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The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Clinical preceptorship is an effective teaching tool for Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs). Strategies for success and barriers to effective clinical preceptorship have been explored across the literature to improve learning experiences for SRNAs., Purpose: The purpose of this literature review was to identify barriers to effective clinical preceptorship in the field of nurse anesthesiology., Method: A rapid review of the literature utilizing PubMed, Embase, CINAHL, Scopus, and Cochrane Library ultimately yielded 14 relevant articles., Results: Clinical preceptorship in the discipline of nurse anesthesiology has a significant impact on both student experiences and preceptor satisfaction. Barriers within the clinical preceptorship model have been identified across the literature from both the preceptor and student perspectives., Conclusions: The overarching theme is that development of clinical preceptor workshops and specific guidelines would enhance the experiences of both clinical preceptors and students and allow goals and objectives to be more easily met., Competing Interests: Declaration of competing interest We have no known conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice., Aim: This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses., Study Design: This study adopted a mixed-methods approach., Methods: Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics., Results: Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training)., Conclusion: IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care., Relevance for Clinical Practice: The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

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., Competing Interests: Name: Sarah Margaret-Ruth Srour, DNP, BA, APRN-CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Margaret (Peggy) Contrera, DNP, APRN-CRNA, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Lee Anne Siegmund, PhD, RN, ACSM-CEP, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

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., Competing Interests: Name: Marjorie Everson, PhD, CRNA, CNE, FNAP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Maria Hirsch, MS, DNAP, CRNA, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Beth Ann Clayton, DNP, CRNA, FAANA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Vicki Callan, PhD, CRNA, CHSE, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Anne Hranchook, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Bryan Wilbanks, PhD, DNP, CRNA, FAANA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Lorraine Jordan, PhD, CRNA, CAE, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None The authors did not discuss off-label use within the article. Disclosure statements are available upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Purpose: Although most anesthetic drugs are classified as compatible with breastfeeding, literature shows that anesthesia providers routinely advise patients to discard milk when receiving all types of anesthesia. The purpose of this project was to determine if a multimodal educational module and cognitive aid improved student registered nurse anesthetists' knowledge and confidence to counsel lactating patients on current anesthesia-related recommendations., Design: This project used a pre-experimental one-group, pretest and post-test design., Methods: Preintervention and postintervention surveys measured knowledge and confidence to counsel lactating patients scheduled to receive anesthesia., Findings: Significant improvement in knowledge and confidence after the intervention were noted., Conclusions: A multimodal educational session and cognitive aid improved student registered nurse anesthetists' knowledge about current anesthesia-related breastfeeding recommendations and their confidence in counseling these patients. Wider use of this educational module with the cognitive aid has the potential to positively impact breastfeeding patients and their children., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: Name: Kevin Bayaca, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Christian R. Falyar, DNAP, CRNA, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Jessica D. Pitman, DNP, CRNA, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Virginia C. Simmons, DNP, CRNA, CHSE-A, FAANA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

Human anatomy education serves as a gateway for entering the intricacies of health science. Human cadavers have been the gold standard for learning regional and gross anatomy. However, increasing barriers in acquisition, maintenance, and longevity have pushed anatomy education toward technology-based alternatives such as the Anatomage Table (AT), an interactive, life-sized virtual dissection table with many anatomy education-centric features. The AT has found purchase in various contexts, such as clinical settings, research, outreach, and education. Studies into the efficacy of the AT in teaching settings have been generally positive but limited in its application, particularly in clinical procedure education. In this study, we conducted an informal workshop for second-year Certified Registered Nurse Anesthetist (CRNA) students to aid in being able to identify the important neuraxial landmarks for performing peripheral nerve blocks (PNBs), an anesthetic technique often used before other procedures. In our workshop, we paired the AT with identification of the same neuraxial landmarks on volunteer models with an ultrasound probe to provide students with relevant tactile experience for the procedure. From our pre-/post-surveys of the participants ( n = 29), we found that our workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for and in performing PNBs. Our results support the use of the AT in clinical education as a supplement, particularly where other anatomic teaching tools, such as cadaver models, may be too difficult to implement. NEW & NOTEWORTHY We implemented the Anatomage Table (AT) and portable ultrasound to teach neuraxial landmarks for performing peripheral nerve blocks (PNB), an anesthetic technique for Certified Registered Nurse Anesthetist (CRNA) students. The workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for performing PNBs. Our results support the use of the AT in clinical education as a supplement.

Background: The diversity in the workforce of Certified Registered Nurse Anesthetists does not reflect the changing demographics., Purpose: This study aimed to evaluate a national mentorship program supporting underrepresented nurses' applications for nurse anesthesia education programs., Methods: Convenience sampling was employed to recruit the participants for this descriptive cross-sectional survey. The survey had 23 questions, including 21 multiple-choice questions and two open-ended questions., Findings: A total of 1,133 participants participated in the survey study. The average score of overall respondents' satisfaction level on the program was 4.87, with almost all participants (1,116, 98.6%) feeling satisfied or very satisfied with the program. The respondents provided 565 comments on the program (i.e., nine domains and 49 themes) and 842 learning reflection notes (i.e., eight domains and 53 themes)., Discussion: This national initiative is a promising intervention to help underrepresented nurses get ready for nurse anesthesia education program applications., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Errors in reasoning are the main causes of poor decision-making in clinical practice. To remedy this, many studies highlight the importance of supervising clinical reasoning during medical internships. Although decision-making is an ongoing process at all key moments of the perioperative period, there are no studies on the supervision of clinical reasoning during student nurse anesthetist internships. The objective of this study was to identify the characteristics of the supervision of clinical reasoning by anesthesia professionals with student nurse anesthetists., Methodology: A multicenter qualitative study was carried out using observations and individual interviews with five nurse anesthetists and five students., Results: Three themes are identified : the characteristics of the learner’s and supervisor’s posture ; the teaching methods used ; and the specificities of clinical reasoning., Analysis: The nurse anesthetists question clinical reasoning only when they detect difficulties in the student. However, no traceability is carried out. Students spontaneously verbalize their clinical reasoning when unexpected events occur., Discussion: The results will be used as a basis for a new tool for tracing learning during internships.

