Certified Registered Nurse Anesthetists' Experience of Relocation to COVID-19 Intensive Care-A Qualitative Interview Study.

In spring 2020, a global SARS-Cov-2 pandemic was declared. The number of patients in need of intensive care exceeded the number of available care places at intensive care units (ICUs) and certified registered nurse anesthetists (CRNAs) were relocated to ICUs to support the care during the pandemic. The aim of this study was to illuminate the experiences of the CRNAs regarding relocation to COVID-19 intensive care. An interview study based on qualitative content analysis was conducted. The participants were CRNAs who usually work in the operating unit, however, were relocated to work in the COVID-19 ICU at a university hospital in southern Sweden during the pandemic. Four themes emerge in the results: sense of pride, competence, work environment, and nursing. The results illuminate the CRNAs' experience of relocating from their usual working environment to caring for critically ill patients in a COVID-19 ICU. The CRNAs managed the relocation well, although sometimes it was difficult. The CRNAs showed great loyalty, dedication, competence, and flexibility in their professional capacity. The time they worked in COVID-19 intensive care was a challenging period, but it gave them a well-deserved sense of pride and competence.

Understanding Pain in Alzheimer's Disease in Anesthesia.

The primary risk factor for developing Alzheimer's Disease (AD) is increasing age, meaning that certified registered nurse anesthetists (CRNAs) will most likely encounter patients with AD with increasing frequency. Patients with AD are a challenge for CRNAs to quickly create a comprehensive anesthetic because of the difficulty with self-reporting and understanding how the brain responds to pain in AD. New research about how the brain processes pain in patients with AD is available, which could prove helpful. Published reports that outline a specific anesthetic plan are scarce, particularly considering each patient's own set of circumstances and where they are in the disease process. This article highlights helpful suggestions and considerations for CRNAs when assessing pain, understanding individual responses to pain, and developing a plan to help control pain when caring for patients with AD.

Examination of a Nurse Anesthesia Program's Teaching Assistant Model and Its Impact on Increasing Nurse Anesthesia Education Capacity.

A nurse anesthesia educator shortage exists that is attributed to factors such as a lack of financial incentive and proper training to be an educator. Due to the faculty shortage, nurse anesthesia programs (NAPs) are forced to defer admission to qualified applicants which reduces the number of certified registered nurse anesthetists (CRNAs) that NAPs can produce. Research regarding students as teaching assistants (TAs) at the university level has shown benefits and challenges to students, professors, and the TAs themselves as well as the impact on the overall faculty capacity. Current research regarding TA programs does not pertain to NAPs, therefore, research regarding the impact of TA programs on increasing nurse anesthesia faculty merits further work. This study was conducted using quantitative surveys and qualitative interviews to bridge the gap in the literature on the potential impact of TA programs on NAP faculty shortages. A survey was sent via email to former TAs (n = 44) of the Georgetown University NAP to assess the impact that the TA program had on their decision to enter a role in academia after graduation. Interviews were then conducted on a voluntary basis via a video conferencing platform to add qualitative data to the survey results. The survey response rate was 45% (n = 20). Following proportional analysis, 80% of the survey respondents indicated that they participated in the education of student registered nurse anesthetists in the clinical or didactic setting as a CRNA. Eighty percent of respondents indicated that being a TA positively influenced their desire to become a faculty member. One hundred percent of CRNAs interviewed reported that the biggest barrier to becoming fulltime faculty was the lack of financial incentives offered by NAPs. Interviewees recalled their TA experience as the foundation for their enjoyment of teaching anesthesia. The results of this study indicate that TA programs in NAPs can be used as a method to increase faculty capacity.

Narrative review of mathematical and psychological studies of staff scheduling for holidays as applicable to anesthesiologists and nurse anesthetists.

