Academic literature on the topic 'Nursing - Anesthesia'

Despite some improvement, no consensus exists to perfect quality in anesthesia handoff practice and policy. This quality improvement project was designed to assist a local anesthesia and perioperative workforce questioning the quality of its current handoff. Theories and models used to inform the project included the Inter-Professional Team Collaborative, Lewin's change theory, the continuous quality improvement theory, and the knowledge to action model. The communication assessment tool (CAT) functioned as a needs assessment yielding a gap in handoff practice of 25 participants. The CAT also served as the post project evaluation survey. The situation, background, assessment, and recommendation (SBAR) tool was preferred. Participants received SBAR education, and clinical evaluation experience (CEX) survey training. The CEX described the quality indicators of participant handovers during four consecutive weeks. Descriptive and inferential statistics used to analyze data collections included means and standard deviations, examining trends in the continuous level variables. Reliability of the CAT variables was evaluated through Cronbach's alpha test of internal consistency. Inferential analyses included independent sample t tests, Pearson correlations, and analyses of variance (ANOVAs). Statistical significance was evaluated at the conventional level, α = .05. The use of the SBAR handoff tool showed parity in communication competency. Quality indicators of overall handoff remained highly satisfactory. Recommendations include the consensual use of SBAR handoff and competency evaluation across the anesthesia community. Modification of handoff practices and policies will enable social change by promoting quality indicators in anesthesia collaborative communication.

Performance of hand hygiene is among the most effective means of preventing healthcare associated infections (HAI) among patients. Deaths resulting from HAIs are one of the top ten leading causes of death in the United States. Any improvement in the frequency of hand hygiene among healthcare professionals may have a direct impact on patient mortality and associated costs. While anesthesia professionals have been found to have low rates of hand hygiene adherence, few targeted studies seeking to improve hand hygiene adherence among this group exist. Studies conducted to improve hand hygiene among health care professionals have reported limited improvement, with overall inconclusive recommendations for improving prolonged hand hygiene adherence rates. The purpose of this project was to improve anesthesia professionals’ hand hygiene through encouragement of performance and education on the current state of research in the area of anesthesia associated HAIs. Hand hygiene rates were evaluated through measuring the amount of hand sanitizer used at eleven anesthesia workstations in the main operating room of a hospital. Measurements were taken at baseline and continued for three months after the educational program was implemented.

This study was designed to characterize postcesarean pain and examine its relationship with surgical anesthesia. Pain intensity was measured using a 0 to 10 numerical rating scale. The Short-Form McGill Pain Questionnaire was used to measure quality. The most common pain types reported were movement-associated and constant incisional pain (100% of subjects), gas pain (88.1%), and uterine contraction pain (83.3%). Each pain type differed in its intensity, duration and quality. Movement-associated incisional pain was the most intense and long-lasting pain type reported. On postoperative days 2 to 4, mothers who received complete epidural anesthesia during surgery reported less intense movement-associated incisional pain than those who received general or incomplete epidural anesthesia. However, statistical significance was not often obtained. These findings demonstrate the uniqueness of each pain type composing the postcesarean pain experience. The clinical data also support the hypothesis that epidural anesthesia diminishes the sustained hyperexcitability of the central nervous system caused by surgery.

Glass particle contamination of medication occurs when opening ampules which may cause patient harm. The use of filter needles reduces this risk. Many anesthesia providers use ampules daily, but do not use filter needles when aspirating medications from ampules. In addition, filter needles may not be readily available at the anesthesia medication preparation site. Not using filter needles or having them available for use can increase the risk of patient harm by glass particle contamination. The purpose of this project was to increase anesthesia provider’s knowledge thereby improving compliance with evidence-based standards when preparing medications from ampules. The goal is to increase filter needle use when medication is aspirated from an ampule in order to decrease the risk of glass particle contamination to the patient. This project consisted of a one-group pre/post intervention design using a piloted self-developed survey, an education intervention, and tracking of filter needle use. The convenience sample of eighty-three recruited anesthesia providers included anesthesiologists, nurse anesthetists, and anesthesiologist assistants that consented to participate. The filter needle inventory was tracked via an existing software program to determine filter needle use three months prior and three months after the intervention. Data were collected and analyzed using descriptive statistics. The results of this project found greater awareness among participants of standards and organizations regarding filter needle use with ampules, greater awareness of availability of filter needles on anesthesia carts, and a five-fold increase in filter needle usage by participants three months following the intervention as compared to three months prior to the intervention.

