Nursing Capstone: An Analysis of an Advanced Role in Professional - Essay Example

? Nursing Capstone: An Analysis of an Advanced Role in Professional Nursing (Nurse Anesthetist) Nurse Anesthetist: Background and History of the Role A nurse anesthetist is a registered nurse (RN) who has advanced education in the field of anesthesiology. Nurse anesthetists administer, supervise, and monitor anaesthesia-related care for those patients who undergo surgeries. The educational requirement for the nurse anesthetist is advanced training in anesthesiology and a Master’s degree (MSN). At school, those wishing to become nurse anesthetists in the future are supposed to study anatomy and physiology, chemistry, biology, mathematics, and health. First, one becomes a RN (Registered Nurse) with at least a Bachelor’s degree (BSN). For this, one needs to finish the undergraduate program and pass a licensing exam. The undergraduate program encompasses the course in human anatomy and physiology, nutrition, microbiology, biology, statistics, and psychology. Those who decide to enrol in a Master’s program are required to have one year or more of experience as a registered nurse in an intensive care unit. They further study anatomy and physiology, pharmacology, pathophysiology, chemistry, biochemistry, and physics, and spend hundreds of hours practicing to provide anesthesia-related care in surgery and obstetrics (What Can I Do Now? Nursing, 2007, p.50). To become a Certified Registered Nurse Anesthetist (CRNA), which is another name for nurse anesthetist, the registered nurse must take national certification exams. These are held by the Council on Certification of Nurse Anesthetists. The latter is a part of NBCRNA (abbreviation for National Board of Certification and Recertification of Nurse Anesthetists). Another certification program is offered by the American Society of PeriAnethesia Nurses. The certification is to be renewed every two years. Practice requirements include pain management through administration of anesthetics during a variety of medical procedures. Namely, nurse anesthetists work with patients before, during and after surgery. Also, nurse anesthetists’ assistance is required during baby delivery. Apart from excellent anesthesia skills and knowledge, nurse anesthetists should have good problem-solving skills, be capable of handling stressful situations, stay calm in emergencies, concentrate well, and be excellent communicators (What Can I Do Now? Nursing, 2007, p.51). Prior to the development of adequate anesthetic methods in the 1840s, surgeons had deadened the pain by alcohol or opium. Anesthesiology brought revolution to surgery practice. The earliest documented involvement of nurses as anesthetists was fixed during the Civil War (Nagelhout & Plaus, 2009, Chapter 1) The first nurse anethesthetist worked in the 1870s. It was Sister Mary Bernard from Pennsylvania. The first educational establishment for nurse anesthetists opened in St.Vincent Hospital located in Portland, state Oregon. It was back in 1909. Before World War I, nurse anesthetists were increasingly sought by hospitals and surgeons, which led to opening of 4 nursing programs in the U.S. (Nagelhout & Plaus, 2009, Chapter 1). At the time of the World War I, U.S. nurse anesthetists were greatly involved in providing medical care to French troops. Additionally, they provided training to both French and British medical staff in anesthesiology. In 1931, a national organization was formed of nurse anesthetists. Up to the beginning of the World War II, anesthesiology was considered a nursing occupation (What Can I Do Now? Nursing , 2007, p.53). References Nagelhout, J. & Plaus, K. (2009) Nurse anesthesia. Elsevier Health Sciences. What can I do now? Nursing (2007) Infobase Publishing. Nurse Anaesthetist: Issues & Challenges of the Profession Nurse anesthetist is a challenging career since it requires excellent mental and physical abilities and professional skills in providing safe and high-quality anesthesia care. Besides, nurse anesthetists must be aware of the current issues and challenges within the field, as well as adequate solutions to these problems. One of the current issues in nursing anesthesiology has been pain management of older patients. According to Talley et al, anesthetic management of this group of patients requires careful evaluation while planning anesthesia. This is explained by multiple physiological and anatomic changes that take place in older individuals with time. The importance of the problem is conditioned by the fact that life expectancy increases in the States, which means the number of elderly patients that undergo surgery increases, too. According to Talley et al, 20 or more per cent of all surgical procedures are done on people older than 65 years old (Talley et al, 2009, p.451). Another issue that receives lots of attention in scholarly research into nursing anaesthetics is related to management. Specifically, an innovative approach to preparing leaders to benefit the American Association of Nurse Anesthetists (AANA) has been explored. The study by Shekleton et al examines the background, design, and delivery of the new approach to training elected leaders in AANA state associations. The new approach has been conceptualized on the basis of assessment of the effectiveness of ‘Boot Camp’ leadership development program for nurse anesthetists that are elected as presidents. The latter involved participation in a 3-day workshop created on the ground of adult learning theory. The findings of the research, it is claimed, may be used for leadership