Search

• The nursing profession, across specialty roles, continues to lack diversity especially in underrepresented racial and ethnic marginalized populations. • Based on historical information and a need to increase diversity in the Certified Nurse Anesthetist role, the DNAMP was developed. • The Immersion Model (IMDNAP) can be applied to other areas of nursing to inspire, recruit and retain a pipeline of diverse cohorts. The changing racial and ethnic demographic population in the United States and the nursing profession, particularly in nurse anesthesia created a shift in addressing persistent barriers to grow a diverse workforce. Building diversity initiatives to remedy this dilemma requires strong relationships by essential stakeholders with resultant positive outcomes for graduate nurse anesthesia programs. The Diversity in Nurse Anesthesia Mentorship Program (DNAMP) has made substantial impact in three pipeline professional socialization mentorship initiatives with a nationwide focus and outreach. These initiatives increase a diverse nurse anesthesia workforce, improve health equity for diverse populations with ability to provide culturally informed care to patients. The purpose of this article is three-fold a) highlight a historical account of the context of disparities within the nurse anesthesia profession and faculty workforce b) discuss the need for diversity in the profession leading to the emergence of the DNAMP, and c) describe DNAMP program initiatives, and as a national recognized model. Recommendations will be discussed to address sustainability and long-term impact of expanding historically underrepresented racial and ethnic nurse anesthetists nationwide. This manuscript will explore the historical context of disparities within the nurse anesthesia workforce and discus how the DNAMP model can be used to combat it [ABSTRACT FROM AUTHOR]

Background: The organizational environment can foster or impede full deployment of advance practice registered nurses (APRNs), affecting the quality of care and patient outcomes. Given the critical role APRNs play in health care, it is important to understand organizational factors that promote or hinder APRN practice to maximize the potential of this workforce in health care systems. Purpose: The aim of this study was to synthesize evidence about APRN practice environments, identify organizational facilitators and barriers, and make recommendations for better APRN utilization. Methods: A literature search was conducted in CINAHL, PubMed, and PsychInfo, yielding 366 studies. No time or geographic limitations were applied. Study quality was appraised using the National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Studies. Results: Thirty studies conducted in the United States, Canada, and the Netherlands met inclusion criteria. The majority of the studies involved nurse practitioners. Facilitators to optimal practice environment were autonomy/ independent practice and positive physician/APRN relations. Barriers included policy restrictions on practice, poor physician relations, poor administrator relations, and others' lack of understanding of the APRN role. Barriers correlate with job dissatisfaction and increased intent to leave job. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, healthcare workers, health systems, as well as economies. While, healthcare systems are globally operating at maximum capacity, healthcare workers and especially anesthesia providers are facing extreme pressures, something that is also leading to declining availability and increasing stress. In this regard, it is extremely concerning the fact that some regions worldwide have reported up to 20% of their cases to be healthcare workers. When considering that the global case fatality rate may be as much as 5.4%, these numbers are concerning and unacceptable. As this pandemic accelerates, access to personal protective equipment for health workers is a key concern since at present, healthcare workers are every country's most valuable resource in the fight against COVID-19. Governments and heath organizations should take care of their staff and support them in any way possible. This review aims to describe the current situation anesthesia providers are facing in the setting of COVID-19 and provide solutions and evidence on important concerns, including which guidance to follow, the level of equipment that is adequate, and the level of protection they need for every patient being administered an anesthetic. [ABSTRACT FROM AUTHOR]

To investigate nurse anesthetists' experiences of strategies that alleviate adult patients' preoperative anxiety before anesthesia administration. The study has a qualitative approach wherein the data were collected through semistructured interviews. The study included interviews with six active nurse anesthetists with at least 5 years of experience who worked in a hospital in southern Sweden. Critical incident technology was used to analyze the data. Four different categories emerged: behavior of nurse anesthetist, preoperatively providing information, diverting attention to create security, and medicine as an alternative. Awareness can increase the use of different strategies by both new and experienced nurse anesthetists, as well as by nurses in preoperative units, which in turn alleviates patient anxiety about anesthesia. This may result in a better perioperative experience for the patient. [ABSTRACT FROM AUTHOR]

