Watchful Care Flashcards
William T.G. Morton
- Demonstrated the first surgical anesthesia @ mass gen 10/16/1846 (didn’t publicly document it)
- concerned about infection control and consistent techniques. Rival of “discovery of surgical anesthesia (Wells vs. Jackson vs. Long)
Alice Magaw
- “Mother of anesthesia”
-1860-1928
-stressed the need for the anesthetist to be sensitive to the unique needs of every patient - First publication 1899 “observations in anesthesia” a report on over 3,000 cases `
Agatha C. Hodgins
- Founder of AANA 1931 (chosen by George Crime)
- Organized Lakeside alumnae into Alumnae association of the lakeside school of Anesthesia in 1923
- 1926 she announced her plan for a national organization of nurse Anesthetists Preliminary bylaws and constitution are written (est. 1931)
- July 17, 1931 meeting in order to establish international association of nurse anesthetist (name changed from international to national bc she sought the affiliation with the ANA which got denied)
- Had a MI 1993 (no progress for AANA for a while)
- Believed that nurse anesthetist didnt fully under medical or Nurisng and needed separate protection
- worked for state registration of nurse anesthetist (fife stated this was impractical and need to be national -boards)
Sophie Winton
- Croix De Guerre
- 6 overseas service bars, honors from overseas nurses association, American legion and the veteran for foreign wars.
- partner in private dental clinic then published research on dental anesthesia (honored by Mexican dental society with international dental association for her work)
- opens outpatient plastic surgery center in Hollywood
- formed first California association of nurse anesthetist
Anne Penland
- first official nurse anesthetist on British front
- her expertise in anesthesia contributed to British decision to train their own nurses in the work
Dr. Eleanor Seymour
President of the Associated anesthetist of the United States and Canada 1923
Dr. Mary Botsford
Calmes identified as probably the 1st woman physician anesthetist
Dr. Virginia Apgar
created Apgar score- began her medical career in anesthesia
Dr. Ralph waters
- “Father of Academic Anesthesia” 1927
- Opposed nurse anesthetists
Margaret Boise
Collaborated with surgeon Hugh. H Young -→ invented gas-ether machine (known as Boise-Young apparatus)
Alice Hunt
- 1922 was appointed instructor in anesthesia with university rank at Yale Medical School
– taught nurses and med students 26 years
Eva Wilson
graduate nurse of Samuel Merrit Hospital school of nursing
Adeline Curtis
- 1928- launched her own legal investigation after she got the letter from the cali state board of medical examiners
- she won the case and started talking to other nurse anesthetists
- fought efforts to outlaw nurse anesthesia
- created the nurse anesthetist association
Dagmar Nelson
- invited by Dr. Hunt to come from Minnesota to Cali @ St. Vincent to be his and other physicians anesthetist after there was a case of death from asphyxiation of a 23 year old patient (anesthesia was provided by a physician)
-The physician anesthetists sought injunction to permanently restrain her from administering anesthetics.
-The Bulletin of the Los Angeles County Medical Association lied and published basically that she was illegally practicing medicine and violating the California medical practice act – this was called out quickly – 12 day trial –July 31, 1934 – it was found that she was in fact not practicing outside of her scope. Physicians tried to appeal this, but there was a financial burden. - went on trial for violating medial practice act. May 18, 1936 – Supreme Court of California found that Nelson’s activities were part of “established and uniformly accepted practice followed by surgeons and nurses”
Helen Lamb
chairman of Committee of Education
Goldie D. Brangman
first black president of the AANA
Nurse Anesthesia Facts
- surgical anesthesia born in US in mid 19th century
- 1st nursing speciality
- national association of physician- anesthetists- 1905
- late 1930s—term anesthesiologist to differentiate nurses vs. physicians
- thatcher discovered significant contribution of religious nursing sisters to nurse anesthesia
Sister Mary Bernard
First nurse anesthetist 1877 at St. Vincents hospital
Early methods of surgical anesthesia
- handkerchief soaked chloroform
- ether soaked sponges over nose & mouth (ether pneumonia)
- carless administration (sponge to close to nares preventing admixture of air with the vapor)
- duty was assigned to the least experienced (people were to interested in surgery no the pt)d
-“Ghost anesthesia”
Anesthesia Evolution
- 2 sisters of the Third Order of the Hospital Sisters of St. Francis from Muenster, Germany → springfield, IL 1875
- 1880-→ administration of chloroform and either was taught by the surgeons to sister Aldonza Eltrich (1860-1920
- 1880-→ Vonassa Woenke trained as anesthetist
Sister Marie S. Anderson
- compassionate, experimented on herself.