<p> The purpose of this exploratory qualitative study was to identify experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) transition into management and; if these shared experiences can prepare future CRNA managers by providing insight into what knowledge, skills, and abilities are necessary to ensure a smooth and successful career transition. </p><p> A representative sample by email and Facebook (FB) elicited 18 phone interviews of current and past Certified Registered Nurse Anesthetist (CRNA) managers. One interviewer asked 16 questions: seven demographic and nine open-ended. Survey information was (1) transcribed, (2) reviewed and de-identified, and (3) coded for content and classical analysis by two experienced independent coders. A coding tree was developed by coders after independent and random assessment of codes with an IRR (0.93). NVivo 11 software was used to assist with analysis of codes. </p><p> CRNA participants (66%) had less than five years of CRNA management experience, and 61% had no previous management experience or education before accepting their first role as a CRNA manager. An incidental finding, 83% of participants were reluctant managers and 76% of CRNA managers devoted greater than 50% of their time to performing clinical duties over managerial duties. Two resources that CRNA participants agreed were helpful resources during transition included: mentors (83%) and previous education or experiences (44%), especially in business, finance, or management. The skills CRNA participants believed were important during transition included people skills (56%), financial knowledge (33%), and communication (28%). </p><p> CRNA managers are more likely to be reluctant managers that may be relatively new in the role, and with no previous management experience or education. Recommendations for new CRNA managers during transition included; mastering &ldquo;people skills,&rdquo; either through relationship management or communication skills. Derailment may be avoided if new managers consider the results of this investigation.</p><p>

Advanced practice nurses fill a vital need in the U.S. by increasing access to needed healthcare. Certified Registered Nurse Anesthetists (CRNAs) are one type of advanced practice nurse with a long history of safe and effective peri-anesthetic care. Nurse anesthetists have a rich tradition of providing anesthetic care for rural and underserved communities, and are a primary provider of anesthesia for active and retired military personnel. CRNAs comprise over one-half of the actively practicing U.S. anesthesia workforce currently, and are able to function in any anesthetic care model. Nurse anesthesia educational programs (NAEPs) are the single source for new graduate nurse anesthetists in the U.S. Demographic, geographic and epidemiological factors have combined to produce a predicted increase in the demand for peri-operative anesthesia care among a complex, aging and increasing patient population. The uninterrupted or increased supply of CRNAs to the anesthesia workforce is important. The goal of this study was the production of a comprehensive analysis of potential resource constraints upon the NAEPs in the U.S. This was accomplished through a focused, prospective and correlational research design, grounded conceptually in Resource Dependence Theory. A novel survey tool was developed for the assessment of critical resource constraints, completed by U.S. NAEP administrators and faculty. This research was exploratory in nature and is the basis for continued work in critical resource planning tools for U.S. NAEPs.

<p> Chronic pain has become a public health crisis in America, with subsequent high dependence on opioids. The use of nonsurgical pain management methods to treat pain is a viable alternative. Certified registered nurse anesthetists (CRNAs) have treated chronic pain patients with nonsurgical pain management methods for years, however, scope of practice and reimbursement issues over the past decade have threatened patients&rsquo; access to chronic pain care by CRNAs. As a result, the need for specialty certification in nonsurgical pain management became apparent. Assessing decision-making in healthcare professions with computerized simulation-based methods which aim to assess higher performance-based domains of competence have gained notoriety in recent years, however validity evidence is lacking. The purpose of this dissertation was to assess the validity and reliability of computer-based case simulations on the nonsurgical pain management certification examination for CRNAs who specialize in nonsurgical pain management. Computer-based case simulations, also known as clinical scenario items (CSIs), were developed by the National Board of Certification and Recertification for Nurse Anesthetists in 2013, and were tested for construct validity and internal consistency in this study. Miller&rsquo;s pyramid was chosen as the theoretical framework based on its hierarchical progression of assessment methods from foundational knowledge to performance in practice. Data from a convenience sample of 32 examinees who took the nonsurgical pain management examination were utilized, and consisted of 134 multiple choice questions (MCQs) and 2 clinical scenario items (CSIs) per examinee. Exploratory factor analysis revealed two underlying factors in the assessment of knowledge using MCQs, and three factors in the assessment of decision-making using CSIs. Internal consistency reliability was low to moderate for all constructs. A weakly positive correlation between MCQ scores and CSI scores revealed a weakly modest validation that CSIs measure a higher construct of competence. Correlation between time in practice to MCQ scores and CSI scores were both nonsignificant, and demonstrated that more time in practice did not correlate with higher examination performance. This study demonstrated that competence is best evaluated by a multimodal approach, such as practice outcome data and peer attestations of competent performance. </p><p>