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Standar Praktik Perawat Anestesi dari Ikatan Perawat Anestesi Indonesia.

Standar Praktik Perawat Anestesi.

Ikatan Perawat Anestesi Indonesia.

Satu karakteristik dari setiap profesi adalah tanggungjawabnya kepada masyarakat untuk mengumumkan standar-standar yang menyatakan kualitas praktik yang diberikan oleh para anggautanya itu dapat dinilai. Standar-standar, berdasarkan pada falsafah, teori, ilmu pengetahuan dan prinsip-prinsip, dibuat untuk meningkatkan praktik klinis. Sebagai suatu representasi dari suatu profesi, Pengurus Pusat dari Ikatan Perawat Anestesi Indonesia memakai dan mengumumkan standar-standar praktik dengan masukan dari para anggauta dari organisasi ini. Tanggungjawab utama untuk penerapan dari standar-standar ini terletak pada pundak para praktisi, para Perawat Anestesi. Sebagai suatu organisasi yang terdiri dari petugas pelayanan kesehatan, Ikatan Perawat Anestesi Indonesia menyadari bahwa prinsip-prinsip dari praktik anestesi harus secara jelas digambarkan sebagai standar professional yang menuntun para praktisi dalam memelihara dan meningkatkan kualitas perawatan dan pelayanan anestesi.

Maksud dan Tujuan.

Standar-standar ini dimaksudkan untuk membantu para praktisi Perawat Anestesi untuk memberikan perawatan dan pelayanan anestesi yang konsisten dan aman.
Standar-standar ini deskriptif, menetapkan suatu dasar untuk penilaian pada praktik dan merefleksikan hak-hak dari mereka yang menerima perawatan dan pelayanan anestesi. IPAI menyadari bahwa tidak mungkin setiap Perawat Anestesi dapat menuruti setiap standar-standar ini dalam kondisi yang luar biasa atau keadaan gawat-darurat. Diharapkan bahwa Perawat Anestesi seyogianya menilai setiap keadaan pasien dan menggunakan keputusan professional dalam memilih satu bentuk tindakan, dan dalam tiap kasus, Perawat Anestesi dapat menunjukkan bahwa keputusan yang diambil itu adalah demi kepentingan yang terbaik bagi pasien . Lagipula, meskipun standar ini dimaksudkan untuk meningkatkan kualitas yang tinggi dalam pelayanan pasien, hal itu tidak menjamin adanya hasil yang spesifik pada pasien.
Maksud dari standar-standar itu adalah :

1. Membantu profesi dalam melakukan penilaian kualitas perawatan dan pelayanan yang
diberikan oleh praktisi.
2. Menetapkan dasar umum bagi para Perawat Anestesi untuk digunakan dalam koordinasi
pelayanan dan menyatukan usahanya dalam perkembangan dari kualitas pelayanan pasien
secara nasional.
3. Membantu masyarakat untuk memahami apa yang diharapkan dari para Perawat
Anestesi.
4. Membantu dan melindungi hak-hak dasar dari pasien.

Standar I.

Pasien semestinya menjalani penilaian pra-anestesi yang lengkap dan seksama.
Interpretasi:
Perawat Anestesi akan melakukan dan atau berpartisipasi dalam tindakan penilaian fisiologi dan psikologi pada masa sebelum dilaksanakannya pemberian anestesi. Penilaian itu meliputi riwayat kesehatan pasien dan masalah-masalah kesehatan yang sedang dialami dan kondisi fisik sebagai dasar untuk menentukan kebutuhan perawatan selama periode pembedahan.Bagi Perawat Anestesi, fungsi ini dilakukan pada masa sebelum, selama, dan sesudah pemberian anestesi.Kecuali dalam keadaan luar biasa atau gawat darurat, Perawat Anestesi memiliki kewajiban untuk memastikan bahwa pemeriksaan yang relevan telah dilengkapi dan penilaian yang seksama terhadap pasien itu telah dibuat.

Standar II.

Rencana perawatan anestesi yang akan diterapkan semestinya didasarkan pada ilmu pengetahuan perawatan, konsep dan prinsip perawatan yang mutakhir.
Interpretasi :
Rencana perawatan dibuat secara sistimatik berdasarkan informasi dari riwayat psikologis pasien, riwayat sosial dan riwayat medis dari pasien, pemeriksaan fisik, laboratorium, radiologis dan data diagnosis yang lain. Rencana perawatan juga didasarkan pada antisipasi dalam prosedur, penggunaan alat-alat dan dikoordinasikan dengan petugas kesehatan lain yang tepat. Catatan medis dari pasen semestinya merefleksikan bahwa “informed consent” telah didapat.

