AANA Journal[JOURNAL]
Sun
200 papers
Perception of the Scholarly Work Project by DNP/DNAP Graduates: A Preliminary Survey.
Burns SM, Morrow M
AANA J · 2023 Jun · PMID 37227954
The purpose of this descriptive pilot survey was to understand the experiences of students completing scholarly work projects for practice doctorate programs. With this work, we hoped to fill the literature gap and to in...
The purpose of this descriptive pilot survey was to understand the experiences of students completing scholarly work projects for practice doctorate programs. With this work, we hoped to fill the literature gap and to inform curriculum. A descriptive survey was used to answer the question: How do graduates of entry level and completion degree Doctor of Nursing Practice (DNP) and Doctor of Nurse Anesthesia Practice (DNAP) programs perceive the scholarly work requirements? The Chi-square test of independence was used to compare whether there was a statistically significant association between the responses to the survey question and the demographic variable. Only 46 DNP/DNAP graduates (4%) completed the survey. The survey results indicated that students in completion programs believed that their scholarly work empowered them to conduct future scholarly work as compared with the entry-topractice cohorts. Variables addressing each aspect of scholarly work project were described by the participants. This preliminary work provides a glimpse into the experience of scholarly work projects for the practice doctorate. To provide greater depth and understanding of this important aspect of doctoral education, a larger sampling of graduates is needed. A collaborative study might be beneficial.
Cervical Erector Spinae Plane Block for Giant Dermatofibrosarcoma Protuberans of Neck and Chest Wall: A Case Report.
Mahendru K, Gupta N, Rangarajan K … +2 more , Kumar S, Chandrashekhara SH
AANA J · 2023 Jun · PMID 37227953
We encountered a giant dermatofibrosarcoma protuberans (DFSP) of the neck and chest wall which presented a challenge in terms of perioperative analgesia management. In recent years, erector spinae plane (ESP) block has e...
We encountered a giant dermatofibrosarcoma protuberans (DFSP) of the neck and chest wall which presented a challenge in terms of perioperative analgesia management. In recent years, erector spinae plane (ESP) block has emerged as an effective and safe analgesia technique for various surgical procedures as well as for chronic neuropathic pain without any untoward complications. A continuous lower cervical ESP block can be used successfully as an effective analgesic technique for extensive DFSP surgery involving the neck and chest wall area.
The Editor's Desk: A Look Back and a Nod to the Future.
Biddle C, Virginia R
AANA J · 2023 Jun · PMID 37227952
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Entrustable Professional Activities: Can this Framework be Applied to Nurse Anesthesia Education to Assist in the Transition to Competency-Based Teaching?
Yerdon A, Taylor K
AANA J · 2023 Apr · PMID 38809206
Entrustable professional activities (EPAs) are the tasks or responsibilities which can be entrusted to a learner competent in that task to allow for unsupervised practice. The concept of EPAs is well documented in medica...
Entrustable professional activities (EPAs) are the tasks or responsibilities which can be entrusted to a learner competent in that task to allow for unsupervised practice. The concept of EPAs is well documented in medical education literature, but only recently in nursing education. A paucity of literature exists on the application of an EPA framework specifically in nurse anesthesia. Based on the successful application of EPAs in competency-based medical and nursing education, we are of the opinion that this framework may also be utilized in the transition to competency-based education for nurse anesthesia learners. Many certified registered nurse anesthetists clinical preceptors lack training in competency-based education and teaching. The concept of EPAs may assist clinical preceptors in the translation of competencies and performance evaluation of learners. EPAs are defined for the nurse anesthesia clinical education setting. Examples of EPAs specific to nurse anesthesia include anesthesia machine checks, intubation, invasive line placement, regional anesthesia blocks, and preoperative assessment. Criteria of EPAs, barriers to use, and concrete examples are provided. Deliberate use of the EPA framework by clinical preceptors may lead to a more effective evaluation of the learner, thus resulting in purposeful progression to competence.
Prototype of Indigenous Low-Cost Cuff Pressure Gauge.
Sriganesh K, Umamaheswara Rao GS
AANA J · 2023 Apr · PMID 38809205
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Increased Scholarly Movement on Embedded Racial Inaccuracies of Peripheral Pulse Oximeters.
Sergon J
AANA J · 2023 Apr · PMID 38809204
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Release of the Workplace Civility White Paper.
Rojo A, Morgan B
AANA J · 2023 Apr · PMID 38809203
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Revision to Analgesia and Anesthesia for the Obstetric Patient.
Rojo A, Greenier E
AANA J · 2023 Apr · PMID 38809202
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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.
