PeriAnesthesia Nursing refers to the phases of perianesthesia nursing where care of the patient takes place, when the patient is about to have, or has had, an anesthetic for an intervention, treatment or surgical procedure.
PeriAnesthesia Nurses are Registered Nurses that have advanced knowledge of the care of patients during all phases of perianesthesia nursing, from PreAdmission to postanesthetic care through the continuum of return to wellness.
Practice Settings of the PeriAnesthetic Nurse include (but are not limited to):
A. PreAdmission units
B. Phase 1 Recovery: Post Anesthetic Care Units (PACU)
C. Phase 2 Recovery: Same Day Surgery (SDS), Diagnostic Imagining (DI), Free Standing Surgical Clinics, Dental Offices, Labour and Delivery and any other area where sedation or anesthetics are given to patients
D. Phase 3 Recovery or Extended Observation: inpatient units, day surgery or clinic waiting areas prior to discharge
History of PeriAnesthesia Nursing
PeriAnesthesia nursing is a relatively new specialty in the nursing profession. Originally, patients undergoing anesthesia for interventions or surgery were cared for in the operating room but as this was soon deemed an inappropriate use of OR time when needed for another patient, this recovery period was moved to the patient's ward bed (or inpatient unit bed). It was recognized that postoperative patients out of sight of the surgeon, anesthetist and the unit nurse succumbed to any number of postoperative complications: respiratory depression/arrest, hemorrhage, unstable blood pressures, etc.
It was then that the idea of a centralized area for recovery of postoperative patients was suggested and explored: all patients were cared for in one area not necessarily close to the operating room. When medical attention was required, this area was at a distance from the surgeon and the anesthetist who best knew how to treat these patients. The "recovery room" was then moved closer to the operating room, where concentration of resources, both equipment and nurses trained in the effects and side effects of the anesthetics and surgical procedures performed, became a more efficient solution. Most hospitals began to implement a centralized recovery area during the 1940's, but it was not until after World War II that hospitals were redesigned with this unit in a location adjacent to every Operating Room.
As the Canadian population grew after the second World War and into the 1950's (the era of the "baby boom"), expansion and new facilities included more "modern" recovery rooms with newly designed lifesaving equipment. A breathing machine or "respirator" was invented to assist the heavily anesthetized patient so that transfer from the operating room occurred more quickly. The new blood pressure manometer (sphygmomanometer) was produced and nurses were taught to use it.
By the end of the 1960's, most hospitals had a Recovery Room in close proximity to the Operating Rooms. The numbers of Operating Rooms expanded as anesthetics improved, surgery was refined and surgical intervention became a positive choice for care of many health problems, previously untreatable. With an ever increasing number of surgical procedures, the postanesthetic nurse had much to learn. Education in preparation of care consisted of the surgeon explaining the surgical technique. It was then recognized that having patients better prepared for surgery was related to better outcomes. Preoperative testing and treatment meant that the preoperative patient scheduled for surgery was admitted the night before surgery. All patients received a "sedative" prior to transfer to the operating room both the night before and on the morning of surgery.
Even in the 1970's, surgery was considered risky. The cry for better postoperative monitoring devices went out, and medical equipment manufacturers soon developed devices that would assist the postoperative nurse have a better understanding of the patients' hemodynamic and respiratory status prior to any major catastrophic event. This too lead to a better chance of survival following surgery.
The respirators of the late 1960's became more complex in the 1970's but were able to deliver oxygen at a higher percentage than room air, and give full, partial or minimal ventilatory support. This improved oxygenation of tissues and brain cells in the delicate postoperative period. New cardiac monitors were developed that could capture a single rhythm and count the rate of the heart. By the late 1970's, monitors could connect to the patient's arterial system and transduce the pressure into a meaningful numerical value for blood pressures.
The number of surgical procedures increased at an alarming speed, and became less critical for the patient. Surgery became an accepted way to treat many health issues, so that beds and surgical care increased in proportion. More nurses had to be trained in this specialized area as the length of stay for the postoperative patient increased: patients were being transferred from the operating rooms now still under anesthetic at the end of the case and with breathing tubes to maintain patency of the airway (endotracheal tubes). More and more, patients required postop ventilatory assistance because of the type of anesthetics, the new paralytic medications used for better surgical performance and the prolonged time in the operating room. More invasive monitoring equipment was necessary in order to recognize any unstable hearts, blood pressures, respiratory distress or signs of hemorrhage.
As the cost of health care grew with an ever-increasing requirement for medical equipment, efficiencies had to be developed. In the 1980's, with better recovery following lighter anesthetics, patients were ready for discharge home following surgery more quickly, sometimes on the same day of surgery. Soon, the attending physician discharged the patient on the day of surgery following certain types of operations. Day Surgery units were then created and became popular in most hospitals.
Then, in the 1990's, preparation of the patients was done days or weeks prior to surgery. These "preadmission" units, as they became to be known, were soon the norm in most hospitals by the early to mid 1990's. In these units, patients were assessed as suitable for surgery and were also given information to prepare themselves for surgery and postoperative management.
In order to enhance patient transfer from the recovery area, computers were soon installed at the beside, so that lab data could be recovered quickly. It was soon recognized that patient morbidity following surgery was directly related to patient discomfort, the body reacting to the stress of this noxious side effect. Analgesics became the routine postoperative treatment, first by injection through the skin, then intravenously, then with the patient controlling the number of dosages required. Better cardiac monitors could detect subtle changes in multiple leads, ventilators became multimodal, taking over respirations totally or minimally assisting with patient effort, and heart and lung pressures were measured with the use of a catheter inserted through the heart to the pulmonary artery.