Standar III.

Manajemen anestesi itu meliputi kehadiran Perawat Anestesi secara kontinyu dalam memberikan atau berpartisipasi dalam pemberian anestesi umum atau anestesi regional dan obat-obat tambahan kepada pasien semua umur dan kategori dalam berbagai prosedur pembedahan dan prosedur medis lainnya.
Interpretasi:
Perawat Anestesi semestinya menggunakan berbagai macam tehnik, obat-obat anestesi, obat-obat tambahan dan berbagai macam peralatan dalam tindakan perawatan pasien.

Standar IV.

Perawat Anestesi semestinya memonitor respon fisiologis dan psykologis, menaksir dan menggunakan data yang didapat dari alat-alat monitoring invasive maupun noninvasive guna memelihara dan menstabilkan kondisi pasien, dan melakukan perawatan pemulihan. Kewaspadaan semestinya dijaga terhadap terjadinya reaksi yang teridentifikasi dan tindakan korektif dilakukan kapanpun diperlukan.
Interpretasi:
Perawat Anestesi semestinya melakukan pengamatan, mencatat dan melaporkan gejala dan tanda-tanda fisologis dan psykologis dari pasien dan memberikan perawatan pemulihan yang meliputi pemberian cairan , pemeliharaan jalan nafas dan tindakan bantuan ventilasi atau ventilasi terkendali.

Standar V.

Perawat Anestesi bertanggung-jawab atas pencatatan yang cermat dan akurat dari segala informasi dalam lembar pencatatan pasien.
Interpretasi:
Pencatatan yang akurat akan memudahkan perawatan pasien secara komprehensive, menyediakan informasi untuk data peninjauan ulang dan riset, dan menciptakan pencatatan medis yang legal.

Standar VI.

Perawat Anestesi semestinya mengakhiri atau ikut serta dalam pengakhiran anestesi, menentukan kondisi fisiologis dan psikologis yang cukup baik dan melaporkan data yang berhubungan dengan pasien itu kepada petugas yang tepat.
Interpretasi:
Perawat Anestesi mengakhiri atau ikut serta dalam pengakhiran anestesi, mengidentifikasi masalah-masalah pasien dan mengambil tindakan yang tepat pada periode awal pasca bedah. Perawat Anestesi melaporkan secara tepat tentang kondisi pasien kepada petugas yang tepat yang memerlukan informasi sejenis itu dan tetap berada didekat pasien sampai kondisi cukup aman untuk memindahkan tanggung-jawab perawatan kepada petugas yang tepat.

Standar VII.

Pasien semestinya mendapatkan perawatan langsung pasca bedah oleh petugas yang tepat.
Interpretasi:
Perawat Anestesi semestinya tetap berada disamping pasen selama dibutuhkan guna menstabilkan kondisi pasien dan melaporkan semua data yang penting dalam perawatan peri-operative kepada personil yang bertugas untuk perawatan lebih lanjut.

Standar VIII.

Tindakan perlindungan keamanan yang selayaknya semestinya dilakukan untuk menciptakan pelayanan anestesi yang aman.
Interpretasi:
Tindakan keamanan dan kontrol, sebagaimana ditegakkan dalam institusi, semestinya diterapkan secara ketat, sebagai usaha untuk menekan sekecil mungkin bahaya dari listrik, api, dan ledakan ditempat pelayanan anestesi. Mesin anestesi, sebelum digunakan semestinya diperiksa oleh Perawat Anestesi sesuai dengan pedoman. Perawat Anestesi mencek kesiapan, keberadaan, kebersihan, dan kondidi kerja dari semua peralatan yang digunakan dalam pelayanan anestesi. Dokumentasi semestinya dibuat dalam catatan medis pasen mengenai mesin anestesi dan peralatan yang dicek. Kebijakan pengecekan secara rutin untuk menjaga keamanan dari peralatan anestesi dan monitor semestinya dikembangkan oleh orang-orang yang kompeten maupun oleh departemen dalam institusi. Kebijaksanaan tertulis tentang pengendalian infeksi semestinya dikembangkan dan diikuti agar supaya memperkecil resiko terjadinya penyakit infeksi pada pasien maupun petugas kesehatan dan kebijakan lain untuk melindungi pasien dari bahaya dan komplikasi yang tak diharapkan.

Standar IX.

