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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]

Abstract Background Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training. Method The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed. Results Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved. Conclusion In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.

Background: Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training. Method: The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed. Results: Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved. Conclusion: In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills. [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]

Background: Nurse anesthetists as medical personnel have an important role in the continuity of work in the operating room. Although they have considerable responsibility and role, no research has focused on the job satisfaction of nurse anesthetists. In addition, no literature review has shown low job satisfaction among nurse anesthetists. Objectives: This research aimed to determine the relationship between the work environment and job satisfaction of nurse anesthetists in hospitals. Methods: This research used a quantitative method with a cross-sectional design through an online survey. The population of this research covered all nurse anesthetists working in hospitals in Central Java and Bali, of which 108 respondents were selected as the sample using a simple random sampling. The data were collected using questionnaires and analyzed using inferential statistics, namely chi-square, to determine the relationship between the work environment and job satisfaction of nurse anesthetists. Results: This research showed that a total of 60 respondents (55.6%) had a high category of job satisfaction. In addition, the work environment factor (p=

Bakgrunn: Anestesisykepleiefagets historiske utvikling har vært påvirket av generelle samfunnsmessige endringer og de krav og forpliktelser faggruppen har blitt satt til å ivareta. Hensikt: I denne studien ønsker vi å beskrive utviklingen av anestesisykepleiernes rolle og funksjon gjennom fortellingene til erfarne anestesisykepleiere som har hatt og fortsatt har sentrale roller innen klinisk arbeid, utdanning og organisasjonsarbeid. Metode: Studien fulgte en kvalitativ forskningsmetode med beskrivende design. Det ble utført semistrukturerte dybdeintervjuer med tre nøkkelinformanter ved hjelp av en intervjuguide. Lydbånd ble transkribert ad verbatim. Meningsbærende enheter i teksten ble identifisert på bakgrunn av studiens forskningsspørsmål. Disse ble videre kondensert og omskrevet slik at det sentrale innholdet kom frem som beskrivende kategorier og tema. Resultat: Dataanalysen førte frem til fem temaer som svarer ut ulike aspekter ved studiens forskningsspørsmål: En «salig» blanding av medisin og sykepleie; Det handler om å kunne observere; Anestesisykepleiere er privilegerte; Fra spesialelev til masterstudent; Utfyllende profesjoner. Konklusjon: Vår studie viser hvordan anestesisykepleie har utviklet seg til å bli et spesialisert fagområde innenfor sykepleie med stor grad av autonomi, solid teoretisk forankring og spesielt god rekruttering. Utdanningen har hatt spesiell oppmerksomhet på å utvikle faget til å fremstå som en egen profesjon, og et fag som hele tiden har tatt høyde for den sykepleiefaglige, medisinskfaglige og teknologiske utvikling. ENGLISH ABSTRACT The development of nurse anesthetists role and function described by experienced nurse anesthetists Background: The historical development of the anesthetic nursing profession has been influenced by general societal changes and the demands and obligations the professional group has been set to take care of. Purpose: In this study we want to describe the development of the role and function of nurse anesthetists through the stories of experienced nurse anesthetists who have had and still have central roles in clinical work, education, and organizational work. Method: The study followed a qualitative research method with a descriptive design. Semistructured in-depth interviews were conducted with three key informants using an interview guide. Audiotapes were transcribed ad verbatim. Meaningful units in the text were identified based on the study’s research questions. These were further condensed and rewritten so that the central content emerged as descriptive categories and themes. Result: The data analysis led to five themes answering various aspects of the study’s research questions: A «blissful» mix of medicine and nursing; It is about observation; Nurse anesthetists are privileged; From special student to master’s student; Complementary professions. Conclusion: Our study shows how anesthetic nursing has developed into a specialized field within nursing with a large degree of autonomy, a solid theoretical foundation, and good recruitment. The education has paid special attention to developing the subject to appear as a profession, and a subject that has constantly considered nursing, medical and technological developments.

BackgroundAll anesthesia providers, including nurse anesthetists and anesthesiologists work in a stressful environment with diverse tasks. The profession is characterized by high workload, both dependent and independent job descriptions, and unpredictable conditions. This study was designed and conducted to explain the factors affecting the workplace health of Iranian anesthesia teams.MethodsTwenty anesthesia team members including nurse anesthetists and anesthesiologists from 7 different hospitals were enrolled in this phenomenological research. The data were collected in 2022. Semi-structured interviews were used for data collection, and the transcripts were analyzed using qualitative content analysis.FindingsThe most notable theme emerging from the data which was found to affect workplace health was consistency of anesthesia team. Other themes derived from the data included team tranquility and physical well-being.ConclusionThe participants' emphasis was more on behavioral and managerial factors affecting workplace health, and desirable interpersonal cooperation to create a suitable work environment for them was more prominent. These findings can raise the awareness of chief nurse anesthetists and planners to provide more effective teamwork, modify the job description structure, and reduce staff conflicts.

