American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide.

Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses' risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses' health and well-being are provided.

Simulation for Student Registered Nurse Anesthetists: Common Pediatric Anesthesia Complications.

Student registered nurse anesthetists (SRNAs) are required by the Council on Accreditation to provide anesthetics to a minimum of 30 patients ages 2-12 years and 10 patients younger than 2 years. Pediatric anesthesia can prove to be stressful because children are at higher risk for morbidity and mortality during the perioperative period compared with adults. Simulation allows SRNAs the opportunity to review and develop skills in a safe and supportive environment. The purpose of this project was to provide a high-fidelity pediatric simulation for SRNAs prior to their pediatric rotation to improve skills, knowledge, and self-confidence in the recognition and management/treatment of common pediatric anesthesia complications (airway obstruction, laryngospasm, bronchospasm, and bradycardia). Twenty SRNAs enrolled in a nurse anesthesia program participated in the pediatric anesthesia simulation prior to the start of their pediatric anesthesia rotation. Participants completed surveys at three intervals; presimulation, postsimulation, and at the end of their pediatric rotation that addressed the trainee's perceived self-confidence level and ability to identify and manage/treat common pediatric anesthesia complications. Statistical significance (P < .05) was achieved in the participants overall self-confidence levels in their ability to recognize, treat, and manage common pediatric complications (P = .00) after completion of simulation experience.

Support Methods for Healthcare Professionals Who Are Second Victims: An Integrative Review.

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.

Corneal Injury Risk Reduction During Sedation for Colonoscopy: An Evidence Based Practice Change.

PURPOSE: This evidence-based practice change project examined the use of supine positioning as a substitute for lateral positioning after sedation for endoscopic procedures for the purpose of preventing corneal injuries in this patient population. DESIGN: This study used a pre and post implementation design. METHODS: Retrospective data was collected over 12 months, including 4,422 endoscopic procedures for comparison to the prospective data collected after implementing the practice change, which totaled eight months and 3080 procedures. FINDINGS: Incidence rates for corneal injury and eye irritation were 0.158% before the practice change, with a decrease in incidence to 0.097% after the change. Using a two-sided Fisher's exact test, the results were not statistically significant (P => .05). Additionally, linear regression showed a slight downward trend with implementation; however, these results were also not statistically significant. CONCLUSIONS: The intervention did not have a statistically significant impact on the incidence of corneal injury. It is possible that more than one risk factor was contributing to corneal injury in this setting and the intervention only addressed one potential risk factor.

Probable Delirium as a Risk Factor for Adverse Surgical Outcomes in Geriatric Patients With Acute Hip Fracture: Preoperative Assessment Using a Short Screening Tool.

Hip fractures in geriatric patients are associated with substantial morbidity and mortality including postoperative delirium. Few data are available regarding preoperative identification of patients at risk of postoperative delirium before surgical repair of hip fracture. We used the Ultrabrief Two-Item Bedside Test, a proxy for delirium, to identify patients who are likely to have adverse outcomes postoperatively. This prospective pilot study included patients 65 years and older with an acute hip fracture. The questionnaire was administered preoperatively, and patients were followed up for 30 days postoperatively. We enrolled 30 patients, with a mean age of 78 years. The 12 patients with an abnormal test result had a significantly lower body mass index, a trend in descriptive statistics for pulmonary disease, and a higher ASA physical status. In addition, hospital stay following fracture repair was longer for patients with an abnormal test result, although not significantly (mean [SD]=8.8 [4.2] days vs 6.4 [2.0] days, median=8 vs 6 days, log-rank P=.052). A 2-item questionnaire could help identify patients who have sustained hip fracture who are likely to have a longer hospitalization. Future studies are needed to confirm these findings and determine whether interventions can reduce risk.

Cost Analysis of Intravenous Propofol Monotherapy versus Intravenous Combination Sedation in Patients Undergoing Outpatient Gastrointestinal Endoscopy.

In outpatient gastrointestinal (GI) endoscopy, for which postanesthesia care unit (PACU) stays are expected to be brief, sedative choices by anesthesia providers can affect costs. The purpose of this project was to evaluate the cost of propofol monotherapy compared with combination sedation consisting of propofol with any of the following: midazolam, fentanyl, dexmedetomidine, and/or ketamine. A total of 277 patients who underwent outpatient GI endoscopy were included in this retrospective medical record review. Patients were separated into 2 groups: propofol monotherapy (n = 233) or combination sedation (n = 44). Outcomes included PACU length of stay, episodes of postoperative nausea and vomiting (PONV), PACU costs, and medication costs. The average PACU length of stay was 35.0 minutes for propofol monotherapy and 35.75 minutes for combination sedation (P = .918). The average PACU cost was $566.37 for propofol monotherapy and $578.44 for combination sedation (P = .918). The average cost for sedatives was $3.13 for propofol monotherapy and $3.34 for combination sedation (P = .964). There was 1 incident of nausea among all patients. There were no significant differences in PACU length of stay, PACU cost, medication costs, and episodes of PONV between propofol monotherapy and combination sedation for outpatient GI endoscopy.

The revised scope of nurse anesthesia practice embodies the broad continuum of nurse anesthesia services.

The AANA determines the scope of nurse anesthesia practice. It is important for all members to understand the scope of practice that governs their work to better practice their profession and mentorship. In January 2013, the AANA Board of Directors charged the Practice Committee to revise the Scope of Nurse Anesthesia Practice. A systematic review of literature, focus groups, and a survey were conducted. Major focus group themes were identified, and survey results were analyzed to identify relationships between variables. The literature search resulted in 8,739 abstracts. Forty-six articles were reviewed. Full scope of advanced practice registered nurse (APRN) practice was a recurrent theme across the literature. Focus group themes include: (1) elements of nurse anesthesia practice; (2) future practice opportunities; (3) interprofessional collaboration; (4) full scope of practice; (5) autonomous practice; and (6) barriers to practice and recommendations. Of the 4,200 CRNA survey respondents, 44.6% are not permitted to practice to their full scope of practice. The revised Scope of Nurse Anesthesia Practice embodies the comprehensive span of nurse anesthesia practice.

A closer look at the standards for nurse anesthesia practice.

As part of its ongoing work, the AANA's Practice Committee reviewed the Scope and Standards for Nurse Anesthesia Practice, particularly focusing on the Standards for Nurse Anesthesia Practice. Revisions and updates were made to the standards to ensure clarity and reflect current anesthesia practice. This article highlights several of the important revisions made to the Standards for Nurse Anesthesia Practice, specifically focusing on the importance of documentation, updates to Standard V-Patient Monitoring, and changes to other documents affected by the updates. This is not an exhaustive discussion of all changes made to the document. The updated Standards for Nurse Anesthesia Practice are presented in their entirety.

An update from the AANA practice committee: application of the evidence-based process.

The American Association of Nurse Anesthetists Practice Committee applies a standardized evidence-based process to the development and revision of practice-related documents and member resources. This article highlights recent Practice Committee work related to the revision and development of new materials for the Professional Practice Manual for the Certified Registered Nurse Anesthetist. Specific areas discussed include infection control, Certified Registered Nurse Anesthetists and the interprofessional team, safe practices for needle and syringe use, securing propofol, safe surgery and anesthesia, patient safety and fatigue, and the use of mobile devices.