Chest radiographs provide vital information to clinicians. Medical professionals need to be proficient in interpreting chest radiographs to care for patients. This review examines online methods for teaching chest radiograph interpretation to non-radiologists. An online database search of PubMed and the Cochrane Databases of Systematic Reviews revealed 25 potential evidence sources. After using the similar articles tool on PubMed, eight evidence sources met the inclusion criteria. Three sources supported the use of online learning to increase students' confidence regarding chest radiograph interpretation. The evidence suggests that through self-directed online learning, students can learn skills to diagnose disease processes as well as to confirm the placement of invasive lines and tubes. Using online learning for teaching radiograph interpretation to non-radiologists is an evolving practice. A flexible schedule is needed when implementing the electronic learning process for busy students. Monitoring module completion and postlearning assessment of knowledge is important. Further research is warranted on electronic teaching of chest radiograph interpretation in nurse anesthesia programs. A list of potential online resources for teaching chest radiograph interpretation is presented., Competing Interests: Name: Lisa Hood, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Hope Seelinger, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Sharon M. Burns, EdD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Paul N. Austin, PhD, CRNA, FAANA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

Approximately 6.5 million people in the U.S. are affected by an intellectual or developmental disability (IDD). However, their healthcare needs often remain unmet due to the inadequate education and training of healthcare professionals. Given that various procedures may require anesthesia in as many as 40% of individuals with IDD, Certified Registered Nurse Anesthetist Programs need to incorporate IDD training into their curriculum. A cross-sectional survey using a 12-item questionnaire was conducted to assess IDD training. Statistical analyses included the chi-square test and participant demographics were reported as frequencies or percentages. Numerical data were presented as means and standard deviations. A total of 277 respondents completed the survey and most reported (55%) a lack of IDD training at nurse anesthesia programs and 90% recognized the need for additional training. Only 24% felt competent in providing care for patients with IDD, while 52% reported feeling somewhat or very competent. A significant correlation was found between the number of clinical anesthesia experiences and self-rated competence ( P < 0.001). Incorporating IDD training into the nurse anesthesia curriculum is critical to preparing competent graduates capable of serving this diverse population. Nurse anesthesia programs should evaluate their curriculum to effectively address this healthcare inequality., Competing Interests: Name: Virginia Londahl Ramsey, DNAP, CRNA, APRN, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Tito D. Tubog, PhD, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Tammy Sadighi, DNP, APRN-FNP, MBA, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Traci Mays, MLIS Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

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 Professional Practice Manual for the CRNA (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., (Copyright © by the American Association of Nurse Anesthetists.)

Anesthesia providers must be experts in advanced airway management techniques such as laryngeal mask airway and endotracheal tube insertion. However, practicing anesthesia providers may work in clinical settings where advanced airway management techniques are rarely required. Infrequent advanced airway skill performance in these clinical settings can lead to skill decay, which is the gradual loss of acquired skills through infrequent practice or extended periods of skill nonuse. This literature review synthesizes available evidence regarding advanced airway management skill decay. Themes emerging from the literature review include skill decay association with decreased endotracheal intubation success rates, a timeframe within which advanced airway management skill decay may begin to occur, and recommendations for preventing decay of advanced airway management skills. With infrequent use of advanced airway skills in clinical settings, routine practice is crucial for skill maintenance. Clinical simulation could play a role in mitigating skill decay among practicing anesthesia providers at risk for decay in advanced airway management skills resulting from skill nonpractice., Competing Interests: Name: Russ Branch, DNP, CRNA, ACNP-BC, CNE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Katie Cole, DNP, CRNA, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

Background: Performing CPR (Cardiopulmonary Resuscitation) is an extremely intricate skill whose success depends largely on the level of knowledge and skill of Anesthesiology students. Therefore, this research was conducted to compare the effect of the scenario-based training method as opposed to video training method on nurse anesthesia students' BLS (Basic Life Support) knowledge and skills., Methods: This randomized quasi-experimental study involved 45 nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran in 2022-2023. The practical room of the university formed the research environment. The participants were randomly divided into three groups of scenario-based training, video training, and control. Data were collected by a knowledge questionnaire and a BLS skill assessment checklist before and after the intervention., Results: There was a significant difference between the students' scores of BLS knowledge and skill before and after the educational intervention in both SG (scenario group) (p < 0.001) and VG (video group) (p = 0.008) (p < 0.001). However, no significant difference was observed in this regard in the CG (control group) (p = 0.37) (p = 0.16). Also, the mean scores of BLS knowledge and skills in the SG were higher than those in the VG (p < 0.001)., Conclusion: Given the beneficial impact of scenario-based education on fostering active participation, critical thinking, utilization of intellectual abilities, and learner creativity, it appears that this approach holds an advantage over video training, particularly when it comes to teaching crucial subjects like Basic Life Support., (© 2024. The Author(s).)