training of nurse managers in general (Shekleton et al, 2010, p. 662). Also, the search of a successful primary care nursing model in the context of a perianesthesia setting has been an issue. Individuals who experience the perianesthesia continuum should have a chance to clearly express their concerns and needs to be included into the perioperative plan. This information appears to be valuable. Therefore, Carabetta et al (2012) conducted a study in which they added three questions to the basic preoperative nursing assessment so that patients’ needs are better met. This helped to focus on patients’ needs more effectively during the recovery process from anesthesia. References Carabetta, M. et al (2012) Implementing primary care in the perianesthesia setting using a relationship-based care model. Journal of PeriAnesthesia Nursing, 28 (1), p.16-20. Shekleton, M. et al (2010) Growing leaders in a professional membership organization. Journal of Nursing Management, 18 (6), p. 662-668. Talley, H. et al (2009) AANA journal course. Update for nurse anaesthetics. Evaluation of older adults. Aana Journal, 77 (6), p.451-460. Nurse Anesthetists and Philosophy of Nursing Nurse anesthesia is one of the professions within nursing. Just as nursing in general aims at helping people to achieve, keep or renew health and adequate quality of life, so do nurse anesthetists. According to ANA (American Nurses Association), nursing should be understood as protection, as well as promotion and enhancement of people’s health and individual abilities, as well as removal or ease of sufferings, prevention of injury and illness, and patients’ advocacy in issues of care (American Nurses Association, 2013). Today the holistic approach to nursing care is getting increasingly popular. It is about treating every patient as a unique individual that exists at numerous levels of being (Brown, n.d). While people got used to having parts of themselves treated by a few experts, the holistic approach to health suggests that each patient should be treated as a whole and approached individually. In this context, traditional (or orthodox) treatment is perceived as just one part of the holistic health recovery. It goes along with other practices aimed at health restoration. These are largely based on understanding that a person is not just a body to be fixed, but a unity of the body, mind, and soul. Rather than wishing to ‘repair’ a particular organ or organs, patients are encouraged to ask themselves in which areas and how they can empower their bodies so that they achieve good health; or think whether their emotional condition allows them to renew their health. In a nutshell, as many areas as possible are to be found and filled with positive changes. Spirituality and people’s quest of God is important here. Nurse anesthetists take part in extremely responsible procedures – surgical operations. The first and foremost implication for them in the context of holistic approach is to develop such thinking and outlook that allows perceiving the patient as a living being and God’s creation. If the nurse anesthetist is a believer himself/herself, he or she could pray for the patient’s health and support their patient with words of faith. Nurse anesthetist by this approach is welcome to listen out to the patient’s concerns and provide generous emotional support. The nurse anesthetist should be governed by belief in people’s innate capacity of self-healing. If possible, he or she may help the patient find the meaning of his sufferings, illness, and experiences. Performing his or her role, the nurse anesthetist is to be guided by understanding that he or she is a part of nursing (healing) environment, and deliver care with compassion, respect, warmth, trust, and authenticity (Mariano, 2007, p.72) References Brown, E. (n.d.) Holistic health. Retrieved from http://www.shareinternational.org/archives/health-healing/hh_ebhealth.html. Mariano, C. (2007) Holistic nursing: Scope and standards of practice. Jones and Bartlett Publishers. “What is nursing?” (2013) American Nurses Association. Retrieved from http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing. Caring How is the concept of caring incorporated into understanding of the role of a nurse anesthetist? First of all, it is worth mentioning that anesthesia performed by an anesthetic nurse is defined as loss of sensation in a person and may be either complete or partial. While local anesthesia blocks sensation of certain regions of the patient’s body, general anesthesia blocks every sensation in a body and leads to the patient’s unconsciousness, relaxed condition, and loss of the body’s reflexes (Rosdahl & Kowalski, 2008, p. 717). Anesthesia along with surgery disrupt the patient’s bodily systems and subject the patient to a variety of risks during the procedure of operative performance (Smeltzer et al, 2010, p.443). Clearly, in this condition, the patient is totally helpless and thoroughly depends on the nurse anesthetist and other medical staff. In the condition when the patient is incapable of controlling basic functions of the body, in particular the management of airway and breathing, it is of crucial importance that the nurse anesthetist provide quality care while observing and monitoring him/her in careful and vigilant manner. The nurse should be careful while administering anesthesia so that he or she does not administer too much. In case it happened and the patient enters the Danger Stage, prompt intervention is required to save the patient from death (Rosdahl & Kowalski, 2008, p.719) Seven major components of nursing