Professional Aspects Flashcards
Arizas lecture
What are the standards of nursing practice?
The standards of nursing practice outline the responsibilities and expectations for nurses, ensuring safe and effective patient care.
These standards include ethical practice
patient-centered care
and evidence-based practice.
What is the role of the nurse anesthetist?
The role of the nurse anesthetist includes planning and delivering anesthesia, pain management, and related care.
Nurse anesthetists are advanced practice registered nurses (APRNs) who function independently or in collaboration with other healthcare professionals.
What is the function of the American Association of Nurse Anesthesiology (AANA)?
AANA promotes patient safety, practice excellence, and the profession of nurse anesthesia.
It represents almost 61,000 CRNAs and SRNAs.
List the different anesthesia delivery models.
- Physician Anesthesiologist Model
- Anesthesia Care Team (ACT)
- Independent CRNA Practice
Each model varies in terms of collaboration and supervision.
What is the function of state associations and international associations in nurse anesthesia?
State and international associations provide support, resources, and advocacy for nurse anesthetists and promote standards of practice.
They also help in policy-making and educating members.
What is culturally competent care?
Culturally competent care refers to the ability to understand, communicate with, and effectively interact with people across cultures.
It emphasizes respect for diverse values and beliefs in healthcare.
Discuss infection control issues that compromise safe patient care.
Infection control issues include cross-contamination, improper sterilization, and lack of adherence to hygiene protocols.
These factors can lead to increased risk of hospital-acquired infections.
What is the One and Only Campaign?
The One and Only Campaign aims to promote injection safety and reduce the risk of infections associated with unsafe injection practices.
It provides a checklist for safe injection practices.
Who is known as the ‘Mother of Anesthesia’?
Alice Magaw is known as the ‘Mother of Anesthesia’ for her proficiency in open drop ether.
1893
She worked for Dr. Charles Mayo at St. Mary’s Hospital in Rochester, MN.
When was the first hospital-based nurse anesthesia program opened?
The first hospital-based nurse anesthesia program was opened in 1909 by Agnes McGee at St. Vincent’s Hospital in Portland, OR.
1909
This marked a significant development in the formal training of nurse anesthetists.
What significant event occurred in 1931 related to nurse anesthesia?
The National Association of Nurse Anesthetists (NANA) was founded on June 17, 1931.
It was established by Agatha Hodgins in Cleveland, OH.
What is the scope of practice for CRNAs?
The scope of practice for CRNAs includes:
* Pre-op assessment
* Developing anesthetic plan
* Administering anesthesia
* Airway management
* Post-op pain management
It varies by state and is influenced by education and local laws.
True or False: CRNAs can practice independently without physician supervision in all states.
False
The level of independence varies by state laws and regulations.
What is required for a nurse to become a CRNA?
To become a CRNA, one must:
* Be a licensed registered nurse
* Have critical care nursing experience
* Complete an accredited nurse anesthesia program
* Pass the National Certification Examination
This pathway ensures that CRNAs are well-prepared for their roles.
What is the AANA’s motto?
The AANA’s motto is ‘Safe and effective anesthesia care for every patient.’
This reflects their commitment to patient safety and quality care.
Fill in the blank: The current model of practice supports the role of RNs in _______.
[advanced practice]
This includes roles such as nurse anesthetists.
What are the core values of the AANA?
- Integrity
- Member Centered
- Diversity, Equity, Inclusion
- Advocacy
- Growth Through Excellence
These values guide the organization in its mission and operations.
When is a doctoral degree in nurse anesthesia required for entry-level CRNAs?
A doctoral degree in nurse anesthesia will be required for entry-level CRNAs by 2025.
This reflects the evolving educational standards in the profession.
What is the estimated impact of rural hospital closures if Congress does not act?
An estimated 7 million patients will lose direct access to care while local economies suffer.
What act does the AANA support to prevent rural hospital closures?
The Save Rural Hospital Act.
What was the purpose of the provider nondiscrimination laws passed by Congress in 2010?
To prohibit insurers from discriminating against qualified healthcare providers solely on the bases of their licensure.
What does the ‘No Surprises Act’ direct the Departments of HHS, Labor, and Treasury to do?
To promulgate rulemaking related to provider nondiscrimination within one year.
What is the location of the AANA Annual Congress in 2025?
Nashville, TN.
What is one of the workshops offered at the AANA Annual Congress?
Ultrasound Guided Peripheral Nerve Block Workshop.
What is defined as ‘conference time’ in the NAR program?