Patient safety became the focus of care in the late 90's, and into the 21st century and more equipment became available to measure the subtle changes in patient oxygenation status with the technology that translated a light over the nail bed into a saturation of oxygen value in the bloodstream.
As technology and therapeutic interventions progress at an alarming rate, it is rare that the preoperative or postoperative nurse does not require further education or information. Patient safety and safer healthcare are the focus of each nurse's daily routine. Incorporating families as partners in care has its own challenges while respecting the privacy of patients is expected and even mandated.
It is difficult to predict what the future holds for all perianesthesia nurses as the demand for patient inclusion in decision-making often conflicts with the need for best practices in care. As technology progresses and surgical techniques become less invasive, perianesthesia nursing care will be ever-evolving.
History of Nursing in Canada:
The Nurses Memorial, Ottawa Ontario Canada commemorates nurses during the wars. For further information, go to: http://www.parl.gc.ca/About/House/Collections/collection_profiles/CP_nurses-e.htm
The Nurses' Memorial
David Monaghan, Curator, Curatorial Services
The term commemoration is used to encompass all of the acts that we as a society perform to honour the memory of someone or something. It is also a term used to refer to an object intended to preserve the memory of someone or something from the present to future generations. The key in understanding the role of commemorations is that they are intended to preserve the public memory of something. It is for this reason that we often refer to them as memorials. They are also a statement, as the generation that performs the act of commemoration is informing future generations that they believe that the subject of the memorial is worthy enough to be remembered.
There are many forms of commemoration within the Centre Block, ranging from plaques, such as the Parliamentary Plaques on the first floor, to portraits and sculpture. Certainly one of the most impressive, both in terms of style and size, is the Nurses' Memorial located in the northern section of the Hall of Honour. It is a remarkable example of low relief sculpture; carved out of a single piece of beautiful white Italian Carrera marble, measuring 537 cm by 288 cm and weighing approximately 6 tons.
The project was initiated in January 1922 when the Canadian Association of Trained Nurses, the forerunner of today's Canadian Nurses Association, approached the Prime Minister, the Rt. Hon. William Lyon Mackenzie King, regarding the possibility of installing a memorial to army nursing sisters who had died during the First World War in the new Centre Block. The Prime Minister referred the request to the Minister of Public Works and for the next six months discussions between Public Works, the Nurses Association, and the Prime Minister resulted in the suggestion that the memorial be installed in Major's Hill Park.
At first, this proposal appeared acceptable to all of the parties involved. However, by May 1922, the Association's business committee had approached the Prime Minister directly in the hope of having the memorial installed in the Hall of Honour. On June 1st, a meeting was held in the Hall of Honour to discuss a possible location for the memorial. Based on reports of the meeting, the Prime Minister was instrumental in changing the character of the commemoration, turning it from a war memorial into "a historical tableau, illustrating a broad period of Canadian history and illustrating the Canadian experience." King's comments established the basic thematic parameters of the sculpture.
It took a further two years to identify a sculptor for the work. In December 1924, noted Canadian sculptor, George William Hill was awarded the commission by the Memorial Committee of the Canadian Association of Trained Nurses and subsequently accepted by the Cabinet and Prime Minister. The monument cost $38,000 and was paid entirely through funds contributed by nurses from across the country and their provincial associations.
Hill's proposal for the sculpture, one of approximately six submitted, emphasized the theme of a historical tableau; a full size plaster model of the work was exhibited in the Centre Block by the end of January 1925. The sculpture itself was completed by Hill in Italy and shipped to Canada where it was unveiled on August 24, 1926.
The Nurses' Memorial
The finished sculpture is comprised of three components supporting the main theme of the heroic service of nursing sisters from the founding of Hôtel Dieu in Québec City in 1639 to the end of the First World War. Hill, himself, described the meaning of the figures in the following way:
The group on the left-hand side of the design represents the courage and self sacrifice of the nurses who offered their services and lives in the great cause of freedom. Two sisters dressed in service uniform are nursing a wounded soldier.
In the background is "History" holding the Book of Records from 1639 to 1918, who, lifting the veil, reveals down through the ages the great deeds of heroism and martyrdom of the early nursing sisters.
The group on the right of the panel represents these noble sisters who at the call of "Humanity" left their native country, France, and came to a land to help the sick and needy. A sister within the palisades is nursing a sick Indian child.
In the centre dividing the two groups and presiding over them, stands the draped figure "Humanity" with outstretched arms. She holds in one hand her scepter, the Caduceus, the emblem of healing - and with the other indicates the heroic courage and self-sacrificing loyalty of the nurses down through the ages.
While the classical allegorical style of the sculpture may require some interpretation to understand its meaning, the inscription at the base of the monument is very clear. It states:
Erected by the nurses of Canada in remembrance of their sisters who gave their lives in the Great War, Nineteen Fourteen-Eighteen, and to perpetuate a noble tradition in the relations of the old world and the new.
Led by the Spirit of Humanity across the seas woman, by her tender ministrations to those in need, has given to the world the example of heroic service embracing three centuries of Canadian history.
Hill's sculpture is a remarkable and beautiful contribution to the Centre Block, a work that serves as the focus for an annual Remembrance Day ceremony, that took over four years to create, but whose message will endure for generations to come.