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.

Nurse Anesthetist Practice Over 40 Years: A Repeated Cross-Sectional Study in Norway

Research focusing on the scope of practice by nurse anesthetists (NAs) is limited. The purpose of this study was to examine NAs' scope of practice in Norway, and to explore whether and how this has changed during the period from 1979 to 2018. The study had a repeated crosssectional design. All members of the Norwegian Association of Nurse Anesthetists at the four time-points (1979, 1989, 1999 and 2018) were invited to participate in a questionnaire study. Inclusion criteria were education and work as an NA and currently working in Norway. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Findings indicate that the scope of NAs' practice in Norway has been increasingly restricted from 1979 to 2018 (N = 2171, P < .001). Additionally, the presence of an anesthesiologist when performing anesthesia had significantly increased during that time (39% in 1979 vs 90% in 2018). However, NAs' independent practice significantly increased in some areas, such as handling of acute situations, (i.e., handling of laryngospasm/bronchospasm [41% in 1979 versus 54% in 2018]). International and national standards underline the independent role of NAs. The development shown in our results should be addressed to avoid further restrictions of NAs' scope of practice.

Nurse Anesthesia Diversion Prevention: A Knowledge and Needs Gap Analysis

BACKGROUND

Substance misuse is an occupational health problem for anesthesia providers (APs). More than 10% of nurse anesthetists misuse and divert medications. No standard exists for addressing AP drug diversion. The purpose of this quality improvement project was to evaluate the use of a knowledge and needs assessment to inform the development of a successful drug diversion prevention program for certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs).

METHODS

A 28-item questionnaire, using the health belief model (HBM) and the risk perception attitude (RPA) framework, was developed to assess knowledge, beliefs, and practices of substance misuse and diversion. RPA groups were determined by level of belief in self-risk and perceived efficacy of prevention strategies. The survey was emailed to 100 CRNAs and over 100 SRNAs. Survey results were organized using the RPA framework.

FINDINGS

One hundred twelve surveys were completed. The RPA avoidant category (high-risk belief and low perceived efficacy of preventive interventions) comprised 52.5% of CRNAs; SRNAs were divided primarily among the RPA responsive category with high perceived risk and high-efficacy beliefs (38.9%) and the indifferent category of low-risk beliefs and low perceived efficacy (31.9%).

CONCLUSIONS/APPLICATIONS TO PRACTICE

Anesthesia providers have varying beliefs regarding drug misuse and diversion risks and perceptions of their ability to be successful with preventive strategies. Failure to address nurse anesthesia needs-based diversion prevention may result in missed opportunities to educate this group. Implementation of RPA-tailored interventions by health care organizations may produce effective, long-term outcomes for drug diversion within the profession.

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.

[The comparative analysis of professional standards of specialists with higher and secondary medical professional education]

In 2020, the Mintrud of Russia approved a number of professional standards for specialists with secondary professional medical education. The implementation of professional standards is called to actualize outdated normative base concerning functions of medical workers, including assurance of separation of labor functions and actions of physicians and medical nurses, facilitation of development of job descriptions, and minimizing number of conflicts that occur during process of work activities at personnel functions crossing. The medical organization, focusing on requirements established by professional standards, can more competently develop personnel policy, make timely changes in staff list, establish progressive remuneration system. In this regard, it is useful to learn to what extent approved professional standards facilitate solution of practical problems of medical organizations.The article presents results of comparative analysis of three pairs of professional standards for paramedical personnel and specialists with higher education in comparable specialties. Certain contradictions and inaccuracies were esnablished too.

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.

Organizational facilitators and barriers to optimal APRN practice: An integrative review

BACKGROUND

The organizational environment can foster or impede full deployment of advance practice registered nurses (APRNs), affecting the quality of care and patient outcomes. Given the critical role APRNs play in health care, it is important to understand organizational factors that promote or hinder APRN practice to maximize the potential of this workforce in health care systems.

PURPOSE

The aim of this study was to synthesize evidence about APRN practice environments, identify organizational facilitators and barriers, and make recommendations for better APRN utilization.

METHODS

A literature search was conducted in CINAHL, PubMed, and PsychInfo, yielding 366 studies. No time or geographic limitations were applied. Study quality was appraised using the National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Studies.

RESULTS

Thirty studies conducted in the United States, Canada, and the Netherlands met inclusion criteria. The majority of the studies involved nurse practitioners. Facilitators to optimal practice environment were autonomy/independent practice and positive physician/APRN relations. Barriers included policy restrictions on practice, poor physician relations, poor administrator relations, and others' lack of understanding of the APRN role. Barriers correlate with job dissatisfaction and increased intent to leave job.

PRACTICE IMPLICATIONS

The review highlights the importance of physician and administration relations, organizational-level policies, and colleagues' understanding of the APRN role in promoting effective practice environments. Organizations should align policy reform efforts with factors that foster positive APRN practice environments to efficiently and effectively utilize this increasingly vital workforce. Future research is warranted.

