combined. The clusters are not presented in the results but are solely used to identify pat-terns of meaning. Throughout the process of analysis, the authors moved back and forth between the parts and the whole. The process of analysis emerged into the essential structure of the meanings and the constituents, which are the textual nuances of the material. The bridling method was used throughout the analysis process. Com-parisons and discussions, regarding the phenomena of interest and the structural essence, continued until consensus between the au-thors were obtained.
9 | R E S U L T S
The results are initially presented as an essential structure of meanings, followed by the constituents of the phenomenon under study: a sense of vulnerability, an opportunity for symptom ex-planation, and sensibility regarding information. The phenomenon of undergoing colonoscopy as experienced by adolescents can be de-scribed as a collision of emotions. On the one hand, there is a desire to obtain answers to questions about the examination, and there are concerns about its result as well as the meaning of undergoing a colonoscopy. On the other hand, there is an unspoken reluctance to undergo a colonoscopy due to the extensive preparation required
and the knowledge that the examination will be performed through the rectum. Colonoscopy is an unknown medical procedure among adolescents and therefore raises many questions and concerns; however, undergoing a colonoscopy also means allowing oneself to understand information about the procedure. The Table1includes a list of constituents and selected exemplary quotes.
10 | A S E N S E O F V U L N E R A B I L I T Y
Undergoing a colonoscopy implicated a sense of vulnerability in situations where the adolescents understood that a colonoscopy could be an uncomfortable examination, given the way it is per-formed. The bowel cleansing, performed before colonoscopy, causes diarrhea, and the adolescents already experienced diarrhea as stressful during symptom periods. A sense of vulnerability was also related to difficulties of privacy when using hospital toilets and experiencing diarrhea before and after colonoscopy. The adoles-cents felt that they did not have enough privacy, because they feared that others could hear sounds and feel the bad smell of their diarrhea. Other examples of vulnerability were described by several adolescents, in relation to situations where they felt that their parents or responsible staff did not listen to them and failed to recognize their needs for more detailed explanations regarding the colonoscopy.
The sense of vulnerability increased with the knowledge that undergoing a colonoscopy meant that their body would be examined by a stranger who could see inside of their body and that they would be unable to control their body. At the same time, being able to see inside of the body was exciting, and being able to see intestinal contents on a large TV screen was described as something that would
be interesting to experience. However, being awake while examined through the rectum was not an acceptable option. The fact that the examination would be carried out under anesthesia was a positive element; however, at the same time, this further reduced the control over one's own body. During a colonoscopy, the body would be handed over to an unfamiliar person, which felt uncomfortable and quite difficult for the adolescent to accept. Fear of waking up in the middle of the investigation was also indicated as a problem. Fur-thermore, difficulties in trusting the healthcare staff arose due to the feeling of losing control during anesthesia. The adolescents perceived the procedure as stigmatizing, and they experienced a fear of being laughed at by peers if information about how a colonoscopy is per-formed came out, which also increased anxiety.
11 | O P P O R T U N I T Y F O R S Y M P T O M
E X P L A N A T I O N
For the adolescents in the study, undergoing a colonoscopy was ex-perienced as a necessary procedure due to the possibility of ob-taining symptom explanation, and in that respect, it was seen as a positive alternative. However, a variety of different emotions were experienced by adolescents throughout the process, emotions such as anxiety, frustration, and uncertainty. Anxiety was present during the entire journey, from the moment when the adolescent was told that a colonoscopy needed to be performed until the day the ado-lescent returned home with a preliminary diagnosis after the colo-noscopy. Nevertheless, the colonoscopy was considered a necessity by the adolescents, to receive help with the troublesome and em-barrassing symptoms that had negatively affected their everyday lives and well‐being.
T A B L E 1 An example of data analysis
Constituents Quotations
A sense of vulnerability “I was worried about diarrhea … running to the toilet all the time … it wasn't fun … I was tired of this since before…”
“Everyone could hear me when I was on the toilet … I used my phone to play music at quite a high volume … ha… ha … my mom thought it was disturbing.”
“We've seen pictures of bowels in school, and it would have been exciting to be able to see it in real life.” “Being awake during the examination was not a good solution, so I was glad they gave me medicine… I felt
nothing and it felt good.”