We performed a narrative review of articles applicable to anesthesiologists' and nurse anesthetists' choices of who works each statutory holiday for operating room and non-operating room anesthesia. We include search protocols and detailed supplementary annotated comments. Studies showed that holiday staff scheduling is emotional. Working on holidays often is more stressful and undesirable than comparable workdays. Intrinsic motivation may overall, among practitioners, be greater by preferentially scheduling practitioners who choose to work on holidays, for compensation, before mandating that practitioners who would prefer to be off must work on holidays. Granting each practitioner (who so desires) at least one major holiday off can depend on identifying and scheduling other clinicians who want to work holidays for monetary compensation or extra compensatory time off. Scheduling holidays by random priority (i.e., a lottery choosing who gets to pick their holiday[s] first, second, etc.) is inefficient, resulting in fewer practitioners having their preferences satisfied, especially for small departments or divisions (e.g., cardiac anesthesia). No article that we reviewed implemented a random priority mechanism for staff scheduling. The selection of practitioners to take turns in choosing their holidays is perceived to have less fairness than a selection process that collects each participants' preferences. Although holidays often are scheduled separately from regular workdays and weekends, doing so will not increase efficiency or fairness. Holidays can, in practice, be scheduled simultaneously with non-holidays. Models can explicitly include fairness as an objective. For example, fairness can be based on the difference between the maximum and minimum number of holidays for which practitioners of the same division are scheduled. Holidays can be given greater weights than other shifts when estimating fairness. Staff scheduling for holidays, when done simultaneously with regular workdays, nights, and weekends, can also use personalized weights, specifying practitioners' preferences to be satisfied if possible.

How nursing care is expressed among nurse anaesthetists in the perioperative context: A meta-ethnographic synthesis.

AIM: To develop a conceptual framework describing nursing care from the anaesthesia nurse's perspective in the perioperative context. BACKGROUND: Surgical patients find themselves in a vulnerable situation in need of advanced treatment and care. Nurse anaesthetists have a central role in reducing harm and enhance patient safety, in which person-centred care has been identified as a key component. However, they are challenged by productivity and efficiency demands leading to a potential risk to patient safety. DESIGN: Noblit and Hare's interpretative meta-ethnography, directed by the eMERGe reporting guidance. METHODS: A comprehensive systematic search of nine databases without year limitation. Fifteen studies published between 2002 and 2021 were found eligible for inclusion. Quality appraisal was performed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. RESULTS: Four themes were identified: being vigilant to keep safe from harm, strengthening patients' confidence, expressing courage to act and speak up, and endorsing team collaboration to achieve best practice. The themes were synthesised into the metaphor, 'Continuously assessing and acting according to the patients' needs in a holistic perspective'. A conceptual framework was developed, illustrating the interconnection between the different nursing expressions, as the nurse anaesthetists seek to care for the patient as a whole person. CONCLUSIONS: Nurse anaesthetists aim to deliver holistic nursing care. Nursing care is expressed at two levels, foregrounding and backgrounding anaesthetic nursing, in line with the philosophy of person-centred care. Nursing care in anaesthesia is a matter of how and why it is performed, expressed in attitudes toward the recipients of care. RELEVANCE TO CLINICAL PRACTICE: The framework may be used to inform educational programs and clinical practice in nurse anaesthesia and to promote person-centred care as a shared value across all levels involved in perioperative patient care. NO PATIENT OR PUBLIC CONTRIBUTION: Data were retrieved from already published literature.

A Qualitative Examination of Opioid Sparing Anesthesia Practices Among CRNAs.

PURPOSE: The purpose of this study was to examine the experiences of CRNAs using opioid sparing techniques in their perioperative anesthesia practice. DESIGN: This study used a qualitative descriptive methodology. METHODS: Semistructured individual interviews were conducted with Certified Registered Nurse Anesthetists who use opioid sparing anesthesia in their clinical practice in the United States. FINDINGS: Sixteen interviews were completed. Thematic network analysis revealed two major themes: (1) perioperative benefits of opioid sparing anesthesia and (2) prospective benefits of opioid sparing anesthesia. Perioperative benefits described include reduction or elimination of postoperative nausea and vomiting, superior pain control, and improved short-term recovery. Prospective benefits described include higher surgeon satisfaction, superior surgeon-managed pain control, increased patient satisfaction, reduction of opioids in the community, and awareness of positive prospective benefits of opioid sparing anesthesia. CONCLUSIONS: This study highlights the significance of opioid sparing anesthesia and its role in comprehensive perioperative pain control, reduction of opioids in the community, and patient recovery beyond the postanesthesia care unit.

Workplace health in anesthesia team: A qualitative study in Iran.

