Barriers to effective clinical preceptorship in nurse anesthesiology.

BACKGROUND: Clinical preceptorship is an effective teaching tool for Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs). Strategies for success and barriers to effective clinical preceptorship have been explored across the literature to improve learning experiences for SRNAs. PURPOSE: The purpose of this literature review was to identify barriers to effective clinical preceptorship in the field of nurse anesthesiology. METHOD: A rapid review of the literature utilizing PubMed, Embase, CINAHL, Scopus, and Cochrane Library ultimately yielded 14 relevant articles. RESULTS: Clinical preceptorship in the discipline of nurse anesthesiology has a significant impact on both student experiences and preceptor satisfaction. Barriers within the clinical preceptorship model have been identified across the literature from both the preceptor and student perspectives. CONCLUSIONS: The overarching theme is that development of clinical preceptor workshops and specific guidelines would enhance the experiences of both clinical preceptors and students and allow goals and objectives to be more easily met.

Collaborative nursing education between advanced practice registered nurses.

The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork.

A new approach to peripheral nerve block education with the Anatomage Table as a learning adjunct.

Human anatomy education serves as a gateway for entering the intricacies of health science. Human cadavers have been the gold standard for learning regional and gross anatomy. However, increasing barriers in acquisition, maintenance, and longevity have pushed anatomy education toward technology-based alternatives such as the Anatomage Table (AT), an interactive, life-sized virtual dissection table with many anatomy education-centric features. The AT has found purchase in various contexts, such as clinical settings, research, outreach, and education. Studies into the efficacy of the AT in teaching settings have been generally positive but limited in its application, particularly in clinical procedure education. In this study, we conducted an informal workshop for second-year Certified Registered Nurse Anesthetist (CRNA) students to aid in being able to identify the important neuraxial landmarks for performing peripheral nerve blocks (PNBs), an anesthetic technique often used before other procedures. In our workshop, we paired the AT with identification of the same neuraxial landmarks on volunteer models with an ultrasound probe to provide students with relevant tactile experience for the procedure. From our pre-/post-surveys of the participants (n = 29), we found that our workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for and in performing PNBs. Our results support the use of the AT in clinical education as a supplement, particularly where other anatomic teaching tools, such as cadaver models, may be too difficult to implement.NEW & NOTEWORTHY We implemented the Anatomage Table (AT) and portable ultrasound to teach neuraxial landmarks for performing peripheral nerve blocks (PNB), an anesthetic technique for Certified Registered Nurse Anesthetist (CRNA) students. The workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for performing PNBs. Our results support the use of the AT in clinical education as a supplement.

Opportunities and Obstacles: The Impact of COVID-19 on Student Registered Nurse Anesthetists.

In March of 2020, the World Health Organization declared COVID-19 a pandemic. The pandemic had unprecedented impacts on nurse anesthesia education delivery. The aim of this mixed methods study was to describe and quantify the personal and educational impacts of the COVID-19 pandemic on student registered nurse anesthetists (SRNAs). Three themes emerged from the qualitative arm of the study: 1) COVID-19 caused feelings of isolation, anxiety, and stress; 2) COVID-19 was a financial silver lining; and 3) COVID-19 changed nurse anesthesia education delivery and learning for SRNAs. The quantitative arm of the study revealed that SRNAs experienced anxiety, social isolation, and a sense of being overwhelmed. Almost half of the participants received federal stimulus money. Most participants reported an increase in distance education delivery and virtual simulation. This study summarizes the impact of the COVID-19 pandemic on SRNAs and how nurse anesthesia education was altered.

The Development and Validation of an Objective Assessment Tool for Performing Ultrasound-Guided Transversus Abdominis Plane Blocks.

The transversus abdominis plane (TAP) block is a regional anesthesia technique used as part of a multimodal pain management plan in patients undergoing abdominal surgery. There are numerous approaches and techniques described in the literature, resulting in a lack of consistency in block performance. This potentially reduces efficacy while increasing risk to the patient. Competency assessment tools have been shown to lower patient risk and improve outcomes by improving provider skill. Checklists are used as formative and summative assessment tools throughout healthcare education, however, there is no validated tool for ultrasound-guided TAP blocks. The purpose of this evidence-based project was to develop a checklist using a modified Delphi method. The primary outcome measure was validation of the assessment tool, established by an expert panel consensus and guided by Messick's validity framework. A 43-item checklist was validated by six certified registered nurse anesthesiologists throughout the United States with expertise in regional anesthesia. Three rounds of feedback were required to exceed the threshold of consensus (0.8), establishing a method of evaluation that may allow future research in educational settings through improved skill assessment among providers performing TAP blocks.

