Running head: PERIANESTHESIA NURSING STANDARDS OF PRACTICE

Perianesthesia Nursing Standards of Practice

Jennifer J. Smith
Ferris State University

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

Abstract
The American Society of PeriAnesthesia Nurses, 2012-2014 Perianesthesia Nursing Standards,
Practice Recommendations and Interpretive Statements sets standards of practice for providing
safe, high quality care. A self-evaluation was completed analyzing current nursing practice
according to each of these standards. Professional goals are identified after self-reflection
allowing opportunity for professional growth and development.

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

Perianesthesia Nursing Standards of Practice

Perianesthesia nursing encompasses a scope of practice that includes preanesthesia and
postanesthesia levels of care. The American Society of PeriAnesthesia Nurses (ASPAN)
provides the standards of perianesthesia nursing practice, clinical practice guidelines and
recommendations for professional nurses. This paper will provide a self-assessment of these
standards and an analysis of current clinical experiences that meet the standards. The selfevaluation will determine professional goals and develop a measureable plan to attain these
goals.
Standards of Perianesthesia Nursing Practice
Standard 1: Patient Rights
This standard identifies the importance of patient rights that includes recognizing and
maintaining the autonomy, confidentiality, privacy, dignity and worth of individuals (ASPAN,
2012). As a perianesthesia nurse, it is important to value and understand each patients
individuality in order to provide comprehensive, quality care. This also includes providing
culturally competent care, which can affect the patients understanding of instructions and
compliance with the proposed treatment plan. It is vital to include the patient and family in the
development of the treatment plan in order to establish what they value and address the patients
needs and concerns.
Maintaining confidentiality protects the patients rights. Closing a door or a curtain
assists with maintaining confidentiality. I introduce myself to the patient and indicate what my
role is in caring for the patient. One of the questions I ask patients is if they want information
shared with their family. This question establishes that the nurse will only share information
about the patients care if they give their permission. It also helps to establish a relationship of

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

trust and respect and it demonstrates to the patient that the nurse is concerned with the patients
privacy.
I feel that one of my strengths is the patient rights nursing standard. I strive to adhere to
preserving patient rights and act as a patient advocate throughout the perianesthesia experience.
The perianesthesia environment is challenging as patients are anxious about having surgery and
there is limited time to spend with the patient and family. By utilizing Jean Watsons Theory of
Human Caring (2008), when entering the room I am able to focus on connecting with the patient,
being present, and developing a transpersonal relationship. Applying nursing theory into
practice has enhanced my effectiveness as a nurse and provided a way to connect with patients
and families while maintaining patient privacy and dignity.
I plan to maintain competency for this standard by keeping the patient as the center of my
focus and care. To do this I will continue to utilize Jean Watsons theory of human caring to
establish a transpersonal relationship. This will focus my attention on the individual and their
unique needs, providing non-judgmental care regardless of their socio-economic status, culture,
personal attributes, or age. I will continue to ask the patients permission prior to sharing
information with family. In order to evaluate my effectiveness, each month I will do a selfevaluation of my nursing care along with asking for feedback from patients and families.
Standard 2: Environment of Care
According to the ASPAN (2012) standards, perianesthesia nursing practice promotes and
maintains a safe, comfortable and therapeutic environment of care. The perianesthesia practice
environment involves administration of medications, anesthetic agents and the performance of
procedures that can have a significant impact on patient safety altering motor and sensory
functions (ASPAN, 2012). Maintaining competency with perianesthesia clinical skills is crucial

