Background and Historical Information of Nurse Anesthetist - Term Paper Example

Nurse Anesthetist Section I: Background and historical Information A nurse anesthetist is an advanced-by-practice-nurse with specialization in administration of anesthetics to patients and advanced coordination of their care with the appropriate support from other medical professionals, as described by McAuliffe M. S. and Henry B. (2010). Bohmer A.B. et al. (2012) adds that Nurse Anesthetists are quite important and very necessary in the healthcare institutions. This is because they are charged with the responsibility of looking after the patients and ensuring that they are safe and comfortable right from the periods of pre-operative procedures to the recovery stage and eventual medical checks on the progressions. As described by American Association of Nurse Anesthetists (2009), Certified Registered Nurse Anesthetists (CRNAs) in the United States were awarded with an anesthesia bachelor’s degree, diploma or certificates. These Degree programs commenced as early as 1976 as drafted by the Council of Accreditation. In 1990, master’s degree programs were rolled out scheduled for a duration of eight years (1990-1998) in the Kaiser Permanente California State University. However, modifications have ever since been made to enhance the educational and experience parameters. According to the current obligations spelt out in USA, nurse anesthetists are first required to go through a complete bachelor’s degree course in Nursing or related field. This is then followed by a registration as a nurse after having served as a full-time nurse in an acute care setting to gain adequate nursing experiences. In the third place, any nurse anesthetist has to pass the state certification examinations to attain Certified Registered Nurse Anesthetist (CRNA) qualification. Lastly, continuous assessments to earn educational credits and re-certification are conducted. This is a strategy meant for all nurse anesthetists to continuously and regularly earn educational credits at an interval of every two years throughout their professional practice as nurses. Section II: Professional Issues and Challenges in Nurse Anesthesia As research works provide (Dackiewicz N. et al. 2012), there are varied challenges and issues that have raised concerns over the professional roles of nurse anesthesia. Such issues and challenges range from cultural, spiritual, educational, legal, professional and economical intricacies. In the first instance, healthcare policies have propagated increased healthcare spending (economical challenge). For instance, the US has reported an outrageous 14% of their gross domestic products as being spent on health care activities. The 14% rate is very high and as a result of this, much pressure has been exerted on the medical expertise to justify their existence and need to further provide their services at that high costs. Secondly, patients having appointments to face surgery do regard such medical administrations and health implications involved as of meaning and significance for their need to live, Nixon A, Narayanasamy A. (2010). They draw upon spiritual contents to effectively respond to challenges they have as pertaining to illness and surgery. It is evidenced therefore that there exist effects of life transitions and uncertainty on patients facing surgery, hence resolving to spiritual beliefs and neglecting medical instructions. The third issue is that: Despite nurses’ loyalty towards the World Health Organization’s checklist pertaining to their roles, surgical team involvements were adjusted only according to social, practical and professional situations depending on their work environment; hence bringing out an incomplete use of their checklist as was stipulated and therefore a very low compliance rates are realized, Dackiewicz N, et al (2012). Still on this, various challenges are still experienced in recruiting best candidates and developing good academic culture and evaluation systems for them. These limitations have been as a result of lack of enough equipments, drug shortages and poor facilitations of anesthesia programs. Varying educational levels of practice have also complicated professionalism in this field of Nurse Anesthesia. The ability of some institutions to offer better theoretical as well as practical education over other institutions results into unequal graduates in terms of knowledge and skills levels. The traditional or cultural beliefs have to a very large extent interfered with medical practices and administration. For instance, some cultures i.e. the Zulu of South Africa have never believed on the modern medication practices. They have always insisted on their traditional medicines and only turn out for modern medication when their conditions have grown worse and hard to restore. Such cases have negated the general positive results of nurse Anesthesia, and complicated medical administration for the nurse Anesthetics. Section III: Philosophy of nursing Philosophy statement defines and gives explanation to how systems of beliefs, in