Giving Your Preceptors What They Need: Developing an Innovative Clinical Preceptor Education Program.

ABSTRACT: Advanced practice registered nursing (APRN) educational programs require students to complete many hours of clinical education to prepare them for their role. This article outlines the process of developing a novel nurse anesthesia preceptor training program that could be implemented by any graduate APRN program. Preceptors' requests for specific information about how to best educate students served as a catalyst to develop a customized preceptor training program tailored to the needs of the program, the preceptors, and students to optimize clinical education and improve quality of care.

Bridging an Education Gap: Ultrasound-guided Peripheral IVs.

PURPOSE: To provide ultrasound (US) education to anesthesia providers to increase usage for peripheral intravascular (IV) cannulation on difficult IV access patients. DESIGN: This project reflects a qualitative descriptive quality improvement project with outcomes measured. Data in this project include the overall knowledge and competency scores from the provider's US survey before and after education and training were provided. METHODS: A presentation was developed and provided to 38 certified registered nurse anesthetists (CRNA) via the hospital's online platform. Next, in-person simulations were conducted to facilitate the skills of US utilization. Each CRNA participating in simulations successfully performed the skill. The impact and success of the education bundle were collected via the disbursement of a Likert-scale survey via an automated data collection software. FINDINGS: Seventeen of the 38 (45%) participants responded to the survey. Of these respondents, 88% of providers indicated that their US skills and confidence had increased following the intervention, and 100% of participants stated that the intervention was helpful in learning US-guided peripheral IV insertion. CONCLUSIONS: Education and hands-on skills sessions increased provider confidence in US use. While this project focused on educational training of CRNAs, this is applicable to all health care providers who are responsible for IV cannulation. The project team members will disseminate these findings and plan to improve perioperative nurses' confidence in US-guided peripheral IV insertions; thus, improving efficiency in the operative setting.

Doctor of Nursing Practice Team Project Synthesis Form.

ABSTRACT: The importance of teamwork in health care, the need for doctorally prepared advanced practice nurses, and the nationwide faculty shortage provided the impetus for an educational tool to synthesize the doctor of nursing practice (DNP) project. Clearly outlining the stages of the DNP project in a concise manner, the DNP project synthesis form aids learners and faculty in organization and documentation of planning, implementation, and evaluation of the project and serves as a one-stop resource when students are completing semesters. This article delineates why one school of nursing developed a project synthesis form for use across all DNP programs.

Introduction of evolving roles of Japanese perianesthesia nurses.

The aim of this special article is to introduce Perianesthesia Nurses (PANs) who play an essential role in assisting anesthesiologists to ensure the safety of patients undergoing anesthesia and to improve the quality of anesthetic care. In Japan, there is no national license for nurse anesthesia providers. Therefore, most of the tasks related to anesthesia are performed by the anesthesiologists. Due to the size and complexity of the aging population, higher quality perioperative care is needed. In search of a solution, PANs were introduced to improve anesthetic care in Japan, enabling anesthesiologists to delegate some of their tasks to PANs who work within the scope of registered nurse's policies. They are a new type of anesthesia care provider in Japan, and different from Certified Registered Nurse Anesthetists in the United States. Currently, six schools provide 2-year master's degree perianesthesia nursing programs, and graduates are now providing anesthetic care both inside and outside of the operating room under the direct supervision of anesthesiologists. PANs not only assist anesthesiologists and help to reduce anesthesiologists' workload, but also contribute to the expansion of anesthesia services. They ensure patient safety and improve the quality of patient care before, during, and after the patient undergoing anesthesia.

A Practical Approach to Acute Postoperative Pain Management in Chronic Pain Patients.

In the United States, more than 100 million people suffer from chronic pain. Among patients presenting for surgery, about one in four have chronic pain. Acute perioperative pain management in this population is challenging because many patients with chronic pain require long-term opioids for the management of this pain, which may result in tolerance, physical dependence, addiction, and opioid-induced hyperalgesia. These challenges are compounded by the ongoing opioid epidemic that has resulted in calls for a reduction in opioid use, with a concurrent increase in the number of patients with chronic opioid exposure presenting for surgery. This article aims to summarize practical considerations for acute postoperative pain management in patients with chronic pain conditions. A patient-centered acute pain management plan, including nonopioid analgesics, regional anesthesia, and careful selection of opioid medications, can lead to adequate analgesia and satisfaction with care. Also, a meticulous rotation from one opioid to another may decrease opioid requirement, increase analgesic effectiveness, and improve satisfaction with care.

