Nurse Anesthetists Research Articles

A Cross-Sectional Survey on the Clinical Management of Emergence Delirium in Adults: Knowledge, Attitudes, and Practice in Mainland China.

Background: Emergence delirium (ED) occurs immediately after emergence from general anesthesia, which may have adverse consequences. This cross-sectional survey assessed Chinese physicians’ and nurses’ knowledge of, attitudes towards, and practice regarding ED in adults. Methods: Electronic questionnaires were sent to 93 major academic hospitals across mainland China and both attending anesthesiologists and anesthesia nurses were recommended to complete them. Results: A total of 243 anesthesiologists and 213 anesthesia nurses participated in the survey. Most of the participants considered it a very important issue; however, less than one-third of them routinely assessed ED. In terms of screening tools, anesthesiologists preferred the Confusion Assessment Method, while anesthesia nurses reported using multiple screening tools. Divergence also appeared with regard to the necessity of monitoring the depth of anesthesia. Anesthesiologists considered it only necessary in high-risk patients, while the nurses considered that it should be carried out routinely. No unified treatment strategy nor medication was reported for ED treatment during the recovery period. Conclusions: This study illustrated that there are high awareness levels among both Chinese anesthesiologists and anesthesia nurses regarding the importance of ED. However, a specific practice in terms of routine delirium assessment, anesthesia depth monitoring, and a standardized treatment algorithm needs to be implemented to improve ED management.

Discussion on the Application Effect of Humanistic Nursing Service in Anesthesia Nursing

Discussion on the Application Effect of Humanistic Nursing Service in Anesthesia Nursing

Anesthesia Nursing of Patients Undergoing Laparoscopic Appendectomy

Anesthesia Nursing of Patients Undergoing Laparoscopic Appendectomy

Application of intelligent management mode for drugs and consumables in anesthesiology department.

To explore whether anesthesiologists' efficiency can be increased via the use of intelligent equipment, thereby improving the quality of surgical anesthesia. This paper first introduces the intelligent management system and work flow of drugs and consumables in the department of anesthesiology in our hospital, and then compares the time before and after the use of intelligent equipment, the time for anesthesiologists and nurses to manage drugs and consumables, the misdistribution rate of drugs distributed by anesthetic nurses, and the inventory time and accuracy of narcotic drugs. For the intelligent management with intelligent drug cabinets and logistics robots as the terminal, compared with traditional management, the anesthesiologist saves an average of 24±1 (min) per day in acquisition of drugs and consumables, and the total error rate in drugs and consumables distribution by anesthesia nurses is reduced from 4% to 1%, the inventory time of anesthetic drugs is 12±5 (min) earlier than before, and inventory accuracy has been increased from 94.6% to 98.6%. The anesthesia nurses save an average of 53.1±10 (min) per day from taking medicines to operating anesthesia billing than before. The intelligent management of drugs and consumables in the Anesthesiology Department improves management efficiency, ensures medication safety for surgical patients, increases anesthesia management time for anesthesiologists, and improves the quality of surgical anesthesia.

Obstetric Anesthesia Procedure-Based Workload and Facility Utilization of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Designated Institutions.