the medical profession, which determine how a mission or set purposes are made achievable. Therefore, nursing philosophy states the beliefs, concepts and principles medical institutions. According to (Therese C Meehan, 2012) Philosophy of nursing is the human conceptual understanding, clarification and assessment of arguments by considering the traditional philosophical problems that have helped in the development of nursing theory and practices with a focused view on the framework propositions that constitute the general nursing discourse. Harmonized relationship between Philosophy of Nursing and Nurse Anesthesia (as research findings depict) have helped in the formulation of nursing philosophy as included in the conceptual clarifications and explicit evaluation of claims. Secondly, nurse anesthesia ensures that philosophy of nursing considers all the relevant traditional philosophies and their related predicaments in the context on medical practices. Finally, both philosophy of nursing and nurse anesthesia are for the existence of sensitivity to create distinctions between internal and external questions which have to be presented in the formulation of nursing philosophy. A different relationship is that between Nurse Anesthesia and an individual’s spirituality. Spirituality is defined as an individuals’ manner of being, reasoning/ thinking, selecting, and acting in the universe under the guidance of his/her ultimate values, as stated by Griffin A.T. and Yancey V. (2009). Additionally, Griffin A.T. and Yancey V. (2009) outline three major activities in the human spiritual caring as: being close to the patients as they undergo such depressions caused by the illness; giving ears to the patients for their verbal anxieties; and by giving physical, emotional, or spiritual touch to assure them of their close relations with their friends, relative, neighbors e.t.c. This assurance creates a spiritual living attitude, as stipulated by Tamura K, Kikui K, Watanabe M. (2009). Section IV: Caring in nurse anesthetics Nursing is a medical practice that is concerned with the initiative and efforts aimed at health promotion, illness prevention, offering care for the sick and health restoration. All these objectives are central to the holistic to the practice of caring in nursing profession. In the first study under caring in nurse anesthetics, Dackiewicz N, Viteritti L, and Marciano B, et al (2012) explains that medical practitioners (in the task of nurse anesthetics caring) are provided with standards that they have to keep to for effective care and monitoring of the patients. These measures include: Post anesthesia management which is provided to all patients who have received medication attention i.e. general anesthesia, monitored anesthesia or regional anesthesia; Accompaniment of any patient who is on a translocation to PACU by a member of the anesthesia care team to continuously check the condition of the patient; and Re-evaluation and provision of the patient’s report upon arrival in the PACU for purposes of situation analysis. Secondly, taking into account an integrative review of the main factors that are related to patient satisfactions, considered important are the patients’ outcome in relation to the anesthetic and the relative measure of the standards from the patients’ point of view on the quality of services and attention received. A review of such issues brought to light a number of modifiable issues that relate to adult-patients’ level of satisfactions with the general anesthesia care in every healthcare facility, Hawkins RJ, Swanson B, and Kremer MJ. (2012). For the cases in breast-feeding, pregnancies and drug used in the dentistry (observations under the third analysis), dentists have to weigh the risks projected to the fetus versus all the benefits that the mother will acquire and then coming up with a suitable conclusion on what should supersede between these two. In cases of complications, medications have been avoided as a care measure. Besides, breastfeeding has its clinical challenges that have to be conceptualized by both parties involved; that is the patient and medical practitioner doing the administration prior to any medical administration, Donaldson M, Goodchild JH. (2012). Section V: Ethical issues within nurse anesthetics Nursing, as a practice, integrates ethical provisions such as maintaining therapeutic and professional patient and nurse relationship; delivering care in a way that preserves patients’ dignity, autonomy and personal rights; utilizing available resourced in strategizing ethical decisions; maintaining patients’ confidentiality with legal and medical regulatory parameters; and reporting illegal/ incompetent/impaired practices in areas of practice (Chorney JM, Torrey C, Blount R, et al, 2009). According to American Association of Nurse Anesthetists (2009), CRNAs are expected to practice their nursing roles by availing anesthesia and anesthesia-related services by being responsible as conferred upon the by the profession, state/ country and society at large. For instance, among the measures