Background: Without highly qualified nurse anesthesia educators and administrators, the health care system will be threatened by the inadequate supply of certified registered nurse anesthetists (CRNAs)., Purpose: American Association of Nurse Anesthesiologists' Faculty Stabilization Task Force (FSTF) analyzed reasons for high faculty turnover and developed recommendations to support nurse anesthesia faculty and administrators., Methods: A survey evaluated participants' current role, leadership development opportunities, mentorship experiences, and resource needs., Results: Of 109 respondents, 87 (80%) were program administrators or assistant administrators with less than 5 years of experience in their role. Despite academic experience, 51% felt adequately prepared for their role., Conclusions: The FSTF provided 2 recommendations: to create a robust faculty development program for all faculty at all levels of CRNA education and a repository of information needed for program administrators and faculty to oversee and educate students in a high-quality CRNA program., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Working in the perioperative context is complex and challenging. The continual evaluation in this environment underscores the need for adaptability to technological advancements, and requires substantial allocation of resources for training and education. This study aimed to explore personality characteristics of nurse anesthetists and surgical nurses that are instrumental for sustainable employability in technologically advanced environment., Methods: Exploratory, cross-sectional survey study including nurse anesthetists and surgical nurses, both certified and in training, and a sample of the normative Dutch population. Personality characteristics were identified with the Big Five Inventory, which consisted of 60 items answered on a five-point Likert scale (strongly disagree to strongly agree)., Results: Specific personality traits were found for nurse anesthetists and surgical nurses when compared to the normative Dutch population. Traits of both nurse anesthetists and surgical nurses differed significantly on all domains of the Big Five Inventory, with the largest differences found within the dimension negative emotionally., Conclusions: This study highlights the role of specific personality traits in maintaining employability within the rapidly evolving and technologically advanced landscape of healthcare. It emphasizes the relationship between individual traits and professional excellence, being crucial educational strategies for overall improvement in healthcare., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Skill decay refers to the loss of skills and knowledge resulting from lack of consistent use. Among certified registered nurse anesthetists (CRNAs), skill decay can lead to negative results. One method that has been shown to mitigate skill decay is low-dose, high-frequency (LDHF) simulation. There is a gap in the LDHF simulation literature regarding CRNAs to determine its effectiveness in reducing skill decay or increasing confidence levels., Method: This study used a quasi-experimental pretest-posttest follow-up design. The pretests and posttests were evaluated using a Wilcoxon signed rank test to determine CRNAs' proficiency and confidence in central venous catheter (CVC) insertion before and after a simulated refresher training course., Results: The CRNAs showed a significant improvement in CVC insertion proficiency, from a 50% pretest average to a 94% posttest average ( p < .0001), and they retained proficiency 6 months later (91%, p = .0109). There was no significant change in CRNAs' confidence level following the training ( p = .4486)., Conclusion: A program of LDHF simulation training is an important activity in meeting the continuing education/training needs of CRNAs in improving and retaining CVC insertion proficiency. This study demonstrates the efficacy of a LDHF simulation program for CRNAs and helps to bridge the gap in the literature on the use of LDHF simulation among CRNAs. [ J Contin Educ Nurs . 2024;55(4):187-194.] .

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., Competing Interests: Charles A. Griffis, PhD, CRNA, FAANA Contributions: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Elizabeth Bamgbose, PhD, CRNA, FAANA Contributions: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Maria Van Pelt, PhD, CRNA, FAAN, FAANA Contributions: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Holli DeVon, PhD, RN, FAAN Contributions: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Holly Wilhalme, MS Contributions: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Kristen Choi, RN, PhD, PMHNP-BC, FAAN Contributions: This author made significant contributions to the conception, synthesis, writing and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

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., Competing Interests: Name: Michelle L.R. Gonzalez, PhD, CRNA, CHSE-A, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: L. Alan Todd, DNP, CRNA, CHSE, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Greta Mitzova-Vladinov, DNP, APRN, CRNA, CHSE, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Brett Kendon, DNP, CRNA, DipCA, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Cynthia Betron, DNP, CRNA, CHSE, CNE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Chad Moore, DNP, CRNA, CHSE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Bernadette Henrichs, PhD, CRNA, CCRN, CHSE, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: John M. O’Donnell, DrPH, CRNA, CHSE, FSSH, FAANA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Gina Pantone, MPH Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. American Institutes for Research®, Arlington, VA, conducted an IRB expedited review of this project on 7/30/21. It was determined that EX00560 Simulation Subcommittee Nurse Anesthesia Program Simulation Survey was exempt from further human subjects review., (Copyright © by the American Association of Nurse Anesthetists.)

