tea, coffee, and alcohol, and assisting with the preparation of food in diet kitchens. Catholic sisters who nursed were given more freedom to provide direct care; their work included assisting in surgery, particularly with the administration of chloroform. Because the administration of chloroform was a relatively simple procedure in which the anesthetizer poured the drug over a cloth held over the patient's nose and mouth, the nuns quickly mastered this technique, providing the surgeons with invaluable assistance during the war (Jolly, 1927; Wall, 2005). At St. Mary's Hospital in Rochester, Minnesota, Dr. William Worrall Mayo was among the first physicians in the country to recognize and train nurse anesthetists formally. In 1889, Dr. W.W. Mayo hired Edith Granham to be his anesthetist and office nurse. Subsequently, he hired Alice Magaw (later referred to as the “mother of anesthesia”; Keeling, 2007) CRNAs provide services in conjunction with other health care professionals such as surgeons, dentists, podiatrists, and anesthesiologists in diverse clinical settings. These APNs practice in a variety of clinical environments. Nurse anesthetists provide anesthesia services on a solo basis, in groups, and collaboratively. Some CRNAs have independent contracting arrangements with physicians or hospitals. Today, most surgery is performed on a same-day admission or outpatient basis. Anesthesia practices have adapted to this change from a predominantly inpatient model for surgery. A number of mechanisms, ranging from preoperative telephone interviews to preanesthesia clinics, are used to conduct preanesthesia assessment and allow anesthesia providers an opportunity to discuss care options, procedures, and risks with patients. However, detailed physical assessment and establishing a rapport between the anesthesia provider and patient often still occurs on the day of surgery. • Essentials of masters and doctoral education for APNs – Initially, this initiative was aimed at ensuring adequate educational preparation for APNs and was developed in response to the reality of ever-increasing curricular requirements in master's programs throughout the country (Keeling, Kirschgessner & Brodie, 2010). As originally proposed by the AACN, the DNP would standardize practice entry requirements for all APNs by the year 2015, assuring the public that each APN would have had 1000 supervised clinical hours prior to entering the practice setting. (The DNP has also broadened to include nurses with specialties such as informatics, administration, and public health . See Chapter 3 for further discussion of DNP education for non- APNs.) Moreover, the proposed curriculum for DNPs would include competencies deemed essential for nursing practice in the twenty-first century, including the following: (1) scientific underpinnings for practice; (2) organizational and systems leadership; (3) clinical scholarship and analysis for evidence-based practice; (4) information systems technology; (5) health care policy; (6) 8
interprofessional collaboration; and (7) clinical prevention and population health (AACN, 2006).
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- Nursing, APNs