- Held mask farther away at first – after 44 years she was able to claim a career with thousands of anesthetics
-“WITHOUT A SINGLE DEATH!”
Drop method
- the essential feature of the open ether method in America was the absolutely continuous administration; a drop on the mask every 2 seconds
- mastered by Alice Magraw
Women in anesthesia
- opened anesthesia practice to nurses functioned to open the field to female physicians
- Women physicians were seen by many as a desirable presence and anesthesia because they combined the “naturally” appropriate female traits of submissiveness and physical attractiveness with medical knowledge
Types of Anesthetics
- Ether
- Chloroform
- Nitrous Oxide
Chloroform
noninflammable, less safe than ether, depresses respiratory drive, histotoxic properties, increases irritability of VF
Nitrous Oxide
-discovered by 2 dentists – Dr. John Stephan & Dr. Teter
-better protection of CNS
- Lakeside Hospital
antisepsis
using disinfectants during surgery to kill microorganisms
asepsis
using sterile procedure to exclude microorganisms from field of operation – masks, gloves, steam and dry heat sterilization
When was Morton’s successful demonstration of anesthesia?
1846
early 19th century
- discovery of germs
- Louis Pasteur
- Joseph Lister – 1867 antiseptic surgery “Listerism” – atomizer sprayed carbonic acid solution/ surgical dressings soaked and antiseptic solutions
1860
Florence Nightingale founded St. Thomas Training School for Nurses
When did Thomas Skinner develop the chloroform drop tube and how did it work?
- 1862
- attachment controlling it’s flow onto a small fabric-covered wire frame held over the patients face
1873
3 nurses’ training schools – NY, New Haven & Boston – nursing started to become respectable profession
1877
Mary Bernard – first nurse anesthetist
1879
Johannes Friedrich August von Esmarch designed simplified Skinner mask
1880
sisters trained
1889
Sisters of St. Francis established St. Marys in Rochester, Minnesota ran By Dr. William Worrell
1895
- x ray
- development of the sciences of physiology and pathology -→ surgery transformed
When did Mother Magdalane Wiedlocher organize a course in anesthesia? where was this course located?
- 1912
- St. Johns Hospital for Sisters who were graduate nurses
1914
WWI – service of lakeside unit and the American Ambulance at Neuilly – Cile -→ “We literally introduced gas-oxygen anesthesia into war surgery and into England and France.”
-The first time the navy and army trained nurses as anesthetists for war service
Dr. Crile
- Got American Red Cross to by a plant for manufacturing nitrous oxide early 1918
- developed nitrous oxide technique
- helped on Lakeside school of anesthesia
April 6, 1917
-US declared war – Lakeside hospital unit “Base No. 4”
-maggots
- 1917 deliberate bombing of hospitals
When did Frank v. South happen?
1917
When did postgraduate courses open to secular nurses
1924
1930- Hilda Salomon
- organized group of local nurse anesthetists to meet once monthly and discuss cases
—She would become the fist vice president of the National Association of Nurse Anesthetists in 1934 - president in 1935 and 1936
When was the first meeting to discuss forming the AANA and where was the meeting held?
- July 17, 1931
- at lakeside hospital 49 anesthetists from 12 states
1934
the legality of nurse anesthetists established through the 1934 trial of Dagmar Nelson
When did California State Association of Nurse anesthetists became an “official” affiliate of the National Association of Nurse Anesthetists
1935
1938
Board of surgery pressured Board of Anesthesia to embrace the national organization of nurse anesthetists – it was denied
November 26 1938
- meeting with members of the American board of surgery and the American board of Anesthesiology – Miriam Shupp did not agree of “hooking up with the surgeons” and Helen lamb did
When was WWII and what was the significance?
