The role of nonmedical staff in the delivery of anaesthesia service

Certified Registered Nurse Anesthetists' Experiences of Nursing in Anesthesia Care: An Interview Study

PURPOSE

The purpose of this study was to understand certified registered nurse anesthetists' (CRNAs) experiences of nursing in anesthesia care.

DESIGN

An explorative qualitative study was conducted with inspiration from Ricoeur's hermeneutic phenomenological theory of interpretation.

METHODS

Three focus group interviews were carried out with participants representing 5 anesthesiology departments from 3 hospitals in Denmark (a total of 14 participants). The participants were all CRNAs. The transcribed interviews were examined as one coherent text using a Ricoeur-inspired approach, in which the analysis was conducted on three levels: naive reading, structural analysis, and critical interpretation.

FINDINGS

The structural analysis identified three themes relevant to the CRNAs' experiences of nursing: (1) the relationship with the patient, in which caring and professionalism are equally important; (2) differences between professions when sitting in the operating room; and (3) conflicts between production and caring. The study showed that CRNAs are aware of their professional identities as nurses and view anesthesia nursing as an integration of technical tasks and caring, in which the relationship with the patient and serving as the patient's representative are central. A major aspect of nursing is performed while the patient is anesthetized, and the CRNA attends to the patient's basic needs. The study also found that CRNAs find it difficult to define nursing in anesthesia care because of the overlapping tasks and skills between CRNAs and anesthesiologists.

CONCLUSIONS

CRNAs are very aware of their professional identities as nurses. The professionalism involved in their relationships with patients is evident in the CRNAs' representation of the patients themselves.

The experience of working with anaesthesia associates in the United Kingdom and the impact on medical anaesthetic training

Anaesthesia Associates have been established in the UK for over 10 years, but without statutory regulation. Renewed interest surfaced based on a widening gap between patient need and workforce supply in the UK and established advanced practice non-doctor roles within healthcare systems elsewhere. However, there are no robust data on their impact on patient or hospital outcomes, or training opportunities for medical anaesthetists, and perceptions of the profession within the anaesthetic community are mixed. This paper describes an investigation into the demographics and scope of practice of Anaesthesia Associates in the UK in 2017, and the experience of working together as an anaesthetic team. Through qualitative interviews, we explored the role and relationships, the impact on medical anaesthetic training and ideas about future development. The overall experience of working with Anaesthesia Associates was positive. Successful integration requires understanding of the educational needs and competencies of all. Future development relies on strong leadership and robust patient outcome and efficiency measures. Interviewees strongly supported statutory regulation, which was agreed by the government in 2019 but not yet implemented. Anaesthesia Associates were seen as a benefit to anaesthetic departments and as such may provide part of the solution to the prevailing workforce issues in UK Anaesthesia, further critically challenged by the SARS-CoV-2 pandemic.

What do patients know about anesthesiologists? Results of a comparative survey in an U.S., Australian, and German university hospital

STUDY OBJECTIVES

To determine patients' knowledge of the role of the anesthesiologist in the hospital.

DESIGN

Prospective survey instrument.

SETTING

Three university hospitals (University of Virginia, Charlottesville, VA, USA; St. George Hospital University of New South Wales, Sydney, Australia; and University Hospital, Ruhr-University Bochum, Bochum, Germany).

PATIENTS

900 patients (300 pts per center) undergoing elective surgery.

MEASUREMENTS

Patients completed a standardized questionnaire before surgery and before speaking to an anesthesiologist.

MAIN RESULTS

Most patients knew that anesthesiologists were medical doctors (Charlottesville, 58%; Bochum, 83%; Sydney, 71%). The majority (> 75%) underestimated the amount of training required to become anesthesiologist. While patients recognized the role of anesthesiologists in keeping patients asleep and awakening them, many patients did not understand the anesthesiologists' role in treating intraoperative medical problems. Patients had diverse concerns including infection, awakening during surgery, and failure to awaken, although patients were unclear about who was responsible for treating these issues. Outside the operating room (OR), 71% of patients rated Intensive Care Unit treatment as a duty of the anesthesiologist in Bochum, but fewer (P < 0.05) did so from Charlottesville (42%) and Sydney (49%). Understanding of duties outside the OR (resuscitation, teaching medical students, or chronic pain treatment) was very low (< 50%) in all centers.

CONCLUSION

Patients underestimated the training and role of the anesthesiologist in the OR and hospital.

[Anesthesia nurses' self-assessment of competence]

OBJECTIVES

The aim of this study was to assess nurses' perceptions of their level of competence in their work in the department of anesthesiology, recovery care, and pain management. A second objective was to establish a training strategy after possibly detecting subjectively perceived needs in different areas of competence.

MATERIAL AND METHODS

In 2007, 25 nurses belonging to the department of anesthesiology, recovery care, and pain management responded to a questionnaire based on the hospital's professional development plan. The questionnaire included items listing activities performed by anesthesia nurses in various areas of competence (patient relations and communication, health education, nursing process, task delegation, safety and prevention, team work, ethics, teaching and research, administration).

RESULTS

A self-assessment of "good" or "very good" was recorded by 87.8% of the nurses, while only 6.3% evaluated their skills as "sufficient" or "insufficient". The main areas in which training was felt to be needed were safety and risk prevention, and teaching and research.

CONCLUSIONS

In self-assessment, the anesthesia nurses in our hospital expressed awareness of training needs. The means to correct skill deficits should be provided, through training in theory and practice and attendance at continuing professional development courses for anesthesia nurses. The nurses' interest in further training should be encouraged given the direct effect it has on quality of care.