A Review of Measuring the Cognitive Workload of Electronic Health Records.

The To Err Is Human report stated that 98 000 patients die yearly because of medical errors, and that medication errors kill more people than workplace injuries. The inadequate design and utilization of the electronic health record have been identified as major contributing factors to medical errors. Increased cognitive workload of clinicians has consistently been linked to the occurrence of medical errors. The purpose of this article was to synthesize the current state of the science on measuring clinicians' cognitive workload associated with using electronic health records in order to inform evidence-based guidelines. The major considerations identified in the literature involve the use of psychometric instruments, using efficiency as a proxy for cognitive workload, and eye tracking. The National Aeronautics and Space Administration Task Load Index was the most used psychometric instrument, but reliability measures were not reported. It is important to evaluate reliability of psychometric instruments because the consistency of the instrument can change when administered to different populations. Efficiency is an observable measure defined by the total time to complete a task and the total number of physical interactions with the user interface. Efficiency can allow the use of statistical modeling, but it does not directly evaluate the mental activity associated with using an electronic health record interface. Eye tracking has been used extensively in the literature to measure cognitive workload via changes in pupil size related to mental activity, but it is not often used to measure the cognitive workload associated with using the electronic health record. Eye tracking is very useful for continuous monitoring of cognitive workload.

Certified Registered Nurse Anesthetist Perceptions of Factors Impacting Patient Safety.

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.

Concept analysis of longitudinal assessment for professional continued certification.

BACKGROUND: This concept analysis presents a scholarly epistemological approach to defining the attributes, empirical referents, antecedents, and consequences of a knowledge maintenance approach-known as longitudinal assessment-to professional certification. AIM: The analysis reports on the efforts of the National Board of Certification and Recertification for Nurse Anesthetists to explore this educational method as an approach to meet requirements for continued professional certification. METHOD: Using the classical approach to concept analysis, the authors explore the structure and function of longitudinal assessment and define the characteristics of the concept in a way that is meaningful to the continued certification of nursing and medical professionals. CONCLUSION: This analysis establishes a link between the goal and outcome of the continued certification process, including continuing education in nursing and medical practice, and the desirable characteristics of longitudinal assessment, which include proven principles of educational psychology. Through exploring model and borderline cases, the authors seek to demonstrate that longitudinal assessment is the best approach to foster lifelong learning of continuously evolving scientific, theoretical, and clinical knowledge in support of safe care for patients.

The Psychometric Analysis of the Certified Registered Nurse Anesthetist Workload Perception Scale (CWPS): Final Phase.

BACKGROUND AND PURPOSE: In two previous studies, the Certified Registered Nurse Anesthetist (CRNA) Workload Perception Scale (CWPS) was developed. The purpose of this paper is to report the final psychometric validation of the CWPS. METHODS: An 11-item CWPS was tested in a population of CRNAs. Classical psychometrics were performed on the 11-item instrument piloted in a sample of 393 CRNAs. RESULTS: Parametric and nonparametric analysis indicated 7 of 11 items were a good fit to measure perception of workload. CONCLUSIONS: A revised 7-item final CWPS was developed.

Mentoring Team Projects for the Doctor of Nursing Practice: Considerations for Nurse Anesthesia Faculty.

