Amendola S, Stemmler N, Cosgrove M
… +1 more, Ruggiero F
AANA J
· 2024 Aug · PMID 39056500
Approximately 0.6% of the United States population identifies as transgender or gender nonbinary. The term transgender refers to a person who experiences incongruence between their sex at birth and their gender identity....Approximately 0.6% of the United States population identifies as transgender or gender nonbinary. The term transgender refers to a person who experiences incongruence between their sex at birth and their gender identity. The care of the transgender patient is complex, often requiring the expertise of various medical and surgical specialties. The prevalence of gender-affirming surgery is increasing as societal acceptance and cultural norms are shifting. While gender-affirming procedures include a variety of body systems, airway and facial procedures are of particular importance to anesthesia providers. Anesthetic concerns for masculinization and feminization procedures of the airway and face include bleeding, injury to the airway, and other perioperative challenges. Transgender procedures of the airway and face often require advanced airway techniques. Following airway surgery, patients are at an increased risk for tracheal stenosis or perforation, glottic stenosis, vocal cord damage or dysfunction, and/or dysphagia. Additionally, transgender patients may undergo hormone therapy to achieve their gender goals. Providers should be aware of the implications associated with administration of hormones such as thromboembolic events, cardiovascular effects, and changes in various laboratory values. A knowledge of novel surgical procedures, medical therapies, and the psychosocial implications associated with transition is essential for the safe, comprehensive, and holistic care of the transgender patient.
Safely anesthetizing patients with left ventricular assist devices (LVADs) can be intimidating, particularly for novice anesthesia providers. Given the variety of complex issues anesthesia providers may encounter with pa...Safely anesthetizing patients with left ventricular assist devices (LVADs) can be intimidating, particularly for novice anesthesia providers. Given the variety of complex issues anesthesia providers may encounter with patients, it would be impractical to expect expertise in every population. To combat the inevitable loss of knowledge, education experts recommend active learning techniques, including test-enhanced learning, active recall, and spaced repetition. To that end, this research team created an LVAD Assessment for Anesthesia, or LAmA tool, to be evaluated for content validity by eight experts. The LAmA tool and content validity assessment were distributed to two anesthesiologists and four nurse anesthetists in the cardiothoracic anesthesia department at a hospital in Northeast Ohio, as well as to two outside nursing research experts. Results were analyzed by the research team and the content validity index (CVI) was determined. A CVI of at least 0.875 was required for the tool to be valid, and final scores in the categories of relevance, clarity, and importance were all ≥ 0.9. The data from the validated tool were used to create a pocket reference on LVAD anesthetic management. Both educational assessments and pocket references have the potential to positively impact knowledge retention and patient outcomes, making them excellent clinical resources.
Yerdon A, Woodfin K, Richey R
… +1 more, McMullan S
AANA J
· 2024 Aug · PMID 39056498
Intraoperative hypotension (IOH) is a common issue associated with acute kidney injury, myocardial injury, stroke, and death. IOH may be avoided with the incorporation of newer advanced hemodynamic monitoring technologie...Intraoperative hypotension (IOH) is a common issue associated with acute kidney injury, myocardial injury, stroke, and death. IOH may be avoided with the incorporation of newer advanced hemodynamic monitoring technologies. This case study examines the use of advanced hemodynamic monitoring with an early warning system for the intraoperative hemodynamic management of a patient presenting for pancreaticoduodenectomy. Incorporating the hypotension prediction index and other hemodynamic parameters to anticipate impending hypotension and treat potential causative factors is an emerging technological advancement. Understanding and embracing the potential for new advanced hemodynamic technology to reduce intraoperative hypotension's severity, duration, and occurrence is key to reducing negative patient outcomes.
Everson M, Hirsch M, Clayton BA
… +4 more, Callan V, Hranchook A, Wilbanks B, Jordan L
AANA J
· 2024 Aug · PMID 39056497
In March of 2020, the World Health Organization declared COVID-19 a pandemic. The pandemic had unprecedented impacts on nurse anesthesia education delivery. The aim of this mixed methods study was to describe and quantif...In March of 2020, the World Health Organization declared COVID-19 a pandemic. The pandemic had unprecedented impacts on nurse anesthesia education delivery. The aim of this mixed methods study was to describe and quantify the personal and educational impacts of the COVID-19 pandemic on student registered nurse anesthetists (SRNAs). Three themes emerged from the qualitative arm of the study: 1) COVID-19 caused feelings of isolation, anxiety, and stress; 2) COVID-19 was a financial silver lining; and 3) COVID-19 changed nurse anesthesia education delivery and learning for SRNAs. The quantitative arm of the study revealed that SRNAs experienced anxiety, social isolation, and a sense of being overwhelmed. Almost half of the participants received federal stimulus money. Most participants reported an increase in distance education delivery and virtual simulation. This study summarizes the impact of the COVID-19 pandemic on SRNAs and how nurse anesthesia education was altered.
