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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    Related Documents

    NRAN 80526 Scope of Practice PDF

    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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