Questions and Answers
Who is credited with bringing anesthesia into the realm of medical practice?
What was the main reason physicians were reluctant to become anesthetists?
What was the outcome of the three challenges brought against nurse anesthetists for illegally practicing medicine?
What is the primary role of an anesthetist, according to Dr. James Cottrell?
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What is the name of the organization established in 1931 for nurse anesthetists?
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What is the key difference between the surgeon's role and the anesthetist's role?
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What is the paradigm of anesthesia practice?
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What was the outcome of the Montana Society of Anesthesiologists v Montana Board of Nursing case in 2007?
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What is the primary responsibility of a CRNA?
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What is the primary responsibility of a CRNA to society?
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What is a unique aspect of anesthesia care provided by CRNAs?
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What is the scope of practice for a CRNA in terms of anesthesia techniques?
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What do numerous studies show about anesthesia care provided by CRNAs?
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What is true about state legislation regarding CRNA practice?
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What is not included in a CRNA's scope of practice?
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What is a CRNA's responsibility in managing a patient's airway and pulmonary status?
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What is the purpose of the AANA Code of Ethics?
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What is an additional responsibility that a CRNA may have?
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What is a potential consequence of restrictive CRNA practice bylaws?
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What is unique about the anesthesia profession?
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What is part of a CRNA's preanesthetic preparation?
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What is a key aspect of CRNA practice?
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What is governed by state statues and regulations?
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What is part of a CRNA's post-anesthesia care?
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What is true about JCAHO and Medicare requirements?
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What is the focus of the CRNA's ethical responsibility?
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What is the primary goal of Standard XIV: A Culture of Safety?
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What do Standards of Care set the benchmark for?
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What is a key aspect of a standard, as defined in the context of healthcare?
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What influences the customs and behavior of healthcare professionals in a particular profession?
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What is a key characteristic of a Culture of Safety, as described in Standard XIV?
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What is used to judge individual transgressions in a profession?
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Who is responsible for establishing standards of care in a profession?
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What is the purpose of an expert witness in a court case?
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What is the basis for developing standards of care in healthcare?
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Why are published professional practice documents important in healthcare?
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What is the purpose of closed claim studies in anesthesia care?
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Why is documentation important in healthcare?
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What is the role of professional associations in establishing standards of care?
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Why are standards of care important in healthcare?
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Study Notes
History of Anesthesia
- 1927: Ralph Waters established the first medical academic anesthesia department, bringing anesthesia into the realm of medical practice, which was previously a nursing practice.
- Physicians were reluctant to become anesthetists due to money and the refusal to acknowledge contributions of innovative nurse anesthetists.
- Denial to nurse anesthetists of a just place in the literature of the field.
Agatha Hodgins and the National Association of Nurse Anesthetists (NANA)
- Agatha Hodgins suggested nurse anesthetists organize into a “coherent and acting body” at the American Nurses Association biennial convention.
- 1931: NANA was established in Cleveland, OH.
- 1936: American Society of Anesthesiologists (ASA) was established.
Challenges to Nurse Anesthetists
- The US has seen 3 challenges brought against nurse anesthetists for illegally practicing medicine:
- Frank v South (1917)
- Hodgins v Crile (1919)
- Chalmers-Francis v Nelson (1936)
- These cases were found in favor of the nursing profession, with the premise that the surgeon was the person practicing medicine.
- Montana Society of Anesthesiologists v Montana Board of Nursing (2007) reaffirmed CRNA practice.
Scope of Practice
- CRNAs have a unique role in providing physiologic support, monitoring, and intervention, whereas surgeons focus on patient anatomy.
- "Our job is to keep patients alive while the surgeon does things that could kill them." - Dr. James Cottrell, ASA President
- CRNAs continuously monitor vital signs and other parameters, counteracting untoward reactions, and balancing dosages of analgesics to levels of surgical pain.
- Numerous studies show anesthesia care by CRNAs to be safe and of high quality.
Politics
- Courts have upheld the concept of anesthesia practice by both physician and nurse anesthetists.
- State legislation: no state in the US requires supervision by an anesthesiologist, and 33 states do not have a physician “supervision” or “direction” requirement from CRNAs.
- Within hospitals, bylaws may require supervision, but such restrictions have denied patients access to the full scope of anesthesia services.
Code of Ethics for the Certified Registered Nurse Anesthetist
- The AANA Code of Ethics is a guide for CRNAs to make ethical decisions in all practice roles.
- The CRNA’s ethical responsibility is primarily to the patient, but also to the profession, other healthcare providers, self, and society.
Scope of Practice
- CRNA scope of practice includes:
- Performing and documenting preanesthetic assessment and evaluation
- Developing and implementing an anesthesia plan
- Performing anesthesia techniques
- Managing a patient’s airway and pulmonary status
- Facilitating emergence and recovery from anesthesia
- Implementing acute and chronic pain management
- Responding to emergency situations
- Additional responsibilities may include administration/management and supporting AANA documents.
Standards of Care
- Definition: “Something set up and established by authority, custom, or general consent as a model, example or rule for the measure of quantity, weight, extent, value, or quality.”
- Standards of care are customs and behavior of the members of the profession, and what others in the profession would do under similar circumstances.
- Expert witnesses provide testimony to assist judges, juries, and attorneys to understand the evidence and make factual determinations.
Documentation
- (No specific information provided)
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Description
Learn about Ralph Waters, who brought anesthesia into medical practice in 1927, and the history of nurse anesthetists' contributions being denied recognition.