The transversus abdominis plane (TAP) block is a regional anesthesia technique used as part of a multimodal pain management plan in patients undergoing abdominal surgery. There are numerous approaches and techniques desc...The transversus abdominis plane (TAP) block is a regional anesthesia technique used as part of a multimodal pain management plan in patients undergoing abdominal surgery. There are numerous approaches and techniques described in the literature, resulting in a lack of consistency in block performance. This potentially reduces efficacy while increasing risk to the patient. Competency assessment tools have been shown to lower patient risk and improve outcomes by improving provider skill. Checklists are used as formative and summative assessment tools throughout healthcare education, however, there is no validated tool for ultrasound-guided TAP blocks. The purpose of this evidence-based project was to develop a checklist using a modified Delphi method. The primary outcome measure was validation of the assessment tool, established by an expert panel consensus and guided by Messick's validity framework. A 43-item checklist was validated by six certified registered nurse anesthesiologists throughout the United States with expertise in regional anesthesia. Three rounds of feedback were required to exceed the threshold of consensus (0.8), establishing a method of evaluation that may allow future research in educational settings through improved skill assessment among providers performing TAP blocks.
Parilli-Johnson C, Pitman JS, Barbee K
… +5 more, Flowe A, Hooge N, Thompson JA, Dear G, Funk EM
AANA J
· 2024 Aug · PMID 39056495
Operating rooms (ORs) use energy-intensive equipment such as anesthesia gas machines, patient monitors, and lights. They are major contributors to an institution's carbon footprint; yet ORs are unoccupied 40% of the time...Operating rooms (ORs) use energy-intensive equipment such as anesthesia gas machines, patient monitors, and lights. They are major contributors to an institution's carbon footprint; yet ORs are unoccupied 40% of the time. Implementing an initiative to power down electrical devices can reduce energy consumption, equipment failure, and financial outlay. This quality improvement project developed and implemented a power down initiative for anesthesia staff to use in ORs. The initiative included turning off anesthesia gas machines, patient monitors, auxiliary oxygen delivery, and room lights at the end of scheduled cases in ORs that were not used for emergencies. Convenience audits were conducted. Pre- and postimplementation compliance outcomes showed that there was an increase in powering down the anesthesia gas machine, patient monitor, auxiliary oxygen, and room lights. Powering down unnecessary equipment at this facility has the potential to save approximately $50,000 and prevent the emission of over 80 metric tons of CO2 per year. Other facilities can implement a similar quality improvement project aimed at fiscal and ecological conservation.
Moral distress is recognized as a serious problem not only among healthcare providers, but also in the healthcare system in general. It is considered that moral distress in health care is defined as a phenomenon in which...Moral distress is recognized as a serious problem not only among healthcare providers, but also in the healthcare system in general. It is considered that moral distress in health care is defined as a phenomenon in which nurses know how to proceed ethically in certain situations but are constrained from acting. There are currently no studies conducted on moral distress among anesthesia and intensive care nurses in Latvia, but the moral distress scale has been adapted since beginning the research. Additionally, there have been no studies conducted in Latvia to analyze the correlations between the level of moral distress and burnout syndrome. The results of the conducted research confirmed H0 (null hypothesis), which suggests that there is no association between moral distress and burnout rates in nursing practitioners in anesthesiology and intensive care. The results of the study and a review of the existing literature suggest that there is a statistically significant relationship between moral distress rates and the rates of emotional exhaustion, as well as the rates of depersonalization.
Gonzalez MLR, Todd LA, Mitzova-Vladinov G
… +6 more, Kendon B, Betron C, Moore C, Henrichs B, O'Donnell JM, Pantone G
AANA J
· 2023 Oct · PMID 38809212
Simulation is an integral part of the healthcare educational landscape and a key element in the future of graduate professional education. For the past three decades, simulation-based educational methodology has been gai...Simulation is an integral part of the healthcare educational landscape and a key element in the future of graduate professional education. For the past three decades, simulation-based educational methodology has been gaining popularity in nurse anesthesia educational programs (NAEP). There is currently limited objective evidence documenting modalities used or educational outcomes addressed through simulation in NAEPs. In 2018, the American Association of Nurse Anesthesiology (AANA) established a Simulation Subcommittee of the AANA Education Committee and tasked the group with two primary goals: 1) to gain a better understanding of the current state of simulation education and 2) to review responses with regard to how NAEPs could best incorporate simulation elements within their curriculum to meet requirements while adhering to the guidelines of the Council on Accreditation of Nurse Anesthesia Educational Programs. A survey tool was developed and distributed to all programs to assess the utilization of simulation, available simulation resources, ongoing faculty development efforts, and barriers to use of this educational approach. Survey results indicated that simulation is valued as an effective method within NAEPs for a variety of teaching and learning activities and is utilized to support achievement of both technical and nontechnical learning outcomes for student registered nurse anesthetists.