Attendance at a state association meeting or an approved anesthesia conference.
How many days of conference time are allocated for NAR professional development?
Five (5) days.
What is the first standard for Nurse Anesthesia Practice?
Patient’s Rights: Respect the patient’s autonomy, dignity, and privacy.
What must be documented as part of Standard 2: Preanesthesia Patient Assessment and Evaluation?
A preanesthesia evaluation of the patient’s general health, allergies, medication history, and relevant diagnostic tests.
What is required for Standard 4: Informed Consent for Anesthesia Care?
Obtain and document informed consent from the patient or legal representative.
What does Standard 6: Equipment require regarding anesthesia equipment checks?
Verify function of anesthesia equipment prior to each anesthetic.
How often should a patient’s blood pressure, heart rate, and respiration be documented during anesthesia?
At least every five minutes.
What does Standard 10: Infection Control and Prevention emphasize?
Adhere to infection control policies and procedures to minimize the risk of infection.
What is the CRNA’s primary ethical responsibility according to the Code of Ethics?
To the patient.
What is the CRNA’s responsibility as a professional?
To be accountable for judgments made and actions taken in professional practice.
What ethical principles must a CRNA adhere to in research?
Respect for persons, beneficence, and justice.
What is the mission of the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)?
To promote patient safety through credentialing programs that support lifelong learning.
What is the vision of the NBCRNA?
To be recognized as the leader in advanced practice nurse credentialing.
What is the role of the AANA Board of Directors?
To provide leadership and governance for the AANA.
What are practice considerations according to AANA?
Advisory documents intended to provide practice elements that support clinicians in anesthesia.
What is one of the practice considerations related to anesthesia care?
Informed Consent for Anesthesia Care.
What is the fee for active membership in AANA?
$710.
What type of committee is the AANA Communications Committee?
An elected committee.
What does Standard 11: Transfer of Care emphasize?
Evaluate the patient’s status before transferring responsibility of care.
What is required for Standard 12: Quality Improvement Process?
Participate in the ongoing review and evaluation of anesthesia care.
Fill in the blank: The AANA recognizes the _______ as the foundation for ethical values in nursing practice.
American Nurses Association (ANA) Code of Ethics.
True or False: CRNAs may endorse products and services without any restrictions.
False.
What is the composition of the CRNA Board of Directors?
An eleven-member Board consisting of:
* Eight certified nurse anesthetists
* One board-certified anesthesiologist
* One board-certified surgeon
* One public representative
Members serve staggered three-year terms.
When was the accreditation program for nurse anesthesia initiated?
1952 by the AANA
The accreditation function was transferred to the Council on Accreditation in 1975.
What is the role of the Council on Accreditation of Nurse Anesthesia Educational Programs?
It serves as a fiscally autonomous multidisciplinary body overseeing nurse anesthesia accreditation since 1975.
Name three Pennsylvania CRNA programs.
- Allegheny School of Anesthesia, Pittsburgh, PA
- Cedar Crest College Nurse Anesthesia Program, Allentown, PA
- Drexel University Nurse Anesthesia Program, Philadelphia, PA
What is the mission of the AANA Foundation?
To advance the science of anesthesia through education and research.
What is CRNA-PAC?
The Certified Registered Nurse Anesthetist Political Action Committee that advocates for CRNAs on public policy issues.
What percentage of anesthesia in the world is provided by nurse anesthetists?
More than 80%
Nurse anesthetists are the sole providers in 60% of those cases.
What does Campinha-Bacote’s Culturally Competent Model include?
- Cultural Awareness
- Cultural Knowledge
- Cultural Skill
What is cultural competence?
The ability to understand, communicate with, and effectively interact with people across cultures.
What leads to cultural incompetence in healthcare?
- Miscommunication
- Noncompliance
- Lack of provider acceptance
What are the requirements for a state to ‘opt-out’ of the federal supervision requirement for CRNAs?
- Consultation with boards of medicine and nursing
- Determination that opting out is in the best interests of citizens
- Consistency with state law
True or False: The CMS rule allows states to opt out of the federal supervision requirement for CRNAs.
True
Fill in the blank: The International Federation of Nurse Anesthetists (IFNA) was founded in _______.
[1989]
What is the focus of the important article ‘The Future of Nursing: Focus on Scope of Practice’?
Eliminating outdated regulations that limit nurses’ practice.
What major finding did Dulissa and Cromwell (2010) report regarding nurse anesthetists working without physician supervision?
