STANDARD OF PROFICIENCY FOR NURSE ANAESTHETICS IN TANZANIA TANZANIA NURSES AND MIDWIVES COUNCIL

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1 STANDARD OF PROFICIENCY FOR NURSE ANAESTHETICS IN TANZANIA TANZANIA NURSES AND MIDWIVES COUNCIL June 2007

2 FOREWORD The Tanzania Nurses and Midwives Council recognizes the challenges that are faced by nursing profession as a result of on going reforms, political and social changes. To address these challenges the TNMC commissioned the professional nurses from various discipline to develop a standards of proficiency for anesthetic Nursing. This is a major step to wards improving the quality of anesthetic care and advancing anesthetic nursing profession in Tanzania. The document covers the standards, areas of competencies and core competencies. This will be a key guide in both education and clinical practice. 2

3 PREFACE The standard of proficiency for anesthetic nursing has been written by seasoned expert educators and practitioners who are at the cutting edge of both the science and art of anesthetic nursing. As recognized leaders in the field, they are able to provide a comprehensive perspective of anesthetic nursing standards in clear and easily understood terms. The standards are solidly grounded in: Ethical and legal framework Professional practice Documentation and reporting Professional development Conducting research and utilization of research findings. TNMC hopes that this document will more firmly establish anesthetic nursing as a substantive health care spatiality with well defined knowledge base and standards. The ultimate aim is to help improve the care of our patients and their quality of lifetime firmly believe that this thorough contemporary and clinically relevant document will also effectively nurture students in their guest to become competent anesthetic nurse practitioners. 3

4 INTRODUCTION Tanzania is facing a challenge of developing adequate capacity to provide anaesthetic services to its health facilities. More than 90% of this services is provided by nurses. For ages an educated Anaesthetist has been taken as somebody who knows how to put people asleep and wake them up again. This definition is not complete. Putting the patient safety asleep, ensuring that he/she is maximally protected from the trauma of surgery and waking him again is a task which demands commitment, intelligence and proficiency skills if morbidity is to be kept low and mortality avoided. Training for anaesthetist has been taking place at KCMC and MNH locally. No official school that has been accredited to provide training for nurses in anaesthesia in the country. No doubt, an official school of anaesthesia which will insist on proficient standards of excellence will attract more trainees. It will put standards for accurate documentation, clear management policies, equipment, drugs and techniques. Establishing a nursing school that will specialize in training anaesthetic nurses will have double advantages. Capacity building of anaesthetic work force and using trainees in other theatre activities such as, participating in pre-op & post operative visit as well as assisting in operating rooms, recovery & intensive care unit. We are proposing an Advanced Diploma Training School in Anesthesia due to the fact that The National Health Sector Reform strategy emphasizes for improved health services at the Health Centre/District/Regional Level. Furthermore the employment of the graduates at this level is ensured because demand of safe anesthetic services in the country is very high. Along with this, the nursing cadre being the majority of country s work force, training continuity is rather guaranteed. SCOPE OF PRACTICE Nurse anesthetist registered by TNMC shall perform all anesthetic procedures except in the following special conditions: Cardiac surgeries Neurosurgery Neonatal/infant surgeries Complicated regional blocks Internal jugular annulations GUIDING PRINCIPLES Act in accordance with code of professional conduct and ethics in relation to consent for anesthesia. Be professionally accountable for anesthesia decisions, including actions and omissions, and cannot delegate this accountability to any other person. Communicate effectively with other practitioners involved in the care of the patient/client; refer the patient/client to another anesthetist when necessary. Provision of anesthesia shall be evidence-based responding to relevant national guide lines. 4

5 STANDARDS OF PROFICIENCY FOR NURSE ANAESTHETIST Introduction The standards of proficiency define the overarching principles of being able to practice as an anesthetist nurse; the context in which they are achieved defines the scope of professional practice. The following are the general standards, Practice in accordance with an ethical and legal framework which ensures the primacy of patient and client interest and well-being and respects confidentiality Based on the best available evidence, apply knowledge and an appropriate selection of skills indicative of safe nursing practice. Demonstrate sound knowledge and skill of assessing patients fitness for anesthesia Provide a rational decision on type of anesthesia suitable for the patient. Document and reports accurately all relevant information on the client situation and care to facilitate continuity of care. Responds effectively and efficiently in case of emergency situation to save life and prevent disability. Cooperate with other heath care team in managing a patient during pre, intra, and post operative. Enhance the professional development and safe practice of others through peer support, leadership, supervision and teaching Areas of competence Ethical and legal framework Assessment Provision of anesthesia Evaluation communication Management of human and non human resources Professional development Standard 1: Practice in accordance to legal, policy and ethical aspects of anesthetic Core competence carry out nurse anesthetic practice in accordance existing legal, policy, ethical and professional guidelines identify unsafe practice and respond appropriately to ensure a safe outcome Manage the delivery of care services within the sphere of one s own accountability. 5

6 Standards 2: Demonstrates ability to assess the patients fitness for anesthesia Core competencies Utilizes communication, interpersonal and client-provider interaction skills in conduction nursing assessment. Perform head to toe physical assessment of the patient to identify and exclude other health problems Interpret correctly laboratory investigations Classify the patients for anaesthesia according to ASA classification Decide the type of anesthetic technique that will assure safety of patients Standard 3: Demonstrate knowledge and skills in administering safe anesthesia Core competencies: Prepare complete anesthetic trolley Position and maintain the patient in appropriate position according to the type of anaesthesia and surgery Induce anesthetic drugs in a correct dose and route Display ability to Intubate a patient Demonstrates ability to administer regional anaethesia Monitor levels of anesthesia and vital signs to ensure patients wellbeing Standard 4: Apply appropriate skills in evaluating patients condition following anesthesia Core competencies: Observe levels of consciousness Perform resuscitation of patients Keep appropriate record of vital signs until when the patient is fit to return back to the ward Recognize and report situations that are potentially unsafe for patients, clients, oneself and others Review and evaluate care with members of theatre team Standard 5: Exhibit ability in managing human and non-human recourses Core competencies Show ability in executing managerial skills such as planning, organizing, coordinating, delegating and evaluating Maintain an inventory of equipment and supplies for essential for providing anaethetic services. Participate with other members in decision making concerning anaethetic services. Demonstrate the ability to coordinate the delivery of anesthetic services Develop a personal development plan which takes into account personal, professional and organizational needs 6

7 Reference: Standards of proficiency for pre-registration nursing education, 2004, nursing and Midwifery Council London ECSACON Professional Regulatory Framework.. 7