care provided by a nurse anesthetist are Checking for patient’s allergies before they undergo surgery Bringing to the attention of the physician all available laboratory results either pre- or postoperatively Notification of the physician about any abnormal apprehension before/after the administration of anesthesia Keeping the patient flat until the moment the anesthetic wears off if spinal anesthesia has been used Observation of the patient’s urine output after the operation in a careful manner; watching for possible bladder distension Watching for signs of respiratory distress and cautiously administering any postoperative narcotics Observing the patient for the signs of circulatory depression (Rosdahl & Kowalski, 2008, p. 718). References Rosdahl & Kowalski (2008) Textbok of basic nursing. Lippincott Williams & Wilkins. Smeltzer et al (2010) Brunner and Suddarth's textbook of medical surgical nursing. Lippincott Williams & Wilkins. Ethical Issues What ethical issues are likely to be faced by a nurse anesthetist? Nurse anesthetists often encounter ethical dilemmas during their practice. Ethical issues and ethical dilemmas occur when the goals of nurse anesthetist care stand in conflict with the goals of some other disciplines or family members (Grace, 2009, p.191). One of the issues is competence and qualification. Sometimes an employer may assign the nurse to a certain surgery, but the nurse may find that she or he is not qualified enough to deliver quality anesthesia. In this case, the nurse should make an ethical decision and refuse from the task so that nursing malpractice does not occur and the patient does not suffer (Westrick et al, 2006, p.112). So, here the rule works: the patient’s safety comes above all. Another ethical issue is working with dying patients. For a nurse anesthetist it may be morally distressful to care about the patient during the surgery who has no chances of recovery. While the surgeon, who is also aware that nothing will actually help, is about to perform an operation, the nurse anaesthetist has a desire to talk with the patient and the family and explain the situation. This happens when a physician does not let the client make an informed decision but opts for surgical intervention despite the fact it will not help (Chat Communication). One more ethical issue may be accepting gifts. This does not seem to be a wrong practice. The guidance for anesthesiology professionals says, “accepting gifts is not prohibited, provided that the gift is not seen as an inducement” (“Ethical issues and difficult decisions”). However, it is recommended that very costly gifts not be accepted. Accepting “a gift of significant value” is regarded unwise (“Ethical issues and difficult decisions”). References Grace, P. (2009) Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Publishers. “Ethical issues and difficult questions” (n.d.) Anaesthesia UK. Retrieved from http://www.frca.co.uk/page.aspx?id=124. Westrick et al (2006) Quick look nursing: Legal and ethical issues. Jones & Bartlett Learning. Legal Implications One of the greatest legal concerns has been the liability of the supervising physician (either anaesthesiologist or a surgeon) for the nurse anesthetist’s mistakes or professional negligence. According to the law, CRNAs must be supervised by some licensed doctor (either any licensed doctor or an anesthesiologist). This means that the primary responsibility remains on the latter. Just as the primary responsibility is attributed to the doctor, the nurses are not sued for their errors. Instead, surgeons or anesthesiologists are (Richards & Rathburn, n.d.). Another issue is administering anesthesia to a child that refuses to undergo both anesthesia and surgery. While there are no clear legal guidelines, decisions are to be made in urgent manner. Dealing with the child that refuses from anesthesia should be based on considering, first of all, his or her autonomous capacity, presence of a valid concern from the parents, and possible practical implications of administering anesthesia without the child’s consent (Walker, 2009). Nurse anesthetists are legally liable for malpractice that results from negligence or tort. Groom (2010) defines negligence as either omission (something could have been done but was not) and essentially negligence (no reason to avoid doing what was not done). Tort is understood as a civil wrong that is associated with intentional harm (abandonment, fraud, assault, privacy invasion, emotional harm, breech of confidence, intentional infliction, etc) (Groom, 2010). References Groom, J. Medical-legal aspects of nurse anesthetist practice. Retrieved from http://www.slideshare.net/tomwinfrey/medicallegal-aspects-of-nurse-anesthetist-practice Richards, E. & Rathburn, K. (n.d.) Law and the physician: A practical guide. Retrieved from http://biotech.law.lsu.edu/books/lbb/xfc.htm. Walker, H. (2009), The child who refuses to undergo anesthesia and surgery – a case scenario- based discussion of the ethical and legal issues. Pediatric Anesthesia, 19, p.1017–1021. Issues of Cultural Competence With the population of the United States becoming increasingly diverse, American health care system faces the challenge of increasing the cultural awareness of its providers. The gap in cultural competency of nurse anesthetists, as well as other medical professionals, should be closed by integration of cultural competency education into their graduate education. Essentially, the trend of the future is by 2020 one in every four patients in the U.S. will be of different cultural, linguistic, religious, or ethnic heritage