The transition from classroom academic environment to clinical patient-focused learning is a celebrated milestone, yet it is a source of stress and anxiety for student registered nurse anesthetists (SRNAs). In nurse anesthesia education, limited information exists on perceptions of clinical readiness, either from the certified registered nurse anesthetist (CRNA) clinical educators' or the SRNAs' experiences. The purpose of this study was to explore the perceptions of CRNA clinical coordinators and SRNAs regarding clinical readiness as the students transition from classroom to clinical training. A qualitative descriptive design from a postpositivist philosophical mindset was utilized and a semistructured interview guide and content analysis methodology described by Graneheim and Lundman was used. Seventeen participants were interviewed. Four themes emerged from the analysis of the CRNA clinical coordinators' perceptions: 1) going in with good attitudes and professionalism, 2) the expectation of clinical readiness, 3) mental preparedness, and 4) solid simulation experiences. Additionally, four themes emerged from the content analysis of students' perception: 1) expectations of readiness is higher than anticipated, 2) transitional orientation/adjuncts for preparedness, 3) sound didactic training, and 4) simulation and the effects of COVID-19. While prioritization is different, educators and SRNAs value knowledge, skills (including simulated), and positive attitudes as measures of clinical readiness., Competing Interests: Name: Tito D. Tubog, PhD, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Scott K. Shaffer, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Terri D. Kane, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Jennifer D. Hestand, EdD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

A nurse anesthesia educator shortage exists that is attributed to factors such as a lack of financial incentive and proper training to be an educator. Due to the faculty shortage, nurse anesthesia programs (NAPs) are forced to defer admission to qualified applicants which reduces the number of certified registered nurse anesthetists (CRNAs) that NAPs can produce. Research regarding students as teaching assistants (TAs) at the university level has shown benefits and challenges to students, professors, and the TAs themselves as well as the impact on the overall faculty capacity. Current research regarding TA programs does not pertain to NAPs, therefore, research regarding the impact of TA programs on increasing nurse anesthesia faculty merits further work. This study was conducted using quantitative surveys and qualitative interviews to bridge the gap in the literature on the potential impact of TA programs on NAP faculty shortages. A survey was sent via email to former TAs (n = 44) of the Georgetown University NAP to assess the impact that the TA program had on their decision to enter a role in academia after graduation. Interviews were then conducted on a voluntary basis via a video conferencing platform to add qualitative data to the survey results. The survey response rate was 45% (n = 20). Following proportional analysis, 80% of the survey respondents indicated that they participated in the education of student registered nurse anesthetists in the clinical or didactic setting as a CRNA. Eighty percent of respondents indicated that being a TA positively influenced their desire to become a faculty member. One hundred percent of CRNAs interviewed reported that the biggest barrier to becoming fulltime faculty was the lack of financial incentives offered by NAPs. Interviewees recalled their TA experience as the foundation for their enjoyment of teaching anesthesia. The results of this study indicate that TA programs in NAPs can be used as a method to increase faculty capacity., Competing Interests: Name: Olivia Baker, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Hannah Sparks, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Carrie Bowman Dalley, PhD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Marjorie Everson, PhD, CRNA, FNAP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Nancy Crowell, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None Name: Ladan Eshkevari, PhD, CRNA, LAc, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None, (Copyright © by the American Association of Nurse Anesthetists.)

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., Competing Interests: Name: Amy Yerdon, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author; this author is the corresponding author. Disclosures: None. Name: Kenneth Taylor, DNP, CRNA, CMQ Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors would like to thank Karen Taylor, DNP, RN, CNE for reviewing and editing the article and Lauren Antia for her adaptation and creation of Figures 1 and 2., (Copyright © by the American Association of Nurse Anesthetists.)

The clinical learning environment is essential for student registered nurse anesthetists (SRNAs) to develop intricate clinical knowledge and acquire proficiency in technical skills required for anesthetic care. The perioperative experience of an SRNA can differ greatly based on the program, preceptor, hospital rotation, or geographic location. This literature review synthesizes the historical and current state of certified registered nurse anesthetist (CRNA)/SRNA preceptorship in the clinical setting. Themes analyzed include the current CRNA/SRNA learning and teaching environment, student perceptions of effective CRNA preceptors, evaluation tools and feedback practices, and overall CRNA preceptor preparedness as well as the availability and effectiveness of preceptor training programs. We compare their findings to best practices seen in the United States Air Force (USAF) pilot training program because of its similar "high stakes" learning environment and utilization of a preceptor teaching model. Actionable recommendations, based on CRNA preceptorship data, preceptorship theory, and the USAF pilot training model are presented in the effort to improve preceptor transfer of knowledge and SRNA clinical competence., Competing Interests: Name: Logan MacLean, CRNA, DNP Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Julie Fairman, RN, PhD, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Current funding: RWJF Future of Nursing Scholars Program., (Copyright © by the American Association of Nurse Anesthetists.)

Lack of moral courage may lead to moral stress for healthcare personnel and to unethical behavior or adverse events for patients. Hospital operating room (OR) teams include surgeons, OR nurses, Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, and student registered nurse anesthetists (SRNAs). Due to the multidisciplinary work in a stressful, high-technology and high-risk environment, the OR is the context for most of the unethical behavior reported in hospitals. The purpose of this study was to explore SRNA experiences of moral courage in the OR. We used a critical incident technique, utilizing 40 SRNA narratives of situations including moral courage/lack of moral courage. The narratives were analyzed using thematic analysis. Findings indicate that unethical behavior potentially leading to patient safety or work environment issues could be avoided when OR personnel showed moral courage by speaking up for patients or for colleagues. Lack of moral courage was indicated by tacit acceptance of unethical behavior or lack of collaboration. SRNAs need not only to learn about the CRNAs' professional obligations and tasks but also to develop moral courage to be able to respond to unethical behavior or communication in the OR. Hence, students should be introduced to such issues during their education., Competing Interests: Name: Anne-Marie Gran Bruun, RN, NA, MNSc Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Berit T. Valeberg, RN, NA, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Ann-Chatrin L. Leonardsen, RN, NA, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