set in place to ensure preservation of human dignity, respecting of legal and moral rights to health consumers, and additional patients’ support through a number of reasons as will be discussed in the following paragraphs. CRNAs are charged with the responsibility of rendering quality anesthesia care regardless of patients’ religion, age, race, nationality and even economic status; meaning that no discriminative terms should be applied, (Therese C Meehan, 2012). Nurse anesthetists are also bound to offer sufficient protection to patients from harm by trying to avoid personal integrity conflict with rights of the patients’. Patients’ rights are supposed to be upheld to instill respect and sense of being alive, Wright S. M. (2008). Through maintaining confidentiality of patients and their information not unless in the rare events of trespassing this to save the situation, i.e. in the outbreak of communicable diseases; patients’ right to privacy are kept intact and adhered to by all professional nurses. Principles of verifying validity of anesthesia informed consents are acquired from the patients so as to enable for better follow-ups. Anesthesia informed consents are also used by medics to study the prevailing causes of such illness, duration taken under such condition, any treatment sort thereafter and determining on the best procedures to take during anesthesia treatments and administration. CNRAs are also charged with the responsibility of taking recommendable actions to protect patients against incompetent, impaired, or rather from those engaged in unsafe/ illegal/ unethical practices as healthcare providers. Section VI: Legal implications Nursing practices are carried out in relation to set professional practice standards and guidelines, relevant statues, rules and regulations that outline professional expectations of its members; promote guides and direct professional nursing practices; provide nurses with a measure for developing competencies; and facilitate in the development of better understanding and respect for various roles of nurses. Strategies set in aid of these include determination of physician supervision requirements, opt-outs, surgeon liabilities and distinguishing overlaps between nursing and medicine. An analytic evaluation of the legal aspects shows that the early legal challenges to nurse anesthesia practices were basically based on ideologies. As in the provision of the licensing laws state legislature helps in the distinguishing of the recommended practice of medicine and that which is in the public’s best interest, Arakelian E, Gunningberg L, Larsson J. (2008). The guidelines and standards set for the nurse anesthesia profession are not in the requirements of CRNAs to be supervised by any physician. Anesthesia’s results are influenced by issues i.e. attention and concentration. Besides, APRN Model Rules and the Consensus Model for APRN Regulation, Licensure, Certification and Education usually do without the requirements of physician supervision of CRNAs; Fudickar A, Bein B. et al (2012). The adoption of opt-out rule is to provide States with the flexibility to enhance access in states which give considerations to issues regarding patients’ safety and quality furnished care by aid of Federal programs, McAuliffe M. S. and Henry B. (2010). Under all circumstances, nurse anesthetics are usually solely responsible for their actions regardless of the states’ requirement of nurse anesthetists to be supervised by a physician. Any healthcare professional or surgeon has no obvious liability for the negligent actions of a CRNA, or immune from liability when operating together with an anesthesiologist. Section VII: Culture Caring attitude should be transmitted by the cultural practices of this Nurse Anesthesia profession as a unique criterion of making up to the social aspects. Language considerations, under cultural factors, are very important. Nurse anesthetics, by ethics, are never allowed to always use patients’ bilingual children, family members and friends as translators. Additionally, patients privacy and also deemed important and considered foremost in securing such anesthesia consents, Wright S. M. (2008). Among the Asian populations, aged patients are given some traditional-custom-care that needs to be of knowledge to the nurse anesthetics. It involves applying hot oil to the back and torso and then rubbing a coin continuously until circular or linear marks are embedded on the patients’ skill. In case CRNs would identify such marks while giving spinal epidurals and not know their cause, it may be so dangerous, American Association of Nurse Anesthetists (2007). Among the Muslim and Orthodox Jewish, couples are always concerned about their female patients’ exposure to males in the operation rooms. They may also insist on being in their ‘hijab’ or any simple scurf or wig while in public to keep up to their modesty, Wright S. M. (2008). Concurrently, there are groups of women (from Africa) who also practice FGM (Female Genital Mutilation). Under such cases, nurse anesthetics are supposed to be aware