Anesthesia for Patients With the Centrifugal-Flow Left Ventricular Assist Devices: A Content Validity Assessment.

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 impact knowledge retention and patient outcomes, making them excellent clinical resources.

Characterization of the supervision of clinical reasoning by nurse anesthetists with student nurse anesthetists: a qualitative study / Caractérisation de la supervision du raisonnement clinique par les infirmiers anesthésistes auprès des étudiants infirmiers anesthésistes : une étude qualitative.

Introduction: Errors in reasoning are the main causes of poor decision-making in clinical practice. To remedy this, many studies highlight the importance of supervising clinical reasoning during medical internships. Although decision-making is an ongoing process at all key moments of the perioperative period, there are no studies on the supervision of clinical reasoning during student nurse anesthetist internships. The objective of this study was to identify the characteristics of the supervision of clinical reasoning by anesthesia professionals with student nurse anesthetists. Methodology: A multicenter qualitative study was carried out using observations and individual interviews with five nurse anesthetists and five students. Results: Three themes are identified : the characteristics of the learner's and supervisor's posture ; the teaching methods used ; and the specificities of clinical reasoning. Analysis: The nurse anesthetists question clinical reasoning only when they detect difficulties in the student. However, no traceability is carried out. Students spontaneously verbalize their clinical reasoning when unexpected events occur. Discussion: The results will be used as a basis for a new tool for tracing learning during internships.

Introduction: Les erreurs de raisonnement sont les principales causes de mauvaise prise de décision en clinique. Pour y remédier, de nombreuses études montrent l'importance de la supervision du raisonnement clinique pendant les stages en médecine. Bien que la prise de décision soit permanente lors de tous les moments clés de la période péri-opératoire, il n'existe aucune étude sur la supervision du raisonnement clinique durant les stages des étudiants infirmiers anesthésistes. L'objectif de cette étude est d'identifier les caractéristiques de la supervision du raisonnement clinique par les professionnels d'anesthésie auprès des étudiants infirmiers anesthésistes. Méthodologie: Une étude qualitative multicentrique a été réalisée à l'aide d'observations et d'entretiens individuels auprès de cinq infirmiers anesthésistes et cinq étudiants. Résultats: Les trois thèmes identifiés sont les caractéristiques de la posture de l'apprenant et du superviseur, les méthodes pédagogiques utilisées et les spécificités du raisonnement clinique. Analyse: Les infirmiers anesthésistes questionnent le raisonnement clinique uniquement quand ils détectent des difficultés chez l'étudiant ; cependant, aucune traçabilité n'est réalisée. Les étudiants verbalisent spontanément leur raisonnement clinique lors d'événements imprévus. Discussion: Les résultats serviront de base à un nouvel outil de traçabilité des apprentissages en stage.

Underrepresented nurses' perceptions of a mentorship program supporting their applications for advanced practice nursing programs: A descriptive cross-sectional survey study.

BACKGROUND: The diversity in the workforce of Certified Registered Nurse Anesthetists does not reflect the changing demographics. PURPOSE: This study aimed to evaluate a national mentorship program supporting underrepresented nurses' applications for nurse anesthesia education programs. METHODS: Convenience sampling was employed to recruit the participants for this descriptive cross-sectional survey. The survey had 23 questions, including 21 multiple-choice questions and two open-ended questions. FINDINGS: A total of 1,133 participants participated in the survey study. The average score of overall respondents' satisfaction level on the program was 4.87, with almost all participants (1,116, 98.6%) feeling satisfied or very satisfied with the program. The respondents provided 565 comments on the program (i.e., nine domains and 49 themes) and 842 learning reflection notes (i.e., eight domains and 53 themes). DISCUSSION: This national initiative is a promising intervention to help underrepresented nurses get ready for nurse anesthesia education program applications.

Advanced Airway Management Skill Decay: A Review of the Literature.

