American Society of Perianesthesia Nurses professional standards

American Society of PeriAnesthesia Nurses

Why Organization Exists

Community Interaction

Effect on Society

Organization's Effect on Social Change

Structure

Power and Outcomes

Leadership

Decision Making

Communications

Change

Environments and Relationship

Effectiveness

Theory

The responsibility of any nursing professional is to ensure that they are fully prepared to do the best possible job that they can do to maintain good patient outcomes. The best possible way for a professional to ensure preparedness is to begin with a solid foundation of general nursing education. Yet, this is not enough. Most nurses will at some point in their career choose a more specialized field of practice. This can include almost any facet of medical care. One growing nurse specialty is that specialty that surrounds the use of anesthesia care, before during and after surgical procedures that require anesthetization.

Anesthesia nursing is an under-researched area of practice and is not always well understood by nursing and medical colleagues with limited experience of the specialty, or indeed, by patients who, because of anesthesia, are not in a position to comment on the care they receive. The role of the...anesthesia nurse is to ensure patient safety and well-being during the journey from the operating theatre back to the ward. This trajectory, from unconsciousness and instability to consciousness and stability, includes a number of stages separated by critical transitions when the patient is physiologically unstable. (Prowse and Lyne, May2000, pp. 1115-1116)

Due to the seriousness of the physiological state of the patient and their inability to act for themselves there is special need for well trained and specialized perianesthesia nurses.

The American Society of Perianesthesia Nurses is and society developed to assist the nursing specialty of anesthesia. The nursing specialist includes professionals who work with surgery patients prior to anesthesia procedures after anesthesia procedures and during anesthetization. The special patient needs during the time associated with anesthetic are specialized and require a raised bar of nursing abilities and standards. Organizations like the ASPAN help ensure that nurses choosing such a responsibility will be fully prepared to assist patients to achieve the best possible outcomes in surgical situations.

In 1980 the American Society of Post Anesthesia Nurses (ASPAN) was born of the need for education specific to perianesthesia care. ASPAN has continued to prosper with membership over 5,600 in 1989. Through ASPAN other avenues of growth have occurred which include a bimonthly journal devoted to perianesthesia nursing, a bimonthly newsletter, annual conferences, and an opportunity to become certified in this specialty of nursing. (ASPAN, 2003, (http://www.aspan.org/Historical.htm)

ASPAN exists to perform the functions of continuing education for nursing professionals interested in or practicing in the field of anesthesia. ASPAN makes clear that its mission is current and effective education of both the care consumer and he nursing professional as well as the whole of the medical profession. Community and professional outreach engender greater awareness of the special needs of the anesthetized patient. "The American Society of PeriAnesthesia Nurses advances nursing practice through education, research and standards." (ASPAN, 2003, (http://www.aspan.org/MissionStmt.htm) The ASPAN accomplishes its objectives through a series of goals and missions outlined in their professional mission statement:

Providing education with respect to all phases of perianesthesia care through a variety of formats.

Developing Standards of Perianesthesia Nursing Practice.

Promoting public awareness and understanding of the care of preanesthesia and postanesthesia patients.

Exchanging professional knowledge.

Facilitating cooperation between perianesthesia nurses and physicians and other members of the healthcare team concerned with the care of the patient in the immediate preanesthesia and postanesthesia period.

Encouraging specialization and research in all phases of perianesthesia nursing.

Promoting interest and professional growth of nurses engaged or interested in the care of patients in the immediate preanesthesia and postanesthesia nursing period.

Cooperating with universities, government agencies or any organization in matters affecting the purposes of the Society.

ASPAN, 2003, (http://www.aspan.org/MissionStmt.htm)

ASPAN interacts within the medical industry and outside of it through educational programming, standard guideline submissions and community outreach systems such as their official website and their professional events and assemblies. They serve as the number one information hub for the practice of nursing as it relates to the anesthesia specialty. They promote specialization and awareness improvement through several avenues as detailed in their mission statement.

One community interactive service they provide can be accessed through their website at, http://www.aspan.org/CpNetwork.htm. At this location online any person who has a question or concern regarding practice, standards, procedures or simply a request for information about specializing in perianesthesia can access what ASPAN calls the Clinical Practice Network. Through this system ASPAN offers a personal response service that will help the interested party in any way they can. When logged on to the site the party will receive a message about how the system works and when they might expect an answer from an anesthesia professional:

If you have a clinical practice question on any topic, whether a clarification on a particular ASPAN Standard or how other PACUs are handling a certain issue, please feel free to use ASPAN's Clinical Practice Network.

