Nursing & Healthcare International Journal ISSN: 2575-9981 The Application of the Theory of Unpleasant Symptoms to the Education and Practice of Nurse Anesthetists Nguyen J2, Haas RE1* and Pugh L3 1York College/WellSpan Health Nurse Anesthetist Program, USA Conceptual 2 York College of Pennsylvania, USA Volume 1 Issue 4 3University of North Carolina Wilmington Received Date: May 11, 2017 Published Date: July 26, 2017 *Corresponding author: Richard E Haas, York College/WellSpan Health Nurse Anesthetist Program, York, PA, USA, Tel: 717.815.6550; E-mail: [email protected] Abstract Aim: A discussion of the applicability of a middle range theory to the education and practice of nurse anesthetists. Background: The educational standards of nurse anesthetists is transitioning to a doctorate level by the year 2025, in response to the increased demands of more complex surgical services and increased patient comorbidities, which requires the need to apply nursing theory. However, the application of nursing theory to nurse anesthesia is very limited. Design: Discussion paper Data Sources: A literature search for the period of 1860 – 2016 was undertaken. This included searching the following databases: Cumulative Index for Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, and Google Scholar. Implications for Nursing: Educational programs for nurse anesthetists and CRNAs in practice could apply the Theory of Unpleasant Symptoms (TOUS) during their educational training and while caring for patients requiring anesthesia. Conclusion: To further explore the application of the TOUS to the education and practice of nurse anesthetists to fulfill requirements of educational standards and to improve the quality of patient performance outcomes. Keywords: Nursing theory; Middle range theory; Conceptual model; Nursing practice; Nurse anesthesia; Nursing education; Theory of Unpleasant Symptoms; Symptom management Impact Statement success and the causes of failure in educating future nurse anesthetists. Only then can CRNAs provide the best care Nurse anesthesia education is not based on any to patients, and the strongest impact on health care. overarching nursing theory. Rather the educational processes are an assembly of knowledge of disparate Summary Statement sciences, a range of psychomotor skills, and passing along of cultural attitudes, some of which have no link to Why is this research or review needed? evidence based practice. This makes research into the There is limited evidence concerning the use of nursing drivers of success in anesthesia education difficult if not theory in the education and practice of nurse impossible to measure. If nurse anesthetists are to be anesthetists. taught to the maximum extent of their scope of practice, Educational programs for nurse anesthetists are some form of theoretical underpinning is crucial to required to transition to a doctorate degree by 2025 to provide a more uniform foundation for the analysis of expand knowledge and skills needed to care for more The Application of the Theory of Unpleasant Symptoms to the Education and Practice of Nurse Anesthetists Nurs Health Care Int J 2 Nursing & Healthcare International Journal complex procedures and patients with increased history, nurse anesthetists have overcome challenges comorbidities. from those who have sought to limit their scope of practice [3]. Despite the important contributions nurse What are the key findings? anesthetists have made to the US health care system as well as research evidence that validates their record of The paper highlights the need to utilize a conceptual safety and cost-effectiveness, attempts to discredit and framework that aims to assist the CRNA in formulating restrict their practice rights continue to the present day an individualized anesthetic care plan to prevent, treat, [3]. and ameliorate unpleasant symptoms. This discussion suggests that further insight is required The practice of nurse anesthesia is recognized as a into developing nursing theory that may be applied to unique nursing specialty defined by its scope of practice nurse anesthesia. and standard of care. Certified registered nurse anesthetists (CRNAs) are advanced practice registered How should the findings be used to influence nurses (APRNs) who practice both autonomously and in policy/practice/research/education? collaboration with a variety of health care professionals There is a need for greater awareness of the level of [4]. CRNAs administer anesthesia for patients in all acuity education of nurse anesthetists and the contributions levels and across the lifespan in a variety of settings for CRNAs have made in clinical practice. procedures including, but not limited to, surgical, To improve patient performance outcomes by obstetrical, diagnostic, therapeutic, and pain management decreasing the experience of unpleasant symptoms in [4]. The role of the nurse anesthetist has often been patients requiring anesthesia for surgical services. defined in terms of functional abilities, which include a plethora of technical skills that are implemented when Introduction caring for patients requiring anesthesia. However, viewing their role solely in terms of technical skill sets is The quality of education in health care has waxed and inadequate. CRNAs are graduate-prepared providers with waned for hundreds, if not thousands of years. The an expert degree of clinical judgment skills and critical Flexner Report, published in 1910 by high school teacher thinking capabilities [4]. and expert in pedagogy Abraham Flexner, was a milestone in converting medical education from a strict Historically, nursing has struggled to assert itself as a apprentice-based model to one of pre-clinical scientific profession [5,6]. The professionalization of nursing is education. This study subsequently enhanced and focused on the interrelationship between nursing theory, improved the apprenticeship model used to teach nursing research, and nursing practice. Some have physicians how to care for patients [1]. Before Flexner, claimed that nursing exposes itself to external control due however, there was Florence Nightingale, whose to its failure to articulate a distinct theoretical framework innovations formed in the crucible of the Crimean War of which to be based upon in order to establish itself as a resulted in the greatest advances in health care in modern legitimate profession [5,6]. history. Nightingale, fifty years earlier than Flexner, noted and commented on the importance of education in Theoretical frameworks are intended to provide nursing [2]. Nightingale (1860) [2] noted: The everyday guidance and rationale for professional clinical practice management of a large ward, let alone of a hospital—the [7]. When reviewing the standards and scope of practice knowing what are the laws of life and death for men, and of nurse anesthesia, as well as nurse anesthesia what the laws of health for wards—(and wards are educational programs, it is apparent that a theoretical healthy or unhealthy, mainly according to the knowledge framework is lacking. The profession tends to be defined or ignorance of the nurse)—are not these matters of as a skill set or a series of partially related terminal sufficient importance and difficulty to require learning by objectives rather than an integrated whole [8]. The classic experience and careful inquiry…? hallmarks of a profession include: 1) systematic theory, 2) authority, 3) community sanction, 4) ethical codes, and 5) As nursing and medicine advance only through a culture [9]. One can add to this a sixth attribute, that of “learning by experience and careful inquiry”, it is useful to having a research-based germane to the profession [10]. review the backdrop of the education of the nurse While nursing anesthesia possesses attributes two anesthetist, and to see if scientific inquiry leads to a more through five, as well as some success with attribute six, useful way of learning. The birth of nurse anesthesia as a the concept of a systematic theory undergirding the specialty came amid many challenges. Throughout their profession (established during and integral to the Nguyen J, et al. The Application of the Theory of Unpleasant Symptoms to the Copyright© Nguyen J, et al. Education and Practice of Nurse Anesthetists. Nurs Health Care Int J 2017, 1(4): 000120. 3 Nursing & Healthcare International Journal educational process) is still fragmented. According to Using these concepts as a backdrop, it is clear that Greenwood (1957) [9], preparation for a profession changing the basic education of nurse anesthetists to that involves considerable preoccupation with systematic of the clinical doctorate should include the application of theory, which is best obtained through education in the nursing theory. Its inclusion results in meeting the AANA academic setting. standards, which state that students must “learn and apply a variety of anesthesia techniques and monitoring As both basic and continuing educational requirements modalities, test theory, hone critical thinking skills, and for nurse anesthetists increase in depth and quantity, it is apply evidence-based knowledge to clinical problems” imperative that students be prepared with knowledge of [11]. Likewise, the COA’s standards of accreditation [13] nursing theory, and that this theory is applied to their mandate doctoral students to be prepared to advance didactic and clinical instruction, as well as providing a theory and knowledge of the discipline in which the foundation for their