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

with providing safe, patient care. In addition, knowledge of medications and anesthetic agents
along with the appropriate dosage, side effects, and possible complications is important to
maintaining a safe environment of care.
I maintain the necessary perianesthesia skills by completing continuing educational
opportunities along with clinical experience. I participate in internal/external disaster drills to
ensure patient safety should a disaster occur. This also includes practicing mock drills with
evacuation of patients in case of an emergency.
There are policies in place to ensure patient safety in the perianesthesia environment. I
initiate appropriate safety measures when assisting with invasive lines such as hand hygiene,
administration of medication, application of oxygen and closely monitoring the patient for any
adverse effects. As a patient advocate, I promote a therapeutic, calming environment by giving
the patient warm blankets, dimming the lights, and turning the television to the relaxation
channel. Patient safety is vital to providing the patient with a positive outcome.
For this standard, I plan to maintain a safe environment of care by following policies and
procedures that protect the patient from harm. This includes monitoring the patient closely after
administering sedation. I will also adhere to infection prevention and isolation standards to
protect staff, patients, and families. On a yearly basis, I will keep up to date on policies and
procedures that affect patient safety and care.
Standard 3: Staffing and Personnel Management
Staffing and personnel management refers to appropriate staffing levels with competent
staff to meet the needs of patients and families based on patient acuity, census, patient flow
process and physical facility (ASPAN, 2012). Nurses working in the perianesthesia areas need
to maintain a current Advance Cardiac Life Support (ACLS) and Pediatric Advanced Life

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

Support (PALS) provider status. There are also two specialty certifications available to increase
the expertise of practicing in this area. I maintain my ACLS and PALS certifications along with
successfully completing the Certified Ambulatory PeriAnesthesia (CAPA) certification to
maintain competency and increase expertise.
I am actively involved with ensuring safe staffing levels and skill mix in providing care
to perianesthesia patients. My role and responsibility as a patient care coordinator is to adjust
staffing on a daily basis to meet the individual needs of the patients based on acuity, census, and
patient flow. This includes assessing staffs skill levels and determining appropriate
assignments, along with assigning mentors to new staff for optimal patient outcomes.
My professional goal for this standard is to maintain my perianesthesia skills in order to
meet the needs of patients and families. To do this, every two years I will renew my ACLS and
PALS provider status. Every three years I will maintain the CAPA certification by meeting the
necessary requirements. In addition, I will continue to evaluate staffing on a daily basis to
ensure appropriate staffing levels to provide safe, quality care to patients. This will be evaluated
at daily huddles as well as at weekly leadership meetings.
Standard 4: Quality Improvement
Quality improvement for perianesthesia nursing includes monitoring and evaluating
patient care to identify issues, implement resolutions and evaluate outcomes to improve care and
safety (ASPAN, 2012). Nurses need to be actively involved in quality improvement initiatives to
provide quality care and to enhance the surgical experience for the patient and their family. An
example of a quality improvement initiative that I am involved with is an identified increase in
post-operative surgical site infections for total joint replacement patients. Surgical site infections
are part of a Surgical Care Improvement Project (SCIP) measurement to improve surgical care

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

by significantly reducing surgical complications (Joint Commission, 2014). A multidisciplinary

team was formed to review evidence-based practice (EBP) along with current practices. This
included the current processes for pre-operative patient cleansing, surgical clipping, appropriate
pre-operative antibiotic selection, and the intra-operative surgical site prep process.
I am leading a multidisciplinary team to implement a new pre-operative patient cleansing
protocol based on EBP. To accomplish this new process, the team is focusing on planning,
collaboration, education, and implementation. A baseline measurement was conducted prior to
implementation to monitor compliance with the new protocol. Further evaluation will include a
short-term goal to increase patient compliance and a long-term goal to monitor the effect on
infections rates. Perianesthesia nurses need to seek opportunities for improvement, utilize
research and evidence, and incorporate new processes into practice to improve outcomes for
patients.
My goal for meeting and exceeding this standard is to monitor quality of patient care by
monitoring compliance with quarterly SCIP measures. If SCIP measures fall below standards, I
will participate in developing an action plan to meet the quality measures and re-evaluate six
months after implementation. Another intervention is to review patient satisfaction scores to
determine the patients perception of quality and care. This information is beneficial as it
provides the patients perception of their surgical experience and allows an insight into
developing interventions to improve patient satisfaction scores. Patient satisfaction scores will
be reviewed bi-annually to assess if quality improvement initiatives need to be developed.
Standard 5: Research and Clinical Inquiry
According to ASPAN (2012), research and clinical inquiry is important mechanisms for
describing, understanding and validating perianesthesia nursing practice (p. 23). Research and