Optimal workload and staffing for obstetric anesthesia services have yet to be determined. We surveyed Society of Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence (COE) for Obstetric Anesthesia Care institutions to evaluate procedure-based obstetric anesthesia workload and facility use. After institutional review board (IRB) exemption, an online survey instrument (REDCap) was sent by email (1 initial and 2 reminders) to all SOAP COEs. Survey data included the number of deliveries, cesarean delivery rate, neuraxial labor analgesia rate, the number of labor and operating rooms, and the number of in-house and backup obstetric anesthesia providers. Obstetric anesthesia activity was estimated using a time-based workload ratio per provider (Stanford Work Index, 1.0 = clinically working every minute of every hour on duty) during weekday, weeknight, and weekend shifts. We compared workload between academic and nonacademic centers and correlated operating and labor rooms with cesarean and vaginal delivery volume. Fifty-one of 53 surveys were returned (96% response rate). Data from 33 academic and 14 nonacademic US institutions were analyzed. For academic centers, median Stanford Work Index for all staff (included trainees and Certified Registered Nurse Anesthetists) was 0.20 (weekday) and 0.19 (weeknight and weekends); nonacademic centers were 0.33 (weekday, P < .001 versus academic), 0.23 (weeknight, P = .009 versus academic), and 0.23 (weekends, P = .03 versus academic practices). Attending-only Stanford Work Indices were similar between academic and nonacademic centers. Total number of rooms on the obstetric suite (operating, labor, or triage room) was strongly correlated with delivery volume ( R2 = 0.55). The results outline staffing procedure-based workload ratios and facility utilization at SOAP COEs in the United States. These data can be used by other institutions that provide obstetric anesthesia services to guide their obstetric anesthesia staffing. The importance of considering the workload associated with different shifts and between academic and nonacademic centers is also highlighted. The results show that approximately one-third of an obstetric anesthesiologist's workload is spent on performing procedures. We did not, however, measure the other tasks anesthesiologists practice as peripartum physicians (eg, managing critically ill parturients, doing pre- and postprocedural evaluations, or performing emergent and unexpected procedures), and future studies are required to determine the time required to perform these tasks. Studies to determine the optimal staffing models to handle workload fluctuations and improve outcomes are also required.

Anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China: a cross-sectional observational study

ObjectiveThe aim of this study was to explore the current status of the anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China.DesignA cross-sectional observational study of hospitals, anaesthesiologists, assistant...

Lactation in Anesthesiology.

There are several work-related barriers to breastfeeding among physician mothers including: lack of appropriate place for breastmilk expression, unpredictable and inflexible schedules, and lack of time to breastfeed or express milk. In a survey of physician mothers, those who were in surgical and procedural subspecialties, including anesthesiology, reported a lack of lactation facilities in close proximity to the operating room as a barrier to breastfeeding. Unlike other physicians and clinicians in different health care environments, anesthesiology is unique in that there is often no built-in time for breaks or a predictable end time to the operating room schedule. A break system is typically established, within an institution, for meal break relief for trainees, Certified Registered Nurse Anesthetist, and Anesthesia Assistants. This system for breaks may not be sufficient to accommodate the frequency or length required for lactation sessions. In addition, these break systems do not typically provide relief for supervising anesthesiologists for meals or lactation sessions. A study of physician mothers across specialties identified anesthesiologists as significantly more likely than women of other medical specialties to self-report maternal discrimination. The study defined maternal discrimination as discrimination based on pregnancy, maternity leave, or breastfeeding. As a workforce and specialty, we must support our breastfeeding anesthesiologists and facilitate lactation needs on return to the workplace.

Assessment of Anaesthesia Nurses’ Attitude to Teamwork

Abstract Teamwork is one of the most important aspects in medicine today. It is known that the operating room is the place where communication is most needed between doctors and other medical staff. The purpose of this study was to analyse the view of nurses towards collaboration between the physician and nurse in an anaesthesiology department depending on education and work experience. The study was conducted in three Lithuanian hospitals. The questionnaires “Jefferson scale of attitudes toward physician–nurse collaboration” and “Barriers of communication between doctors and nurses” were used. The statements of the questionnaires were rated using the Likert scale; the attitude was evaluated as positive when the assessment was more than median (2.5). The results were processed by SPSS Statistics 23.0 pack, using descriptive statistics and ANOVA, with statistically significant results when p &lt; 0.05. A total of 138 nurses participated in this study, all female, aged 43.00 ± 12.48 years and with different education levels. According to the nurses, the most important aspects of teamwork were dominance of physicians (3.08 ± 0.65), nurse’s autonomy (3.46 ± 0.54), patient care (3.33 ± 0.56) and sharing knowledge and cooperation (3.33 ± 0.47) (F = 12.47; p &lt; 0.001). Patient care and autonomy of nurses were most important aspects for nurses with higher education and short job experience, and physician dominance was the most important for nurses with a longer job experience and lower education level. Barriers to cooperation arising from environmental factors are the greatest drivers for ineffective teamwork.

Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice

Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia care to thousands of patients each year. Despite increased anesthetic safety, low-frequency, high-risk perioperative critical events still occur. Although CRNAs have been expected to rely on memory alone to manage the spectrum of these critical events, the use of an emergency manual (EM) may improve CRNA performance. At one Army community hospital, recent experiences with similar critical events led to the development of the following question: Will the use of high-fidelity simulation training with the staff CRNAs on the use of EMs produce both increased performance in key tasks and positive satisfaction scores related to the use of the emergency manual during critical events now and in the future? Twenty staff CRNAs participated in high-fidelity simulated scenarios involving low-frequency, high-risk critical events before and after training on the use of an EM based on a change strategy developed by Goldhaber-Fiebert and Howard in 2012. Changes in performance after training were evaluated using a tool designed by Arriaga et al. Before EM training, CRNAs completed 46.05% of key tasks in the simulated scenario. After EM training, CRNAs completed up to 94.02% of key tasks in simulated scenarios. The observed increase in the completion of key tasks by CRNAs during simulated critical events after EM training and increase in satisfaction scores demonstrates how a well-constructed training program facilitates the implementation of an evidence-based EM into practice and can improve the quality and consistency of CRNA performance during low-frequency, high-risk perioperative events.

Application of Predictive Nursing in Anesthesia Nursing of Operating Room

Application of Predictive Nursing in Anesthesia Nursing of Operating Room

Epidural analgesia information sessions provided by anesthetic nurses: impact on satisfaction and anxiety of parturient women a prospective sequential study

BackgroundInformation on epidural analgesia delivered to parturient women is frequently incomplete, making it difficult for expectant mothers to make an appropriate choice for their delivery. We assessed the impact of a multimodal information session on epidural analgesia delegated to anesthetic nurses on new-mothers’ satisfaction.MethodsWe performed a prospective sequential study including parturient women who gave birth with epidural analgesia. During the first period, information on epidural analgesia was delivered by anesthetists during the scheduled anesthesia consultation, according to French standard-of-care. Then, a dedicated information session about epidural analgesia provided by anesthetic nurses was implemented. The primary endpoint was the satisfaction of women with the quality of information received. Main secondary endpoints were knowledge of women about epidural analgesia, anxiety before epidural catheter placement, and satisfaction with delivery.Results259 and 298 women were included during the first and second periods respectively, among whom 178 and 188 were analyzed. Information on epidural analgesia delivered by anesthetic nurses was associated with improvement of new-mothers’ satisfaction with information received (9 (8–10) vs. 10 (9–10) – p < 0.001). Moreover, information delivered by anesthetic nurses was associated with decreased anxiety before epidural catheter placement (4 (1–8) vs. 3 (1–6) – p = 0.006) and increased satisfaction with delivery (8 (7–10) vs. 9 (8–10) – p = 0.01). Women’s knowledge on epidural analgesia was durably increased when information was delivered by anesthetic nurses compared to conventional information by anesthetists. After adjustment, the only variable associated with both new mothers’ satisfaction with information and delivery was the information session taught by anesthetic nurses.ConclusionsInformation sessions on epidural analgesia delivered by anesthetic nurses was associated with improved satisfaction of women with their delivery. Such information sessions may be used in maternity wards to improve new-mothers’ childbirth experience.

An Overview of the Implications for Perianesthesia Nurses in terms of Intraoperative Changes in Temperature and Factors Associated with Unintentional Postoperative Hypothermia.