Preparation for surgery with the induction of general anesthesia is one of the most stressful events that a child can experience. It produces several threats to the child, including physical harm, parent separation, and fear of the unknown. Anesthesia providers utilize non-pharmacological and pharmacological interventions to decrease this preoperatively. However, little is known about the non-pharmacological interventions utilized by anesthesia providers in practice. The purpose of this study was to explore non-pharmacological interventions utilized by anesthesia providers before and during the induction of general anesthesia to reduce preoperative distress in children ages one to six years old. A qualitative descriptive approach was used in this study. Twenty anesthesia providers, fourteen registered nurse anesthetists and six anesthesiologists, participated in face to face, in-depth interviews in South Florida. Content analysis was used to identify and define the major themes that emerged from the interviews. A total of seven main themes were identified. Only the three themes directly related to parent-provider-child relationship are discussed in this paper: (I) Communication, (II) Observational Skills, and (III) Parental Presence. The anesthesia providers who participated in this study offered an opportunity to better understand the non-pharmacological interventions used to impact the management of preoperative distress among children. Study findings provide evidence about non-pharmacological anesthesia providers' clinical work not found elsewhere in the literature. Non-pharmacological interventions are effective in reducing preoperative distress in children. • Preparation for surgery with the induction of general anesthesia is a stressful event for a child • Providers can implement non-pharmacological interventions to address preoperative stress in children. • verbal and non-verbal communication techniques to be of most importance during critical times, such as a child's separation from the parents in the preoperative holding area or during induction of anesthesia [ABSTRACT FROM AUTHOR]

Robotic‐assisted surgery (RAS) presents unique teamwork challenges for perioperative team members, including anesthesia professionals. The purpose of this study was to explore anesthesiologists' and nurse anesthetists' teamwork experiences during RAS using an exploratory qualitative study design involving individual semistructured interviews. Study participants expressed that teamwork during RAS is both positive and challenging, and the start‐up phase is the most demanding phase of RAS in terms of teamwork. Anesthesia professionals believe that both technical and nontechnical skills are necessary to provide excellent patient care and maintain patient safety during RAS. Furthermore, they believe that a more concentrated focus on nontechnical skills than is traditional is an essential component of teamwork. [ABSTRACT FROM AUTHOR]

• Written examinations are the primary method of competency assessment for CRNAs. • OSCEs assess higher tiers of Miller's Pyramid of competency. • OSCEs can supplement written examinations for high-stakes assessments of learners. Certified registered nurse anesthesiologists (CRNAs) undergoing high stakes assessment must demonstrate competency. Written competency is the current method of high-stakes assessment, and this paper uses Miller's Pyramid of competency to explore use of the objective structured clinical examination (OSCE) for high-stakes assessment. The modified Delphi method was used with 10 experts to design and execute an anaphylaxis OSCE simulation scenario of 3 proficiency levels. OSCE performance assessment tools included a checklist and global rating scale (O-GRS). A system usability survey was used to assess OSCE utility. The overall system usability survey score was below our goal of 75. Assessment tool results did not demonstrate high correlation among panelists, although mean scores for each performance showed statistically significant differences in scores (p <.001). Our paper showed the process of OSCE design, execution, and utility. Although results did not allow us to strongly recommend use of OSCEs for high-stakes assessment of CRNAs, we are encouraged that our results will provide direction for future papers related to this topic. [ABSTRACT FROM AUTHOR]

• Aligning simulation experiences with the Healthcare Simulation Standards of Best Practice significantly reduced simulation-related anxiety and improved student perceptions of psychological safety. • A deliberate debriefing process utilizing an advocacy-inquiry technique that allows adequate time for learner self-reflection results in more meaningful reflection following simulation and enhances student experiences. • Faculty describe integrating simulation best practices into a nurse anesthesia simulation as feasible and beneficial. The negative impact of high levels of anxiety on learning outcomes is well established. Clinical simulation is an essential element of nurse anesthesia training that can produce anxiety and stress, ultimately impacting effective learning. Despite emerging evidence surrounding optimizing simulation experiences, gaps remain regarding methods and interventions to reduce student anxiety as it relates to simulation experiences. This quality improvement project explored the impact of aligning a nurse anesthesia simulation program with simulation standards of best practice, and the influence of this transition on student learning experiences and perceptions of anxiety. The transition was assessed using a pretest-posttest design. Prior to the transition, 39 student nurse anesthetists completed a pretest regarding prebriefing, scenario design, and debriefing up to the time of implementation. After three months of the updated simulation format, 37 participants completed a postimplementation survey. The data demonstrate statistically significant improvement in all assessed areas. This simulation best practice-based initiative improved student experiences by reducing anxiety and offers a guide to simulation programs seeking to make similar adjustments. [ABSTRACT FROM AUTHOR]