While knowledge surrounding opioid-free anesthesia (OFA) has increased in current literature, there is an absence of research specific to nurse anesthesia practice. This study aimed to identify the number of surveyed Certified Registered Nurse Anesthetists (CRNAs) who incorporated OFA into practice and uncovered barriers to its implementation. This quantitative survey solicited data from 2,883 CRNAs across the United States. Of the participants, 81% administered OFA, and 88% felt that OFA techniques are beneficial in anesthesia practice. The results of the survey revealed that gender may be a barrier to the implementation of OFA. Female respondents were less likely to administer OFA often due to the facility culture. The level of education also influenced how CRNAs perceived their facility's culture as a barrier. Perceived access to a variety of multimodal anesthetics was also problematic. While most of those surveyed had administered OFA and acknowledged its benefit, barriers to wider implementation still exist., Competing Interests: Name: Morgan Morrow, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Amanda Gibson, DNAP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Amy Stein, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Sharon Burns, EdD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request. Grant support provided by Midwestern University Glendale Office of Research ' Sponsored Programs., (Copyright © by the American Association of Nurse Anesthetists.)

Perioperative goal-directed fluid therapy (GDFT) is a prime component of the Enhanced Recovery After Surgery (ERAS) protocol. Multiple studies have demonstrated a relationship between GDFT and positive patient outcomes, including shorter hospital stays, decreased ileus formation, reduced gastrointestinal-related issues, decreased nausea, and hemodynamic stability. Electrolyte disturbances following a positive fluid balance may occur, and GDFT is aimed at euvolemia to avoid a hypervolemic state. Carbohydrate loading, early discontinuation of postoperative intravenous fluids, and use of isoosmotic solutions all are components of GDFT. Lactated Ringer's solution is the fluid recommended for nonrenal patients and patients with hepatic compromise. The negative consequences associated with hypervolemia deem it pertinent to devise an individualized GDFT plan in the ERAS protocol., Competing Interests: Name: Nina McLain, PhD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Stephanie Parks, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Mary Jane Collins, DHA, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

In 1934, Gertrude Fife, President of the National Association of Nurse Anesthetists (NANA) sought to elevate the standards of anesthesia practice and standardize the education of nurse anesthetists. NANA members located schools, developed education standards and a school approval process, that eventually led to creation of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) in 1975. Examination of historical documents demonstrated that COA developed into a well-known accreditation agency recognized by both governmental and non-governmental organizations, enhancing the standards of anesthesia education and promoting high-quality educational programs. Note: See the April 2020 issue of AANA Journal for Part One of this article., Competing Interests: Name: Betty Horton, PhD, CRNA, FAAN; Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Michael Kremer, PhD, CRNA, CHSE, FNAP, FAAN; Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Simulation is an effective tool to learn or refresh skills and knowledge, but numerous barriers prevent the routine use of simulation. The purpose of this project was to assess the feasibility and acceptability of the use of a low-tech simulation kit by the hospital's personnel for overcoming those barriers. A phenomenological qualitative approach using semistructured interviews was conducted with a convenience sample of 5 Certified Registered Nurse Anesthetists (CRNAs) and a student registered nurse anesthetist at a rural community hospital. Additionally, a CRNA served as the facilitator and was interviewed. After the data were independently analyzed by 2 individuals, 6 themes emerged. A low-tech simulation was acceptable, although the sense of stress was difficult to replicate. The facilitator found that simulation preparation and execution were easier and less work than expected. A low-tech simulation kit is a viable option for increasing the frequency of simulating anesthesia emergencies and overcoming the barriers that prevent the frequent use of simulation in the clinical setting. Psychological fidelity can be enhanced through innovative methods (flip book containing screenshots of an electrocardiographic monitor, video) to overcome the limitations of a low-tech simulation., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article., (Copyright © by the American Association of Nurse Anesthetists.)

In patients with difficult airways, there can be difficulty with advancing the endotracheal tube into the airway even with a good view of the glottis using video laryngoscopy. The purpose of this study was to determine if the time required to intubate an airway and the number of gaze changes by the laryngoscopist could be decreased by using a novel video laryngoscope technique. Sixteen experienced Certified Registered Nurse Anesthetists were recruited to intubate a manikin with a normal or difficult airway using both the laryngoscope first technique and a new endotracheal tube first technique (4 intubations total) in a randomized sequence. The data were analyzed with the Mann-Whitney (U) test to compare the differences between the normal and difficult airway conditions. Although no significant difference was noted in the time to intubation between intubation techniques, the number of gaze changes was found to be significantly fewer in the tube first technique (P=.0009). A steep learning curve, associated with the accommodation of the manikin, was demonstrated by a decrease in time and gaze changes with subsequent intubations. Incorporating the endotracheal tube first technique into an education curriculum could increase patient safety by decreasing the time to secure a difficult airway., Competing Interests: The authors have no financial relationships with any commercial interest related to the content of this article. The authors did not discuss off-label use within the article., (Copyright © by the American Association of Nurse Anesthetists.)

