« MANDATORY SECURITY SCREENING FOR THE GROUP OF 14 REVERSED | Home | The Concept of Mediation and Its Relevance in Modern Court. Paper presented by Louis Brown Ogbeifun (ChMc (Nig); CEDR accredited Med, (UK); MTI Accredited Mediator and Trainer in Workplace Conflicts (USA).) To a Workshop on Alternative Dispute Resolution (ADR) for Magistrates’ of the FCT. Organized by the Abuja Multi-Door Courthouse, High Court of the FCT in conjunction With the Security Justice and Growth Programme of the British Council. At Rockview Hotel; On 26TH November, 2008 »
THE PLACE OF THE NURSE ANAESTHETIST IN THE MODERN DAY HEALTH INDUSTRY AND DISASTER/EMERGENCY MANAGEMENT:AT A CONFERENCE ORGANIZED BY NATIONAL ASSOCIATION OF NURSE ANAESTHETISTS OF NIGERIA (NANAN) ON 25TH – 26TH APRIL 2008 AT THE CONFERENCE HALL, ASOKORO DISTRICT HOSPITAL, PLOT 31, JULIUS NYERERE STREET, ASOKORO, ABUJA.
By Louis Brown Ogbeifun | April 11, 2010
Let me congratulate NANAN; Abuja Chapter for this laudable step in organizing a conference that has brought together Nurse Anaesthetists to brainstorm on their relevance in the modern day medical health care delivery system and their place in emergency/disaster management. Continuous updating of knowledge is a critical factor in capacity building and human development. As you know and for so many reasons, the human resource is the most critical variable in an enterprise.
The Nurse Anaesthetist
The Nurse Anaesthetist is a Registered Nurse who has gone through a specialist programme in anaesthesia and has passed the examinations to be so Certified as Registered Nurse Anaesthetist (CRNA). The certification qualifies him or her to administer anaesthetics to a surgical client. During this period of care, the nurse anaesthetist has both legal and moral obligations of ensuring that the client returns to the level of pre-operative functioning of all the senses and the cardiopulmonary systems soon thereafter. Despite the independency associated with the practice, majority of our hospital policies put the medical responsibilities on either the Anaesthesiologist who is a physician or the Surgeon.
The Nurse Anaesthetist belongs to the Advance Practice of Nursing (APN), a global term for describing specialized skills over and above the basic nursing certificate. These skills enable the practitioner meet with the challenging and emerging complex roles played in the course of caring for the needs and comfort of the clients. This training under this name APN is, Nurse Midwives, Accident and Emergency (A&E) Nurses, Intensive Care Unit (ICU) Nurses and Nurse Anaesthetists.
Characteristics of a certified nurse anaesthetist
- Specialization: In Nigeria, majority of our Nurse anesthetists hold the R.N. certificates plus the Diploma in Nursing Anaesthesia. In several advanced nations e.g. the United States of America (USA), the nurse anaesthetists requires a master’s or post master’s degree to practice anaesthesia. In 1998, the UKCC advised Nurses on the need for advanced practitioners to have a first degree level of education and increased professional responsibility.
- Application of theory and research in the integration of practice that would serve the best interest of the clients
- Knowledge management
- Evaluation of practice and research findings
- Network and inter-sectoral collaboration
- Independence
- Accountability
From the above, for practitioners to practice safe anaesthesia, it is imperative to have the knowledge of medicine, knowledge of pathological processes responsible for the clients coming in for surgery, skills to understand what the surgical team would seek to achieve, the challenges of the procedures, basic understanding of anatomy, physiology and pharmacology and above an up-to-date facilities. The aforementioned would give rise to the first task in our client care, the pre-operative care/evaluation.
Roles
- Hospital Base Care
- Accidents/Disaster Management
- Major events
a) Hospital base care
- Care of anaesthetic equipment and drugs
b) Pre-operative care (Out-Patient or wards):
- Pre-operative assessment to determine the best procedure and safest anaesthetic
- Prescriptions of preoperative medications
c) Operating theatre (intra-operative care)
- Administering of induction and maintenance doses of anaesthtetics
- Administration and monitoring of fluids and electrolytes all through the surgical procedure
- Monitoring of vital signs
- Alerting the surgical team of unforeseen challenges
d) Post-operative care
- Monitoring of vital signs and the recovery rate of the client
- Follow up visitation to assess upper respiratory system functionality especially if intubation had been carried out
e) Accident and emergency units-assist in the resuscitation in emergencies
f) Intensive care
g) Pain management
Of the above, the most common of our routine are the Pre, intra and post-operative (PIP) care of clients, which seem to be the focus of our practice in the third world because of using the Nurse Anesthetists to fill the gap of anesthesiologists that are in short supply.
