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Safely anesthetizing patients with left ventricular assist devices (LVADs) can be intimidating, particularly for novice anesthesia providers. Given the variety of complex issues anesthesia providers may encounter with patients, it would be impractical to expect expertise in every population. To combat the inevitable loss of knowledge, education experts recommend active learning techniques, including test-enhanced learning, active recall, and spaced repetition. To that end, this research team created an LVAD Assessment for Anesthesia, or LAmA tool, to be evaluated for content validity by eight experts. The LAmA tool and content validity assessment were distributed to two anesthesiologists and four nurse anesthetists in the cardiothoracic anesthesia department at a hospital in Northeast Ohio, as well as to two outside nursing research experts. Results were analyzed by the research team and the content validity index (CVI) was determined. A CVI of at least 0.875 was required for the tool to be valid, and final scores in the categories of relevance, clarity, and importance were all ≥ 0.9. The data from the validated tool were used to create a pocket reference on LVAD anesthetic management. Both educational assessments and pocket references have the potential to positively im [ABSTRACT FROM AUTHOR]

The purpose of this pilot study was to investigate wellness and student suicidality in nurse anesthesia programs. Graduate students such as student registered nurse anesthetists (SRNAs) are at increased risk of suicide from environmental and educational stressors. Wellness interventions may help. An observational, anonymous online survey of all program directors (PDs) was conducted. Identical responses on a simultaneous pilot SRNA study were compared. Quantitative data were analyzed using Wilcoxon rank sum and Fisher's exact tests. Three PDs reported student suicides. Anxiety, depression, and emotional lability were warning signs. Student and PD responses to wellness program assessments were varied, with PD responses more positive and students more negative. PDs were as stressed as students and struggled to meet their own wellness needs. Most PDs reported no or insufficient training in suicide risk and prevention. Suggestions for improving wellness initiatives included to improve and standardize activities and make initiatives more accessible and seek innovative solutions to fit more content into an overcrowded curriculum. PDs and SRNAs need suicide prevention training and improved wellness efforts at local and national levels. Approaches are needed to counter stigma and reluctance to discuss mental health challenges. Suicide is multidimensional, but with proactive awareness, it may be preventable. [ABSTRACT FROM AUTHOR]

Research focusing on the scope of practice by nurse anesthetists (NAs) is limited. The purpose of this study was to examine NAs' scope of practice in Norway, and to explore whether and how this has changed during the period from 1979 to 2018. The study had a repeated cross-sectional design. All members of the Norwegian Association of Nurse Anesthetists at the four time-points (1979, 1989, 1999 and 2018) were invited to participate in a questionnaire study. Inclusion criteria were education and work as an NA and currently working in Norway. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Findings indicate that the scope of NAs' practice in Norway has been increasingly restricted from 1979 to 2018 (N = 2171, P < .001). Additionally, the presence of an anesthesiologist when performing anesthesia had significantly increased during that time (39% in 1979 vs 90% in 2018). However, NAs' independent practice significantly increased in some areas, such as handling of acute situations, (i.e., handling of laryngospasm/bronchospasm [41% in 1979 versus 54% in 2018]). International and national standards underline the independent role of NAs. The development shown in our results should be addressed to avoid further restrictions of NAs' scope of practice. [ABSTRACT FROM AUTHOR]

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic prompted profound shifts in the delivery of critical healthcare services. A mixed-methods study was conducted to explore the impact of the pandemic on Certified Registered Nurse Anesthetist (CRNA) practice. The quantitative component involved a survey of CRNAs during the initial period of the pandemic to determine changes in practice and any relationship to removal of state and federal barriers. Approximately 16% of 2,202 responding CRNAs reported practice expansion beyond their normal responsibilities, primarily outside the operating room and involving tracheal intubation, ventilator management, arterial line placement, and central line placement. CRNAs were more likely to experience an expansion of practice in states affected by removal of regulatory barriers. However, respondents also reported missed opportunities to use the full expertise of CRNAs because of state and institutional restrictions. Findings from the qualitative component of this study are reported in a separate article. [ABSTRACT FROM AUTHOR]