Nurse anesthesia programs are stressful, with routine information overload, immersion into new environments, and financial stressors. One strategy to combat this stress is to practice clinical skills in the less intimidating and safe environment of simulation. Evidence strongly suggests that simulation is an important component of a well-rounded nurse anesthesia program. However, no simulation literature was found to assist the transition of student registered nurse anesthetists (SRNAs) into their cardiac anesthesia rotations. The purpose of this evidence-based practice improvement project was to create an open-heart surgery simulation that supplemented the cardiac curriculum of second-year SRNAs, in order to improve self-efficacy prior to their cardiac clinical rotation. Twenty-three SRNAs, enrolled in a nurse anesthesia doctorate of nursing practice program, participated in the anesthesia simulation in cardiac surgery. After the students' anesthesia simulation experience, they shared in a debriefing session and completed a survey-based evaluation. When SRNAs were asked their level of agreement to the statement "I am confident that I am developing the skills and obtaining the required knowledge from this simulation to perform necessary tasks in a clinical setting," the mean score was 4.61, with 5 indicating strongly agree. Overall, SRNAs agreed that skills they learned in the simulation would transfer to their cardiac rotation., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article., (Copyright © by the American Association of Nurse Anesthetists.)

Simulation is used in anesthesia training to reinforce didactic learning. The authors hypothesized that knowledge acquisition in the use of transesophageal echocardiography (TEE) could be accomplished better through the use of a simulator than with online or web-based learning. A total of 71 student registered nurse anesthetists were randomly assigned to either web-based or simulator-based TEE training. Using the same rubric, each group was instructed to use 11 views to identify 12 different cardiac structures. In addition, 15 cardiac abnormalities ("pathologies") were identified through either the simulator or a web-based link. The effect of the interventions were measured using a video-based (ExamSoft) assessment to validate improved knowledge of cardiac structures, recognition of ultrasonographic views, and identification of cardiac pathology. Although both groups demonstrated significant improvement, students who trained with the simulator scored higher than the web-based group, 69.4 vs 42.3 (P < .01). Scores were compared using the Mann-Whitney test and 2-tailed t tests. Implementation of TEE training using either modality improved TEE-related knowledge, and both are recommended as a supplement to conventional didactic training., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

There is a lack of standardization among evaluations completed by clinical educators of student registered nurse anesthetists (SRNAs) during their clinical education as reported by nurse anesthesia program administrators and students. To address this issue, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) Board created the Common Clinical Assessment Tool (CCAT) Special Interest Group to develop a standardized clinical evaluation instrument. The goal was to improve the consistency of clinical evaluation across nurse anesthesia programs while assisting program administrators to make programmatic changes to ensure compliance with COA standards. In May 2016, the CCAT Special Interest Group began to create an evaluation instrument that was competency based and reflective of the COA's Practice Doctorate Standards. After a review of literature, input from the communities of interest, results from the American Association of Nurse Anesthetists professional practice survey, and analysis of the National Certification Examination for Nurse Anesthetists content outline and information from other sources, a draft CCAT was completed. A Delphi study was conducted, and expert opinions from program administrators, academic and clinical faculty, and students were collected to ascertain consensus on competencies, competency descriptors, and progression indicators., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Major depressive disorder affects tens of millions of people each year. One-third of those affected have depression that is resistant to conventional pharmacologic, psychologic, or somatic treatments. Patients with treatment-resistant depression have few remedies other than electroconvulsive therapy or transcranial magnetic stimulation. Recent research has highlighted the promising antidepressant effects of subanesthetic ketamine infusions. This journal course examines the efficacy of ketamine for treatment-resistant depression. Evidence from 10 systematic reviews and randomized controlled trials suggest that most of the researchers concluded ketamine significantly decreased depression severity ratings at short-term assessment intervals, whereas evidence examining the long-term effects is lacking. Ketamine infusion therapy was generally well tolerated, with minimal untoward effects. Large, randomized controlled trials are needed to discern the longer-term efficacy, tolerance, and dependence profiles of ketamine infusions. Optimal dosing schedules to best prolong the antidepressant effects of ketamine have yet to be determined., Competing Interests: Albert Arredondo, DNAP, CRNA, is the co-owner of a healthcare facility offering the administration of ketamine for treatment-resistant depression. The other authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did discuss off-label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)

Increasing the number of nurses of color is one solution for eliminating health disparities and increasing quality of care. This study examines the impact of a 2-tiered outreach, education, and intervention approach on candidates of color applying to and gaining acceptance in a graduate nurse anesthesia program. The authors implemented individual- and social-level recruitment strategies over three 12-month periods targeting candidates of color nearing eligibility for applying to nurse anesthesia programs at 2 points: colleges and workplace. Strategies included developing information sessions and workshops, partnering with diversity organizations, and strategic recruiting. Because institutionalized admissions criteria play a role in patterns that may present barriers to candidates of color, admissions processes were reviewed. Interventions were developed and implemented to move toward equitable admissions processes, including increased panel diversity, interviewer training, standardized question pool, revised scoring rubric, online scoring, and inclusion of nontraditional evaluation criteria. Demographic data were collected when candidates completed an application. Data analysis compared 2016-2018, 2017-2019, and 2018-2020 candidates with historical applicant data using regression analysis at 3 stages of the admissions process: completed applications, interviews, and admission offers. Recruitment strategies resulted in significant gains in applicant diversity (P < .05). Targeted education resulted in increased diversity across program candidates and enrollees., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services under grant number D19HP26972 and title, “CRNAs in 3D: Increasing Diversity, Reducing Disparities, & Understanding the Social Determinants of Health” ($1,026,153). The authors did not discuss off- label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)

Background: In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries., Methods: Between 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation., Results: One hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36-72, 9-48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia)., Conclusions: Despite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts.