To explore the experience of preoperative communication of nurse anesthetists (NAs) in brief meetings with patients in an orthopaedic setting. Qualitative research. Three group interviews based on experiences of 18 NAs were conducted. Content data analysis was used. The brief communication was characterized by both difficulties and opportunities. Protecting the patient's integrity, informing worried patients, lack of routines, language difficulties, being present at the meeting, protecting the patient from disturbance, and encouraging the patient to participate were stated as the main challenges in the brief meeting with patients. The NAs also gave some suggestions for improvement. The Preoperative meetings need to be developed and structured to improve communication. A way to assess the results of this conversation should be developed. Other recommendations include finding a way to improve patient involvement in this dialogue and development of skills of NAs to enhance the meeting for patients. [ABSTRACT FROM AUTHOR]

Purpose: The study aim was to describe nurse anesthetists' reflections on the provision of perioperative care to patients with previous substance dependence. Design: A qualitative approach with a descriptive design. Methods: Semistructured interviews based on clinical vignettes were conducted with 10 nurse anesthetists. Findings: The perioperative care provided to patients with previous substance dependence was perceived as balancing between professionalism and preconceptions for this specific patient group. The nurse anesthetists felt that anesthetizing this group of patients constituted a challenge with regard to knowledge, experience, and time. However, the nurses also had feelings of distrust and uncertain ty because of lack of knowledge. Conclusions: The nurse anesthetists strove to uphold the principle that patients who are/have been substance dependent have the same right to adequate treatment and care as all patients. If guidelines were developed for this patient group, care could be made safer and nurses 'sense of uncertainty minimized. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to determine if nurse anesthetists (NAs) have access, knowledge, and adhere to recommended guidelines to maintain normal body temperature during the perioperative period. Design A descriptive survey design. Methods Questionnaires were sent to heads of the department (n = 56) and NAs in the operating departments in Sweden. Finding The level of access to the recommendations is high, but only one third of the operating departments have included the recommendations in their own local guidelines. The NAs' adherence was low, between 5% and 67%, and their knowledge levels were 57% to 60%. Conclusions A high level of knowledge, access, and adherence are important for the organization of operating departments to prevent barriers against implementation of new recommendations or guidelines. There are needs for education about patients' heat loss due to redistribution and clear recommendations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore how the nurse anesthetist values their professional self, compared with their peers, and also to explore whether professional self is affected by age, work experience, and/or gender. Design: An explorative and prospective cross-sectional design. Methods: During April 2011, a total of 108 registered nurse anesthetists from three different hospitals were surveyed using the Professional Self-Description Form with questions covering 21 items. Findings: A total of 87 (80%) responded: 21 men and 66 women with a mean age of 45 years (range, 28 to 64 years) and mean professional experience of 12 years (range, 1 to 41 years). Four factors were found: professionalism, trait of character, scientific knowledge, and empathy, with Cronbach alpha of 0.96 overall. Analysis showed that perceived professional self depends on age and amount of work experience, but not on gender. Conclusions: The Professional Self-Description Form exhibits satisfactory internal consistency. Work experience and age influenced the development of professional self of nurse anesthetists. [ABSTRACT FROM AUTHOR]