of the practices and their impacts of the delegation of their services. Finally under cultural factors influencing effective roles performance by nurse anesthetics is the changing demographics i.e. of the US. It is expected that patients’ population will results into dictation of new ways of making appropriate approaches to the anesthetic plans. Everyone has to be attended to regardless of communications barriers, ethnicity, or relatively imposed societal cultural norms with the due respect and dedication with which anesthetic is practiced, Wright S. M. (2008). Section VII: Healthcare improvement Nursing roles, as played by the nurse practitioners, were originated in 1960s due to the urge to quickly respond to the impending physicians’ shortages with regards to the rapidly growing world’s population. Healthcare plays the roles of installing faith and hope among patients; initiating a helping-trust relationship; building on sensitivity to one’s self and others; forming humanistic-altruistic values; promoting and accepting both positive and negative feeling as expressed; providing supportive, protective and proper mental, physical, socio-cultural and spiritual empowerments; and promoting inter-personal teaching and learning. Such factors therefore allow for nurses to ensure the following issues of WHO’s concerns. Accessibility health services: Health professionals are committed to ensure efficient and increased access to health facilities/ services to all, regardless of the geographical locations, Elisha S, Nagelhout J. (2008). Affordability: Cost effectiveness of Nurse practitioners as the basic healthcare providers has led to less-costly preventive care through counseling, patient education, and issues of case managements. Dubowitz G. and Evans F.M. (2012). Quality Outcomes: These quality outcomes include improved pain management practices, reduced hospital costs and durations of stay, minimized frequency of emergency room visits, and enhanced identification of depressions, high level of patient satisfaction and nursing care, and very minimal medical complications among patients who are hospitalized; Fudickar A, and Bein B. et al (2012). Reimbursement and Enrolment; As a step to appreciate and further continue getting the good services of CRNA, identified countries .i.e. Florida, reimburse the CRNA for their provision of such professional and advanced anesthesia services to the civilians. Section IX: Goals CRNAs, as spelt out, are dully responsible and accountable (at individual level) for the various services rendered by them in conjunction with each and every step they take. As a professional, one is responsible and accountable for any judgments made and the eventual actions taken in the professional practice; practice their roles in line with the professional practice standards set by the profession; respect any expertise and responsibility of each and every healthcare worker involved in service provision to the patient; be responsible for self actions; work jointly with other healthcare providers involved in the patients’ care; and finally be active in the participation on any ongoing professional development and its whole body of knowledge. Other terminal goals may include: Demonstration of professionalism by collectively/ collaboratively taking part in health care team in concert with other identified healthcare providers; and demonstration of sensitivity to the ethnic and cultural diversity of patients, their families/ relatives, and other health care providers. This is according to Elisha S, Nagelhout J, and Gupte S, et al (2008). Dubowitz G. and Evans FM. (2012) give a brief that training programs were developed to cater for the shortage of health providers in low-and middle-income countries (LMICs), taking into account the identified needs of the recipient region. Such anesthesia educational programs are meant to emphasize quality, safety and very high professionalism among the providers and the type/ quality of care delivered by them to the patients. Under personal goals, a nurse anesthetist one has to uphold ethics, integrity, corporations and understanding of human behaviors and responses under different situations; and try to reach solutions that require medical expertise in line with my profession. These qualities are achievable if one engages in lifelong, professional education activities; participates in all continuous quality improvement activities as scheduled; maintaining personal state of license as a registered nurse, by meeting state advanced practices’ statutory requirements and keeping to recertification as a CRNA. References McAuliffe M. S. and Henry B. (2010) "Nurse Anesthesia Worldwide: practice, education and regulation" http://ifna-int.org/ifna/e107_files/downloads/Practice.pdf American Association of Nurse Anesthetists (2007) A Brief Look at Nurse Anesthesia History Retrieved May 23, 2007, from http://www.aana.com/brieflookhistory.aspx American Association of Nurse Anesthetists (2009) Certified Registered Nurse Anesthetists at a Glance. 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