Praktik Perawat Anestesi semestinya ditinjau ulang dan dievaluasi guna menjamin kualitas pelayanan.
Interpretasi:
Perawat Anestesi semestinya ikut serta dalam peninjauan ulang dan evaluasi secara periodik pada kualitas dan kelayakan dari pelayanan anestesi. Peninjauan ulang dan evaluasi semestinya dilakukan sejalan dengan program jaminan kualitas institusi.

Standar X.

Perawat Anestesi semestinya memelihara praktik anestesinya berdasarkan pada proses peninjauan ulang dan evaluasi yang terus menerus dalam teori ilmu pengetahuan, penemuan riset dan praktik yang mutakhir.
Interpretasi:
Perawat Anestesi semestinya memelihara praktiknya dengan menerapkan tehnik dan pengetahuan yang mutakhir yang didapat melalui suatu pendidikan berkelanjutan. Perawat Anestesi semestinya dilibatkan dalam riset sebagai peneliti, pemberi pelayanan pada pokok penelitian, atau pengguna dari riset demi perkembangan profesi. Perawat Anestesi melindungi hak pasien atau binatang percobaan yang dilibatkan dalam penelitian dan bergabung dalam riset sesuai dengan etika riset dan standar pelaporan.

Standar XI.

Perawat Anestesi semestinya menghargai dan menjaga hak-hak dasar dari pasen untuk kebebasan, menjaga rahasia pasien, hak untuk mengambil keputusan dan bertindak.
Interpretasi:
Perawat Anestesi menghormati kerahasiaan informasi tentang pasien dan menghormati serta menjaga hak-hak pasien dan menunjukkan perhatian pada martabat seseorang dan hubungan antar manusia.

Standar XII.

Perawat Anestesi berpartisipasi dalam pendididkan kepada pasien dan anggota masyarakat lainnya, seperti keluarga, ahli bedah dan perawat yang lain yang terlibat dalam perawatan pasien sebelum dan selama periode perioperative. Perawat Anestesi juga merupakan sumber daya manusia untuk resusitasi kardiopulmonal dan kebutuhan pelayanan pasien lainnya.
Interpretasi:
Sebagai seorang profesional yang mahir dalam anestesi, maka Perawat Anestesi itu mendidik orang lain.

Standar XIII.

Perawat Anestesi menyadari tanggung-jawabnya terhadap praktik profesional dan memelihara tingkat pengetahuannya, pengambilan keputusan, ketrampilan tehnologinya, dan prasarat nilai-nilai profesional untuk menghasilkan pelayanan kesehatan yang berkualitas tinggi.
Interpretasi :
Perawat Anestesi bertanggung-jawab terhadap praktik profesionalnya, giat mengikuti kegiatan pendidikan berkelanjutan sepanjang hidup dan ikut serta dalam mekanisme jaminan kualitas sebagai dasar untuk menilai kualitas pelayanan dan praktiknya.

Kompetensi Perawat Anestesi.
Setelah menyelesaikan program pendidikan, Perawat Anestesi mampu :
a. Melakukan dan mendokumentasikan pemeriksaan dan evaluasi pra-anestesi dari
penderita, termasuk memohonkan konsultasi dan pemeriksaan diagnostik, memilih,
menentukan, meminta atau memberikan premedikasi dan cairan infus dan mendapatkan
“informed consent” untuk anestesi.
b. Membuat dan menerapkan rencana pelayanan / perawatan anestesi.
c. Memilih dan menerapkan rencana teknik dan perawatan anestesi, apakah lokal, regional,
general atau sedasi intravena.
d. Memilih, mendapatkan atau ikut serta dalam memberikan obat anestesi atau obat
tambahan dan cairan yang diperlukan untuk penatalaksanaan anestesi, untuk memelihara
keseimbangan fisiologis dan mengoreksi gangguan yang mungkin timbul akibat anestesi
atau pembedahan.
e. Memilih dan memasangkan alat-alat monitoring invasif maupun non-invasif guna
mengetahui data fisiologis dari penderita.
f. Memelihara kelancaran jalan nafas dan fungsi pernafasan dengan pemasangan pipa
endotrachea, ventilasi mekanik, bantuan obat-obatan, therapi pernafasan, atau ekstubasi.
g. Mengatur atau ikut serta dalam emergence dan pemulihan dari anestesi dengan cara
memilih, mendapatkan, meminta atau ikut serta memberikan medikasi, cairan atau
bantuan ventilasi guna memelihara haemostasis, ikut serta memberikan obat penangkal
rasa sakit dan penangkal efek samping obat anestesi, atau mencegah dan mengatasi
komplikasi.
h. Melepas atau memindahkan penderita dari ruang pulih dan melakukan evaluasi dan tindak
lanjut pasca anestesi guna mencegah dan mengatasi efek samping atau komplikasi.
i. Meminta, menetapkan atau ikut serta memberikan pengobatan untuk mengatasi rasa
sakit dengan cara ikut serta memberikan obat-obatan, tehnik anestesi regional, atau cara
lain yang dapat digunakan untuk mengatasi rasa sakit termasuk epidural analgesia pada
persalinan.
j. Merespon terhadap keadaan gawat darurat dengan melakukan manajemen jalan nafas,
memberikan obat emergensi dan cairan atau melakukan tehnik resusitasi “basic support’
atau “advanced cardiac life support”.
k. Lain-lain tanggungjawab Perawat Anestesi sesuai ketrampilkan individunya