Kraus M, Montague E, Krawczyk S … +1 more , Simonovich SD
AANA J · 2023 Apr · PMID 36951844
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 skill...
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.
A Cognitive Template for Management of Perioperative Adverse Events.
Swerdlow B, Osborne-Smith L
AANA J · 2023 Apr · PMID 36951843
Perioperative crisis management commonly involves both rapid generic responses and slower abstract reasoning for the successful management of adverse events. A metacognitive approach to this process offers the potential...
Perioperative crisis management commonly involves both rapid generic responses and slower abstract reasoning for the successful management of adverse events. A metacognitive approach to this process offers the potential for minimizing errors and thereby improving outcomes. One such metacognitive technique uses templates that guide dynamic decisionmaking. Because stressful circumstances impair memory and cognitive function, templates may be particularly useful during crises both to improve functional recall and to provide mental constructs that compel anesthesia providers to organize their thoughts and direct approaches to problem-solving that rely on critical thinking rather than solely on heuristics. A six-step cognitive template is proposed for formulating a working diagnosis and deciding appropriate therapy during a perioperative adverse event. The template utilizes overlapping differential diagnoses organized using principles of anatomy and/or physiology. It has been effective in nurse anesthesia training to promote a metacognitive approach to decisionmaking during such events, and the template can be widely utilized in nonacademic settings for similar purposes.
Temporary Intraoperative Handoff Report Among Nurse Anesthetists: Utilization of Standardized Handoff Tools and Barriers to Implementation.
Allen R, Nemec C, O'Guin C … +2 more , Wright S, Dalley CB
AANA J · 2023 Apr · PMID 36951842
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 pro...
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%), ( X(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.
A Clinical Trial of a Novel Electroencephalography Device as a Predictor of Postoperative Delirium.
Barnwell LH
AANA J · 2023 Apr · PMID 36951841
Postoperative delirium is a public health and research priority. The International Perioperative Neurotoxicity Working Group recommends baseline cognitive function be assessed for older patients prior to surgery and anes...
Postoperative delirium is a public health and research priority. The International Perioperative Neurotoxicity Working Group recommends baseline cognitive function be assessed for older patients prior to surgery and anesthesia. Perioperative cognitive screening tools trialed in anesthesia are not routinely incorporated into clinical practice related to validity, reliability, or practicality concerns. The ideal perioperative cognitive screening tool would be rapid; easily administrable; valid; reliable; automatically scored; void of language, cultural, and education bias; and cost-efficient. No such tool currently exists. We explored baseline and postoperative neurocognitive characteristics that may help to establish predictive and trend metrics for perioperative neurocognitive assessment in older surgical patients using a novel, Food and Drug Administration-cleared point-of-care electroencephalography device (WAViMed™, Boulder, CO). To our knowledge, our study is the first to assess the device as a perioperative neurocognitive assessment tool. Although an association between P300 auditory-evoked potentials and Montreal Cognitive Assessment scores was not identified, further investigation is warranted given the magnitude of impact that such a device might have on patient outcomes and healthcare costs.
Educating the Georgian Community on the Value and Benefits of Advanced Practice Nursing.
Orkin JR, Layman J, Skibiski J
AANA J · 2023 Apr · PMID 36951840
Advanced practice nurses are not currently recognized in Georgia, the country intersecting Eastern Europe and Western Asia. With a critical nursing shortage and the brain-drain of graduate nurses in Georgia seeking highe...
Advanced practice nurses are not currently recognized in Georgia, the country intersecting Eastern Europe and Western Asia. With a critical nursing shortage and the brain-drain of graduate nurses in Georgia seeking higher pay and more respect in other countries, it is an opportune time to examine the potential for advancing nursing practice through education and professional mentorship. The aim of the study was two-fold. The first goal was to educate the local community about the profession of advanced practice nurse anesthesia and the benefits of advanced practice nursing in Georgia through a certified registered nurse anesthetist-led education session designed for a cohort of undergraduate biochemistry students. Second, a qualitative analysis identified the current state of nursing practice and directed the next steps toward nursing advancement, regulation, professionalism, access to quality care, and globally acceptable standards of practice. An education session held at San Diego State University Tbilisi, although not statistically significant, was successful in improving public knowledge. Qualitatively, the study established extreme enthusiasm for developing a nurse anesthesia program, licensure, regulation, standards of care, continuing education, and quality. In a country eager to advance, certified registered nurse anesthetists have the distinct opportunity of supporting Georgia's movement toward westernized healthcare.
Assessment Tools for the Evaluation of Simulation-Based Competency In Ultrasound-Guided Regional Anesthesia: An Integrative Review.
