Academic journal article Bulletin of the World Health Organization

Practice and Education of Nurse Anaesthetists

Academic journal article Bulletin of the World Health Organization

Practice and Education of Nurse Anaesthetists

Article excerpt

Voir page 269 le resume en francais. En la pagina 270 figura un resumen en espanol.

With a view to providing baseline data for quantitative studies on anaesthesia services provided by nurses and for health planning and policy-making in this field, an exploratory international survey was conducted between 1993 and 1996. In approaching this study we made the following principal working assumptions:

-- health for all through primary care depends on cost-effective training and performance;

-- a sufficient number of appropriate health workers is needed to ensure access to care for all people;

-- international standards for nurse anaesthetists should be based on data relating to training and practice.

The first phase of the study involved locating qualified nurse anaesthetists by contacting ministries of health and nursing organizations in 191 countries. Nurses were reported to be providing anaesthesia services in 107 countries and to be assisting with anaesthesia in 10 countries, and 624 persons knowledgeable in this field were identified in 112 countries. These 624 individuals were invited to participate in the second phase of the investigation. Of the 293 from 96 countries who responded, 42% were men and 58% were women; 92% of the respondents were nurse anaesthetists, the rest being doctors and technicians.

A questionnaire on practice, education and regulation was distributed in English, French, German and Spanish. With regard to practice, the following matters were covered:

-- participation in surgical, emergency and maternity care;

-- performance of preoperative anaesthetic evaluations and anaesthesia induction and provision of intraoperative and postoperative care;

-- provision of care under medical supervision, with medical assistance, or working alone.

In the field of education the following matters were considered:

-- content and duration of basic training for nurses;

-- availability, content and duration of classroom and clinical training in anaesthesia;

-- availability and type of continuing education.

This appears to have been the first study of its kind, although a survey of medical anaesthesiologists in 32 countries was conducted in 1988 (1) and an analysis of education programmes for nurse anaesthetists was performed in 1994 (2).

Clearly, the scope of the present investigation was limited. For instance, there was an average of only three respondents per country, and in general they gave their considered opinions and personal observations without external verification. However, it should be noted that in most countries there are no accessible valid databases concerning the provision of anaesthesia and its outcomes.

Practice

A majority of the nurses had 6-15 years of experience in anaesthesia in small, medium-sized or large hospitals. About a fifth worked in rural localities, the rest in urban areas. Approximately three-quarters of the anaesthetics given in rural communities were administered by nurses, half of whom did this work without a medical anaesthetist in attendance. About a third of the participants reported that nurse anaesthetists were often involved in providing analgesia during labour, after delivery and during the performance of caesarean sections. Over four-fifths indicated that anaesthetics given in the latter circumstance were administered by nurses and half reported that this happened without the supervision of a medical anaesthetist. In the African Region, 86% of the anaesthesia given for caesarean sections was administered by nurses working alone.

The percentages of participants reporting that nurse anaesthetists performed certain essential functions, with or without physician anaesthetists in attendance, are indicated below:

-- ordering pre-anaesthetic medication       42%

-- epidural block                            44%

-- immediate postoperative care management   54%

-- spinal block                              57%

-- tracheal intubation                       75%

-- tracheal extubation                       77%

-- induction of general anaesthesia          78%

-- intraoperative anaesthetic management     78%

Half the respondents reported that tracheal extubation was performed by nurse anaesthetists acting alone, while 47%, 45% and 45% said that this was the case for intraoperative anaesthetic care management, tracheal intubation and general anaesthetic induction respectively. …

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