Guide Line

This artwork is by Juan Quincy Adams, titled "La Operacion." It is part of a series published as advertising postcards for "Ceregumil," probably some sort of pharmaceutical. It's from Spain circa 1910. The "anesthetist" here seems to be maintaining restraint in lieu of anything else. Courtesy of the Zwerdling Nursing Archives.

discovery of succinylcholine"

The National Library of Medicine
PubMed
This is the National Library of Medicine MEDLINE and pre-MEDLINE search service
New York School of Regional Anesthesia
A great site that teaches many aspects of regional anesthesia
University of Chicago Anesthesia References and Manuals

"Advancing Anaesthesia Throughout a Developing World. Produced by World Anaesthesia & the World Federation of Societies of Anaesthesiologists (WFSA)."
This site is also on my links page, but explore this site, it has a HUGE section on updates in anesthesia with many subjects covered, including "how to do" subjects, with lots of information on regional blocks. Great for students!


The Virtual Anaesthesia Textbook. This textbook is always expanding, and has several mirror sites. This address seems to work the best.

Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery . Here it is, a subject nearly every SRNA or CRNA needs to know.

RedbookFrom the Swiss Anesthesia Server. A resident's survival manual on many different subjects.


Capnography
The Gas Laws and More
Critical Care Medicine Tutorials
The Virtual Anesthesia Machine
A Macromedia presentation from the University of Florida. Adjust the ventilation settings, turn on the little switch, and watch it go! Includes many educational downloads.
Spirometry: The Measurement and Interpretation of Ventilatory Function in Clinical Practice
A great reference for students and clinicians from The Thoracic Society of Australia and New Zealand.
Hypertextbook of Obstetric Anesthesia, from Becton-Dickinson.
Anesthesia Reference Materials
Walter Reed Army Hospital's own education site, with field anesthesia information, of interest to the military CRNA. They also list many of other sources of web manuals, several of which I already list.
The MERCK Manual of Diagnosis and Therapy
Searchable edition now online.
The Virtual Naval Hospital
This is a neat site that offers text and links on diagnosis, treatment and guidelines for more than 80 common conditions, and 25 common topics of interest to patients. Also information on anesthesia techniques for the GMO.
Hardin-Meta Directory
A complete guide by medical subject area.
Family Practice Handbook
Lots of good general medical information on many common problems.
Webster Dictionary
Body Surface Area Calculator
Oyston Anesthesia Site

Search the internet for health resources with Health On the Net Foundation's MedHunt



Speaking of on-line information, here are two guides to help you in your anesthesia practice. First is a Microsoft Excel spreadsheet titled "Pediatric Anesthesia Worksheet." Use it to calculate medications and other parameters for pediatric patients. To get a program similar to this, but in a Windows program format, see my friend Mike Loomis web site (Rubber Mallet) listed on the Links page. Download the Pedshelp file that explains how to use the Excel spreadsheet program. Finally, the Anesthesia Medication Guide is available in PDA iSilo3 format. The Palm PDA version requires iSilo3 document reader from www.isilo.com

PAW.zip	Pediatric Anesthesia Worksheet (v 2.0)
pedshelp.zip	Pediatric help file
Updated version available from "MemoWare"	www.memoware.com Search for "Anesthesia" and navigate to the site

Copyright © 1998-2008 Thomas J. Evans, CRNA, MS.
Any logos used on this page are the logos of their organization/web page, and used for linking purposes only.

