AANA journal最新文献

The utilization of simulation has proved to be a valuable tool to train students in the academic setting in preparation for the clinical environment. Student registered nurse anesthetists (SRNAs) receive limited education and training on the use of powered air-purifying respirators when caring for patients with highly infectious diseases (i.e., COVID-19). The purpose of this pilot study was to assess SRNAs' knowledge, self-confidence, and psychomotor skills for the safe performance of donning and doffing of powered air-purifying respirators while managing the airway. A single group pretest and posttest descriptive study was conducted over 7 months which included 45 SRNAs. There was a statistically significant increase in knowledge (P = < .001) and self-confidence (P = < .001) on safe donning and doffing of powered air-purifying respirators for emergent intubation. Descriptive statistics on the psychomotor skills revealed that the SRNAs were able to demonstrate donning and doffing of powered air-purifying respirators for emergent intubation during simulation. Findings suggest that simulation is an appropriate strategy and is relevant for nurse anesthesia educators to consider when training SRNAs to don and doff while managing the airway for patients with COVID-19.

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.

This report presents an unusual case of epiglottic downfolding through the vocal cords which occurred during direct laryngoscopy and loss of view with intubation. Few indicators of an issue were present postintubation, but the providers' interest in one peculiar detail led to timely discovery of the issue avoiding any further injury or complications to the patient.

In spring 2020, a global SARS-Cov-2 pandemic was declared. The number of patients in need of intensive care exceeded the number of available care places at intensive care units (ICUs) and certified registered nurse anesthetists (CRNAs) were relocated to ICUs to support the care during the pandemic. The aim of this study was to illuminate the experiences of the CRNAs regarding relocation to COVID-19 intensive care. An interview study based on qualitative content analysis was conducted. The participants were CRNAs who usually work in the operating unit, however, were relocated to work in the COVID-19 ICU at a university hospital in southern Sweden during the pandemic. Four themes emerge in the results: sense of pride, competence, work environment, and nursing. The results illuminate the CRNAs' experience of relocating from their usual working environment to caring for critically ill patients in a COVID-19 ICU. The CRNAs managed the relocation well, although sometimes it was difficult. The CRNAs showed great loyalty, dedication, competence, and flexibility in their professional capacity. The time they worked in COVID-19 intensive care was a challenging period, but it gave them a well-deserved sense of pride and competence.

The effects of racial/ethnic discrimination in the clinical setting have been shown to cause psychological distress in populations of healthcare workers. However, there are currently no published studies that investigate racial/ethnic transgressions in the clinical arena and their impact on the well-being of student registered nurse anesthetists (SRNAs). The current study aimed to investigate 1) the prevalence and nature of racial/ethnic bias during clinical education and 2) its impact on wellness in a cohort of SRNAs. Data were collected using a three-part 16-item electronic questionnaire distributed to a national sample of SRNAs. A significant association was found between race/ethnicity and an increased incidence of discrimination (χ₂ [5] = 24.1, P < .001). SRNAs who described experiencing at least one discrimination encounter during their training had significantly higher mean Well-Being Index scores-associated with more distress-compared with those students who had never experienced discrimination (P < .05). Participant responses were categorized into five major themes: overt discrimination, covert discrimination, disparate treatment, barriers to reporting, and incivility/bullying. Addressing the distinctive challenges related to race/ethnicity in clinical sites is paramount to ensuring the success of minority SRNAs.

Temperature regulation during the perioperative period plays an essential role in keeping patients safe while optimizing their recovery. The World Health Organization recommends preserving normothermia, identified as a core body temperature greater than 36°C, to minimize morbidity and mortality. The etiology of inadvertent perioperative hypothermia (IPH) varies in origin. Preoperative exposure, decreased ambient operating room (OR) temperature, skin exposure during preparation, unwarmed skin preparation and washout solutions, and lack of warming devices all contribute to IPH. Moreover, general and regional anesthesia blunt the physiologic response to hypothermia which originates in the hypothalamus. Postoperatively, patients with temperatures < 36°C are at greater risk for surgical site infection, increased mortality, longer length of hospital stay, higher 30-day readmission rates, among other complications. Identifying preoperative risk factors and OR practices that contribute to IPH, monitoring temperatures, and use of warming devices during the perioperative period can help to prevent IPH.

Eagle's syndrome is a condition characterized by elongation of the styloid process or calcification of the styloid ligament that can manifest as a constellation of symptoms including dysphagia, globus sensation, hoarseness, headache, and neck pain. Anatomically, this can impinge neurovascular structures, distort the hypopharynx, and stiffen the epiglottis and other pharyngeal structures, increasing the difficulty of airway management. The objective of this case study was to discuss the features of Eagle's syndrome and anesthetic considerations in the management of the condition. Intubation may be challenging and presents a scenario where a glidescope is the preferred tool over direct laryngoscopy. Smooth emergence and extubation strategies, including the novel use of lidocaine and dexmedetomidine, are followed to minimize the risk of surgical complications.

Anterior cervical osteophytes (ACOs) are a common condition in the elderly, leading to dysphagia, odynophagia, aspiration, neck pain, dysphonia, and dyspnea. Transoral surgical resection is an approach to managing cervical (C1 and C2) ACOs where the endoscopic endonasal approach is contraindicated. Advantages of the transoral approach include it providing direct access to the cervical spine, limits injury to surrounding neurovascular structures, and eliminates scarring. Anesthesia considerations for transoral surgical resection of ACOs will be covered in the following case report. A review of the literature examines the prevalence of and anesthesia considerations for the transoral approach to anterior cervical osteophyte resection.

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.