No harm found when nurse anesthetists work without supervision.
What does AANA’s Diversity, Equity, & Inclusion Committee aim to promote?
Cultural sensitivity, diversity, and inclusion in the nurse anesthesia profession.
What is one of the key reasons for increasing the number of CRNAs in healthcare?
To contain costs while maintaining quality care.
What is the significance of the study ‘Cost Effectiveness Analysis of Anesthesia Providers’?
CRNAs are less costly to train than anesthesiologists and can provide efficient anesthesia care.
What cultural issues are emphasized in providing culturally competent care?
- Culture
- Race
- Gender
- Sexual orientation
What is the impact of cultural health care beliefs on patient care?
They influence health care beliefs and practices.
What is one tip for professional success in the workplace?
Arrive early to work.
What is the relationship between effective communication and patient outcomes?
Effective communication leads to better patient outcomes.
What incident led to a hepatitis C outbreak in Nevada in 2008?
Syringe reuse and unsafe medication practices in an endoscopy clinic.
What unsafe practice was transmitted from syringe reuse?
Reuse on individual patients and use of single-use medication vials on multiple patients
This highlights the serious risks associated with improper injection practices.
How many total cases of HCV were reported from July to December 2007?
6 total cases
There was potential for more cases to be identified.
What unsafe practices were commonly used by anesthesia personnel according to staff interviews?
- Reuse of syringes on individual patients
- Failure to wipe off injection ports and med stoppers
- Improper use of single dose medication vials on multiple patients
These practices significantly contributed to the risk of infection.
What was the basis of the lawsuit filed against Providence Health & Services and Oregon Anesthesiology Group?
The woman contracted hepatitis C after surgery and alleged unsafe practices led to her infection
This lawsuit reflects serious concerns about infection control in medical settings.
How many confirmed cases were linked back to one clinician by May 2008?
7 of 8 confirmed cases
This indicates a significant outbreak traced to a single source.
What were the legal ramifications of the unsafe injection practices?
- Several lawsuits filed against the center & practitioners
- Unsafe, unethical, & criminal practices
- Pharmaceutical companies for labeling issues
- HMO for failure to monitor standard of care
These legal actions reflect the severity of the consequences for such practices.
What are the recommendations from AANA regarding needle and syringe use?
- Never administer medications from the same syringe to multiple patients
- Never reuse a needle or needleless access device
- Never refill a syringe once it has been used
- Never use infusion sets on more than one patient
- Never reuse a syringe or needle to withdraw medication from a multidose vial
- Never reenter a single-dose medication vial
These guidelines are critical for patient safety.
What is the impact of unsafe injection practices on patients?
- 114 patients infected with Hep C
- 2 patient deaths
These statistics highlight the severe consequences of unsafe practices.
What did the CDC recommend regarding needle and syringe reuse?
Never reuse a needle or syringe either from one patient to another or to withdraw medication from a vial
This is a fundamental guideline to ensure safety in medical practices.
Fill in the blank: The lawsuit against Providence Health & Services sought _______ in punitive damages for reckless disregard.
$1 billion
This amount reflects the serious nature of the claims against the healthcare providers.
What ethical obligation do CRNAs have regarding infection risk?
To deliver care to minimize risk of infection for their patients or themselves
This obligation is part of maintaining high standards in healthcare.
What should be done with unused items after use according to ASA recommendations?
All syringes should be discarded immediately in an appropriate puncture resistant container
Proper disposal is essential to prevent contamination.
True or False: Multi-dose vials may be used in the operating room if aseptic technique is used.
False
Multi-dose vials should not be used in the OR; if used, they must be discarded.
What action did five nurse anesthetists take in response to the investigation findings?
Voluntarily surrendered their licenses to the Nevada Board of Nursing
This action indicates the seriousness of the violations.
According to the investigation, how many patients were infected by 2013?
114 patients
This figure illustrates the long-term impact of the outbreak.
What is a key takeaway from the impact of unsafe injection practices?
Economic liability includes $505 million against pharma and $24 million against HMO in NV
This financial impact reflects the broader consequences of these practices.
Who used nitrous oxide for tooth extraction in 1844?
Horace Wells
A dentist from Connecticut.
In what year did John Snow use chloroform during childbirth for Queen Victoria?
1853
Who provided anesthesia to soldiers during the Civil War from 1861 to 1865?
Catherine Lawrence and other nurses
Who was the first known nurse to specialize in anesthesia delivery in 1877?