Musium Anestesi

ANESTHESIA AND PAIN HISTORY RESOURCES ON THE INTERNET From the University of Alabama at Birmingham - This has about everything! Historical Anaesthetic Equipment A site with many photographs of old anesthesia equipment. The NDA Online Anaesthesia Museum The Brian Welsh Memorial Museum of Anaesthesia The Wood Library-Museum of Anesthesiology Entrance to the Vienna Virtual Museum of the History of Anesthesia and Intensive Care Medicine Anesthesia History Calender Nurse Anesthesia History from the AANA - Great Link "Discovery of the first volatile anesthesia gas" Courtesy of MEDLAFF

Click on Image(s) to Enlarge
These are two anesthesia records from Dr. E.I. McKesson of Toledo, Ohio, circa 1912. The record on the left shows the use of "Ether open mask, 8 layers of gauze, 1 towel around ..." The record on the right shows the use of nitrous oxide anesthesia. Because nitrous cannot produce surgical anesthesia in a non-hypoxic mixture, today we use nitrous as an adjunct to other anesthetics. However, as you can see from the record, nitrous oxide is used with oxygen in a hypoxic mixture (about 90 percent N20 with 10 percent oxygen) in order to produce a satisfactory anesthetic.

Photograph taken in Europe by the American Gynecological Club in 1926. The anesthesiologist is using an "Inhaler" device, probably the Ombredanne Inhaler, similar to the one pictured to the right. Professor Ombredonne (France) introduced his Ether Apparatus circa 1870-80 and it was manufactured by various makers into the early 1900's.

Mary Fletcher Hospital, Burlington, VT, circa 1910	Russia, circa 1908
Postcards courtesy of the Zwerdling Nursing Archives

PATIENT SAFETY

Here you will learn more about Certified Registered Nurse Anesthetists (CRNAs)

and the important role they play in America’s healthcare system.

Find out what seniors revealed in a survey about nurse anesthetists, and how you can voice your opinion.

Discover the effects that Viagra, herbs, vitamins, and different supplements may have on anesthesia during surgery. Educate yourself on conscious sedation and office-based anesthesia.

To learn more about the Health Care Financing Administration's Medicare rule removing physician supervision of nurse anesthetists, visit our sister site at www.aana.com.

There are many other aspects of anesthesia and healthcare, and AnesthesiaPatientSafety.com will help you explore
them all.

ANESTESIA

What Is Anesthesia?
Anesthesia is freedom from pain. Each year, more than 26 million people in the United States undergo some form of medical treatment requiring anesthesia. Anesthesia, in the hands of qualified professionals like Certified Registered Nurse Anesthetists, is a safe and effective means of alleviating pain during nearly every type of medical procedure.

Anesthesia care is not confined to surgery alone. The process also refers to activities that take place both before and after an anesthetic is given.

Who administers anesthesia?
In the majority of cases, anesthesia is administered by a Certified Registered Nurse Anesthetist (CRNA).

CRNAs work with your surgeon, dentist or podiatrist, and may work with an anesthesiologist (physician anesthetist). CRNAs are advanced practice nurses with specialized graduate-level education in anesthesiology.

For more than 100 years, nurse anesthetists have been administering anesthesia in all types of surgical cases, using all anesthetic techniques and practicing in every setting in which anesthesia is administered.

Will a nurse anesthetist stay with me throughout surgery?
The nurse anesthetist stays with you for the entire procedure, constantly monitoring every important function of your body and individually modifying your anesthetic to ensure your maximum safety and comfort.

Are there different types of anesthesia?
There are three basic types of anesthesia:

• General anesthesia produces a loss of sensation throughout the entire body.
• Regional anesthesia produces a loss of sensation to a specific region of the body.
• Local anesthesia produces a loss of sensation to a small specific area of the body.

Sejarah Perawat Anestesi

Photograph of nurse anesthetist providing open drop ether anesthesia to accident victim, circa 1900-1920.

Note the man taking the patient's pulse with a pocket watch.

The surgeon appears to be suturing the scalp. The right arm is already bandaged.

History of Nurse Anesthesia Practice 

Nurses were the first professional group to provide anesthesia services in the United States. Established in the late 1800s, nurse anesthesia has since become recognized as the first clinical nursing specialty. The discipline of nurse anesthesia developed in response to requests of surgeons seeking a solution to the high morbidity and mortality attributed to anesthesia at that time. Surgeons saw nurses as a cadre of professionals who could give their undivided attention to patient care during surgical procedures. Serving as pioneers in anesthesia, nurse anesthetists became involved in the full range of specialty surgical procedures, as well as in the refinement of anesthesia techniques and equipment. 