The American Association of Colleges of Nursing and the Council on Accreditation of Nurse Anesthesia Educational Programs have specified that Doctor of Nursing Practice (DNP) and Doctor of Nursing Anesthesia Practice students complete a doctorate project as part of the education toward becoming Certified Registered Nurse Anesthetists. As nurse anesthesia programs (NAPs) transition to DNP entry into practice, management of DNP projects has been identified as a major challenge facing nursing faculty. Also, adequate mentorship has been identified as a crucial part of doctorate education. Despite the absence of literature on team mentorship in nursing, many NAPs are opting for DNP team projects and group mentoring. In team DNP projects, the mentors foster professionalism, establish the ground rules for communication, resolve conflict, and provide expert knowledge. Effective implementation of projects can enhance relational learning and teamwork, which are essential for a successful career in healthcare. Additionally, mentoring teams can simultaneously improve the professional growth of junior faculty, reduce the faculty workload, and improve the quality of DNP projects. This article brings attention to best practices for mentoring DNP team projects and also provides an exemplar of successful implementation of DNP team projects in a NAP.

Longitudinal assessment: A strategy to improve continuing professional certification.

Healthcare certification organizations carefully balance a commitment to bring value to their membership through programs that support lifelong learning and professional growth, while protecting the public by ensuring competent certified practitioners. These certifying bodies are challenged with remaining current with their maintenance of certification programs while keeping pace with the growing breadth of knowledge, industry standards and guidelines, innovative advances, and rapid technological gains in testing and assessment. Within the context of process innovation, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) evaluated the current landscape of Longitudinal Assessment (LA) as a potential strategy for the assessment of core knowledge as part of their Continued Professional Certification Program for Certified Registered Nurse Anesthetists. This manuscript details the evaluation of LA using a Logic Model as the tool to scaffold inquiry, a review of LA literature, an environmental scan of current LA programs with identification of LA program elements available, and the results of a LA feasibility study. The findings substantiate that continued professional certification which incorporates a LA strategy can augment lifelong learning, but is not an assessment strategy that can be implemented without thoughtful planning, customization and continuous maintenance.

The Psychometric Analysis of an Instrument to Measure the Perceived Workload for Certified Registered Nurse Anesthetists.

BACKGROUND AND PURPOSE: In a previous study, the CRNA Workload Perception Scale (CWPS) was developed. The purpose of this study was to investigate the psychometrics of the CWPS. METHODS: The CWPS was tested in a population of CRNAs. This study was conducted in two phases. Phase I consisted of classical psychometrics; the 12-item instrument was piloted in a sample of 265 CRNAs. Phase II consisted of qualitative analysis to provide feedback on items that did not perform well. RESULTS: Phase I: Instrument demonstrated good reliability (r = .77). Parametric and nonparametric analysis indicated 6 of 12 items were good fit to measure perception of workload. PHASE II: Qualitative analysis resulted in refinement of four items, addition of one item, and elimination of two items. CONCLUSIONS: A revised 11-item CWPS was developed.

Barriers to Reentry Into Nurse Anesthesia Practice Following Substance Use Disorder Treatment: A Concept Analysis.

Nursing knowledge surrounding anesthesia providers' maintaining or obtaining employment after treatment of substance use disorder (SUD) is notably absent in the literature. An alternative method, dimensional analysis, allows for exploration of this concept from many perspectives, with social context as the basis from which to determine what barriers exist and how to prevail over them. Anesthesia practice is a socially constructed profession. The concept, barriers to reentry into nurse anesthesia practice, was explored and defined for purposes of identifying their impact on the recovering certified registered nurse anesthetist (CRNA). Defining the barriers places the CRNA one step closer to successful reentry into anesthesia practice.

Use of a Novel Memory Aid to Educate Perioperative Team Members on Proper Patient Positioning Technique.

Interdisciplinary collaboration is key to safe surgical positioning. Although the surgical procedure dictates the patient's position, surgeons, anesthesia care providers, intraoperative nurses, and ancillary staff members must work together to achieve the goal of safe positioning. Correct patient positioning includes the provision of adequate access to the surgical site for the surgeon and surgical assistants. Surgical positions may put the patient at risk of injury. Understanding human anatomy, including the nerves commonly affected by each surgical position, can help the surgical team prevent accidental and irreversible patient injury. A lack of knowledge of proper positioning practices can result in serious patient injury, such as permanent paralysis, blindness, tissue necrosis, burns, bone fracture, and even death. This article reviews surgical positioning and introduces a learning module that involves the use of mnemonics as memory aids for perioperative team members who are learning proper positioning techniques.