“I just thought about not waking up in the middle of everything.” Opportunity for symptom
explanation
“The doctor said that a colonoscopy needs to be done in order to possibly find the reason for my problems. He explained that it could be done under anesthesia and that I shouldn't worry. Then, he said nothing more. I wish he had.”
“… to know the diagnosis … but the doctors say it's not certain that they'll find anything … and then you wonder if it's important to do an examination… although the doctor said it was important … I don't know.”
“I didn't tell anyone. Everyone would just ask, “What are they doing?” and because of it, I just said, “It's routine.” I'm not saying I have a camera up my rectum. I am not saying that.”
Sensibility regarding information “There was so much to read I couldn't cope … Mom read everything and told me.”
“They said that I have to do it … thought soon everything would be finished … don't want to think about how … just that I will come home and eat soon.”
Symptoms such as unexpected gastric gases and smell, as well as stomach pain, caused frustration, uncertainty, shame, and discomfort for the adolescents in many situations; for example, GI symptoms were often difficult to explain to both peers and parents because of their nature, in that a relapse of symptoms could occur without any predictable cause or appropriate explanation. Often, the symptoms were linked to several visits to the physician but without the ado-lescents getting any proper explanation of those symptoms after the examination. Thus, when colonoscopy was presented to the adoles-cents as a standard examination that can lead to an explanation, this sparked positive thoughts and hope.
Initially, colonoscopy was accepted by adolescents as one of many examinations that they would need to undergo because of the symptoms they were suffering from. Because they had already ex-perienced blood sampling and had contact with various physicians and nurses, the adolescents did not give the procedure much thought; they wished only to complete the examination as soon as possible to ease their worries. The physician recommended colono-scopy as the next step in the investigation; therefore, the adolescents felt that it was unnecessary to further discuss any problems during a consultation with the physician. Nevertheless, there were also feel-ings of reluctance. Thoughts of a colonoscopy as a difficult ex-amination arose after reading the letter with the instructions and the description of the colonoscopy. Moreover, the adolescents’ percep-tion that a colonoscopy was a necessary investigapercep-tion was negatively affected by the knowledge that a colonoscopy was only one possi-bility to obtain answers.
12 | S E N S I B I L I T Y R E G A R D I N G
I N F O R M A T I O N
Sensibility regarding information about colonoscopy can be explained by the difficulties the adolescents had discussing a topic that led to anxiety, which made them stop listening when professionals tried to inform them. However, the colonoscopy was experienced as a plicated investigation, and the adolescents pointed out that com-munication with professionals regarding details about the colonoscopy procedures was not facilitated. Too much simultaneous information made it difficult for adolescents to be attentive and contributed to most of them not listening. Written information about the precolonoscopy procedure contained several difficult elements, such as diet and bowel cleansing, and the information regarding the colonoscopy procedure itself was perceived as superficial. It was provided without consideration of the patients’ prior knowledge of the procedure. Adolescents who experienced information as in-adequate often had family members who had undergone colonoscopy themselves and who told them about the procedure. For those adolescents, the procedure was perceived as less stressful, but they found it difficult to trust the healthcare professionals. Dissatisfaction regarding information was also due to the written information being received long before the day of the colonoscopy, and to the fact that verbal information was given during the preprocedure on the same
day that the bowel cleansing was performed. Furthermore, an un-spoken resistance to information about colonoscopy was experi-enced by adolescents. They felt that they had no choice regarding the investigation and that it was unnecessary to discuss the procedure. Thus, although the adolescents were eager to know more about why the colonoscopy is recommended as a procedure or why bowel cleansing is important for a colonoscopy, they usually asked no questions of the healthcare professionals. If any family member had undergone a colonoscopy, the questions were directed to them instead.
Overall, the adolescents needed to understand what would happen before, during, and after the procedure. Even though they understood what to expect during and after the colonoscopy, they felt that the procedure, in terms of the bowel cleansing, the results, and the postprocedure symptoms, was difficult, though not danger-ous. In retrospect, the adolescents regretted not asking the questions that they had. They believed that their stress would have been re-duced if they had received answers to their questions.
13 | D I S C U S S I O N
The aim of the present study was to deepen the understanding of the phenomenon of undergoing colonoscopy as experienced by adoles-cents with suspected IBD; therefore, this study was conducted in accordance with RLR based on a phenomenological approach. The choice of the method allowed us to gain a deeper understanding and increase our knowledge of this phenomenon. As earlier described in the introduction, there is a need to understand the adolescents' ex-perience of colonoscopy to create optimal care for them when they need to undergo the procedure.