The emergence of Severe Acute Respiratory Syndrome (SARS) in February 2003 somewhere in Asia and the Acquired immunodeficiency Syndrome (AIDS) has changed the face of anaesthetic practice. While local anaesthesia with intravenous sedation or regional anesthesia is considered appropriate in SARS, the choice of technique and medication regime in AIDS will depend on systemic manifestations of AIDS and opportunistic infections. The P.carini infected client might have impaired oxygenation. More than often, most clients coming in with the above ailments could come into the hospital malnourished, dehydrated and anaemic. That makes it imperative for the Certified Registered Nurse Anaesthetist (CRNA) to be grounded in the understanding of the ever changing dynamics in all medical disciplines in order to know his bounds. The certified nurse anaesthetist cannot be too experienced or too busy to ignore baseline laboratory examinations.
However, in modern and advanced societies; the scope of practice of the Nurse Anaesthetist has widened to cover accidents/disaster management and actively covering major events outside the normal hospital setting. In the United States where nursing is given prominence and dependency of practice, though nurse anaesthetists are under the supervision of anaesthesiologists, nurse anaesthetists administer between 27 and 30 million anaesthetics annually.
2. Emergency/disaster management
Emergency
This is a sudden event that requires urgent, efficient and effective action(s), which would mitigate the negative consequences of such event(s) on lives and properties and on the long run prevent further losses or damage(s) to lives and properties. The Oxford Advanced Learner’s Dictionary defines emergency as a sudden serious and dangerous event or situation which needs immediate action to deal with it.
Disaster
This is an unanticipated event or chain of events, which ultimately lead to loss of lives and destruction of properties. Disasters could be man-made e.g. fire due to pipelines vandalism as it occurred in Jesse (1998) in which over 1000 persons died and Inagbe in the eastern part of Lagos in 2006 in which more than 200 persons died; electrical faults, vehicular or plane crashes, explosions from bombs and terrorists’ act. Disasters could also be as result of natural phenomenon e.g., tornado, hurricane earthquakes, floods/erosions etc. Our region has been relatively safe from these natural occuring disasters.
Accidents, emergencies could occur in the form of natural disasters (tornadoes, flood hurricane, landslide, earthquake, etc) or could be man-made (auto and plane crashes, fire, war; etc). The resultant effects according to Sharon and Idolia among others are: “injured people and animals, damaged properties and overall confusion though each type of disaster has its own special hazard”. The area that is very critical to the Nurse Anaesthetist is the preservation and restoration of the cardiopulmonary functioning before they are transported to hospitals.
A typical disaster scene is characterized by chaos. The community expresses disbelief and shock because of the extent of damage and the loss of close relations. This is where the calmness and skills of the Nurse Anaesthetist become vital.
Whenever disaster occurs, the first phase of operations involves the fire brigade and the law enforcement agencies. They evacuate victims from the disaster zone to a safe place where the medical team can render medical services to aid the victims.
When the site is declared safe, the medical team, which is usually led by a physician, determines those to be given emergency care in order of priority. In disaster management; urgency, efficient and effective actions are taken using the triage measurement, restoration of cardiopulmonary functions on site and prompt transportation to a medical facility. Nowadays, early transportation by aero medical evacuation, infusion and mobile transfusion have saved several lives that would have been lost through hypovolaemic shock. Tis is mostly achievable in the advanced world through the use of medical air ambulances. Here, we still rely mostly on road transportation for the evacuation of the injured.
For optimum functioning, the Nurse Anaesthetist would need a course in disaster management, which would centre on the following:
- Volunteerism
- Command
- Control
- Communications
- Cooperation
- Evaluation
It is noteworthy that though disasters e.g. wars are damaging and devastating, their occurrences have helped in no small measure in the evolution of effective management of emergencies and disasters. The Korean War saw the emergence of helicopters as medical tools, the Vietnam War brought about the emergence of aero-medical evacuation in civilian practice and the Spanish war introduced mobile blood transfusion
In our environment, it is usual to see an ambulance vehicle racing towards an accident scene or a crash site with a nurse and sometime with a doctor with the sole aim of evacuation without the complements of anesthetist(s). This may be due to shortage of such manpower or just lack of the will to involve them in such activities. But this orientation has to change because the Nurse Anaesthetist is better equiped for such evacuations.