Background: In the perioperative dialogue, pre-, intra- and postoperatively, the patient shares their history. In the dialogue, the nurse anesthetist (NA) gets to witness the patient's experiences and can alleviate the patients' suffering while waiting for, or undergoing surgery. The aim of this study was to describe the nurse anesthetist's experiences of the perioperative dialogue. Methods: The study had a qualitative design. Interviews were conducted with 12 NA and analyzed with interpretive content analysis. The methods were conducted in accordance with the COREQ guidelines. Results: In the result, three categories emerge: A mutual meeting (the preoperative dialogue) where the patient and the NA through contact create a relationship. The NA is present and listens to the patient, to give the patient confidence in the NA. In the category, On the basis of the patient's needs and wishes (the intraoperative dialogue), the body language of the NA, as well as the ability to read the body language of the patient, is described as important. In the category, To create a safe situation (the postoperative dialogue) the NA ensures that the patient has knowledge of what has happened and of future care in order to restore the control to the patient. Conclusion: The patient is met as a person with their own needs and wishes. It includes both a physical and a mental meeting. In a genuine relationship, the NA can confirm and unreservedly talk with the patient. When the patients leave their body and life in the hands of the NA, they can help the patients to find their inherent powers, which allows for participation in their care. Understanding the patient is possible when entering in a genuine relationship with the patient and confirm the patient. The perioperative dialogue forms a safety for the patients in the operating environment. [ABSTRACT FROM AUTHOR]

AccessAnesthesiology from McGraw-Hill is an interactive database platform that provides user access to electronic books, quick reference material, drug monographs, multimedia, sample cases, and anesthesia study tools for the board review. It is a database for medical students, nurse anesthetist students, residents, and others in the health care field interested in anesthesia. This article will provide an overview of the features found in this online tool. Layout, resource tools, searching options, and navigation will be shared in addition to unique features in AccessAnesthesiology. [ABSTRACT FROM AUTHOR]

Currently, around 80,000 kidney transplants are performed annually. In Poland, according to Poltransplant statistics, in 2018, this number was 946. The main indication for transplantation is end-stage renal failure, which leads to loss of filtration function through this organ. A nurse anesthetist plays an important role during kidney transplantation, therefore the aim of the work is to present her tasks and identify the nursing care problems during anesthesia and to propose nursing interventions based on the case report. The nurse is responsible for preparing the equipment used during anesthesia, placing the patient on the operating table and assisting the anesthesiologist in introducing anesthesia. Then, during the operation, together with the doctor, she or he monitors the patient's condition, and also prepares and administers drugs and fluids. During the treatment, numerous care problems may occur. A nurse has specialist knowledge and is able to recognize them early and implement appropriate preventive actions. Kidney transplantation is a complicated life-saving procedure. In comparison to other methods of renal replacement therapy, it gives better results and provides patients with greater comfort in everyday functioning. [ABSTRACT FROM AUTHOR]

Surgical care provided through short-term medical missions (STMMs) is an important component of global healthcare. Certified Registered Nurse Anesthetists (CRNAs) are equipped with valuable knowledge and skills to help those lacking access to healthcare. Understanding the motivations and barriers to the participation of CRNAs in STMMs is vital to increasing their participation in these trips, which positively influence global healthcare. A descriptive qualitative design to understand motivations underlying volun- teerism was used to gain this understanding. Clary's use of Functionalist Theory was the theoretical framework informing this study. Semistructured interviews were conducted with 6 CRNAs who had participated in at least one STMM. Colaizzi's qualitative method of inquiry was used for data analysis. The study's main objective was to identify motivations and barriers spe cific to CRNAs' participation in STMMs. Major categories for motivation included humanitarian values, personal and professional growth, readiness to serve, and strong teamwork. Barriers of participation in STMMs were divided into categories of internal (eg, personal discomfort, obligations) and external (weakness of the organization). The study results yield greater understanding of what can draw increased participation in STMMs from CRNAs. Improved understanding may lead to more effective recruitment and better satisfaction of CRNA participants in STMM work. [ABSTRACT FROM AUTHOR]