Beutler Crawford GL, Johnson B, Evans H
AANA J · 2023 Apr · PMID 36951839
Ultrasound-guided regional anesthesia (UGRA) requires the interaction of technical skills, manual dexterity, and cognitive knowledge which many novice anesthesia providers find challenging. Although simulation improves c...
Ultrasound-guided regional anesthesia (UGRA) requires the interaction of technical skills, manual dexterity, and cognitive knowledge which many novice anesthesia providers find challenging. Although simulation improves clinical competency and enhances patient safety, there is no standard tool for assessing UGRA competency in the simulation setting. Therefore, this integrative review aims to determine the most accurate, reliable, and feasible method of evaluating UGRA competency in a simulation environment. Strict inclusion and exclusion criteria were used to conduct this review, yielding 19 articles. The primary objective was the evaluation of validity and reliability outcomes of tools used to assess provider skill level. Secondary objectives were the evaluation of multirater agreement, internal and external reliability, and feasibility. Hand motion analysis and eye motion tracking demonstrated promising results, however, expense and training requirements limit widespread accessibility of those tools. The Regional Anesthesia Procedural Skills tool and McLeod checklist possessed discriminate ability of skill level, high interrater agreement, and feasibility in assessing psychometric competency in simulation. The Naik Global Rating Scale allows for assessment of nontechnical professional attributes. Based on the evidence of this review, the validity and reliability of these tools have the most utility as simulation-based competency tools compared with other tools reviewed.
Hemoglobin Louisville: A Case Report.
Morosanu I, Ergas Y, Cade M … +1 more , Scott-Herring M
AANA J · 2023 Apr · PMID 36951838
This case study examines a patient undergoing an elective procedure who had a past medical history of Hemoglobin Louisville and presented with baseline oxygen saturation levels (SpO) in the 80s as measured by noninvasive...
This case study examines a patient undergoing an elective procedure who had a past medical history of Hemoglobin Louisville and presented with baseline oxygen saturation levels (SpO) in the 80s as measured by noninvasive pulse oximetry. It presents the anesthetic provided, a brief review of physiology, and a discussion pertaining to this particular genetic mutation. Understanding the physiological implications of these types of hemoglobinopathies and their anesthetic management is key to managing patients' care throughout the perioperative period. With new hemoglobin variants continuing to emerge, reviewing some of the rare hemoglobinopathies is prudent to support the anesthesia community in their assessment and care of patients who present with unexpectedly low SPO.
Efficacy and Safety of Buprenorphine in a Single-Shot Peripheral Nerve Block: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Cook A, Tubog TD, Johnson W … +1 more , Evans H
AANA J · 2023 Apr · PMID 36951837
The purpose of this study was to evaluate the safety and efficacy of buprenorphine compared with placebo in prolonging the duration of analgesia in single-injection peripheral nerve block. The systematic review and meta-...
The purpose of this study was to evaluate the safety and efficacy of buprenorphine compared with placebo in prolonging the duration of analgesia in single-injection peripheral nerve block. The systematic review and meta-analysis were conducted following the PRISMA statement and Review Manager was used for meta-analysis. Outcomes were calculated using the mean difference (MD) with 95% confidence interval (CI) for continuous data. For dichotomous outcomes, effect sizes were estimated by calculating pooled risk ratio (RR) with 95% CI. Statistical heterogeneity was estimated by the I statistic. Compared with placebo, buprenorphine prolonged the duration of analgesia by an average of 8 hours (MD, 8.01; 95% CI, 6.79 to 9.24; P < .00001). The cumulative pain scores within 24 hours (MD, -0.8; 95% CI, -1.21 to -0.40; P < .0001) and the 24-hour opioid consumption (MD, -5.56; 95% CI, -10.60 to -0.52; P = .03) after surgery was lower with buprenorphine group. Conversely, buprenorphine increased the incidence of postoperative nausea and vomiting (PONV) (RR, 1.67; 95% CI, 1.16 to 2.39; P = .006). Buprenorphine is effective in prolonging analgesia, decreasing pain scores and opioid consumption, however, it increases the risk of PONV.
Sustained Implementation of an Evidence-Based Extubation Checklist Reduced Extubation Failure in Trauma Patients.
Howie WO, Howie BA, Gibbons ME … +5 more , Fouche'-Weber Y, Zangaro G, McMullen PC, Rock P, Anders MG
AANA J · 2023 Apr · PMID 36951836
Extubation failure remains a challenge in the perioperative setting. The aim of this intervention was to decrease the rate of perioperative extubation failure through the utilization of an extubation checklist. A five-it...
