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Ralph Waters and the Establishment of Anesthesia
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Ralph Waters and the Establishment of Anesthesia

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Questions and Answers

Who is credited with bringing anesthesia into the realm of medical practice?

  • Ralph Waters (correct)
  • Agatha Hodgins
  • Dr. James Cottrell
  • Crile

    • What was the main reason physicians were reluctant to become anesthetists?

  • Fear of malpractice
  • Lack of knowledge in the field
  • Denial of recognition to nurse anesthetists
  • Money (correct)

    • What was the outcome of the three challenges brought against nurse anesthetists for illegally practicing medicine?

  • Found in favor of the nursing profession (correct)
  • Found in favor of the medical profession
  • Legislation was passed to restrict nurse anesthetists
  • Cases were dismissed

    • What is the primary role of an anesthetist, according to Dr. James Cottrell?

    <p>To keep patients alive during surgery</p> Signup and view all the answers

    What is the name of the organization established in 1931 for nurse anesthetists?

    <p>National Association of Nurse Anesthetists</p> Signup and view all the answers

    What is the key difference between the surgeon's role and the anesthetist's role?

    <p>Surgeon focuses on patient's anatomy, anesthetist focuses on patient's physiology</p> Signup and view all the answers

    What is the paradigm of anesthesia practice?

    <p>Physiologic support</p> Signup and view all the answers

    What was the outcome of the Montana Society of Anesthesiologists v Montana Board of Nursing case in 2007?

    <p>Reaffirmed CRNA practice</p> Signup and view all the answers

    What is the primary responsibility of a CRNA?

    <p>To the patient</p> Signup and view all the answers

    What is the primary responsibility of a CRNA to society?

    <p>To collaborate with health professionals to improve public health</p> Signup and view all the answers

    What is a unique aspect of anesthesia care provided by CRNAs?

    <p>Providing support and intense monitoring</p> Signup and view all the answers

    What is the scope of practice for a CRNA in terms of anesthesia techniques?

    <p>Selecting, applying, and inserting appropriate non-invasive and invasive monitoring techniques</p> Signup and view all the answers

    What do numerous studies show about anesthesia care provided by CRNAs?

    <p>It is safe and of high quality</p> Signup and view all the answers

    What is true about state legislation regarding CRNA practice?

    <p>No state requires supervision by an anesthesiologist</p> Signup and view all the answers

    What is not included in a CRNA's scope of practice?

    <p>Conducting surgical procedures</p> Signup and view all the answers

    What is a CRNA's responsibility in managing a patient's airway and pulmonary status?

    <p>Managing a patient's airway and pulmonary status, including facilitating emergence and recovery from anesthesia</p> Signup and view all the answers

    What is the purpose of the AANA Code of Ethics?

    <p>To guide CRNAs in making ethical decisions</p> Signup and view all the answers

    What is an additional responsibility that a CRNA may have?

    <p>Administration/management, such as scheduling and material management</p> Signup and view all the answers

    What is a potential consequence of restrictive CRNA practice bylaws?

    <p>Denied access to the full scope of anesthesia services for some patients</p> Signup and view all the answers

    What is unique about the anesthesia profession?

    <p>It has the greatest overlap within nursing and medicine</p> Signup and view all the answers

    What is part of a CRNA's preanesthetic preparation?

    <p>Performing and documenting preanesthetic assessment and evaluation, requesting consultations and diagnostic tests, and informed consent</p> Signup and view all the answers

    What is a key aspect of CRNA practice?

    <p>Titrating drugs constantly throughout the case</p> Signup and view all the answers

    What is governed by state statues and regulations?

    <p>A CRNA's scope of practice</p> Signup and view all the answers

    What is part of a CRNA's post-anesthesia care?

    <p>Selecting, obtaining, ordering, and administering medications, fluids, and ventilatory support, and discharging the patient from PACU</p> Signup and view all the answers

    What is true about JCAHO and Medicare requirements?

    <p>Neither requires anesthesiologist supervision of CRNAs</p> Signup and view all the answers

    What is the focus of the CRNA's ethical responsibility?

    <p>The patient</p> Signup and view all the answers

    What is the primary goal of Standard XIV: A Culture of Safety?

    <p>To foster a collaborative and cooperative patient care environment</p> Signup and view all the answers

    What do Standards of Care set the benchmark for?

    <p>Expected behaviors and attitudes</p> Signup and view all the answers

    What is a key aspect of a standard, as defined in the context of healthcare?

    <p>A model or rule for the measure of quality</p> Signup and view all the answers

    What influences the customs and behavior of healthcare professionals in a particular profession?

    <p>Consensus documents developed by the profession</p> Signup and view all the answers

    What is a key characteristic of a Culture of Safety, as described in Standard XIV?

    <p>Open communication and interdisciplinary engagement</p> Signup and view all the answers

    What is used to judge individual transgressions in a profession?

    <p>Consensus documents developed by the profession</p> Signup and view all the answers

    Who is responsible for establishing standards of care in a profession?

    <p>Members of the profession</p> Signup and view all the answers

    What is the purpose of an expert witness in a court case?

    <p>To provide objective testimony to assist judges, juries, and attorneys</p> Signup and view all the answers

    What is the basis for developing standards of care in healthcare?

    <p>Consensus and consideration of scientific evidence</p> Signup and view all the answers

    Why are published professional practice documents important in healthcare?

    <p>They reflect consensus on practice and set the standard for judging individual transgressions</p> Signup and view all the answers

    What is the purpose of closed claim studies in anesthesia care?

    <p>To improve the quality of care</p> Signup and view all the answers

    Why is documentation important in healthcare?

    <p>All of the above</p> Signup and view all the answers

    What is the role of professional associations in establishing standards of care?

    <p>They develop and publish professional practice documents</p> Signup and view all the answers

    Why are standards of care important in healthcare?

    <p>They provide a framework for measuring quality of care</p> Signup and view all the answers

    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.

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