Here's how it works. You may either type in your inquiry below or call the National Office with your question at (toll-free). At the end of each week, all inquiries are collected and forwarded by region to a member of ASPAN's Clinical Practice committee. Your regional representative will then research the inquiry and call you the following week to discuss the subject directly with you, or he/she may choose to e-mail the answer to you. (ASPAN, 2003, (http://www.aspan.org/CpNetwork.htm)

ASPAN offers a very comprehensive website which includes not only the Clinical Practice Network but also access to the publications provided by the organization, free with membership and a detailed yearly calendar including all of their upcoming conferences. Many of their services are offered free with membership.

Their publications include: The Journal of PeriAnesthesia Nursing (formerly The Journal of Post Anesthesia Nursing) which is published bimonthly and is free in print form to members and for a nominal subscription price to nonmembers and in electronic form universally online (at: (http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchdbfor=home&id=jpan,)Breathline a newsletter also published bimonthly and available free to members. ASPAN is also the developer of the ASPAN Standards of Perianesthesia Nursing Practice a comprehensive guideline for perianesthesia professionals, the 2002 and 2000 guidelines are available to order through their website at http://www.aspan.org/Pubs.htm#The%20Journal%20of%20PeriAnesthesia%20Nursing.Also available at the same location is the ASPAN Competency-Based Orientation Credentialing Program (1997 Edition), a comprehensive training system for credentialing nurses in the field and the Competency-Based Orientation and Credentialing Program for Unlicensed Assistive Personnel in the Perianesthesia Setting - 2001 Edition, a training guide for non-nursing staff associated with the anesthesia field.

ASPAN also hosts an annual five-day conference, which offers a great body of professional information and networking. Topics for this years conference include women's health, problem solving, management, legal, pain/comfort, integrative medicine, research, complementary therapies, ambulatory care, clinical care, professionalism. One additional source of impact can be seen through the ASPAN Foundation, which is a non-profit organization established to help nurses access scholarship monies for the purpose of furthering their education in the specialty.

Through all of these practices ASPAN affects the medical and medical consumer society through education and information. Broadening the understanding for nursing professionals and consumers has helped the area of practice become more involved in positive patient outcomes and positive professional growth. Establishing specialization in a nursing field affects social change through increased patient efficacy. Increasing the bar on standards by implementing research and development and the dispersing of that information into the field of perianesthesia nursing increases the professionalism and skills of the industry.

A the premise that effective nursing knowledge achieves intended patient outcomes has wider practice and educational implications. If effective knowledge comprises a form of evidence which influences patient outcomes, an understanding of all the factors contributing to its development is an important addition to the body of nursing knowledge...An understanding of how effective knowledge develops in practice, and how that process can be controlled and enhanced, contributes to the delivery of quality patient care and the provision of professional education for nursing practice. (Prowse and Lyne, May2000, pp. 1124-1125)

Through planned and guided educational techniques and personal networking that is afforded active members of ASPAN a professional awareness of needs and demands of the specialty of perianesthesia is furthered.

In a group of personal interviews among educators of Master's Level Nursing professionals a group of UK researchers attempted to answer pertinent questions about what makes a nurse a potential nurse specialist. The interviews were conducted to establish a basis for the personal and professional determinations of why a nurse would be qualified to earn a masters degree and then move on into a specialty field like Perianesthesia. In these interviews the lecturers made clear that an ability to focus on research and interpret it to best meet patients needs was paramount to his/her success as a nurse specialist:

In analyzing the data we were struck by the clearly articulated expectation that master's level education would result in personal change in addition to the development of cognitive and practice-related competencies... confidence and assertiveness in one's own ability and in relationships with others were regarded as discerning features of master's level performance. Such confidence was a feature of the personal dynamism which nursing lecturers professed for their graduates:

At the end of the programme someone will be able to determine for themselves what their practice is about and how they can advance that practice with considered opinion and with a confidence that takes them out of the ordinary mode."

Confidence was also shown in the ability to articulate one's own position assertively, irrespective of one's position in an occupational or a professional hierarchy:

By the time people have completed this programme they should be able to go into the senior arenas in which they work and debate confidently about issues of practice, having a considered opinion, and be able to defend it, be able to convince people."