Study Objective: Anesthesiologists can provide psychometrically reliable daily evaluations of certified registered nurse anesthetist (CRNA) work habits for purposes of the mandatory ongoing professional practice evaluation (OPPE). Our goal was to evaluate the validity of assessing CRNA work habits.Design: Observational study.Setting: Large teaching hospital.Measurements: N=77 anesthesiologists evaluated work habits of N=67 CRNAs. The non-technical attribute of work habits was measured on a 6-item scale (e.g., 1="Only assumed responsibility when forced to, and failed to follow through consistently" versus 5="Consistently identified tasks and completed them efficiently and thoroughly"). One year of scores were used to assess validity. Each daily evaluation could also be accompanied by a written comment. Content analysis of comments was performed using two years of data. Statistical analyses were performed using mixed effects logistic regression, treating each anesthesiologist as a fixed effect to compensate for the leniency of their ratings.Main Results: The N=77 anesthesiologists' response rate was 97.3%, obtained at a mean 2.93days after the request. The internal consistency of the scale was large: Cronbach's alpha 0.952. Controlling the false discovery rate at 5.0%, among the 67 CRNAs, 8 were significantly below average (each P≤0.0048) and 6 were above average (each P≤0.0018). During the 6months after CRNAs knew that their work habits scores would be used for OPPE, there were significant increases in the scores compared with the preceding 6months (odds ratio 1.93, P<0.0001). Greater CRNA's qualitative annual evaluation scores made by the chief CRNA, without knowledge of the work habit scores or comments, were associated with greater odds of the CRNA's leniency-adjusted work habit scores equaling 5.00 (odds ratio 1.53, P=0.0004). Comments of negative sentiment made by the anesthesiologists were associated with greater odds of the leniency-adjusted work habit scores being <5.00 (odds ratio 54.5, P<0.0001). Even though the anesthesiologists were already providing information about work habits using the work habits scale, approximately half the comments of negative sentiment included the theme of work habits (92/153, 60.1%).Conclusions: Reporting OPPE metrics are mandatory for the maintenance of clinical privileges of anesthesia practitioners in the USA. Basing such peer review on work habits can be quantitative, psychometrically reliable, and valid. [ABSTRACT FROM AUTHOR]

Introduction We can find many factors affecting the physical health in the work environment of nurse anaesthetists which are working in the postoperative cardiac surgery unit and cardiac operating rooms. Nurses working in the intensive care unit and operating room are significantly exposed to a high workload. The staff includes mostly aging women, working 12 hours a day, which are at great risk of cervical and lumbar spine pain. Working in forced positions, anteversion, unnatural spine flexions, lifting overly-heavy weights and excessive overload during care and therapeutic work is all contributing to the intensification of the problem. Aim The aim of this work was to assess the extent of the workload through the assessment of the occurrence of spine dysfunction in the cervical and lumbosacral segment in nurse anesthetists working in cardiac surgery unit. Material and methods A group of 102 nurses working in the ICU (intensive care unit) and OR (operating room) were assessed with the Oswestry Disability Index (ODI) and Neck Disability Index (NDI). Results The results show that 69.61% of nurses felt spinal pain at the time of the study. The results also show that 69.61% of nurses felt spinal pain at least once. Minimal disability in the cervical and lumbar spine had 18.6% and 19.6% of the participants respectively. 53% of the examined nurses reported mild dysfunction of the cervical spine and 80% - minimal lumbar disability. We compared groups of nurses working in the postoperative cardiac surgery unit of the Clinical Department of Anesthesiology and Intensive Therapy as well as the Anesthesia Department (operating room). There were no statistically significant differences in the results between both groups. Conclusions 1. Nurse anesthetists working at the cardiac surgery unit suffer from pain in cervical and lumbosacral segment of spine. This is caused by high workload. 2. Mobilizing the patients and a forced standing position both affect the escalation of problems with the spine. As NDI grew, so did the value of ODI. 3. There was no statistically significant difference between the disability of the spine of nurses working in the operating room and the intensive care unit. [ABSTRACT FROM AUTHOR]