- 1941
- emergency training programs threatened to undermine progress of the association
1954
AANA awarded “Award of appreciation” to the Hospital of Sisters of the Third Order of St. Francis – Springfield, IL
when did the title for CRNA come into existence?
1956
1985
first international Symposium for Nurse Anesthetists held in Lucerne, Switzerland
When did CRNA receive Medicare direct reimbursement rights (1st nursing specialty)
1986
Dr. Francis Hoeffer McMechan
– wife Laurette“ there was no place in anesthesia for a nurse”
- waters agreed
-He called nurse anesthetists nurse “technicians”
- write things in the Anesthesia Supplement to the American Journal of Surgery to recommend strategies for the abolition of the “present menace of the nurse anesthetist”
1911-1935 Anti Nurse anesthetist activity
- Gave nurses ZERO credit for any significant advanced in anesthesia
-1919– the national anesthesia research society is founded and became the international anesthesia research society in 1925
-“the nurse anesthetist must go because she is unlicensed and because her employment is much an economic crime against the profession and public as fee splitting” - Stated that nurse and ethicist were violating medical practice acts “infringing on physicians’ very personal property rights”
-1911 – James Taylor Lewis, declared that the administration of an aesthetic by a nurse was in violation of the law of the state of New York
James Taylor Lewis
declared that the administration of an aesthetic by a nurse was in violation of the law of the state of New York in 1911
Lakeside Hospital
- Hodgins and Crile
- Celebrated for nitrous oxide and O2
- School of anesthesia
-1912—ohio medical board stated no one other than a physician could administer anesthetic - 1916 – Interstate Association of Anesthetists (through Frank McMehan) petioned the Ohio State Medical Board to take action against Lakeside Hospital ‘as the chief source of the nurse-anesthetist abuse’ – anesthesia training was then discontinued because if they didn’t, no one could graduate even as a RN
- first class 1916 (physicians, nurses, dentist)
- Reopened 1917
AANA
- John Mannix – helped get the American Hospital Association involved in 1933
- Gertrude Fife, Helen Lamb & walter Powell made out the program for the first convention in Fife’s kitchen.
- Fife assumed AANA when Hodgins became ill
- Fife called for a committee to investigate all schools of nurse anesthesia with the object of creating a list of “accredited” schools
- Priority: development and implementation of educational programs (Obstacles: finances, WWII)
- Really nobody would back the association they tried to get the American board of anesthesiology (there was controversy in this)
- July 12th 1940 – hodgins wrote Helen lamb a letter requesting that she the president of the AANA
What were the objectives for the meeting when they meet with the American hospital association (first annual nurse anesthesia meeting) ?
- To advance the science and art of anesthesiology
- to develop educational standards and technique in the administration of anesthetic drugs
- to facilitate efficient cooperation between nurse anesthetist and the medical profession, hospitals, and other agencies interested in anesthesiology
- to establish and maintain a central Bureau for information, reference, and assistance and matters pertaining to the science and art of anesthesiology
- to promulgate and educational program to enlighten the general public as to the importance of proper administration of anesthetics, and to take all proper steps to accomplish, as nearly as possible, complete protection to the public, as well as to protect the professional rights of the association and its members.
Agnes McGee
held the first nurse anesthesia course at St. Vincents Hospital Portland Oregon 1909
Frank v. South
- stated that nurses were violating the medial practice act by admin anesthesia but it was determined that nurse was not engaging in the practice of medicine
-initially ruled in favor of physicians and then overturned
Spain v. Buch
the ruling stated that is wasn’t only physicians who were able to administer anesthesia. it recognized that people who were trained for this certain role ay be better suited for it that. a physician
Did the ANA support the nurse anesthesia organization ?
they did NOT offer support and said that membership to the ANA was already available to nurse anesthetist through their alumnae, state, and district associations. there could not be a separate section within the ANA for nurse anesthetist and they decided to make their own organization
Did the American Hospital association support the nurse anesthesia organization
yes, they would welcome this arrangement because they believed it could have mutual benefits.