Such confidence was underpinned by an increase in cognitive ability:

At the end (of the course) I'm looking for someone whose confidence has been raised, whose intellectual ability has been raised, who has skills tied in with research, critical analysis, synthesis, dynamism, being proactive in dealing with issues at work, who is conscious not only of the pragmatic side of their work but also the policy and can cue in to what is going on in the wider world, a more informed person and a more skilled person." (Ashworth, Peter D.; Gerrish, Kate; McManus, Mike Jun2001p. 625)

In the end the researchers found that the type of confidence a student gains from a combination of successful interpretation of useful research and successful interpersonal relations determined personal and professional success as nurse specialists. These two roles are perfect examples of the roles that specialization focused organizations like ASPAN fulfill for their member base.

Though it is unclear if ASPAN is officially a 501 c3 non-profit organization, from its publications and documentation it is clear that it functions much as any nonprofit would. ASPAN is a voluntary organization with individual members and subset organizations from all over the United States. Individual state organizations exist with goals to further the same education missions in their own regional location and among their own nursing culture. Those organizations become official subsidiary members of the organization and are furthered by ASPAN's knowledge and expertise as well as by their official association with ASPAN as group members.

ASPAN is thought of an the preeminent PeriAnesthesia organization and educates thousands of nurses a year and consists of a distinguished Board of Directors and large national staff that furthers its goals of developing perianesthesia nursing resources. ASPAN's specific goals are universally focused on the further development of the specialty and the patient care improvements that will issue from their research education and national interaction.

The structure of ASPAN is relatively complex and consists of paid and unpaid members/employees. The governing board is the ultimate leadership center and yet it seems that the subset organizations representing individual states do have a considerable amount of flexible power base. Largely this organic leadership style seems to be based on what would seem to be an open door mentality among leader members.

The cultural factors that might engender this sort of organic leadership and power base could be significantly influenced by the general membership of the organization consisting of the traditionally nonfinite power-based culture in the nursing profession. In the same interview set addressed previously the expression of a general health care focus on an "enriching approach" to pragmatic growth:

Respondents varied in the place they were willing to give to suspicion, but most preferred the enriching mode of critical thinking. A pragmatic motive seemed to govern this preference. The enriching mode was seen as enabling practitioners to cope with the unpredictability and limitations of current health care in order ultimately to improve practice, and this required a positive attitude towards changing practice:

don't think we adopt a very suspicious mode, it's more an enriching approach. In health care, all we can achieve is to strive for the best at that particular time. It's about getting people to think more in that positive way, so that they feel they can improve their practice."

The cautiousness expressed in respect of critical thinking was also evidenced by interviewees consideration of creativity. (Ashworth, Peter D.; Gerrish, Kate; McManus, Mike Jun2001p. 625)

The power structure of ASPAN seems to be greatly influenced by the general history of the organization. In the sense that traditional means of education and membership retention are often the most logical solutions offered by the leadership system in place currently.

Though structurally diverse with representation all over the United States the decision center is most likely to be found in the offices of the paid staff of the organization. "ASPAN includes state and regional associations that have component status in the organization. There are presently 40 chartered component organizations." (ASPAN, 2003, (http://www.aspan.org/Organization.htm) The succession of board members occurs annually. Given the directives of the governing board and of the committees and special function groups that address special concerns of the profession as a whole the staff members direct the decisions from there down.

Communication seems also to be handled in an open door way as many members are accessible via email online to any person who wishes to request information or offer input. It is hard to believe that an organization offering such simple access to leaders and decision makers would be in the least bit closed to multidirectional communication processes.

Technological advances are being demanded of the present governing board as the new move toward international interest seems to be demanding the interplay of internet technology and overall change. There has been a very recent movement to increase the scope of influence of the organization to an international forum. Vallire D. Hooper, MSN, RN, CPAN, is a Clinical Nurse Specialist in Surgical Services at St. Joseph's Hospital and a Clinical Assistant Professor for the School of Nursing at the Medical College of Georgia in Augusta, GA. In an opinion editorial in the February 2003 issue of the Journal of PeriAnesthesia Nurses Hooper discusses the international trend that is emerging in ASPAN.

It is also time to think outside of the confines of the United States. What can we do to promote ASPAN as the international authority in perianesthesia nursing? We are already making great strides, but we aren't really making a concerted effort. And most, if not all of our international growth is due to Internet exposure. The United States continues to take the lead and provide the benchmarks when it comes to health care issues. The specialty of perianesthesia nursing is not immune to this trend. JoPAN [Journal of PeriAnesthesia Nurses] has seen a significant increase in the number of international queries, questions, and submissions since it went online with full-text access 2 years ago... (Hooper, Feb2003)

Hooper also points out that the organizations main publication has begun a long process of evolving into an international spokes piece and because it is the mouthpiece of the ASPAN, ASPAN needs to step forward and continue the trend by addressing internal issues like international membership and alternative Internet organization meetings.