Imposter phenomenon (IP) is an evolving, multidimensional construct defined as self-perceived intellectual phoniness and professional ineptitude frequently experienced by individuals working in high-performance or compet...Imposter phenomenon (IP) is an evolving, multidimensional construct defined as self-perceived intellectual phoniness and professional ineptitude frequently experienced by individuals working in high-performance or competitive environments. IP consequences include psychological distress, role underoptimization, and career dissatisfaction. As high-achieving advanced practice nurses in a profession often evaluated by peers, certified registered nurse anesthetists (CRNAs) are at risk for IP. Identifying impostorism early in the CRNA's career and adopting healthy management strategies can optimize the nurse anesthesiologist's healthcare role, lead to a more fulfilling career, and support personal wellness.
King D, Greenier E, Caballero M
… +1 more, Morgan B
AANA J
· 2023 Aug · PMID 38809193
The American Association of Nurse Anesthesiology Practice Committee and subject matter experts recently evaluated newly published cannabis guidelines titled "ASRA Pain Medicine Consensus Guidelines on the Management of t...The American Association of Nurse Anesthesiology Practice Committee and subject matter experts recently evaluated newly published cannabis guidelines titled "ASRA Pain Medicine Consensus Guidelines on the Management of the Perioperative Patient on Cannabis and Cannabinoids." A summative review of the evidence-based guidelines provides essential recommendations, which are directly applicable to certified registered nurse anesthetist clinical practice.
D'Angelo M, Sims J, Leiter E
… +2 more, Attilio P, Kertes S
AANA J
· 2023 Aug · PMID 38809192
The U.S. was at war for nearly two decades, supporting unprecedented survival on the battlefield. As the nation pivots to a relative peace, it is critical that U.S. Army certified registered nurse anesthetist (CRNA) lead...The U.S. was at war for nearly two decades, supporting unprecedented survival on the battlefield. As the nation pivots to a relative peace, it is critical that U.S. Army certified registered nurse anesthetist (CRNA) leaders mitigate the loss of lessons learned and prepare future Army CRNAs for war. This article describes the U.S. Army CRNA Readiness Model that incorporates the knowledge, skills, and abilities required to sustain readiness. This model will provide U.S. Army nursing leaders with the framework to implement and evaluate solider readiness to provide anesthesia in operational environments.
Quiet quitting is a term used to describe the idea of doing the minimum that is required to do your job but not outright quitting. With the extended fatigue from the COVID-19 pandemic and escalating workforce staffing sh...Quiet quitting is a term used to describe the idea of doing the minimum that is required to do your job but not outright quitting. With the extended fatigue from the COVID-19 pandemic and escalating workforce staffing shortages, quiet quitting could be a phenomenon occurring with certified registered nurse anesthetists. Wellness strategies to mitigate quiet quitting are discussed.
Benson AR, Horvath C, Everson M
… +1 more, Schoneboom B
AANA J
· 2024 Apr · PMID 38809188
Olive Berger was a true nurse anesthesia pioneer for our profession. She dedicated her life to the advancement of nurse anesthesia through her leadership, advocacy, scholarly writing, clinical achievements and innovation...Olive Berger was a true nurse anesthesia pioneer for our profession. She dedicated her life to the advancement of nurse anesthesia through her leadership, advocacy, scholarly writing, clinical achievements and innovation. She blazed the trail by forming and establishing education requirements for nurse anesthesia programs, established a state nurse anesthesia organization, and led the American Association of Nurse Anesthetists as its 14th president in 1958. She was the Chief Certified Registered Nurse Anesthetist and Program Director at the Johns Hopkins Hospital and is best known for her collaboration with surgeons Dr. Alfred Blalock and Dr. Helen Taussig, providing anesthesia care during the groundbreaking repair of tetralogy of Fallot on infants.
Caballero M, Butera E, Schmack D
… +2 more, Greenier E, Morgan B
AANA J
· 2024 Jun · PMID 38758720
The American Association of Nurse Anesthesiology (AANA) Practice Committee, in collaboration with AANA Professional Practice staff, advisory panels, and subject matter experts, annually applies a standardized evidence-ba...The American Association of Nurse Anesthesiology (AANA) Practice Committee, in collaboration with AANA Professional Practice staff, advisory panels, and subject matter experts, annually applies a standardized evidence-based process to review, evaluate, and revise clinical resource documents found in the (Certified Registered Nurse Anesthetist) and on the AANA website. This article highlights several revised and newly developed documents, which include topics such as diversity, equity, and inclusion, anesthesia and analgesia for obstetric patients, and safe injection guidelines.