Gertrude Mary Gerrard, Chief Anesthetist, Peter Bent Brigham Hospital

Gertrude Gerrard is a relatively unknown but important early nurse anesthetist in the United Sates in the early part of the 20th century. She was in the first class to graduate from the Peter Bent Brigham Hospital (PBBH) School of Nursing in Boston, Massachusetts. After graduating from nursing school, she participated in anesthesia training with Walter Boothby and became the first nurse anesthetist at the PBBH. In 1917 she was included in a group of medical professionals from the Harvard hospital system to serve in the medical corps in France during World War I. While there she worked with surgeon Harvey Cushing and this professional relationship continued back in Boston. She also was the first nurse anesthetist at Strong Memorial Hospital in Rochester, New York from 1925-1927. She returned to Boston in 1928 and continued as the chief anesthetist at PBBH until leaving in 1946 during a departmental staffing transition after WWII.

Impact of COVID-19 Pandemic on Certified Registered Nurse Anesthetist Practice

The coronavirus disease 2019 (COVID-19) pandemic prompted profound shifts in the delivery of critical healthcare services. A mixed-methods study was conducted to explore the impact of the pandemic on Certified Registered Nurse Anesthetist (CRNA) practice. The quantitative component involved a survey of CRNAs during the initial period of the pandemic to determine changes in practice and any relationship to removal of state and federal barriers. Approximately 16% of 2,202 responding CRNAs reported practice expansion beyond their normal responsibilities, primarily outside the operating room and involving tracheal intubation, ventilator management, arterial line placement, and central line placement. CRNAs were more likely to experience an expansion of practice in states affected by removal of regulatory barriers. However, respondents also reported missed opportunities to use the full expertise of CRNAs because of state and institutional restrictions. Findings from the qualitative component of this study are reported in a separate article.

Anesthesia Professionals' Perspectives of Teamwork During Robotic-Assisted Surgery

Robotic-assisted surgery (RAS) presents unique teamwork challenges for perioperative team members, including anesthesia professionals. The purpose of this study was to explore anesthesiologists' and nurse anesthetists' teamwork experiences during RAS using an exploratory qualitative study design involving individual semistructured interviews. Study participants expressed that teamwork during RAS is both positive and challenging, and the start-up phase is the most demanding phase of RAS in terms of teamwork. Anesthesia professionals believe that both technical and nontechnical skills are necessary to provide excellent patient care and maintain patient safety during RAS. Furthermore, they believe that a more concentrated focus on nontechnical skills than is traditional is an essential component of teamwork.

Healthcare at the time of COVID-19: A review of the current situation with emphasis on anesthesia providers

Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, healthcare workers, health systems, as well as economies. While, healthcare systems are globally operating at maximum capacity, healthcare workers and especially anesthesia providers are facing extreme pressures, something that is also leading to declining availability and increasing stress. In this regard, it is extremely concerning the fact that some regions worldwide have reported up to 20% of their cases to be healthcare workers. When considering that the global case fatality rate may be as much as 5.4%, these numbers are concerning and unacceptable. As this pandemic accelerates, access to personal protective equipment for health workers is a key concern since at present, healthcare workers are every country's most valuable resource in the fight against COVID-19. Governments and heath organizations should take care of their staff and support them in any way possible. This review aims to describe the current situation anesthesia providers are facing in the setting of COVID-19 and provide solutions and evidence on important concerns, including which guidance to follow, the level of equipment that is adequate, and the level of protection they need for every patient being administered an anesthetic.

Nurse Anesthetists' Communication in Brief Preoperative Meeting With Orthopaedic Patients-An Interview Study

PURPOSE

To explore the experience of preoperative communication of nurse anesthetists (NAs) in brief meetings with patients in an orthopaedic setting.

DESIGN

Qualitative research.

METHODS

Three group interviews based on experiences of 18 NAs were conducted. Content data analysis was used.

FINDINGS

The brief communication was characterized by both difficulties and opportunities. Protecting the patient's integrity, informing worried patients, lack of routines, language difficulties, being present at the meeting, protecting the patient from disturbance, and encouraging the patient to participate were stated as the main challenges in the brief meeting with patients. The NAs also gave some suggestions for improvement.

CONCLUSIONS

The Preoperative meetings need to be developed and structured to improve communication. A way to assess the results of this conversation should be developed. Other recommendations include finding a way to improve patient involvement in this dialogue and development of skills of NAs to enhance the meeting for patients.