In the advanced world, the health care delivery system has gone beyond racing to scenes of accidents, disasters and emergencies with the sole aim of transportation of victims to hospitals. In Sweden, it is common to see emergency cars at the trail of ambulance vehicles. Emergency car is a passenger car registered as a rescue vehicle. The emergency car furnishes the ambulance with a near perfect hospital based support and competencies. The reason for this is simple; the nurse anaesthetist is more equipped in skills of preservation of the airways than the nurse or the general medical practitioner that we usually rely on for rescue operations
For optimizing the potentials of the rescue teams, the following should be considered as necessities:
- Planning
- Effective communication among team members
- Effectuating the drawn up disaster plans e.g. transportation, adequate medical supplies and effective coordination of personnel.
- Prevention of secondary disasters like fires and crashes of rescue vehicles
- Major events
- Sporting
- Political
Necessary actions
- Establish and secure two large bore IV lines
- Take and send blood for grouping and Cross match
- Label tubes and forms properly
- Prevention of further blood losses (pressure and application of splints)
- Infusion/transfusion
- Regular monitoring of vital signs
- Watch urine output. This will help in the assessment of volume-replacement.
Challenges
- Learning Needs: The nurse anesthetists in developing countries have had their educational needs ignored for so long because of inter and intra professional challenges. The University of Nigerian Teaching Hospital (UNTH), Enugu which has contributed immensely to the provision of these critical professionals, would have been closed down long ago because of intra professional supremacy war. Unfortunately the powers that be have refused to acknowlege the enormity of responsibilities that the Nurse Anesthetists have shouldered in the health care delivery system in Nigeria.
- Obsolete equipment.
- Poverty
- Erratic power outages, inadequate water and medical gases’ supplies. Lack of up-to-date rescue vehicles
- Lack of manpower
Your place in modern day health care industry and disaster management was ordained by God at creation. This was demonstrated in when Adam was anaesthetized during the creation of Eve. After the surgery both woke into a painless state. Therefore your role in pain management and saving or preservation of the critical organs before help can reach victims in emergencies/disasters cannot be overemphasized.
However, to effectively carry out this divine calling, you must at all times be abreast with the latest methods, medication, equipment and procedures that will enhance your capacity to perform your tasks. In not too far a time, I foresee our nation toeing the path of the advanced nations in setting the minimum standard of a first degree in sciences to read anaesthesia and progress towards the postgraduate level. It is in this you can authoritatively ask for the kind of autonomy that is needed to put you in your rightful place.
Thank you and god bless.
References
Aitkenhead A.R; Smith G. S. (2001); Textbook of Anaesthesia, Churchhill Livingstone, London
Kenneth Kronohage; The Future role of Nurse Anaesthetists in Swedish pre hospital emergency.
Mondello, E; et al (2006); The Role of Anesthetist in Disaster Medicine, Italy
Nagelhout, J. J. and Zaglaniczny, K. L. (2005); Handbook of Nurse Anesthesia, Elsevier Inc; United States of America
Sharon Mantik Lewis and Idolia Cox Collier, Medical-Surgical Nursing-Assessment and Management of Clinical Problems, McGraw-Hill Book Company, New York
Topics: Uncategorized |
April 12th, 2010 at 2:04 pm
Wow this is a great resource.. I’m enjoying it.. good article
May 4th, 2010 at 11:19 am
Interesting, thank you for article. So little information on this subject…
May 13th, 2010 at 7:23 am
What a great resource!
July 12th, 2010 at 10:33 pm
Nice dispatch and this fill someone in on helped me alot in my college assignement. Thank you on your information.
July 16th, 2010 at 3:45 pm
[…] depend in part on perceptions of risk of those exposed. … market research, surveys and trends THE PLACE OF THE NURSE ANAESTHETIST IN THE MODERN DAY HEALTH … The Concept of Mediation and Its Relevance in Modern Court. Paper presented by Louis Brown […]