Certified registered nurse anesthetists (CRNAs) provide more than 40 million anesthetics each year in the United States. This article describes a study that investigates relationships among CRNA organizational structures (CRNA practice models, work setting, workload, level of education, work experience), CRNA ratings of patient safety culture, and CRNA adverse anesthesia-related event (ARE) reporting. This is a cross-sectional survey study of 336 CRNAs randomly selected from American Association of Nurse Anesthetists database. Workload was measured using NASA Task-Load Index and the Revised Individual Workload Perception Scale. Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Overall Perceptions of Safety' Scale and Hospital Survey on Patient Safety Patient Safety Grade Scale were utilized to measure safety culture. Dependent variables (ARE) included difficult intubation/extubation, inadequate ventilation/oxygenation, and pulmonary aspiration. The Revised Individual Workload Perception Scale workload was significantly associated with ARE. Years’ experience and Patient Safety Grade Scale were inversely associated with ARE. Overall Perceptions of Safety Scale was significantly and inversely associated with ARE. Practice model, education, and work setting were not associated with ARE. Based on findings, CRNA workload, years’ experience, and patient safety culture may be important markers for ARE. Administrative interventions designed to upgrade patient safety culture and ensure manageable CRNA workload may foster quality patient care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this project was to assess the ability of anesthesiologists, nurse anesthetists, and registered nurses to correctly identify anatomic landmarks of cricoid pressure and apply the correct amount of force. Design The project included an educational intervention with one group pretest-post-test design. Methods Participants demonstrated cricoid pressure on a laryngotracheal model. After an educational intervention video, participants were asked to repeat cricoid pressure on the model. Findings Participants with a nurse anesthesia background applied more appropriate force pretest than other participants; however, post-test results, while improved, showed no significant difference among providers. Participant identification of the correct anatomy of the cricoid cartilage and application of correct force were significantly improved after education. Conclusion This study revealed that participants lacked prior knowledge of correct cricoid anatomy and pressure as well as the ability to apply correct force to the laryngotracheal model before an educational intervention. The intervention used in this study proved successful in educating health care providers. [ABSTRACT FROM AUTHOR]

Purpose: Establishing a purposive interaction with a patient who is in a vulnerable situation before coronary artery bypass graft (CABG) surgery poses a challenge for the nurse anesthetist. The aim of this study was to identify and describe the interaction between the patient and the nurse anesthetist immediately before elective CABG surgery. Design: An observational study using a grounded theory design was used. Methods: A theoretical selection of patients and nurse anesthetists was made. A total of 11 situations of patient/nurse anesthetist interaction were observed. The data were analyzed using the constant comparative method. Findings: A core category of reassurance emerged from other categories of continuity, confirmation, and control. Continuity was characterized by expedient anesthesia nursing of high quality, confirmation was related to communication in a trusting atmosphere, and control was associated with skilled nursing interventions in the thoracic operating theatre. Conclusions: Reassurance can be achieved through a well-structured anesthesia nursing performance in the thoracic operating theatre, and by focusing on the patient and continuously giving him/her information during the preoperative preparation phase. [Copyright &y& Elsevier]

The first training center for nurse anesthetists in Jiangsu Province, China was established. The aim of this study is to understand the status of and effectiveness of a training program based on International Federation of Nurse Anesthetists (IFNA) standards for nurse anesthetists in China. China recently issued a clear policy to improve the quality of anesthesia care and to ensure the safety and comfort of patients. As a result, the roles of nurse anesthetists have received more attention, highlighting the importance of the development and implementation of relevant training. IFNA standards were applied to the development of a specialized training program for nurse anesthetists, which is expected to serve as a reference for various medical institutions and to lead to increased uniformity and improvement in the quality and efficiency of care. These standards are divided into two indicators: curriculum and core competencies. Through questionnaires, course evaluations, and satisfaction surveys before and after the implementation of the training program, the effectiveness of the training program was analyzed. Theoretical assessment of the program was higher after its completion than before and the core competencies of nurse anesthetists significantly improved. Overall, the curriculum was highly satisfactory and important. Curriculum design was based on IFNA standards. Nurse anesthetists who are trained in a systematic way can work better with other professionals in providing anesthesia care. The objectives are to improve anesthesia care, reduce errors, improve physician satisfaction, and allow nurse anesthetists to realize their value. Overall, quality of anesthesia care improved after implementation of IFNA-standard training. [ABSTRACT FROM AUTHOR]