The earliest existing records documenting the anesthetic care of patients by nurses were those of Sister Mary Bernard, a Catholic nun who assumed her duties at St. Vincent's Hospital in Erie, Pa. in 1877. The most famous nurse anesthetist of the nineteenth century, Alice Magaw, worked at St. Mary's Hospital (1889), in Rochester, Minn. That hospital, established by the Sisters of St. Francis and operated by Dr. William Worrell Mayo, later became internationally recognized as the Mayo Clinic. Dr. Charles Mayo conferred upon Alice Magaw the title of "mother of anesthesia," for her many achievements in the field of anesthesiology, particularly her mastery of the open-drop inhalation technique of anesthesia utilizing ether and chloroform and her subsequent publishing of her findings. 

Together, Dr. Mayo and Ms. Magaw were instrumental in establishing a showcase of professional excellence in anesthesia and surgery. Hundreds of physicians and nurses from the United States and throughout the world came to observe and learn their anesthesia techniques. Alice Magaw documented the anesthesia practice outcomes at St. Mary's Hospital and reported them in various medical journals between 1899 and 1906. In 1906, one article documented more than 14,000 anesthetics without a single complication attributable to anesthesia. (Surgery, Gynecology and Obstetrics, 3:795.) 

In 1909, the first formal educational programs preparing nurse anesthetists were established. In 1914, Dr. George Crile and his nurse anesthetist, Agatha Hodgins, who became the founder of the American Association of Nurse Anesthetists (AANA), went to France with the American Ambulance group to assist in planning for the establishment of hospitals that would provide for the care of the sick and wounded members of the Allied Forces. While there, Hodgins taught both physicians and nurses from England and France how to administer anesthesia. 

Since World War I, nurse anesthetists have been the principal anesthesia providers in combat areas of every war in which the United States has been engaged. During the Panama action, only nurse anesthetists were sent with the fighting forces. Nurse anesthetists have been held as prisoners of war, suffered combat wounds during wartime service, and have lost their lives serving their country. The names of two CRNAs killed in the Vietnam War are engraved on the Vietnam Memorial Wall in Washington, D.C. (1LT Jerome Olmsted, CRNA, and 1LT Kenneth Shoemaaker, CRNA). Military nurse anesthetists have been honored and decorated by the United States and foreign governments for outstanding achievements, dedication to duty, and competence in treating the seriously wounded. 

 

Although nurse anesthesia educational programs existed prior to World War I, the war sharply increased the demand for nurse anesthetists and, consequently, the need for more educational programs. Nurse anesthetists were often appointed as directors of anesthesia services in both the public and private sectors. In academic health centers, they were frequently responsible for the education of other nurses, medical interns, and physicians. Among the notable early programs of nurse anesthesia were: Johns Hopkins Hospital in Baltimore, the University Hospital of the University of Michigan in Ann Arbor, Charity Hospital in New Orleans, Barnes Hospital in St. Louis, and Presbyterian Hospital in Chicago. In 1922, Alice Hunt, a nurse anesthetist at Peter Bent Brigham Hospital in Boston, was invited by Dr. Samuel Harvey, professor of surgery, to join the Yale Medical School faculty as an instructor of anesthesia with academic rank. She accepted that position, eventually retiring from that institution in 1948. 

Founded in 1931, the AANA is the professional association representing more than 37,000 nurse anesthetists nationwide. The AANA promulgates education, and practice standards and guidelines, and affords consultation to both private and governmental entities regarding nurse anesthetists and their practice. The AANA Foundation supports the profession through award of education and research grants to students, faculty, and practicing CRNAs. 

The AANA developed and implemented a certification program in 1945 and instituted mandatory recertification in 1978. It established a mechanism for accreditation of nurse anesthesia educational programs in 1952, which has been recognized by the U.S. Department of Education since 1955. In 1975, the AANA was a leader among professional organizations in the United States by forming autonomous multidisciplinary councils with public representation for performing the profession's certification, accreditation, and public interest functions. Today, the CRNA credential is well recognized as an indicator of quality and competence. 

The national office of the American Association of Nurse Anesthetists is located in Park Ridge, Ill. The Association's federal government affairs office is maintained in Washington, D.C. 

References 
Bankert, M. Watchful Care: A History of America's Nurse Anesthetists. New York: Continuum. 1989.

Thatcher VS. History of Anesthesia with Emphasis on the Nurse Specialist. Philadelphia: JB Lippincott Company. 1953.