Patients undergo surgery and anaesthesia on a daily basis across the United States and throughout the world. A major source of worry for these patients continues to be inadvertent hypothermia, once core temperature <36°C (96.8°F). Despite well-documented adverse physiological consequences, anaesthesia nurses continue to have a difficult task in keeping patient warmth pre-/peri-/post-surgical procedure. Thermostasis within postoperative patient necessitates the collaboration of many individuals. In order to provide safe and high-quality treatment, it is essential to use the most up-to-date data to guide therapeutic procedures targeted at achieving balance body temperature in surgical patients. Providing a review of the physiology of perioperative temperature variations and the comorbidities linked with accidental intraoperative hypothermia, this article will also provide preventive and treatment methods.

Experiences using an instrument for non-technical skills in nurse anaesthesia education: a focus group study

BackgroundAlthough there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists’ Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice.MethodsThis study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach.ResultsSix categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants’ experiences with using the instrument:Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour.Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation.Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance.ConclusionIncreased awareness of non-technical skills when using Nurse Anaesthetists’ Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists’ Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student’s learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.

Interprofessional Teamwork in a Tertiary Referral Academic Hospital in Boston

From the Front Lines| April 2022 Interprofessional Teamwork in a Tertiary Referral Academic Hospital in Boston Shahla Siddiqui, MD, MSc, FCCM; Shahla Siddiqui, MD, MSc, FCCM Search for other works by this author on: This Site PubMed Google Scholar Vanessa T. Wong, BS; Vanessa T. Wong, BS Search for other works by this author on: This Site PubMed Google Scholar Mary Ellis, BSN, RN; Mary Ellis, BSN, RN Search for other works by this author on: This Site PubMed Google Scholar Tara S. Kent, MD, MS, FACS; Tara S. Kent, MD, MS, FACS Search for other works by this author on: This Site PubMed Google Scholar Michael J. Chen, BS; Michael J. Chen, BS Search for other works by this author on: This Site PubMed Google Scholar John D. Mitchell, MD John D. Mitchell, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2022, Vol. 86, 40–41. https://doi.org/10.1097/01.ASM.0000827012.35158.01 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Shahla Siddiqui, Vanessa T. Wong, Mary Ellis, Tara S. Kent, Michael J. Chen, John D. Mitchell; Interprofessional Teamwork in a Tertiary Referral Academic Hospital in Boston. ASA Monitor 2022; 86:40–41 doi: https://doi.org/10.1097/01.ASM.0000827012.35158.01 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: patient referral, work teams Our institution, Beth Israel Deaconess Medical Center (BIDMC) in Boston, is a teaching tertiary referral academic hospital of Harvard Medical School. There are 673 licensed beds, including 493 medical/surgical beds. There are 77 critical care beds and 62 OB/GYN beds. The perioperative nursing staff provides patient-focused care to the surgical patient population as well as surge ICUs during the pandemic. The patient population includes cardiothoracic, vascular, orthopedics, neurosurgery, transplant, general surgery, trauma, ENT, GYN, podiatry, GI, ophthalmology, cardiology, and urology patients on two campuses. A multidisciplinary team consisting of RNs and surgical and anesthesia teams provide perioperative patient care. The COVID-19 pandemic has wrought havoc among health care staff and the general population. Communication and teamwork among anesthesia providers, surgeons, and nurses can be key in the smooth transition and delivery of perioperative patient care and satisfaction. Therefore, interprofessional interaction and teamwork are valuable skills for our anesthesiology residents rotating... You do not currently have access to this content.

Could Your Patient be Taking Uber or Lyft Post-Anesthesia? A New Era for Transportation Policy and Practice Considerations

PurposeThe purpose of this project was to examine nurse anesthetists’ practice and encounters with ambulatory surgery patients experiencing transportation difficulties after the provision of anesthesia. DesignA mixed method approach was used. MethodsAn eleven-item questionnaire was disseminated nationally to 2,827 Certified Registered Nurse Anesthetists (CRNAs) practicing in the outpatient setting. The survey consisted of multiple-choice questions and open text for qualitative assessment. Questions focused on frequency of encounters with patients experiencing transportation difficulties post-anesthesia and policies for rideshare options. FindingsA total of 43% of responding CRNAs work in a clinical practice setting in which patients have the option of being discharged using rideshare (Uber/Lyft) but only if accompanied by an adult. Issues emerged around patient safety when using a rideshare service for discharge postanesthesia. ConclusionsThe proliferation of rideshare options may provide increased access to surgical services in the outpatient anesthesia care setting. Practice considerations associated with transportation policies for postanesthesia patients in the era of rideshare services are warranted.