Background: All anesthesia providers, including nurse anesthetists and anesthesiologists work in a stressful environment with diverse tasks. The profession is characterized by high workload, both dependent and independent job descriptions, and unpredictable conditions. This study was designed and conducted to explain the factors affecting the workplace health of Iranian anesthesia teams. Methods: Twenty anesthesia team members including nurse anesthetists and anesthesiologists from 7 different hospitals were enrolled in this phenomenological research. The data were collected in 2022. Semi-structured interviews were used for data collection, and the transcripts were analyzed using qualitative content analysis. Findings: The most notable theme emerging from the data which was found to affect workplace health was consistency of anesthesia team. Other themes derived from the data included team tranquility and physical well-being. Conclusion: The participants' emphasis was more on behavioral and managerial factors affecting workplace health, and desirable interpersonal cooperation to create a suitable work environment for them was more prominent. These findings can raise the awareness of chief nurse anesthetists and planners to provide more effective teamwork, modify the job description structure, and reduce staff conflicts.

Temporary Intraoperative Handoff Report Among Nurse Anesthetists: Utilization of Standardized Handoff Tools and Barriers to Implementation.

The demanding nature of the intraoperative period presents several distractions to anesthesia providers that can hinder effective communication. Implementation of intraoperative and postoperative standardized handoff protocols have improved provider communication; however, these protocols remain underutilized. While temporary anesthesia handoffs arise more frequently than permanent handoffs, limited data exist on how the specific transfer of care processes transpire. The purpose of this study was to explore the usage of standardized handoff tools among certified registered nurse anesthetists, as well as the barriers to implementation during temporary intraoperative handoff. Data from this exploratory mixed-methods study were collected using a 16-question voluntary electronic survey. Most participants (81.2%) reported that they do not use a standardized handoff tool during temporary handoff, but over half (57.1%) believed such tools should be used. Study participants who used a standardized handoff tool were significantly less likely to rank "increases the time spent giving a handoff" as an important barrier (48.6%) compared with those who did not use a tool (71.9%), ( X2(1) = 7.39, P = .007, V = .19). Failure to make standardized handoffs a facility standard of care and lack of reception by receiving anesthesia providers were also ranked as major barriers to implementation.

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.

Nurse anesthetist students' experiences of peer learning in clinical education - A qualitative study.

BACKGROUND: As part of an interprofessional operating team, nurse anesthetists need to be skilled in collaboration, problem solving, attentiveness, independent decision-making and knowledge of anesthesiology nursing. Factors that are vital for nurse anesthetist students' future profession. The educational model peer learning, characterized by collaboration and learning through social interaction between individuals, may support nurse anesthetist students' development in such skills. AIM: The aim of the study was to explore nurse anesthetist students' perceptions of their experiences of peer learning as an educational model during their clinical education in a Swedish context. METHODS: The approach was a qualitative descriptive design. Seven nurse anesthetist students from four different universities were interviewed individually using a semi-structured interview guide. The data were analyzed with content analysis. RESULTS: Three generic categories revealed a description of the phenomenon: Increased independence, Holistic view and Expansive learning process. A main category brought together the content of the generic categories and shows the overall finding of the study: Peer learning promotes nurse anesthetist students' personal and professional development. CONCLUSION: Peer learning as an educational model during nurse anesthetist students' clinical education might facilitate preparation for their coming profession.

Improving Anesthesia Providers' Needle Cricothyrotomy Success With Ultrasound-Guidance: A Cadave Quality Improvement Project.

Difficult and failed airway management remains a significant cause of anesthesia-related morbidity and mortality. Failed airway management guidelines include performing a cricothyrotomy as a final step. Correct identification of the cricothyroid membrane (CTM) is essential for safe and accurate cricothyrotomy execution. Ten certified registered nurse anesthetists were assessed for ultrasound-guided (USG) needle cricothyrotomy competency following an online and hands-on education session using a human cadaver and then assessed 60 days later, without additional education or preparation. Both knowledge and confidence improved significantly when assessed immediately after education (P < .05) and were maintained when assessed 60 days later. Overall skill performance declined slightly from post-training although the decline was not statistically significant (P = .373). Overall needle placement time and distance from the CTM improved, despite improper transducer and image orientation by most participants. A one-hour hybrid educational program can significantly improve ultrasound and cricothyrotomy knowledge and confidence for 60 days. Transducer orientation may not be a significant contributor to performing proper USG needle cricothyrotomy.

Registered Nurse Anesthetists' Perceptions of Providing Care Within a Global Health Framework: A Qualitative Study.