Sister Mary Bernard
A nurse at St. Vincent’s Hospital in Erie, PA.
What title was given to Alice Magaw by Dr. Charles Mayo in 1893?
Mother of Anesthesia
In what year did Agnes McGee open the first hospital-based nurse anesthesia program?
1909
Who established the Lakeside Hospital School of Anesthesia in 1915?
Agatha Cobourg Hodgins
What happened to the Lakeside Hospital School of Anesthesia in 1916?
It was closed due to legal questions.
What significant legal finding occurred in 1917 regarding nurse anesthesia?
The Kentucky Court of Appeals found in favor of Margaret Hatfield.
When was the National Association of Nurse Anesthetists (NANA) founded?
June 17, 1931
Which states were the first to organize under NANA?
- Pennsylvania
- Ohio
- Alabama
What year was NANA incorporated?
1932
What was the initiation fee for NANA upon incorporation?
$1
Where was the first meeting of NANA held in 1933?
Milwaukee
Who was elected as the first president of NANA in 1933?
Agatha Hodgins
What resolution did the American Hospital Association adopt in 1935 regarding anesthetists?
Any legislation that bars trained anesthetists would be a mistake.
What happened to the association’s name on October 17, 1939?
Changed to the American Association of Nurse Anesthetists.
What does the AANA Code of Ethics offer to CRNAs?
Guidance to make ethical decisions in all practice roles.
What is the responsibility of CRNAs to patients?
Respect patient’s moral/legal rights, support patient safety, comfort, and well-being, and provide compassionate, holistic, patient-centered anesthesia and pain management.
What must CRNAs respect in their practice?
Human rights, values, customs, culture, and patient beliefs.
What is the CRNA’s responsibility as a professional?
Responsible and accountable for judgments made and actions taken.
Does input from other healthcare professionals relieve CRNAs of their responsibilities?
No, it does not relieve them of their own judgments/actions taken.
What are the CRNA’s responsibilities in research?
Protect integrity in research and adhere to ethical principles: respect, beneficence, and justice.
What must CRNAs maintain in business practices?
Ethical business practices with patients, colleagues, institutions, and corporations.
When can CRNAs endorse products and services?
Only when personally satisfied with the product/service’s safety, effectiveness, and quality.
Can a CRNA claim AANA endorsement for a product/service?
No, unless the Board of Directors has endorsed it.
Can CRNAs endorse any product/service for AANA CE activities?
No, they cannot endorse any product/service for an AANA CE activity.
What is the CRNA’s responsibility to society?
Collaborate with others to improve public health and access to healthcare/anesthesia and pain management.
What is Standard 1 of the AANA Standards of CRNA Practice?
Respect patient autonomy, dignity, privacy, and support patient needs/safety.
What does Standard 2 require regarding preanesthesia?
Perform/document a preoperative assessment/evaluation.
What is included in the plan for anesthesia care according to Standard 3?
Formulate a patient-specific care plan, potentially with the healthcare team and patient’s legal representative.
What is the focus of Standard 4 in relation to informed consent?
Obtain/document that the patient/legal representative has given informed consent.
What does Standard 5 emphasize about documentation?
Document care data/activities in the patient healthcare record.
What are the key aspects of equipment management in Standard 6?
Adhere to manufacturer instructions, verify functionality, and operate safely to minimize risks.
What is the responsibility of a CRNA under Standard 7?
Implement and modify the anesthesia care plan, providing care until responsibility is accepted by another professional.
What does Standard 8 state about patient positioning?
Collaborate with the surgical team to ensure proper body alignment and use protective measures.
What monitoring is required under Standard 9?
Ensure alarms are audible, document vital signs at least every 5 minutes, and monitor patient condition.
What are the specific monitoring requirements for oxygenation in Standard 9?
Observe and use pulse oximetry; collaborate to mitigate fire risk.
What does Standard 9 require for ventilation monitoring?
Confirm EtCO2, verify intubation, and use vent monitors as indicated.
What cardiovascular monitoring is required in Standard 9?
Monitor/evaluate circulation to maintain hemodynamic status, including HR and CV status.
What does Standard 9 state about thermoregulation?
Monitor temperature for significant changes and facilitate normothermia.
What is required for neuromuscular monitoring under Standard 9?
Monitor neuromuscular response when paralytics are used to assess depth of blockade/recovery.
What does Standard 10 focus on regarding infection control?
Verify/adhere to infection control policies/procedures to decrease infection risk.
What is the key consideration in Standard 11 regarding transfer of care?