Gertrude Fife
wanted to address critical issues for the nurse anesthesia organization to be addressed including
- standardizing the education of nurse anesthetist
- creating a list of accredited schools
- establishment of national board examinations
- Establishment of national board exams that “would place in the surgeon ‘s hands an official record showing that her knowledge of the subject has met with the approval of an examining board – a board chosen and functioning to safeguard the surgeons interest, the interests of the hospitals, and the interest of the public (Dr. Karsner helped with this )
- second president of AANA
CRNA roles during Vietnam war
-served on helicopter missions and on arrival to surgical facility they became the director of continued resuscitation procedure (gaining autonomy which was later a issue)
-first war nurses were drafted into (before they just volunteered) women were excluded
-10 nurse died (2 CRNA)
When did men join the AANA
- 1947 during the Vietnam era
- first all Male class graduated from Walter Reed
what is the importance of accreditation and when did the AANA accreditation goal become effective?
- standard of practice ensured acceptable level of quality
- January 19, 1952 only graduates of accredited schools could take the exam
What are the foundations of professional autonomy?
“your rights to control anesthetist training, conduct peer review, help define client needs, and secure what you consider to be an acceptable level of reimbursement are no means rights. they are they foundation of your profession autonomy” page 162
IFNA
international federation of nurse anesthetists
Korea era
- November 20, 1955
- veterans able to qualify for GI benefits
who was drafted into the Vietnam war
Kennet Shoemaker and Jerome Olmsted
Role of Prospective payment system
threatened CRNA more than other incidents
Omnibus budget reconciliation act (ORBA)
Regan signed January 1 1986 which allowed direct reimbursement packaged under medicare B for all CRNA services
Hyde Case
- March 26, 1984
- exclusive contract between anesthesiologist and hospital group. Sherman anti trust laws, derogatory statements made against CRNAs need to revitalized PR program
Medicare part A
when the hospital is billing medicare directly for CRNA services that is a hospital employee but is getting reimbursed within a DRG
Helen Lamb
- attended every AANA meeting from 1933-1978.
- outstanding educator award
established national curriculum standards for schools of nurse anesthesia
Florence McQuillen
gained recognition for the AANA from the AHA and the US department of health, education an welfare for functions of accreditation and certification
John F Garde
first male president of the AANA (1972-1973)
Who alerted members to the need for putting an end to the orphan image of CRNA
Ira Gunn
William Halstead
- father of American surgery
- used cocaine and hypodermic needs for anesthesia
- pioneer aseptic technique at John Hopkins
Dr. Ralph Waters
father of academic anesthesia
(opposed nurse anesthesia)
Chapman-Frances vs. Nelson
July 12, 1928 the CA supreme court affirmed the superior court findings for nurse anesthetist Dagmar Nelson in ruling that confirmed the legality of nurse anesthesia practice
Nurse anesthetist role during WWII
they were not guaranteed assignment to special duties, increase in emergency training programs in anesthesia
First qualifying exam
June 4, 1945
Master of Science in NA
1978
Anti-Adriani bylaw
- 1947
- prohibited the participation of ASA member in anesthesia education any person other than doctors of medicine
- rescinded in 1964
Henry Biglow
-1846
-did not believe that there was an anesthetic that would 1) affect all 2) consistent insensibility to pain and time 3) safe obstacle in advancement of surgery
National association of nurse anesthetist (NANA)
founded June 17 1931, by 47 nurse anesthetist (Agatha hodgins)
what is the Observations in anesthesia?
first publication by Alice Magraw
Dr. Frederick Hewitt
-1896
-british anesthetist that found natural requirements in women
1) satisfactory with subordinate role
2) make anesthesia primary role
3) doesn’t watch and earn from surgeon
4) accepts low pay
5)aptitude and intelligence