PURPOSE: The purpose of this study was to investigate how Registered Nurse Anesthetists (RNAs) who have been working for nongovernmental organizations in low- and middle-income countries perceive their role in global health. DESIGN: A qualitative design was used in this study. METHODS: Data were collected by means of semistructured interviews with 11 participants who met the inclusion criteria, and qualitative analysis of the interview content was performed. FINDINGS: The analysis resulted in three categories and six subcategories. Of the categories, "Using skills" includes the respondents' varying levels of responsibility, tasks, and perceptions of how far they are applying their expertise. "Encountering new cultures" is about adapting to new cultural norms in nursing, education, and cooperation in the international team. "Promoting change through volunteerism" comprises personal and professional development, and impact - both local and potentially global. CONCLUSIONS: This study highlights the relevance of RNAs in global health and emphasizes the cultural encounters, exchanges, and challenges associated with volunteer medical missions. RNAs' knowledge of, and humble approach to the host country's culture are essential for their ability to provide nursing care, engage in cooperation and training, and promote global health in a high-quality, sustainable and effective way.

Preoperative Preparation and Guidelines for Cannabis-Using Patients Undergoing Elective Surgery.

PURPOSE: Appropriate preoperative screening techniques are needed to safely provide anesthesia to increasing numbers of cannabis using surgical patients. DESIGN: This was a quasi-experimental quality improvement project. METHODS: Preoperative identification of cannabis users by registered nurses (RNs) and certified registered nurse anesthetists (CRNAs) was compared to baseline identification rates. CRNAs' compliance with evidenced base guidelines was recorded. Perioperative medication requirements were recorded and compared between cannabis-users and noncannabis users. FINDINGS: Identification of cannabis users by CRNAs conducting preanesthetic assessments increased from 4.08% to 14.36% while RN identification improved from 11.22% to 13.81%. Compliance with identification guidelines was 69.2% among CRNAs. There were no differences in anesthetic requirements, complications, or postanesthesia care unit (PACU) length of stay between cannabis users and nonusers. CONCLUSIONS: Preoperative identification of cannabis users allows for safer, more effective perioperative care by CRNAs, registered nurses, and surgical staff.

Incorporating Evidence-Based Ultrasound-Guided Vascular Access (USGVA) Standards Into the Nurse Anesthetist Armamentarium: A Quality Improvement Project.

PURPOSE: This quality improvement (QI) project developed and implemented a hybrid training program, that included online modules and hands-on training for experienced certified registered nurse anesthetists (CRNAs) to increase confidence, knowledge, and competency with ultrasound-guided vascular access (USGVA). DESIGN: This QI project used a pre-post design. Seventeen volunteer CRNAs participated in USGVA training and education, and a 90-day follow-up assessment was performed. METHODS: The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used as a framework to assess confidence, knowledge, and hands-on competency of 17 CRNAs who regularly place vascular access devices using USGVA in patients with difficult vascular access at a single facility. These assessments were measured at: (1) baseline, (2) immediately after attending a hybrid training educational program, and (3) 90 days after implementation into clinical practice. Additionally, the number of vascular access attempts required for successful placement of peripheral intravenous (PIV) catheters, arterial catheters, and central venous catheters (CVC) with ultrasound assistance over a 90-day period was reviewed. FINDINGS: Certified registered nurse anesthetists' median confidence score increased significantly from pre- to posteducation (P = .009). The confidence reported from post- to 90 days posteducation improved, however it did not reach statistical significance (P = .812). The knowledge scores from pre- to posteducation indicated significant improvement (P <. 001), as well as from pre- to 90 days posteducation (P = .03). However, knowledge scores from post- to 90 days posteducation revealed a statistically significant decline (P = .004). The overall median score for hands-on USGVA competency declined from post- to 90 days posteducation (P = .109). The number of successful USGVA placements increased from 50% to 80% within a 90-day period. CONCLUSIONS: The implementation of a USGVA hybrid training and education program improved overall provider confidence, knowledge, and competency. While confidence remained high in the 90-day follow-up, knowledge retention declined. Despite a decline in knowledge retention over time, results showed a significant improvement when compared to baseline scores. Although a decline in hands-on USGVA competency was seen at 90 days posteducation, it was not statistically significant. The percentage of overall successful USGVA placements in clinical practice increased following implementation.

Certified Registered Nurse Anesthetists' occupational exposure to inhalational anesthetic agents: a survey of anesthetic gas safety.

