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The COVID-19 pandemic has caused major disruptions to U.S. school systems since March 2020. To facilitate our understanding of how school nurses participated in school reopening and what support school nurses needed beginning the 2020-2021 school year during the COVID-19 pandemic, we conducted a national survey in late summer 2020. A sample of 747 school nurses from 43 states responded to an online survey about roles, practices, and concerns. Over one-third (36.9%) reported not being included in school reopening planning. Mitigation practices reported by respondents primarily included measuring temperatures of students before school (21.3%), mask wearing by students (79.9%), and 6 feet social distancing (76.7%). The respondents' greatest concerns were the educational impact on students with individualized education plans, parents sending children to school with COVID-19 symptoms, and the economic impact on families. Our results point to opportunities for greater school nurse involvement, improvements in practices, and measures to address school nurses' concerns.

The use of depth of anesthesia monitoring, such as a processed electroencephalogram (pEEG), can decrease the risk of awareness with recall, yet the current standards for monitoring during the administration of anesthesia do not include the use of brain monitoring for anesthetic depth. This retrospective cohort study describes the frequency of use and explores the characteristics of utilization of pEEG monitoring by anesthesia professionals during the administration of general anesthesia in the adult patient population at a large academic medical center. Descriptive associations with pEEG monitoring were confirmed in both univariate and multivariable analyses with multiple patient, anesthetic, and surgical characteristics. After taking anesthesia provider, patient, anesthetic, and surgical characteristics into consideration, 38.0% of the variability in pEEG use was accounted for. Although these data suggest recommended guidelines are being followed, further analyses should examine explicit relationships and differences in pEEG use. [ABSTRACT FROM AUTHOR]

The National Academy of Medicine recognizes medical errors as a leading cause of death in the United States. Hospitals nationwide have acted to improve patient safety, quality of care, and system processes; however, no standards mandate assessment of the emotional impact of perioperative catastrophes on healthcare professionals. A cross-sectional descriptive study using a sample of 196 Certified Registered Nurse Anesthetists (CRNAs) tested the psychometric properties of an adapted version of the Perioperative Catastrophes Survey and administered this survey along with the Ways of Coping Questionnaire to measure CRNAs' perceptions, experiences, and responses associated with perioperative catastrophes. The adapted survey demonstrated acceptable internal consistency reliability (α = .893) and construct validity (factor analysis), with 4 subscales explaining 68.1% of the variance in the measure. The CRNAs scored similarly to anesthesiologists in a prior study conducted by Gazoni and colleagues, showing that memorable perioperative catastrophes have a negative emotional, cognitive, and functional impact. On the 8 Ways of Coping Questionnaire subscales, CRNAs with less than 10 years of experience reported significantly higher Escape-Avoidance behaviors compared with more experienced CRNAs (P = .016). Future research must examine perceptions of perioperative catastrophic events and coping mechanisms to identify providers at risk of negative consequences. [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]

This pilot study investigated wellness and causes and prevention of suicide in student registered nurse anesthetists (SRNAs). A cross-sectional anonymous survey study was conducted of a sample of randomly chosen SRNAs. Data were analyzed with descriptive and inferential statistics. Responses to open-ended questions were summarized and presented. Results demonstrated elevated SRNA stress levels. There was an association between suicidal ideation in SRNAs and depression, lack of perceived agency, and elevated anxiety in the classroom. SRNAs reported mental health challenges, depression, and anxiety. Sixteen percent of SRNAs felt that classmates were at risk of suicide, and two SRNAs had lost a classmate to suicide. Twenty-nine percent of SRNAs reported suicidal thoughts prior to matriculation, and 35% reported suicidal thoughts during training. Students with suicidal ideation asked for help from friends and family, but not faculty, and some did not ask for help. Students gave existing wellness initiatives low ratings, and many felt faculty did not promote wellness. Involving student group leaders and appointing a student lead wellness point person may encourage students to ask for help. Faculty should continually prioritize, check-in on, and monitor student wellness. Wellness is a never-ending, essential, and continually evolving effort. Suicide is preventable with compassionate intervention. [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., Competing Interests: Name: Michael Neft, PhD, DNP, MHA, RN, CRNA, FNAP, FAANA, FAAN Contribution: As lead author, Dr Neft designed and carried out the review and worked with co-authors regarding the synthesis, writing, rewriting, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Kathleen Sekula, PhD, PMHCNS, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Rick Zoucha, PhD, PMHCNS-BC, CTN-A, FAAN Contribution: This author made contributions to the writing, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Mary Ellen Smith Glasgow, PhD, RN, ACNS-BC, ANEF, FAAN Contribution: This author made contributions to the conception, synthesis, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Maria Van Pelt, PhD, CRNA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, final editing, and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Ann Mitchell, PhD, RN, AHN-BC, FIAAN, FAAN Contribution: This author made contributions to the final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Diversion in the workplace can adversely impact the safety of healthcare professionals and patients. The Anesthesia Patient Safety Foundation (APSF) believes that substance use disorder, diversion in the workplace, and their potential adverse effects on patient safety need to be addressed through open discussion, education, research, policy, and possible other interventions. To make progress in this area, the APSF convened a conference entitled "Drug Diversion in the Anesthesia Profession: How Can APSF Help Everyone Be Safe?" in Phoenix, Arizona, on September 7, 2017 (Supplemental Digital Content, Document, http://links.lww.com/AA/C616). It was comoderated by the authors., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did discuss off-label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)