Evaluate status and communicate essential information before transferring care.
What does Standard 12 involve regarding quality improvement?
Engage in ongoing review/evaluation of care to improve outcomes.
What is the focus of Standard 13 regarding wellness?
Ensure physical and mental ability to perform role/duties.
What does Standard 14 promote in patient care environments?
Foster a culture of safety through communication, supportive leadership, and interdisciplinary engagement.
What is the AANA’s recommendation regarding administering medications from syringes?
Never administer medications from the same syringe to multiple patients, even if the needle is changed.
What should never be done with a needle or needleless access device?
Never reuse a needle or needleless access device even on the same patient.
Fill in the blank: Never refill a syringe once it has been used, even for the same _______.
patient.
What is the protocol for using infusion or intravenous administration sets?
Never use infusion or intravenous administration sets on more than one patient.
What should be done with a multi-dose vial when withdrawing medication?
Never reuse a syringe or needle to withdraw medication from a multidose vial (MDV).
What is the rule regarding single-dose medication vials?
Never reenter a single-dose medication vial, ampoule, or intravenous infusion bag.
What is a recommended practice for drawing up medications?
Draw up medications as close to administration time.
What should not be done with a previously used needle when aspirating vaccine?
Do not aspirate vaccine from a multi-dose vial with a previously used needle.
What should be done with multi-dose vials after opening?
Refrigerate multi-dose vials after opening.
What should be done before inserting any device into a multi-dose vial?
Cleanse diaphragm with 70% ETOH solution before inserting any device into the vial.
What should be done with needles after use?
Dispose of needle and syringe after use.
What should be discarded if sterility is suspected?
Discard any multi-dose vial if sterility is suspected.
What is the protocol for syringes and needles after use?
All syringes should be discarded immediately in an appropriate puncture-resistant container.
Fill in the blank: Unused items should be stored in a _______ to avoid contamination.
clean area.
What is the rule regarding the use of uncontaminated multi-dose vials?
If aseptic technique is used, an uncontaminated multi-dose vial may be used until the manufacturer’s expiration date.
What technique should be used each time a multi-dose vial is entered?
Aseptic technique should be used, including cleaning the rubber stopper with ETOH and using a sterile needle and syringe.
True or False: It is safe to change the needle and reuse the syringe.
False.
What must be used to withdraw medication from multi-dose vials?
Clean needle and syringe.
What are some professional behaviors expected from an anesthesia resident?
Arrive early, develop a reputation as a problem solver, accurate documentation and coding.
What is a key aspect of customer service for an anesthesia resident?
Please your customers and have a pleasant attitude towards staff and patients.
Fill in the blank: Do more than _______.
expected.
what are the 5
Rs?
§ Right time
right dose
right patient
right drug
right route
You have ephedrine 50 mg in 1 mL. You want to prepare a syringe with
10 mg/mL. What size syringe should you use?
If the final concentration is to be 10 mg/mL, how much diluent do you add to
1 mL of ephedrine (50 mg/mL)?
- 50mg/1ML = 10mg/x ML
50/10 = 10/10
x = 5
add 4mL diluent to for total of 5 mLs
Who is the President of the AANA Board of Directors?
Janet Setnor MSN, CRNA, Col. (Ret), USAFR, NC
Who serves as the President-Elect of the AANA Board of Directors?
Jeff Molter, MBA, MSN, CRNA
Who is the Vice President of the AANA Board of Directors?
Tracy Young, MSNA, MBA, CRNA
Who holds the position of Treasurer on the AANA Board of Directors?
Jennifer Banek, MSN, CRNA
Who is the Director for Region 1 on the AANA Board of Directors?
Susan Newell DNP, CRNA, FAANA
Who is the Director for Region 2 on the AANA Board of Directors?
Debra Diaz, DNP, CRNA, APRN, FAANA
Who is the Director for Region 3 on the AANA Board of Directors?
Daniel King, DNP, CRNA, CPPS, CNE
Who is the Director for Region 4 on the AANA Board of Directors?
Stacy Yancey MSNA, CRNA
Who is the Director for Region 5 on the AANA Board of Directors?
Michael MacKinnon DNP, FNP-C, CRNA, FAANA
Who is the Director for Region 6 on the AANA Board of Directors?
Erin M. Foley, DNAP, MSNA, CRNA, FAANA
Who is the Director for Region 7 on the AANA Board of Directors?
Erik Rauch, DNP, MBA, CRNA, NSPM-C