Anesthesia providers must be experts in advanced airway management techniques such as laryngeal mask airway and endotracheal tube insertion. However, practicing anesthesia providers may work in clinical settings where advanced airway management techniques are rarely required. Infrequent advanced airway skill performance in these clinical settings can lead to skill decay, which is the gradual loss of acquired skills through infrequent practice or extended periods of skill nonuse. This literature review synthesizes available evidence regarding advanced airway management skill decay. Themes emerging from the literature review include skill decay association with decreased endotracheal intubation success rates, a timeframe within which advanced airway management skill decay may begin to occur, and recommendations for preventing decay of advanced airway management skills. With infrequent use of advanced airway skills in clinical settings, routine practice is crucial for skill maintenance. Clinical simulation could play a role in mitigating skill decay among practicing anesthesia providers at risk for decay in advanced airway management skills resulting from skill nonpractice.

Chest Radiograph Interpretation: Online Teaching Resources for Non-Radiologists.

Chest radiographs provide vital information to clinicians. Medical professionals need to be proficient in interpreting chest radiographs to care for patients. This review examines online methods for teaching chest radiograph interpretation to non-radiologists. An online database search of PubMed and the Cochrane Databases of Systematic Reviews revealed 25 potential evidence sources. After using the similar articles tool on PubMed, eight evidence sources met the inclusion criteria. Three sources supported the use of online learning to increase students' confidence regarding chest radiograph interpretation. The evidence suggests that through self-directed online learning, students can learn skills to diagnose disease processes as well as to confirm the placement of invasive lines and tubes. Using online learning for teaching radiograph interpretation to non-radiologists is an evolving practice. A flexible schedule is needed when implementing the electronic learning process for busy students. Monitoring module completion and postlearning assessment of knowledge is important. Further research is warranted on electronic teaching of chest radiograph interpretation in nurse anesthesia programs. A list of potential online resources for teaching chest radiograph interpretation is presented.

Supporting CRNA Clinical Practice: A Review of New and Updated Professional Practice Documents.

The American Association of Nurse Anesthesiology (AANA) Practice Committee, in collaboration with AANA Professional Practice staff, advisory panels, and subject matter experts, annually applies a standardized evidence-based process to review, evaluate, and revise clinical resource documents found in the Professional Practice Manual for the CRNA (Certified Registered Nurse Anesthetist) and on the AANA website. This article highlights several revised and newly developed documents, which include topics such as diversity, equity, and inclusion, anesthesia and analgesia for obstetric patients, and safe injection guidelines.

The effect of scenario-based training versus video training on nurse anesthesia students' basic life support knowledge and skill of cardiopulmonary resuscitation: a quasi-experimental comparative study.

BACKGROUND: Performing CPR (Cardiopulmonary Resuscitation) is an extremely intricate skill whose success depends largely on the level of knowledge and skill of Anesthesiology students. Therefore, this research was conducted to compare the effect of the scenario-based training method as opposed to video training method on nurse anesthesia students' BLS (Basic Life Support) knowledge and skills. METHODS: This randomized quasi-experimental study involved 45 nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran in 2022-2023. The practical room of the university formed the research environment. The participants were randomly divided into three groups of scenario-based training, video training, and control. Data were collected by a knowledge questionnaire and a BLS skill assessment checklist before and after the intervention. RESULTS: There was a significant difference between the students' scores of BLS knowledge and skill before and after the educational intervention in both SG (scenario group) (p < 0.001) and VG (video group) (p = 0.008) (p < 0.001). However, no significant difference was observed in this regard in the CG (control group) (p = 0.37) (p = 0.16). Also, the mean scores of BLS knowledge and skills in the SG were higher than those in the VG (p < 0.001). CONCLUSION: Given the beneficial impact of scenario-based education on fostering active participation, critical thinking, utilization of intellectual abilities, and learner creativity, it appears that this approach holds an advantage over video training, particularly when it comes to teaching crucial subjects like Basic Life Support.

Assessing the Nurse Anesthesiologists' Self-Perceived Preparedness to the Care for Individuals With Intellectual and Development Disability: A Cross Sectional Survey.

Approximately 6.5 million people in the U.S. are affected by an intellectual or developmental disability (IDD). However, their healthcare needs often remain unmet due to the inadequate education and training of healthcare professionals. Given that various procedures may require anesthesia in as many as 40% of individuals with IDD, Certified Registered Nurse Anesthetist Programs need to incorporate IDD training into their curriculum. A cross-sectional survey using a 12-item questionnaire was conducted to assess IDD training. Statistical analyses included the chi-square test and participant demographics were reported as frequencies or percentages. Numerical data were presented as means and standard deviations. A total of 277 respondents completed the survey and most reported (55%) a lack of IDD training at nurse anesthesia programs and 90% recognized the need for additional training. Only 24% felt competent in providing care for patients with IDD, while 52% reported feeling somewhat or very competent. A significant correlation was found between the number of clinical anesthesia experiences and self-rated competence (P < 0.001). Incorporating IDD training into the nurse anesthesia curriculum is critical to preparing competent graduates capable of serving this diverse population. Nurse anesthesia programs should evaluate their curriculum to effectively address this healthcare inequality.