Discussion on the Application of Predictive Nursing in Anesthesia Nursing of Operating Room

Discussion on the Application of Predictive Nursing in Anesthesia Nursing of Operating Room

Safeguarding the patient: a grounded theory study of registered nurse anesthetists\u2019 main concerns in the process of extubation in the anesthesia setting

BackgroundThe process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist.AimTo obtain a deeper understanding of Registered Nurse Anesthetists’ main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia.ParticipantsA total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II).MethodA classic grounded theory approach with a qualitative design was used for this study.FindingsThe RNAs’ main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: ‘Having a back-up plan’, ‘Getting into the right frame of mind’, ‘Evaluating the patient’s reactions’, ‘Using one’s own experience’, ‘Dealing with uncertainty’, ‘Pressure from others’, and ‘Being interrupted’. The theory, Safeguarding the patient in the process of extubation, emerged.ConclusionTo be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR.

Study on the Application Effect of Refined Nursing in Anesthesia Nursing of Operating Room

Study on the Application Effect of Refined Nursing in Anesthesia Nursing of Operating Room

Perfusion Practice in Kenya.

Standards and guidelines for cardiopulmonary bypass have been established by various professional societies. They serve as an instrument to guide safe and effective patient care. We conducted a survey of practicing perfusionists in Kenya to learn about their background, education, current clinical practice and about their knowledge, and attitude regarding standards and guidelines. Two multiple-choice surveys were distributed to all known practicing perfusionist in Kenya using SurveyMonkey (San Mateo, CA). Multiple-choice questions related to professional background, training, annual procedure volume, staffing models, clinical practices, the use of safety devices, and the use of checklists were included in the questionnaires. The survey also inquired about familiarity with American and European perfusion practice standards and guidelines and opinions on establishing standards in Kenya. Responses were received from 12 perfusionists practicing at 10 centers. Professional backgrounds included anesthesia nursing, clinical officers, and critical care nursing. Sixty-seven percent (8/12) received formal training and 33% (4/12) trained primarily through clinical instruction. Of those that received formal training, 63% (5/8) received 1-2 years of training, 25% (2/8) <1 year but more than 6 months, and 12.5% (1/8) received 6 months of formal training. The median clinical experience was 5 years (range 1-22). The median annual case load was 54 (range 0-100). Use of safety devices was reported as follows: level sensor 75% (9/12), air bubble detector 17% (2/12), one-way vent valves 67% (8/12), continuous venous oxygen saturation monitoring 25% (3/12), and gas supply analyzers 33% (4/12). More than one-third of the respondents had no knowledge of the American and European perfusion practice standards, and nearly two-thirds were aware of or had read them. This survey provides contextual information about perfusion practice in Kenya in 2021. There was consensus among perfusionists to develop standards and practice guidelines for Kenya.

Where are the practising nurse anaesthetists in Australia? Exploring an advanced practice role for anaesthesia nurses

The perioperative environment has seen the implementation of the perioperative nurse surgical assistant as an advanced practice nursing role for the instrument nurse; however, there is currently no recognised equivalent role for the anaesthesia nurse. Anaesthesia nurses complete post-graduate qualifications and learn advanced clinical skills, and yet the authoritative body for perioperative nurses, the Australian College of Perioperative Nurses, does not define a specific role for advanced practice nursing in anaesthesia. Career advancement for the anaesthesia nurse focuses on education and management roles which are a distinct deviation from advanced clinical practice. A new role should be developed to allow the advanced practice nurse in anaesthesia to be recognised and their skills used in Australian operating rooms.