Called to Lead: A Qualitative Examination of the Experiences and Contributions of Certified Registered Nurse Anesthetists During the COVID-19 Pandemic Response in the United States.

The COVID-19 pandemic strained healthcare providers, particularly certified registered nurse anesthetists (CRNAs). To date, little research has focused on the effects of the COVID-19 pandemic on CRNAs, whose unique skillset conferred on them expanded roles and responsibilities, increasing their stress load. Therefore, the purpose of this study was to utilize qualitative descriptive methodology to examine the experiences of CRNAs during the COVID-19 pandemic. Twelve CRNAs providing patient care in the US during the COVID-19 pandemic completed the interview protocol. Five key themes were identified including 1) roles of CRNAs, 2) collaboration, 3) challenges, 4) mental health implications for CRNAs, and 5) pride in profession. This study's descriptions of CRNA experiences during this unprecedented time in contemporary history identifies critical areas for further investigation and provides insights into anesthetic, mental health, and policy priorities to better support CRNAs now and through future infectious disease outbreaks.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice.

Introduction: The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response. Methods: One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team. Results: Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress. Conclusion: Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.

Cultural Competence of Student Registered Nurse Anesthetists in Illinois.

This study examined the level of perceived cultural competence of student registered nurse anesthetists (SRNAs) in Illinois and made educational recommendations. A descriptive, cross-sectional study was completed using the Clinical Cultural Competency Questionnaire (CCCQ) to evaluate the perceived level of cultural competence among SRNAs in Illinois. Four domains of clinical cultural competency--knowledge, skills, attitudes (awareness), and encounters--were evaluated and reported. The survey response rate was 16.7% (N=57). A significant positive correlation was observed between cultural knowledge and age (P=.03). There was a significant difference in cultural knowledge between students attending a nurse anesthesia program in suburban Northeastern Illinois and students attending a large, urban university in the city of Chicago, with CCCQ knowledge mean rank scores of 38.44 and 13.77, respectively. The overall level of perceived clinical cultural competence of SRNAs was low: mean (SD)=3.13 (0.54); range=2.17 to 4.89. The authors concluded that SRNAs need additional cultural education and training in their program of study to enhance their perceived level of cultural competence and to deliver culturally competent anesthesia care. The desire to become culturally competent coupled with deficient levels of cultural knowledge among SRNAs merits further work.

Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study.

AIM: The aim of this study was to conduct a primary examination of the qualitative communication experiences of nurses during the first wave of the COVID-19 pandemic in the United States. BACKGROUND: Ambiguity in ever-evolving knowledge on how to provide care during COVID-19. Remaining safe has created a sense of urgency, which has in turn created the need for organizations to quickly alter their operational plans and protocols to support measures that increase capacity and establish a culture of safe care and clear communication. However, no known study has described communication in nursing practice during COVID-19. METHODS: Utilizing qualitative descriptive methodology, semi-structured interviews were conducted with 100 nurse participants from May to September 2020 and recorded for thematic analysis. The consolidated criteria for reporting qualitative studies (COREQ), a 32-item checklist, were used to ensure detailed and comprehensive reporting of this qualitative study protocol. FINDINGS: Study participants shared descriptions of how effective communication positively impacted patient care and nursing practice experiences during the first wave of the COVID-19 pandemic. The thematic network analyses identified the importance of effective communication across three levels: (1) organizational leadership, (2) unit leadership and (3) nurse-to-nurse communication. Within this structure, three organizing themes, essential to effective communication, were described including (a) presence, (b) education and (c) emotional support. CONCLUSION: Examining existing crisis communication policies and procedures across healthcare organizations is imperative to maintain highly relevant, innovative, and data-driven policies and strategies that are fundamental to preserving quality patient care and supporting optimal nursing practice. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Effective communication is critical to support nurses through extended periods of crisis. COVID-19 represents a unique contemporary challenge to the nursing workforce given the high stress and prolonged strain it has created for both human and healthcare supply resources. There is value in nurses' presence at local, unit level and organizational leadership levels to convey critical information that directly informs leadership decision-making during unprecedented emergencies such as the COVID-19 pandemic.

How to Prevent Endotracheal Tube Cuff Overinflation: "5 for 25".

Adverse effects associated with elevated endotracheal (ET) tube cuff pressures above 25 cm H2O include postoperative throat pain and tissue ischemia. Anesthesia practitioners' current methods of cuff pressure estimation are often inaccurate. This quantitative, quasi-experimental quality improvement project evaluated the incidence of ET tube cuff overinflation before and after an educational intervention that recommended the use of a 5-mL over 10-mL syringe for cuff inflation. Cuff pressures were measured at 2 hospitals within a large academic health system. The mean ET tube cuff pressure before education was 46.8 cm H2O and after education was 27.1 cm H2O (P=.001). The postintervention average cuff pressure using a 10-mL syringe was 36.8 cm H2O vs 21.1 cm H2O when providers used a 5-mL syringe (P=.039). The relationship between syringe size and cuff pressure was significant (P=.001) with a positive Pearson correlation of 0.471. The ET tube cuff pressures were reduced by 42% after the intervention. Average cuff pressures when providers used a 5-mL syringe were 55% lower than with use of a 10-mL syringe. No critically high postintervention pressures were recorded when a 5-mL syringe was used. The authors recommend 5-mL syringes be used for inflation of an ET tube cuff.

Barriers and Facilitators to Intraoperative Alternatives to Opioids: Examining CRNA Perspectives and Practices.

Opioids are the mainstay of intraoperative pain control, but they have several deleterious effects. Alternative medications and strategies to opioids, while effective in producing intraoperative analgesia, are underutilized by anesthesia providers. The purpose of this study was to examine and describe Certified Registered Nurse Anesthetists' perspectives and practices on administering opioids vs nonopioid or opioid-sparing strategies ("opioid alternatives") to treat intraoperative pain. A qualitative study design using semistructured interviews was conducted (N = 12). Study participants described their perspectives and practices on treating intraoperative pain. Two key themes emerged: (1) barriers to intraoperative opioid-alternative administration and (2) facilitators to intraoperative opioid-alternative administration. Barriers expressed by study participants included opioid superiority, inconsistent analgesic effects of intraoperative opioid alternatives, limited experience with opioid alternatives, limited resources on opioid alternatives, negative experiences with intraoperative opioid-alternative administration, and patient comorbidities. Facilitators expressed by study participants included the adverse effects of opioids, institutional policy and procedures, positive experiences with opioid-alternative administration, and regional anesthesia superiority. This study highlights the importance of improving education, training, and institutional policies in support of opioid-alternative medications and strategies to treat intraoperative pain and better prevent opioid addiction and abuse.