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

EBP need to guide decision making in the nurses clinical, educational and management roles
(ASPAN, 2012). Perianesthesia nurses need to challenge current practices by participating in
clinical inquiry projects and reviewing EBP to determine the best interventions for preventing
surgical complications.
Currently, one challenging area for perianesthesia nurses is determining best practice
protocols for safely caring for patients with sleep apnea. I am participating in an
interdisciplinary team to review EBP and to develop protocols for sleep apnea patients. There
has been limited research conducted on recommended types of anesthesia, perioperative use of
medications, and length of stay for scheduled outpatient surgeries. Benchmarking with other
organizations has resulted with inconsistent practices in caring for these types of patients. It is
essential to use research and clinical inquiry to guide decision-making and development of
protocols for optimal patient outcomes.
I plan to maintain my yearly ASPAN membership that allows me to receive monthly
journals containing EBP articles about current practices and recommended guidelines. Being an
ASPAN member provides an opportunity to network with other perianesthesia units and nurses
to benchmark about best practices and ask clinical questions. I will challenge myself to read
each monthly ASPAN journal and look for opportunities to change processes and to improve
patient outcomes.
Standard 6: Nursing Process
The perianesthesia nurse needs to systematically assess each patient to develop an
individualized plan of care across the perianesthesia continuum (ASPAN, 2012). This process
includes assessment, planning and implementation, and evaluation. Perianesthesia nurses need
to be knowledgeable of clinical protocols and practice guidelines and develop interventions that

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

will result in positive patient outcomes. Collaboration with the patient, family and other
healthcare personnel is vital to developing an effective plan of care throughout the patients
surgical experience.
The nursing process is my strength in the pre-operative and discharge areas. I am able to
develop a plan of care that is individualized for each patient and prioritize care based on the
patients needs. Providing the patient and family with a description of the surgical process helps
to decrease anxiety. Perianesthesia nursing is an art, and being able to establish trust and respect
in a short amount of time can increase patient satisfaction and allow for open communication. In
Watsons (2008) caritas process number eight, the caring relationship and environment are
generated by the nurses heartfelt, loving presence, and the consciousness he or she holds,
helping shape the patients health and healing experience as well as the nurses own experiences
(p. 137). I believe that by connecting with the patient and family, the nurse can positively
influence their care by creating an environment of positive, spiritual energy.
My goal is to continue diligence with thorough, individualized assessments involving the
patients and families. Understanding the patients needs and concerns will help to develop a
perianesthesia care plan. Thorough documentation and communication is the key to sharing this
information with other healthcare providers. I will monitor the effectiveness of the interventions
by reviewing quarterly documentation and patient outcomes. I will also participate in annual
peer reviews to receive constructive input into my professional practice and develop goals based
on the feedback.
Conclusion
This self-assessment of the perianesthesia standards of practice has provided me with
valuable information about my professional nursing practice. Analyzing the standards along

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

10

with my current practice and clinical experience has helped me establish a plan for maintaining
competency and promoting professional growth. Self-reflection allowed me to evaluate my
current level in my specialty area and enhance my professional identity.

PERIANESTHESIA NURSING STANDARDS OF PRACTICE

11

References
American Society of Perianesthesia Nurses [ASPAN]. (2012). 2012-2014 Perianesthesia nursing
standards, practice recommendations and interpretive statements. Cherry Hill, NJ:
ASPAN.
Joint Commission. (2014). Surgical Care Improvement Project. Retrieved from http://
www.jointcommission.org/surgical_care_improvement_project/
Watson, J., (2008). Nursing: The philosophy and science of caring (Rev. ed.). Boulder, CO:
University Press of Colorado.
Yoder-Wise, P. S. (2014). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier
Mosby.