Nontechnical skills are critical for good anesthetic practice but are seldom addressed explicitly in clinical training. The purposes of this study were (1) to evaluate the reliability and validity of the observation-based assessment tool Nurse Anaesthetists' Non-Technical Skills system (N-ANTS) and (2) to evaluate the effect of training nurse anesthetist supervisors in the use of N-ANTS. This system comprises a global rating score, 4 categories, and 15 elements to rate nurse anesthetists' nontechnical skills. A 1-day workshop was conducted for 22 nurse anesthetist supervisors to rate nurse anesthetists' nontechnical skills in 9 scripted video scenarios. Data were gathered from 2 rating sessions separated by a 2-hour training session. The interrater reliability was high before and after the training. It remained stable for the global rating score in N-ANTS and its category ratings, but improved at the elements level. When the raters' ratings were compared with ratings by an expert reference group, there was no statistically significant effect on training. We conclude that Danish nurse anesthetist supervisors without further rater training besides their work experience can use N-ANTS to assess nontechnical skills of nurse anesthetists. [ABSTRACT FROM AUTHOR]

Informatics is a new science within healthcare and anesthesia that leverages computer technology to improve patient safety, the quality of care provided, and workload efficiency. In clinical anesthesia practice, appropriate application of informatics promotes data standardization and integrity, and supports clinical decision-making. This article describes current issues in anesthesia information management to support the critical need for Certified Registered Nurse Anesthetists (CRNAs) to influence functionality, adoption, and use of an anesthesia information management system. The use of informatics tools and concepts should enable CRNAs to enhance their bedside vigilance, align their practice with evidence-based clinical guidelines, and provide cost-effective care for patients and healthcare systems. [ABSTRACT FROM AUTHOR]

In the Netherlands, hospital care production pressure recently increased substantially, while the number of nurse anesthetists available did not match this rise. The longtime existing norm of no night shifts for nurses beyond the age of 55 years was increased to age 57 to meet the demand for more nurse anesthetists. In this pilot study, we aimed to determine the level of fatigue and its correlation with demographic items among this category of employees. A validated questionnaire was distributed to all Dutch nurse anesthetists above 50 years of age working in Dutch hospitals, which asked for their level of fatigue. The Checklist Individual Strength Questionnaire was used to measure fatigue. Overall, 105 of 115 potential participants completed the questionnaire (response rate, 91%). The mean scores (± standard deviation) were as follows: total fatigue, 81.3 ± 8.3; subjective fatigue, 31.4 ± 3.2; physical activity, 13.1 ± 2.2; motivation, 16.8 ± 2.6; and concentration, 20.0 ± 3.8. No correlation could be demonstrated between demographic characteristics and fatigue. Dutch nurse anesthetists above the age of 50 years show a high fatigue score and therefore need special attention to prevent them from harmful physical and psychological effects and to sustain maximal patient safety. [ABSTRACT FROM AUTHOR]

Potential non-physician anesthesia students gauge many different aspects of a graduate program prior to applying, but cost of education and earning potential are typically high priorities for students. Our analysis evaluated the cost of tuition for all certified registered nurse anesthetist (CRNA) and anesthesiologist assistant (AA) programs in the United States, as well as earning potential for both professions. We collected educational cost data from school websites and salary data from the Medical Group Management Association's Physician Compensation and Production Survey: 2012 Report in order to compare the two groups. We found that the median cost of public CRNA programs is $40,195 and the median cost of private programs is $60,941, with an overall median of $51,720. Mean compensation for CRNAs in 2011 was $156,642. The median cost of public AA programs is $68,210 compared with $77,155 for private AA education, and an overall median cost of $76,037. Average compensation for AAs in 2011 was $123,328. Considering these factors, nurse anesthesia school is a better choice for candidates who already possess a nursing license; however, for those prospective students who are not nurses, AA school may be a more economical choice, depending on the type and location of practice desired. [ABSTRACT FROM AUTHOR]

