Barriers and Facilitators to Implementing Holistic Admission Review in Graduate Advanced Nursing Programs.

BACKGROUND: There are strong recommendations and high demand for the use of holistic admission review (HAR). However, there is no study exploring and identifying barriers and facilitators to implementing HAR in health care education programs. METHOD: This qualitative descriptive study aimed to understand the key determinants influencing the integration of HAR in graduate advanced nursing programs. Two online focus groups with content analysis were used to identify barriers and facilitators. RESULTS: The findings highlight 39 key determinants of HAR implementation in the graduate advanced nursing program; the determinants included four neutral influencing factors, 18 barriers, and 17 facilitators. These influencing factors aligned with all four domains in the Consolidated Framework for Implementation Research (CFIR) and with 20 of the 39 CFIR constructs. CONCLUSION: By taking into account the facilitators and barriers, graduate advanced nursing programs may use effective implementation strategies to integrate HAR changes and guide their evolving admissions processes. [J Nurs Educ. 2023;62(10):570-574.].

High O2 a Go To: Effects of Hyperoxia.

Current research on the optimal amount of oxygen delivery during general anesthesia is controversial. It is well described that anesthesia providers create supraphysiological arterial oxygen levels in patients with the delivery of supplemental oxygen. Over the past 20 years, hyperoxia has been studied more thoroughly and potential consequences are better understood. Atelectasis and radical oxygen species can lead to postoperative complications such as infection, prolonged respiratory support, and increased length of hospital stay. Anesthetists should consider the risk and benefit, potential effects, and differentiate the amount of oxygen dependent on the clinical situation. More research is needed in varying patient populations and surgical procedures to better understand the implications of hyperoxia in patients requiring general anesthesia.

Second Victim: A Traumatic Experience.

Research is abundant on second victimhood (the provider who was involved in and traumatized by an adverse clinical event) but minimal about the experience in nurse anesthetists. Physical and psychological symptoms of second victimhood may have a deleterious effect on patient care. Recognizing the important aspects during the various stages of recovery will help guide recovery efforts. Inclusion of important curriculum domains in nurse anesthesia education will improve understanding of this issue. Organizations and departments need to be aware of the seriousness of the effects of second victimhood and how to develop a supportive compassionate recovery program. More research is needed in nurse anesthetists to better understand implications specific to the practice.

Review of Anesthesia Versus Intensive Care Unit Ventilators and Ventilatory Strategies: COVID-19 Patient Management Implications.

The coronavirus disease 2019 (COVID-19) respiratory illness has increased the amount of people needing airway rescue and the support of mechanical ventilators. In doing so, the pandemic has increased the demand of healthcare professionals to manage these critically ill individuals. Certified Registered Nurse Anesthetists (CRNAs), who are trained experts in airway management and mechanical ventilation with experience in intensive care units (ICUs), rise to this challenge. However, many CRNAs may be unfamiliar with advancements in critical care ventilators. The purpose of this review is to provide a resource for CRNAs returning to the ICU to manage patients requiring invasive mechanical ventilation. The most common ventilator modes found in anesthesia machine ventilators and ICU ventilators are reviewed, as are the lung-protective ventilation strategies, including positive end-expiratory pressure, used to manage patients with COVID-19-induced acute respiratory distress syndrome. Adjuncts to mechanical ventilation, recruitment maneuvers, prone positioning, and extracorporeal membrane oxygenation are also reviewed. More research is needed concerning the management of COVID-19-infected patients, and CRNAs must become familiar with their ICU units' individual ventilator machine, but this brief review provides a good place to start for those returning to the ICU.

Building an International Partnership to Develop Advanced Practice Nurses in Anesthesia Settings: Using a Theory-Driven Approach.

The International Federation of Nurse Anesthetists is calling for international collaboration to develop advanced nursing practice in anesthesia settings globally. However, international collaboration is challenging. Limited information is available about what process and factors specifically lead to a successful international collaboration partnership. This article aimed to describe a theoretical and empirical base that can be used to build and maintain long-term international partnerships. The Theoretical Framework of Developing International Partnerships was developed, which comprises seven interrelated concepts including partnerships, collaborations, environment, structure, process for collaborating, outcomes, and sustainability. It was used to guide an equitable horizontal collaboration partnership to develop anesthesia nursing care in local culture and context. Five major challenges were identified during the collaboration process. Sixty-six strategies were developed to facilitate collaboration using the theoretical framework. This work can inform others in establishing an international collaboration and partnership in advancing nursing knowledge and culturally congruent health care delivery.

A survey of moral distress in certified registered nurse anesthetists: A theoretical perspective for change in ethics education for advance practice nurses.

OBJECTIVE: The aim of this study was to examine the relationship between moral distress that may affect patient safety, and the clinical practice model, assessing ethical decision-making skills of certified registered nurse anesthetists (CRNAs). METHODS: A survey using the Ethical Stress Scale (ESS) and the Ethical Assessment Skills Survey (EASS) was conducted with 134 CRNAs. RESULTS: Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge [Wilks's lambda = 0.952, F (6, 256) = 1.068, P = 0.382, n 2  = 0.02]. A statistically significant positive correlation existed between importance and skill (r = 0.275, P = 0.001). CRNAs felt skilled to manage the actions or activities they deemed important. CONCLUSION: CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress. Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

Use of Personal Electronic Devices by Nurse Anesthetists and the Effects on Patient Safety.

Certified Registered Nurse Anesthetists (CRNAs) provide high-quality patient care to ensure patient safety. Strict vigilance and prompt response is required of the CRNA to make critical decisions. Distractions during anesthesia delivery may threaten patient safety. Personal electronic devices (PEDs) have become an integral tool used by 90% of adults. Adaptation of PEDs has permitted their integration into current anesthesia practice. Although technologic advancements have improved accessibility to resources and communication, they also serve as a source of distraction. Inappropriate PED use while administering anesthesia remains grossly underreported and understudied related to its impact on patient safety. The purpose of this article is to illustrate the critical need for further research in order to analyze safety risk, appropriately guide CRNA education, and properly develop and enforce media policies within organizations. Currently, PED use by the CRNA exists in ethically blurred boundaries, with potentially major patient safety and legal consequences.

Comparison of Successful Intubation Between Video Laryngoscopy View Before Attempted Intubation and Direct Laryngoscopic Intubation by Student Registered Nurse Anesthetists: A Pilot Study.

Airway management is a primary focus when student registered nurse anesthetists (SRNAs) begin clinical rotations in their nurse anesthesia program. Successful endotracheal intubation requires both knowledge of and experience with the airway and its structures. Lack of clinical maturity and unfamiliarity with the patient airway intensifies student anxiety in the clinical arena. The purpose of this pilot study was to examine the success rate of direct laryngoscopy by 9 SRNAs who were just entering clinical practice rotations. This study required group 1 to perform direct laryngoscopy in their first clinical opportunity in the operating room; group 2 was required to observe a minimum of 3 video laryngoscopic (GlideScope, Verathon Inc) intubations performed by the clinical preceptor before the students' first attempt using direct laryngoscopy. Other modalities used to secure the airway in this study included the GlideScope and a laryngeal mask airway. Results of the data analysis revealed there was no significant difference between groups for success of direct laryngoscopy (group 1, 54%; group 2, 58%; P = .45).