Our results indicate that adolescents have many thoughts and feelings linked to their IBD symptoms that can have a negative impact on colonoscopy, which was usually experienced as an embarrassing procedure with anxiety represented throughout the procedure. Pre-vious research has shown that prolonged uncontrolled symptoms can have a negative impact on well‐being (Mackner et al.,2004; Mamula et al.,2003; Rabizadeh & Dubinsky,2013; Thakkar et al.,2016; Vejzovic et al.,2018) and that fear of a serious diagnosis contributes to anxiety (Mikocka‐Walus, Moulds, Rollbusch, & Andrews,2012). Although colo-noscopy provides an opportunity to answer questions about trouble-some symptoms, the adolescents were reluctant to undergo the examination. They had undergone various medical tests for their symptoms for a long time before colonoscopy, and they were tired of undergoing examinations that did not guarantee answers to their questions and help them with the problems they were facing. Some of the adolescents found the procedure unnecessary because there were no guarantees that the results would explain their symptoms. This result is in line with Mikocka‐Walus et al. (2012), who showed that an unclear or functional diagnosis after colonoscopy seemed to increase anxiety. Undergoing an examination via the rectum was described as distressing and anxiety‐inducing as well as embarrassing, but the fact that the examination was done under anesthesia made it easier for the
adolescents to take this step. Adolescents’ experience was not linked to physical pain during the examination, but it was strongly linked to a feeling of humiliation that they had difficulties talking about.
In contrast, the results of previous research (Vejzovic, 2019) indicate that professionals focus more on the adolescents’ physical body than on their feelings in connection to colonoscopy. The fact that patients and staff focus on different things can create mis-understanding in the communication between them. This situation may be troublesome, especially since the mind and body, according to the philosophy of Merleau‐Ponty, cannot be separated (Dahlberg et al., 2008). Svenaeus (2011) describes health and illness as “homelikeness” and “unhomelikeness” in being‐in‐the‐world. When experiencing illness, the body becomes alienated, making the being‐in‐ the‐world unhomelike. This highlights the importance of healthcare staff's understanding of the patient's situation of unhomelikeness in being‐in‐the‐world, something which is best achieved through the patient's personal narratives. This indicates that healthcare staff should listen closely to the narratives of adolescents, and thereby gain a wider picture of their life story.
Our results showed that adolescents need to understand the connection between their symptoms, their body, and colonoscopy and this is a task for healthcare staffs. To understand the phenom-enon we can start from Svenaeus (2011) who illuminate the differ-ence between the phenomenological concepts of illness and disease. The disease is the disturbance of bodily functions and is detected through examinations and medical diagnoses. This conception of disease differs from the conception of illness, which is described as suffering that disrupts and affects the being‐in‐the‐world and thereby everyday life. Previous research has shown how healthcare staff describes adolescents undergoing colonoscopy mostly as an alert and healthy group of individuals because adolescents often communicate and move their body without showing pain and dis-comfort (Vejzovic,2019). Vejzovic et al. (2015) described that par-ents also were focusing on the patient's digestive symptoms and that they ought to pay more attention to communicating with the patient when they need to undergoing colonoscopy. By solely focusing on the presence or loss of bodily functions, there is a risk that the healthcare staff may miss the concept of illness and the adolescents’ being‐in‐ the‐world. Illness is not only a loss of bodily functions but also an interruption of the life plan. Illness manifests uncertainty, a loss of control, and a loss of bodily integrity. When illness occurs, the body is no longer taken for granted. We are aware of the bodily changes and limitations, which makes us anxious and insecure (Toombs,1987).
The symptoms described by adolescents have a major impact, and constitute a hindrance, on their lives. Gastric gases and foul smell were described as symptoms that caused feelings of shame and discomfort. Since adolescents are already adversely affected by their usually long‐lasting symptoms, their ability to manage the procedure may be impaired, something which is described by Toombs (1987) as a loss of wholeness.