Nurse anesthesia programs strive to minimize attrition due to academic reasons and maximize student success. The authors examined the evidence for evaluating applicants to nurse anesthesia programs that may help predict success in the program and on the National Certification Examination for Nurse Anesthetists. A search strategy guided gathering of evidence from peer-reviewed journals. Evidence from non-anesthesia graduate nursing programs was included because of the suspected lack of evidence specifically examining nurse anesthesia programs. Eight sources involved solely graduate nurse anesthesia programs, 9 involved graduate nursing programs without student registered nurse anesthetists, and 2 pertained to graduate nursing programs with student registered nurse anesthetists. Most of the evidence sources were descriptive studies. The evidence overall supports current commonly used admissions criteria such as undergraduate grade point averages. The requirement for applicants to take the Graduate Record Examination should be examined closely. Programs should also consider the length of time the applicant has been out of a formal educational setting. Based on these findings, programs may cautiously explore revising the admission policy. Further investigations are proposed to explore the predictive value of various admission criteria. [ABSTRACT FROM AUTHOR]

Abuse and dependency on potent opioids have long been recognized as problems among nurse anesthetists and anesthesiologists. Research has provided insight into the incidence of abuse, risk factors associated with this type of dependency, identification of an impaired provider, treatment for abuse and dependency, and prevention strategies. Although several factors influence the development of abuse and dependency, access to potent opioids likely has a large role. This access also makes returning to practice while in recovery extremely difficult because the temptation for relapse continually surrounds a recovering anesthesia provider. There is research supporting successful reentry of anesthesia providers into the practice of anesthesia; however, research also reveals high relapse rates among anesthesia providers who return to the practice of anesthesia. This article reviews the literature regarding opioid abuse and dependency among nurse anesthetists and anesthesiologists and offers implications for future research. [ABSTRACT FROM AUTHOR]

Finding ways to retain nurse anesthetists in the profession to meet the increasing demands of the healthcare system is of paramount importance. The present study investigates the relationship between work climate and job satisfaction among Dutch nurse anesthetists. A questionnaire was distributed to Dutch nurse anesthetists to assess their perceptions of their work climates, and their levels of job satisfaction. Multiple regression analyses were performed to obtain the predictive value of work climate for job satisfaction. All of the work climate characteristics had statistically significant correlations to job satisfaction, and explained 20% of the variance in job satisfaction. To achieve a higher level of job satisfaction among nurse anesthetists, it is necessary to improve some essential work climate characteristics, such as: (1) making the nurse anesthetist feel an important part of the organization's mission statement, (2) discussing progress at work, (3) giving recognition for delivered work, (4) encouraging development, and (5) providing sufficient opportunities to learn and to grow. [ABSTRACT FROM AUTHOR]