Aim: To investigate whether the CanMEDS-based International Federation of Nurse Anesthetists' Standards could adequately define the scope of practice and reliably be used to train and evaluate Swiss nurse anesthetists (NAs)., Background: Although nurse anesthetists represent a majority of the global workforce in anesthesia, policies that define the scope of practice are frequently non-existent. In low- and middle-income countries, the lack of anesthesia providers with adequate training is a major challenge., Introduction: Despite stringent training requirements, the scope of practice of Swiss nurse anesthetists is actually not defined. Therefore, we surveyed and assessed whether nurse anesthetists felt that the professional competencies outlined in this framework were aligned with their clinical practice., Methods: A cross-sectional survey investigated Swiss nurse anesthetists' relevance ratings of 76 competencies of the International Federation of Nurse Anesthetists according to their professional practice. Cronbach's alpha coefficients were used to determine the internal consistency of the competencies, as well as factor analyses to assess construct validity of these competencies integrated into the CanMEDS roles model., Results: Participants rated the Standards overall as very relevant with high reliability. Factor analyses provided evidence of construct validity of these., Discussion: The International Federation of Nurse Anesthetists' Standards of Practice provide a highly relevant framework and a valuable set of competencies for the scope of practice of Swiss nurse anesthetists, which enabled translation from global guides to local national standards., Conclusion and Implication for Nursing and Health Policy: Adopted by low- and middle-income countries or countries where national standards are non-existent, this survey could introduce national and local policies at minimally acceptable standards of care for nurse anesthetists worldwide. The above standards have the potential to align education, outcomes and assessment of nurse anesthetists with the needs of national healthcare systems., (© 2019 The Authors International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

IntroductionA convergence of needs has enabled nurse anesthetist students (NASs) to lead, for the last four years, an educational workshop that has been a great success among nursing students (NSs).BackgroundSome types of care are characterized by an absence or limited opportunity for internship learning. A clinical solution has been provided based on the theories and processes of active and experiential learning.ObjectivesThe objective of the study was to assess the relevance for and effects on the NSs of the system set up by the NASs.MethodsA post-hoc quantitative monocentric analytical survey was conducted on all participating NSs. The statistical analyses were performed in Excel© for the closed questions. The units of analysis identified in the responses to the survey's open-ended question were processed by semantic categorization.ResultsThe model, which was praised for its form and content, enabled NSs to acquire skills in line with expectations. Being taught by the NASs is considered to be less stressful than when a trainer is involved. The NASs were able to arouse the interest of the NSs, who consider them more legitimate in both their technical and teaching skills. However, the NSs remain cautious about their abilities to prepare and carry out the actions studied.

The International Federation of Nurse Anesthetists (IFNA) is a federation of 45 national anesthesia organizations. Among its activities are setting global standards for anesthesia practice, patient monitoring, and anesthesia education, as well as creating a code of ethics. This article focuses on the use of its education standards as the foundation for the International Federation of Nurse Anesthetists' Anesthesia Program Approval Process. The approval process strongly encourages educational institutions throughout the world to improve the education of nurse anesthetists and other nonphysician anesthetists, with the ultimate goal being patient safety. The approval process also promotes the use of nurses to administer anesthesia whenever adequate resources are available., Competing Interests: The IFNA Education and Research Foundation awarded a grant to the IFNA Education Committee for a Pilot Accreditation Project in 2010. Additional grants have been awarded by the IFNA Board of Directors Executive Committee in support of on-site visits to some nurse anesthesia schools. The authors are current or retired members of IFNA’s Education Committee, which developed and administered the APAP. The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Introduction: Healthcare simulation supports educational opportunities while maintaining patient safety. To reduce costs and increase the availability of training, a randomized controlled study evaluated central venous catheter (CVC) insertion training in the simulation laboratory with nonphysician competent facilitators (NPCFs) as instructors., Method: A group of learners naive to central line placement participated in a blended curriculum consisting of interactive online materials and simulation-based training. Learners were randomized to training with NPCFs or attending physician faculty. The primary outcome was simulated CVC insertion task performance, graded with a validated checklist by blinded physician reviewers. Learner knowledge and satisfaction were also evaluated. Analysis was conducted using noninferiority testing., Results: Eighty-five students, 11 attending physicians, and 7 NPCFs voluntarily participated. Noninferiority testing of the difference in CVC insertion performance between NPCF-trained learners versus physician-trained learners found no significant difference [rejecting the null hypothesis of inferiority using an 8% noninferiority margin (P < 0.01)]. In addition, there was no difference found between the 2 groups on pre/post knowledge scores, self-reported learner comfort, course satisfaction, or instructor satisfaction., Conclusions: An introductory CVC curriculum can be taught to novice learners by carefully trained and supported NPCFs and achieve skill and knowledge outcomes similar to learners taught by physicians.