Svenaeus (2011) describes health and illness as“homelikeness” and “unhomelikeness” in being‐in‐the‐world. When experiencing illness, the body becomes alienated, making the being‐in‐the‐world
unhomelike. This highlights the importance of healthcare staff un-derstanding the patient's situation, something which is best achieved through the patient's personal narratives. Besides being a loss of bodily functions, illness often manifests as uncertainty, a loss of control, and a loss of bodily integrity, as demonstrated in how the adolescents in this study experienced their IBD symptoms and co-lonoscopy. The focus on bodily functions also has an impact on the information given to adolescents. The mind and body cannot be separated, according to Merleau‐Ponty's philosophy of the body (Dahlberg et al.,2008). The adolescents in our study experienced dissatisfaction with the information that was provided to them. They described how the information regarding colonoscopy was provided without consideration of their prior knowledge of the procedure. Furthermore, the results indicate that adolescents who were reluctant to undergo colonoscopy were also resistant to ob-taining information about it. Undergoing colonoscopy is, according to the adolescents, so much more than an examination of the colon. We believe that healthcare staff needs to have a more open and reflective attitude and approach towards the adolescents. By asking questions regarding feelings connected to undergoing colonoscopy, the healthcare staff offers an opportunity for adolescents to discuss and reflect their emotions. This approach also prevents a focus solely on the physical body. Another implication for practice could be to inform the adolescents that the feelings and thoughts as de-scribed in the result, are common and normal when undergoing colonoscopy. This could hopefully reduce anxiety and increase well‐ being. It is important that healthcare staff are aware of these feelings and not solely focused on colonoscopy as a procedure of bodily function.
14 | S T R E N G T H S A N D L I M I T A T I O N S
In this study, we have described the phenomenon of undergoing a colonoscopy from an adolescent's perspective, something which can be seen as a strength. Furthermore, a benefit of the study is the use of RLR methodology, where an open and sensitive approach and analysis enable the phenomena in focus to become visible. The flexible, open approach that is in accordance with the RLR method, was the focus throughout the research process, with the aim of ob-taining trustworthiness. Through a reflective attitude, described as bridling, the researchers' preunderstanding and the process of ana-lyzing the interviews enabled the phenomenon to show itself and thereby achieve validity. Another benefit of the study could be that the adolescents were given an opportunity to share their experiences and let their voices be heard, an opportunity that might not other-wise have been available to them.
A study limitation is the lack of demographic facts, which could have been helpful in describing the population in focus. Even so, we are confident that the results of our study are transferable to healthcare contexts where adolescents undergo colonoscopy, as well as other healthcare settings where bodily examinations are con-ducted and where adolescents are cared for.
15 | C O N C L U S I O N
The results can be concluded in terms of the knowledge that, for adolescents, a colonoscopy means more than an examination. The colonoscopy is not experienced as painful; however, it evokes different emotions, such as anxiety and uncertainty, that affect the adolescents and that may have a negative impact on the adolescents' experiences regarding colonoscopy. Therefore, a psychological preparation, on an individual level, is required before the colonoscopy. It should be noted; however, that since colonoscopy provided increased opportunities for symptom explanation, it was also, by some adolescents, seen as a positive alternative, giving rise to optimistic thoughts and hope.
In conclusion, professionals' understanding of adolescents' ex-perience of colonoscopy can provide them with a greater sense of identifying the problems that adolescents have in relation to colo-noscopy. This can also help professionals plan the colonoscopy pro-cedure and tailor it to individuals.
16 | H O W M I G H T T H I S I N F O R M A T I O N
A F F E C T N U R S I N G P R A C T I C E ?
Knowledge about adolescents' experience of colonoscopy is im-portant for the specialist who needs to guide adolescents through such procedures. We, therefore, believe that this study may be of interest to all those working with pediatric colonoscopy who want to change or improve clinical practice. The study can motivate clinics to create and individualize preparation for colonoscopy and thus opti-mize it for adolescents.
C O N F L I C T O F I N T E R E S T S
The authors declare that there are no conflict of interests.
A U T H O R C O N T R I B U T I O N S
V. V. conceptualized and designed the study, and collected the data. K. Ö. helped with the data analysis and interpretation. Both the au-thors drafted the manuscript.
O R C I D
Vedrana Vejzovic http://orcid.org/0000-0003-0690-3940
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How to cite this article: Vejzovic V, Örmon K. Undergoing colonoscopy as experienced by adolescents. J Spec Pediatr Nurs. 2020;e12290.https://doi.org/10.1111/jspn.12290