shekleton m.e.,preston j.c.& good l.e. (2010) Journal of Nursing Management  18, 662-668 Growing leaders in a professional membership organization Aims This study describes the background, development and delivery of an innovative approach to prepare elected state association leaders for their new leadership roles in their respective state organizations. Background State-based professional associations face unprecedented threats to scope of practice in the current volatile healthcare environment. In 2009 the American Association of Nurse Anesthetists (AANA) began offering a Leadership Development 'Boot Camp' for all nurse anesthetist state association presidents-elect designed with the intent of providing the participants with information, resources and tools they need in their new role. Methods An organizational assessment examined the philosophy of and need for leadership development across the entire organizational structure. Results Recommendations from the assessment included the need for intensive leadership development at the state level. A 3-day intensive workshop was designed and implemented. Adult learning theory was used for its development. Conclusions The success of this programme has lead to its implementation as part of leadership development of the AANA. Implications for nursing management Nurse managers and elected volunteer leaders in state-based professional associations face similar challenges requiring sound leadership ability. Principles applied to the development of the AANA programme can be applied to leadership development for new nurse managers. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the attitudes of anesthesiologists and nurse anesthetists toward collaboration with each other. Data for this descriptive, comparative study were gathered through a mailed survey to 501 nurse anesthetists and 353 anesthesiologists licensed to practice in 1 state of the United States. Attitude toward collaboration was measured using an adaptation of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. The mean total scores were compared using the t test for independent groups. Mean total scores were higher for the nurse anesthetist group (n = 238) compared with the anesthesiologist group (n = 66). Analysis demonstrated that this difference was significant ( t = 14.6, P < .05). Additional analyses failed to show a significant difference based on sexual gender. The results of this study provide some evidence that the divergent perspectives regarding collaboration previously demonstrated between physicians and nurses may also exist in the specialty field of anesthesia. This study provided no support for the supposition that gender contributes to the differences in attitude toward collaboration between physicians and nurses. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To evaluate compliance of anesthesiologists and nurse anesthetists with personal hygiene and anesthetic equipment disinfection procedures in Taiwan. Design: Survey instrument. Setting: Anesthesiologists and nurse anesthetists working in medical and non-medical centers in Taiwan. Participants: 81 anesthesiologists and 181 nurse anesthetists working in medical and non-medical centers. Measurements and Main Results: Questionnaires were sent to 500 anesthesiologists and nurse anesthetists in Taiwan. Two hundred sixty-two (52%) completed questionnaires (127 from medical centers and 135 from non-medical centers). Completed questionnaires were divided into two groups: those from medical centers (Group A) and those from non-medical centers (Group B). There was no significant difference in personal hygienic practices (wearing gloves and washing hands) between Groups A and B. There were significant differences between anesthesiologists and nurse anesthetists in wearing gloves (65.3% vs. 82%; P = 0.001) and hand washing (52.6% vs. 70.4%; P = 0.003). Medical center anesthesiologists and nurse anesthetists performed better than their non-medical-center counterparts when using disinfection procedures and disinfectants for laryngoscope blades and the cleaning of fiberscopes. Conclusions: Teaching programs should include anesthesia infection control in the curriculum for anesthesiologists and nurse anesthetists. [Copyright &y& Elsevier]

Employee or independent contractor designation has significant tax implications for the Certified Registered Nurse Anesthetist (CRNA). On superficial view, it appears that a CRNA who is medically directed would be under a number of controls that would force the CRNA to be in an employee status. However, an analysis, it seems that for tax purposes a CRNA can be medically directed while also being an independent contractor. But when looking closer at all of the controversy in the legal system and the protections available to an employee that are not available to an independent contractor, a CRNA may find the employee status a better option. [ABSTRACT FROM AUTHOR]

Recent and mounting evidence indicates burnout among healthcare providers in the United States has been steadily rising over the last decade. Review of the literature has indicated that burnout affects provider clinical performance, professionalism, quality, incidence of medical errors, and intention to stay in the profession. Burnout has been shown to impact provider quality of life. However, education focused on coping skills can reduce burnout amongst providers. This article describes a quality improvement project conducted to determine the effect of a burnout awareness and coping skills program to decrease burnout among nurse anesthetists at a level one trauma center. The educational program provided information that helped staff to identify signs and symptoms of burnout and offered strategies to reduce burnout. We describe the project methods, and results, which suggested a significant decrease in participants' levels of the emotional exhaustion component of burnout following participation in the program. We offer discussion about the clinical significance of our findings, note project limitations, and conclude with implications for research and practice. [ABSTRACT FROM AUTHOR]