Extubation failure remains a challenge in the perioperative setting. The aim of this intervention was to decrease the rate of perioperative extubation failure through the utilization of an extubation checklist. A five-item evidence-based extubation readiness checklist was implemented at a level I trauma center on all patients who were electively extubated in the operating room (OR). Extubation failure rates before and after implementation of the checklist were compared. Of 26,867 trauma patients extubated in the OR after the intervention, 84 cases (0.31%) failed extubation in the immediate postoperative period. A significant and sustained decrease in extubation failure rate per case performed was observed between the pre- and post-checklist period (OR, 0.33; 95% CI, 0.19, 0.56; < 0.001). Partial (vs full) checklist completion, higher ASA physical status score, advanced age, and longer case length were independently associated with increased odds of extubation failure in the postintervention period.
The Administration of Tranexamic Acid For Complex Spine Surgery.
Jockel K, Lee A, Cosgrove MS … +2 more , Reilly D, Wijesekera S
AANA J · 2023 Feb · PMID 36722785
Currently, there are approximately 1.62 million instrumented spinal surgeries performed each year in the United States. Complex procedures such as wide exposures and composite osteotomies, compounded by the spine's exten...
Currently, there are approximately 1.62 million instrumented spinal surgeries performed each year in the United States. Complex procedures such as wide exposures and composite osteotomies, compounded by the spine's extensive vascular network, often result in major blood loss and increased fibrinolysis. Substantial intraoperative blood loss often necessitates blood transfusion and is a significant predictor of postoperative morbidity. Antifibrinolytic medications have been utilized prophylactically to reduce perioperative blood loss, particularly in surgeries where excessive blood loss is common. Tranexamic acid (TXA), a lysine analog that reversibly binds to plasminogen, inhibits the activation of plasminogen to plasmin, delaying clot degradation. The intravenous and topical administration of TXA during the perioperative period safely and effectively reduces blood loss, transfusion requirements, and/or hospital length of stay in patients undergoing major or complex spine surgery. Although the use of TXA for multilevel spine surgery is increasing, there remains widespread equivocality regarding ideal dosing regimens. Recent evidence suggests that high-dose TXA significantly reduces perioperative blood loss when compared with low-dose TXA, with no increase in perioperative morbidity and mortality. Translating this evidence into sustained change in clinical practice has the potential to improve both outcomes and blood product utilization in patients undergoing major or complex spine surgery.
Full Mouth Dental Restoration on a Treacher-Collins Patient Without Intubation.
Orr RW
AANA J · 2023 Feb · PMID 36722784
Patients with Treacher Collins syndrome have a known difficult airway particularly if intubation is required. In most institutions that perform full mouth dental restoration (FMDR) procedures the patient is nasally intub...
Patients with Treacher Collins syndrome have a known difficult airway particularly if intubation is required. In most institutions that perform full mouth dental restoration (FMDR) procedures the patient is nasally intubated to protect the airway from debris and irrigation fluid. For patients with Treacher Collins syndrome the actual intubation and securing the airway can be more difficult and traumatic than the actual dental restoration itself. However, there is an airway technique using nasopharyngeal airways combined with a dental technique called "dry prepping" that can provide those patients a safe way of receiving an FMDR without intubation. A recent case report of a 29-month-old child with Treacher Collins syndrome received an FMDR without intubation.
Design and Validation of a Simulation Scenario and Assessment Tool: A Pilot Project.
Flewelling GP, Augustine BD, Groom JA … +2 more , Kardong-Edgren S, Simmons VC
AANA J · 2023 Feb · PMID 36722783
In 2016, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) launched a Continued Professional Certification (CPC) Program to promote lifelong learning and to facilitate ongoing profes...
In 2016, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) launched a Continued Professional Certification (CPC) Program to promote lifelong learning and to facilitate ongoing professional competency checks for practicing certified registered nurse anesthesiologists (CRNA). The use of simulation-based assessment is currently being studied by the NBCRNA for potential use in the CPC Program. The aim of the pilot project was to create and validate simulation scenarios and assessment tools for potential incorporation into the CPC Program. Using the modified Delphi method, an expert panel of eight CRNAs evaluated the validity of four simulation scenarios and the content validity and reliability of four scenario-specific assessment tools. Each of the eight individual surveys assessing simulation scenario validity and assessment tool validity reached ≥ 75% agreement among the expert panelists. Overall content validity index values for the four assessment tools ranged from 0.960 to 0.993. There was a direct relationship between panelists' scores and level of performance on all returned assessment tools. The expert panel validated four simulation scenarios and four accompanying assessment tools. All scenarios and assessment tools were determined to have high content validity and reliability. Using these scenarios and assessment tools would provide unique advantages over standardized assessment methods.
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