Background: Substance misuse is an occupational health problem for anesthesia providers (APs). More than 10% of nurse anesthetists misuse and divert medications. No standard exists for addressing AP drug diversion. The purpose of this quality improvement project was to evaluate the use of a knowledge and needs assessment to inform the development of a successful drug diversion prevention program for certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). Methods: A 28-item questionnaire, using the health belief model (HBM) and the risk perception attitude (RPA) framework, was developed to assess knowledge, beliefs, and practices of substance misuse and diversion. RPA groups were determined by level of belief in self-risk and perceived efficacy of prevention strategies. The survey was emailed to 100 CRNAs and over 100 SRNAs. Survey results were organized using the RPA framework. Findings: One hundred twelve surveys were completed. The RPA avoidant category (high-risk belief and low perceived efficacy of preventive interventions) comprised 52.5% of CRNAs; SRNAs were divided primarily among the RPA responsive category with high perceived risk and high-efficacy beliefs (38.9%) and the indifferent category of low-risk beliefs and low perceived efficacy (31.9%). Conclusions/Applications to Practice: Anesthesia providers have varying beliefs regarding drug misuse and diversion risks and perceptions of their ability to be successful with preventive strategies. Failure to address nurse anesthesia needs-based diversion prevention may result in missed opportunities to educate this group. Implementation of RPA-tailored interventions by health care organizations may produce effective, long-term outcomes for drug diversion within the profession. [ABSTRACT FROM AUTHOR]

In 2012, representatives of the 44 International Federation of Nurse Anesthetists (IFNA) member countries were surveyed about their scope of practice. Ten years later, the researchers repeated the study to evaluate the professional development of nonphysician anesthesia providers. The survey was prepared by the IFNA Practice Committee and explored demographics, training, anesthesia team members, and daily activities of the nonphysician anesthesia providers (NPAPs). The online survey was sent to all IFNA Country National Representatives. In 2022, 22 out of 44 countries had more than one type of NPAP including five countries that had anesthesia technicians. NPAPs work in operating theatres (94.4%), postanesthesia care units (81.9%), intensive care units (46%), acute (51%), chronic pain (28%), air ambulance (28%), resuscitation (69%), or trauma team (42%), preoperative screening (57%). Formal recognition of the profession and the requirement of licensure to practice has increased. Education levels have increased substantially, which resulted in more indirect supervision. Direct supervision by physicians is related to education levels and limited scope of practice. The NPAP workforce is growing toward IFNA standards, but it has become a more diversely educated workforce. NPAPs who are educated at a bachelor or higher level and require officially recognized licensure to practice, have an extensive scope of practice., Competing Interests: Name: Vera Meeusen, PhD, MBA, FACPAN, RN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: James R. Walker, DNP, CRNA, FNAP, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Jakob Ibsen Vedtofte, MeD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. At the time of this research project, the authors were members of the IFNA Practice Committee., (Copyright © 2024 by the American Association of Nurse Anesthesiology.)

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]

Abstract 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.

Purpose: To investigate the self-perceived functional health literacy (FHL) of patients who underwent advanced endoscopic treatment, explore whether FHL could explain aspects of patients' perioperative experiences, and determine whether patients read the provided patient information., Design: A prospective cross-sectional explorative study., Methods: One hundred patients who underwent endoscopic bile duct intervention were enrolled and asked to answer the Swedish version of the FHL Scale and their perioperative experiences of the intervention. Along with procedural data, all data were analyzed for group comparisons; high or low FHL., Findings: The study included a total of 100 patients, with half of them rating their FHL as problematic or inadequate (low FHL). Among those who perceived their FHL as inadequate, a majority had not read the provided information before the procedure. Patients with problematic or inadequate FHL experienced perioperative anxiety and pain more frequently than those with sufficient FHL (high FHL)., Conclusions: This study supports previous research on the association between low FHL and patients' well-being. To better meet patients' information needs, it is crucial for nurse anesthetists and other health care providers to have knowledge about FHL. Additionally, the study highlights the importance of using alternative and more effective means of delivering information to patients., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

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]

• 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]

Olive Berger was a true nurse anesthesia pioneer for our profession. She dedicated her life to the advancement of nurse anesthesia through her leadership, advocacy, scholarly writing, clinical achievements and innovation. She blazed the trail by forming and establishing education requirements for nurse anesthesia programs, established a state nurse anesthesia organization, and led the American Association of Nurse Anesthetists as its 14th president in 1958. She was the Chief Certified Registered Nurse Anesthetist and Program Director at the Johns Hopkins Hospital and is best known for her collaboration with surgeons Dr. Alfred Blalock and Dr. Helen Taussig, providing anesthesia care during the groundbreaking repair of tetralogy of Fallot on infants., Competing Interests: Name: Andrew Benson, DNP, MSN, CRNA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. He is the corresponding author of the article. Disclosures: None. Name: Catherine Horvath, DNP, CRNA, CHSE, CNE, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Marjorie Everson, PhD, CRNA, FNAP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Bruce Schoneboom, PhD, MS, MHS, CRNA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

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]

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]

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]

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]

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the cognitive aid). Statistically significant improvement in the transmission of 3 of the 5 measured elements occurred when the cognitive aid was used. These areas included: intake and output (95.6% vs. 70.7%, p = 0.018); antibiotic administration (95.6% vs. 73.8%, p= 0.033); and intravenous access (100% vs. 76.9%, p = 0.009). An additional area that reached statistical significance (78.2% vs. 41.5%, p = 0.003) was the transmission of all 5 elements when the handoff cognitive aid was utilized in the handoff. In a postimplementation survey, nurse anesthetists utilizing the cognitive aid overwhelmingly agreed that the handoff cognitive aid was easy to use, contained appropriate content, and minimized risks to patient safety. Incorporation of a cognitive aid to standardize intraoperative handoffs was well received and improved communication of pertinent patient information during handoffs between nurse anesthetists. [ABSTRACT FROM AUTHOR]