Personality characteristics of Dutch nurse anesthetists and surgical nurses when compared to the normative Dutch population, a quantitative survey study.

BACKGROUND: Working in the perioperative context is complex and challenging. The continual evaluation in this environment underscores the need for adaptability to technological advancements, and requires substantial allocation of resources for training and education. This study aimed to explore personality characteristics of nurse anesthetists and surgical nurses that are instrumental for sustainable employability in technologically advanced environment. METHODS: Exploratory, cross-sectional survey study including nurse anesthetists and surgical nurses, both certified and in training, and a sample of the normative Dutch population. Personality characteristics were identified with the Big Five Inventory, which consisted of 60 items answered on a five-point Likert scale (strongly disagree to strongly agree). RESULTS: Specific personality traits were found for nurse anesthetists and surgical nurses when compared to the normative Dutch population. Traits of both nurse anesthetists and surgical nurses differed significantly on all domains of the Big Five Inventory, with the largest differences found within the dimension negative emotionally. CONCLUSIONS: This study highlights the role of specific personality traits in maintaining employability within the rapidly evolving and technologically advanced landscape of healthcare. It emphasizes the relationship between individual traits and professional excellence, being crucial educational strategies for overall improvement in healthcare.

Using a Cognitive Aid to Improve Confidence in Counseling Regarding Current Anesthesia-Related Breastfeeding Recommendations.

PURPOSE: Although most anesthetic drugs are classified as compatible with breastfeeding, literature shows that anesthesia providers routinely advise patients to discard milk when receiving all types of anesthesia. The purpose of this project was to determine if a multimodal educational module and cognitive aid improved student registered nurse anesthetists' knowledge and confidence to counsel lactating patients on current anesthesia-related recommendations. DESIGN: This project used a pre-experimental one-group, pretest and post-test design. METHODS: Preintervention and postintervention surveys measured knowledge and confidence to counsel lactating patients scheduled to receive anesthesia. FINDINGS: Significant improvement in knowledge and confidence after the intervention were noted. CONCLUSIONS: A multimodal educational session and cognitive aid improved student registered nurse anesthetists' knowledge about current anesthesia-related breastfeeding recommendations and their confidence in counseling these patients. Wider use of this educational module with the cognitive aid has the potential to positively impact breastfeeding patients and their children.

Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences.

BACKGROUND: Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice. AIM: This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses. STUDY DESIGN: This study adopted a mixed-methods approach. METHODS: Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics. RESULTS: Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training). CONCLUSION: IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care. RELEVANCE FOR CLINICAL PRACTICE: The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT.

Preliminary Investigation: Pilot Study of Program Directors' Perceptions of Wellness and Suicide Prevention for Student Registered Nurse Anesthetists.

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.

Using Simulation Training to Reduce Skill Decay Among Certified Registered Nurse Anesthetists.

BACKGROUND: Skill decay refers to the loss of skills and knowledge resulting from lack of consistent use. Among certified registered nurse anesthetists (CRNAs), skill decay can lead to negative results. One method that has been shown to mitigate skill decay is low-dose, high-frequency (LDHF) simulation. There is a gap in the LDHF simulation literature regarding CRNAs to determine its effectiveness in reducing skill decay or increasing confidence levels. METHOD: This study used a quasi-experimental pretest-posttest follow-up design. The pretests and posttests were evaluated using a Wilcoxon signed rank test to determine CRNAs' proficiency and confidence in central venous catheter (CVC) insertion before and after a simulated refresher training course. RESULTS: The CRNAs showed a significant improvement in CVC insertion proficiency, from a 50% pretest average to a 94% posttest average (p < .0001), and they retained proficiency 6 months later (91%, p = .0109). There was no significant change in CRNAs' confidence level following the training (p = .4486). CONCLUSION: A program of LDHF simulation training is an important activity in meeting the continuing education/training needs of CRNAs in improving and retaining CVC insertion proficiency. This study demonstrates the efficacy of a LDHF simulation program for CRNAs and helps to bridge the gap in the literature on the use of LDHF simulation among CRNAs. [J Contin Educ Nurs. 2024;55(4):187-194.].