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.

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

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.

School Nurses' Reports on Reopening Roles, Practices, and Concerns During the COVID-19 Pandemic at the Start of the 2020-2021 School Year.

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.

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.

Association of Nutritional Status with New-Onset Delirium in Elderly, Acute Care, Orthopaedic Trauma Patients: A Single-Center Observational Study.

OBJECTIVE: To determine whether nutritional status at hospital admission is independently associated with new-onset delirium (NOD) in elderly, orthopaedic trauma patients. DESIGN: Single-center, retrospective, cross-sectional study. SETTING: Data from patients at a large teaching hospital in Boston, MA, were analyzed. PATIENTS: All patients were ≥65 years and hospitalized for acute surgical management of their major fractures after trauma. INTERVENTION: None. MAIN OUTCOME MEASUREMENT: Nutritional status was assessed at admission using the Mini Nutritional Assessment-Short Form (MNA-SF). Delirium was assessed using the Confusion Assessment Method within 24 hours of admission and daily throughout hospitalization. RESULTS: The incidence of delirium was 20% (94/471). Each unit decrement in MNA-SF was associated with a 14% higher risk of NOD (adjusted OR 1.14; 95% CI 1.05-1.28). Moreover, malnourished patients (MNA-SF score 0-7) were twice as likely to develop NOD (adjusted OR 2.07; 95% CI 1.01-4.35) compared with patients who were not malnourished (MNA-SF score 8-14). CONCLUSIONS: In hospitalized, elderly, orthopaedic trauma patients, poor nutritional status may be a modifiable risk factor for NOD. Future studies are needed to determine whether aggressive nutritional interventions can reduce the incidence of NOD and improve outcomes in this cohort of patients. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Dual Epidemics of 2020: Nursing Leaders' Reflections in the Context of Whole Person/Whole Systems.

The Greater Boston Nursing Collective, a consortium composed of university nursing deans and chief nursing officers within academic medical centers and specialty hospitals in Boston, Massachusetts, was formed in 2014. Since the group's inception, our mission has been to create and reinforce whole-person/whole-system healing environments to improve the health of all communities. Through our collaboration in navigating the dual epidemics of COVID-19 and structural racism within our respective organizations, and across the United States and the world, we share experiences and lessons learned. Our common mission is clearer than ever: to create safe and joyful work environments, to protect the dignity of those we are privileged to serve, and to generate policies to advance health equity to rectify societal forces that have shaped this dual epidemic. We are humbled by the many who persist despite limited rest and respite, and whose stories, innovations, and leadership we are honored to witness and share. They have defined our generation, just as nurses in earlier crises have done: leading through service to others as our purpose and privilege.

Drug Diversion in the Anesthesia Profession: How Can Anesthesia Patient Safety Foundation Help Everyone Be Safe? Report of a Meeting Sponsored by the Anesthesia Patient Safety Foundation.

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.

Preliminary Psychometric Evaluation of the Nurse Anesthesia and the Aftermath of Perioperative Catastrophes Survey and the Ways of Coping Questionnaire.

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.