from their provider (Wright, 2008). In this situation, good health care provision will be inevitably related to good cultural competency (Jeffreys, 2010, p.17). One of the directions in increasing awareness in this field is learning of health disparities among minority groups. Research data provide evidence that there are considerable health disparities among white Americans, African Americans, Native Americans, and Hispanic Americans, etc who live in the United States. This is related to genetic differences, peculiar health behaviors, certain environmental factors, as well as factors of health care delivery (Wright, 2008). Just as cultural competency involves attitudes, behaviors, skills, and different policies that enable health care providers to deliver effective services in cross-cultural settings, lack of any of these may seriously hamper the work of a nurse anesthetist. Miscommunication which results from the language barrier may cause inaccurate information acquisition when anaesthetist is preparing for a surgery. Another issue may be obtaining an informed consent regarding the suggested anesthetic administration from a patient of a different cultural background. Additionally, it is virtually impossible to keep to AANA standards of nurse anesthetists practice if there is a language and cultural barrier in such issues as: formulation of the anesthesia-care specific plan, assessment of care, and respect for patient’s rights (Wright, 2008). References Jeffreys, M. (2010) Teaching cultural competence in nursing and health care. Springer Publishing Company. Wright, E. (2008) Cultural competency training in nurse anesthesia education. Education News 76 (6), p.421-424. Health Care Delivery How could a nurse anesthetist improve the delivery of health care for clients? First of all, a CRNA may get well involved in enhancing professional capabilities through “building and nurturing of a culture of safety” (Biddle, 2008). This basically involves learning from other CRNA’s experiences in difficult situations, so that when a complex and dangerous case occurs they will operate in a safe and flawless manner. This may be done through Patient Safety Vignettes use. These are “filmed reenactments of actual clinical situations that stimulate healthcare providers to analyze situations in a safe environment where no real patients are involved” (Biddle, 2008). Another health care delivery improvement may be establishing rapport with clients and their families. This will help clients psychologically and support them emotionally. Besides, nurse anesthesiologist will obtain specific information about the client’s specific features/needs (Wright, 2008). Finally, raising one’s educational level to the Doctorate level is recognized a good way of quality improvement. This will allow nurse anesthetists make their practice safer and place them in the position of senior staff who will also take part in executive decisions. Given considerable experience and excellent qualification, this will directly benefit the patient (O’Grady, n.d.). References Biddle, C. (2008) Nurse Anesthetists: Improving the landscape of healthcare safety. VANA. Retrieved from http://vana.org/news/2008/nurse-anesthetists-improving-the-landscape-of. O’Grady, E. (n.d.) Advanced practice registered nurses: The impact on patient safety and quality. Retrieved from http://www.ahrq.gov/qual/nurseshdbk/docs/O%27GradyE_APRN.pdf. Wright, E. (2008) Cultural competency training in nurse anesthesia education. Education News 76 (6), p. 421-424. Professional Goals The overall professional goal of the author is to master the following advanced skills in the field of nursing anesthesiology: Become highly competent in delivering anesthesia care to patients that undergo surgical, therapeutic or various diagnostic procedures. It means being able to effectively plan, perform, and assess the anesthesia care. Develop collaborative skills to work productively as a part of a team, together with other health professionals. Develop research skills: conduct critical analysis of the latest research and integrate these findings into anesthesia practice; Learn to instruct patients and medical staff on issues related to anesthesia care. The author aims to become proficient in delivering local and general anesthesia to patients of different age groups and in different surgical fields. The author also aims at mastering a variety of anesthesia procedures and techniques. Besides, the author aims to master patient monitoring and postoperative recovery (Urman, Gross, & Philip, 2011). As for the author’s personal goals, these are to become a highly qualified CRNA. This means after receiving the Bachelor’s degree, the author would like to successfully pass the national certification exam and apply for the Master’s program. This will enable the author to receive the qualification of nurse anesthetist. Having become an excellent CRNA, the author would like to pursue a career in nursing in one of the hospitals. The author would love to help people recover and go through the hardest moments of their lives. The author believes that her well-qualified assistance and compassionate care will reduce the sufferings of patients. To do good to people is the author’s major aim in pursuing the career in nursing anesthesiology. As for the BSN program, it has provided the author with the foundations of nursing practice and has given the author a chance to fulfil the dream of becoming a nurse anesthetist. References Urman, R., Gross, W., and Philip, B. (2011) Anesthesia outside of the operating room. Oxford University Press. Read More