Understanding Motivations and Barriers of CRNAs Involved in Global Health: A Qualitative Descriptive Study

Surgical care provided through short-term medical missions (STMMs) is an important component of global healthcare. Certified Registered Nurse Anesthetists (CRNAs) are equipped with valuable knowledge and skills to help those lacking access to healthcare. Understanding the motivations and barriers to the participation of CRNAs in STMMs is vital to increasing their participation in these trips, which positively influence global healthcare. A descriptive qualitative design to understand motivations underlying volunteerism was used to gain this understanding. Clary's use of Functionalist Theory was the theoretical framework informing this study. Semistructured interviews were conducted with 6 CRNAs who had participated in at least one STMM. Colaizzi's qualitative method of inquiry was used for data analysis. The study's main objective was to identify motivations and barriers specific to CRNAs' participation in STMMs. Major categories for motivation included humanitarian values, personal and professional growth, readiness to serve, and strong teamwork. Barriers of participation in STMMs were divided into categories of internal (eg, personal discomfort, obligations) and external (weakness of the organization). The study results yield greater understanding of what can draw increased participation in STMMs from CRNAs. Improved understanding may lead to more effective recruitment and better satisfaction of CRNA participants in STMM work.

Comfort Theory in Practice-Nurse Anesthetists' Comfort Measures and Interventions in a Preoperative Context

PURPOSE

The Comfort Theory proposes a systematic work approach to respond to patients' holistic needs. The usefulness of the Comfort Theory in the perioperative setting should be investigated. The aim of this study was to describe and analyze the nurse anesthetist's comfort measures in the preoperative context on the basis of the Comfort Theory DESIGN: Qualitative observational study METHODS: Semi-structured, clinical observation data collection in the preoperative context and deductive thematic analysis FINDINGS: The nurse anesthetist's comfort measures in the preoperative phase in the operating room department aim to ensure the patient's needs of relief, ease and transcendence in the physical, psycho-spiritual, environmental and socio-cultural contexts CONCLUSIONS: The application of the Comfort Theory to daily work in the preoperative phase is of value for the nurse anesthetist in becoming more aware of the individual holistic needs of the patient and in this way adapting and initiating comfort measures and interventions.

The Nurse Anesthetists' Adherence to Swedish National Recommendations to Maintain Normothermia in Patients During Surgery

PURPOSE

The aim of this study was to determine if nurse anesthetists (NAs) have access, knowledge, and adhere to recommended guidelines to maintain normal body temperature during the perioperative period.

DESIGN

A descriptive survey design.

METHODS

Questionnaires were sent to heads of the department (n = 56) and NAs in the operating departments in Sweden.

FINDING

The level of access to the recommendations is high, but only one third of the operating departments have included the recommendations in their own local guidelines. The NAs' adherence was low, between 5% and 67%, and their knowledge levels were 57% to 60%.

CONCLUSIONS

A high level of knowledge, access, and adherence are important for the organization of operating departments to prevent barriers against implementation of new recommendations or guidelines. There are needs for education about patients' heat loss due to redistribution and clear recommendations.

Swedish-Registered Nurse Anesthetists' Evaluation of Their Professional Self

PURPOSE

This study aimed to explore how the nurse anesthetist values their professional self, compared with their peers, and also to explore whether professional self is affected by age, work experience, and/or gender.

DESIGN

An explorative and prospective cross-sectional design.

METHODS

During April 2011, a total of 108 registered nurse anesthetists from three different hospitals were surveyed using the Professional Self-Description Form with questions covering 21 items.

FINDINGS

A total of 87 (80%) responded: 21 men and 66 women with a mean age of 45 years (range, 28 to 64 years) and mean professional experience of 12 years (range, 1 to 41 years). Four factors were found: professionalism, trait of character, scientific knowledge, and empathy, with Cronbach alpha of 0.96 overall. Analysis showed that perceived professional self depends on age and amount of work experience, but not on gender.

CONCLUSIONS

The Professional Self-Description Form exhibits satisfactory internal consistency. Work experience and age influenced the development of professional self of nurse anesthetists.

The interaction between the patient and nurse anesthetist immediately before elective coronary artery bypass surgery

PURPOSE

Establishing a purposive interaction with a patient who is in a vulnerable situation before coronary artery bypass graft (CABG) surgery poses a challenge for the nurse anesthetist. The aim of this study was to identify and describe the interaction between the patient and the nurse anesthetist immediately before elective CABG surgery.

DESIGN

An observational study using a grounded theory design was used.

METHODS

A theoretical selection of patients and nurse anesthetists was made. A total of 11 situations of patient/nurse anesthetist interaction were observed. The data were analyzed using the constant comparative method.

FINDINGS

A core category of reassurance emerged from other categories of continuity, confirmation, and control. Continuity was characterized by expedient anesthesia nursing of high quality, confirmation was related to communication in a trusting atmosphere, and control was associated with skilled nursing interventions in the thoracic operating theatre.

CONCLUSIONS

Reassurance can be achieved through a well-structured anesthesia nursing performance in the thoracic operating theatre, and by focusing on the patient and continuously giving him/her information during the preoperative preparation phase.