BACKGROUND: Anesthetic gases have been known to cause damage when inhaled over long periods of time. Modern safety measures have been put in place to reduce the risk to anesthesia providers, however there is continued lack of information on providers experiencing short term effects (lethargy, fatigue, headache, slowed cognitive ability, nausea, and mucosal irritation) thereby leading to long-term sequalae (sister chromatid exchanges, micronuclei, chromosomal aberrations, and comet assays). METHOD: A thirteen item, multiple choice survey was sent to 3,000 anesthesia providers, of which 463 completed the survey. A Chi-square test of independence was used to determine the association between gas exposure and participant self-reported symptoms. A Spearman's Correlation test was also utilized to interpret this data since both frequency of smelling gas and frequency of symptoms were ordinal variables for which Spearman's rho correlation was the appropriate measure of association. RESULTS: The major findings were that as the frequency of smelling anesthetic gas increased, so too did the frequency of self-reported headaches and fatigue. Spearman's rho = .148 and .092. P value = .002 and .049, respectively. CONCLUSION: There have been many efforts to decrease the risk of exposure of anesthesia providers to anesthetic gases. While there is a decrease in reported exposures, indications of possible long-term effects remain a concern in anesthesia providers. Potential implications of exposure could lead to chromosomal aberrations, sister chromatid exchanges, comet assays, spontaneous abortions, and genotoxic effects.

Chronic Opioid Use After Surgery: An Exploratory Study Examining Rural Certified Registered Nurse Anesthetist Strategies to Mitigate Chronic Opioid Use and Their View of Their Role in the Opioid Crisis.

Certified registered nurse anesthetists (CRNAs) provide most of the anesthesia care in the rural United States. Rural regions of the US also have the highest opioid prescribing rates and opioid-related hospital admissions and deaths. Although CRNAs are the primary anesthesia providers in these regions, little research examines the strategies CRNAs may use to mitigate the development of chronic opioid use after surgery. The purpose of this study was to assess the views of rural CRNAs regarding their role in mitigating chronic opioid use after surgery and to determine what, if any, preventative strategies they may use. A survey was developed and distributed to CRNAs practicing in rural areas of the US with the highest opioid prescribing rates. Of the 160 CRNAs who responded, 73% agreed that they could influence whether their patient developed chronic opioid use after surgery. Those who agreed were more likely to be involved in policy development to decrease opioid use. The survey also found that CRNAs with a doctoral degree, compared with those with master's level preparation, were more likely to report that they could influence whether their patient developed chronic opioid use after surgery.

Innovating Student Registered Nurse Anesthetist Clinical Learning Through United States Air Force Pilot Training Practices: A Review of the Literature.

The clinical learning environment is essential for student registered nurse anesthetists (SRNAs) to develop intricate clinical knowledge and acquire proficiency in technical skills required for anesthetic care. The perioperative experience of an SRNA can differ greatly based on the program, preceptor, hospital rotation, or geographic location. This literature review synthesizes the historical and current state of certified registered nurse anesthetist (CRNA)/SRNA preceptorship in the clinical setting. Themes analyzed include the current CRNA/SRNA learning and teaching environment, student perceptions of effective CRNA preceptors, evaluation tools and feedback practices, and overall CRNA preceptor preparedness as well as the availability and effectiveness of preceptor training programs. We compare their findings to best practices seen in the United States Air Force (USAF) pilot training program because of its similar "high stakes" learning environment and utilization of a preceptor teaching model. Actionable recommendations, based on CRNA preceptorship data, preceptorship theory, and the USAF pilot training model are presented in the effort to improve preceptor transfer of knowledge and SRNA clinical competence.

An Analysis and Review of the Use of State Legislator Clinical Site Visits to Increase Advocacy for Nurse Anesthesiologists.

Nurse anesthesiologists have successfully influenced legislative change to include full practice authority across the United States. These legislative changes directly impact the scope of practice as well as patient care and the advancement of the nursing profession. However, nurse anesthesiologists remain hesitant to embrace health policy advocacy as a professional responsibility. To act as advocates, awareness must exist around professional responsibility to engage in political advocacy, and how to engage in this role. We describe successful statewide strategies involving members of a professional state organization for nurse anesthesiologists. Leaders from the state organization incorporated clinical site visits to create a shared vision and inform legislators about their role and its influence on providing safe, quality, cost-effective care to patients. These efforts were effective in moving the policy agenda forward. Additionally, this process of educating legislators within the hospital has empowered a new generation of nurse anesthesiology advocates.