1.

Purpose of your paper: to educate people on the changes that have been made to
nurse anesthesia in order to put people at ease about anesthesia. This will be answered
with my essential question: How has the practice of nurse anesthesia evolved over time?

2. Thesis: Many people fear anesthesia today, especially by a nurse anesthetist, but they
know little as to how the practice has evolved and how much safer it is today.

3. Subheading Topic #1: Educational Changes

a. Argument 1: Education when it began

i. Surgeons originally sent their nurses all over the country to learn how to
provide anesthesia
ii. Mayo Clinic in Rochester, Minnesota: surgeons sent their nurses to learn
from Alice Magaw, the Mother of Anesthesia (Stewart, 2012)

iii. Lakeside Hospital in Cleveland, Ohio: surgeons sent their nurses to

observe and learn how to administer nitrous-oxide anesthesia (Stewart,
2012)

1. What is nitrous-oxide anesthesia?

iv. American Association of Nurse Anesthetists founded in 1931 (Wilson,

2012)

1. Their beliefs and standards

2. In 1935, their academic requirements were: length of course: six

months, but with one year recommended. Classroom instruction:
95 hours. Hours of operation room instruction (class): 18 hours.
Number of anesthetics administered: 325, of which 250 had to be
general, 25 obstetrical, 25 dental and 25 regional, divided among
spinals, locals, etc. (annotated artifact #2)

b. Argument #2: Education today

 i. AANAs support for a doctoral education by 2025 (Wilson, 2012)
ii. Education requirements as of January 2012 to present:

1. a Bachelor of Science in Nursing (BSN) or other appropriate

baccalaureate degree, a current license as a registered nurse, at
least one year of experience as a registered nurse in an acute care
setting, graduation with a minimum of a masters degrees from an
accredited nurse anesthesia educational program, [the] national
certification examination [is passed] following graduation, [must
obtain a minimum of forty hours of approved continuing education
every two years, document substantial anesthesia practice,
maintain current state licensure, and certify that they have not
developed any conditions that could adversely affect their ability to
practice anesthesia.] (Wilson, 2012)

iii. In 2011, 111 programs in 38 states exist for students. Over 2,000
students were admitted in 2009. (Annotated artifact #5, Matsusaki &
Sakai, 2011)

1. Its a pretty competitive program, so only top students from all

over the country are selected.

iv. 65% of CRNAs practice in collaboration with anesthesiologists.

(Matsusaki & Sakai, 2011)

1. Most of them are working with professionals

v. In nursing school they are using simulation technology (annotated artifact

#10)

1. The clinical setting can be realistically simulated. There is no

threat to patient safety. Active learning can occur. Specific and
unique patient situations can be presented. Errors can be
corrected and discussed immediately. Consistent and comparable
experiences can occur for all students.
 c. Conclude with contrasting the two subheadings by showing how much the
education has improved with the vast technological advancements. They are
always learning and adapting to their surroundings, therefore a lot has changed
since the 1800s when it began.

4. Subheading Topic #2: Technology Changes

a. Argument #1: Technology/practice when it began

i. When did the demand for nurse anesthetists increase? (annotated artifact
#2)

1. World War I

a. Agatha Hodgins was sent with George Crile, a surgeon to

France in 1914 (before Lakeside Hospital)

b. She trained both physicians and nurses how to administer

anesthesia

c. Soon the U.S. Army and Navy sent some of their nurses to
St. Marys Hospital (Rochester, Minnesota) and
Pennsylvania Hospital (Philadelphia, Pennsylvania) for 6
six weeks

ii. First recorded technique in 1906: open-drop technique, using chloroform

and ether anesthesia (Wilson, 2012)

1. What is chloroform and ether anesthesia?

2. What is the open-drop technique?

a. Reported not a single fatality related to anesthesia

iii. Two years later, 1908: Agatha Hodgins perfected administering nitrous-
oxide anesthesia (Wilson, 2012)

b. Argument #2: Technology/practice today (all information from Leslie Cryster)

 i. Anesthesia Machine

1. Two gases: Sevoflurane and Desflurane

2. Contains patients vitals, heart rate, oxygen intake, and carbon

dioxide outtake

ii. Anesthesia Cart

1. Contains drugs, laryngoscopy endotracheal tubes, IVs, drugs, etc.

iii. Intubation

1. Process of putting a patient to sleep (see internship paper)

c. Conclude by contrasting the differences in the techniques and practices and how
they have adapted with technology in order to become safer.

5. Subheading Topic #3: A Nurse Anesthetists Role

a. Argument #1: Their interactions with patients (their role beyond an anesthesia
provider)

i. Nurse anesthetists see their role as a guide through a frightening

experience. (Stewart, 2011)

1. They are more than just an anesthesia provider, they care about
their patients due to their nursing background

ii. Nursing is integral to the role of the CRNA (Steward, 2011)

iii. Nurse anesthetists take into account the patients physical and
psychosocial needs. (Aagaard et al., 2016)

b. Nurse anesthetists instill trust with their patients, therefore the patients put their
life in their anesthesia providers hands. CRNAs go beyond their role of
providing anesthesia to their patient, they form an emotional bond with their
patients in order to help put their patient to ease.