Ultrasonography (US) proficiency has become a desirable skill for anesthesia providers. It is commonly used in the perioperative arena for establishing peripheral and central vascular access. Establishing intravenous access is one of the most common procedures performed by Certified Registered Nurse Anesthetists (CRNAs) as frontline anesthesia providers. However, there is no structured US training program for CRNAs for vascular access at our institution. We designed and implemented a multimodality US training program specifically for the use of surface US for central and peripheral vascular access for CRNAs. The course was conducted over 2 days and consisted of an online self-paced didactic component, integrated proctored hands-on workshops, and a posttraining examina-tion to quantify knowledge gain. Twenty-five CRNAs attended the course, with significant improvement in knowledge (pretest mean (SD) score = 59.13% (15.74%) vs posttest mean score = 70.0% (9.43%), P = .03). Two weeks after the course, each participant reported that they attempted 1.46 (1.56) ultrasound-guided vascular access procedures on average. Therefore, it is feasible to design short, focused, multimodality training programs for proficiency in the use of surface US for obtaining venous access. The CRNA's proficiency in US is likely to improve efficiency, patient experience, and safety., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Early recognition of intraoperative critical events is essential in optimizing the health outcomes of surgical patients. Use of simulation in nurse anesthesia education allows students to practice recognizing changes in the patient's condition in a safe learning environment. Second- and third-year student registered nurse anesthetists were randomly assigned to 2 groups to explore differences in recognizing intraoperative myocardial infarction (MI) using highfidelity mannequin simulation vs virtual simulation. One group participated in a virtual simulation first, followed by a high-fidelity mannequin simulation. The other group participated in a high-fidelity mannequin simulation first, then virtual simulation. Second-year students recognized an intraoperative MI faster when using high-fidelity mannequin simulation than when using virtual simulation. However, there was no significant difference among third-year students in the time it took to recognize a critical event when using high-fidelity mannequin simulation vs virtual simulation. These findings indicate that both simulation modalities are useful in evaluating student registered nurse anesthetists' timely recognition of intraoperative critical events such as MI. However, for students with less didactic and clinical practicum experience in the program, such as second-year students, the use of high-fidelity mannequin simulation for recognizing an intraoperative MI may be more beneficial than virtual simulation., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

National and state legislative decisions have an impact on the care that Certified Registered Nurse Anesthetists (CRNA) provide their patients. Historically, professional advocacy resulted in CRNA title recognition and direct reimbursement for CRNA services and led to providing states an opt-out option for medical supervision when billing Medicare and Medicaid. It is critical that CRNAs continue to grow as advocacy leaders and, in preparing for this role, each CRNA must be provided with the knowledge and skills to be successful. The objective of this research project was to determine the impact that CRNA advocacy education in Pennsylvania nurse anesthesia educational programs has on students' professional involvement. Two surveys were distributed to all 12 Pennsylvania nurse anesthesia educational programs to determine the quality and quantity of advocacy education incorporated into their program and how it affected the professional political involvement of senior student registered nurse anesthetists. Pearson r calculations were conducted to assess for correlations between variables. The results showed a strong positive correlation between advocacy education in nurse anesthesia educational programs and the impact it has on students' professional advocacy involvement (r = 0.481, P = .001)., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

First responders need hands-on experience with pediatric airway management, but the impact of a learner program in the operating room (OR) is unknown. We developed, implemented, and evaluated a pediatric airway "rotator" (PAR) program for 8 multidisciplinary groups to obtain this experience. This quality improvement pilot was conducted in the pediatric ORs from November 2017 to January 2018. We surveyed learner group leaders and anesthesia teachers about their PAR airway management expectations and developed a universal set of prerequisites, objectives, and simulation experiences. Airway management skills were assessed in a group of PARs at baseline. During implementation, another group of PARs completed prerequisites and reviewed objectives before coming to the OR for simu-lation using an infant mannequin. Then they entered the OR for "live" airway management. A comparison of preintervention and postintervention skills suggested an improvement in performance for most airway management domains except laryngeal mask airway insertion, which stayed about the same, and intubation, which decreased in the postintervention group. In the postassessment surveys, the PARs indicated that the interventions were helpful to their learning, and the anesthesia teachers' responses indicated that the primary goals to improve PARs' preparedness, airway management, and communication skills were achieved., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Patients wait an average of 23 hours for a peripherally inserted central catheter (PICC) in our hospital. Long waits lead to delays in discharge and medication administration. For quality improvement, development of a Certified Registered Nurse Anesthetist (CRNA) PICC line backup service was proposed. This project collected benchmarking data about the current PICC line service over 3 months. The Intravenous (IV) Nursing Unit and the Interventional Radiology Division teams insert an average of 8.1 PICC lines daily, but the demand for PICC lines is 12 insertions per day; thus, the current, combined PICC service meets 66% of its demand. The CRNAs insert IV catheters daily and are eligible to insert PICC lines. A PICC training pro-gram was developed to train a CRNA in a standardized curriculum with simulation using a partial-task trainer. Using an N-of-1 method, the CRNA inserted 10 PICCs over 3 weeks under the guidance of an IV team PICC nurse. The CRNA reached a level of competence in PICC insertion after 10 attempts, with a 70% success rate, in intervals equivalent to those of IV PICC RNs. A CRNA can be trained in a short timeframe as a resource to decrease waiting for patients needing PICC lines., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)

Background: Aspiration of gastric contents is a leading cause of airway management-related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10-30 N during application of CP., Methods: Clinicians (attending anesthesiologist, anesthesiology residents, certified registered nurse anesthetists, or operating room nurses) applied CP on a Vernier force plate simulator with measurements taken at 4 time points over 60 seconds, 2 measurements before and 2 measurements after loss of consciousness. A successful cycle required all 4 time points to be within the target range (10 ± 5 and 30 ± 5 N, respectively). After baseline assessment (n = 100 clinicians), a subset of 40 participants volunteered for education on recommended force targets, underwent self-regulated practice, and then performed 30 1-minute cycles of high-frequency simulation analyzed by cumulative sum analysis to assess their change in performance., Results: At baseline, 5 cycles (1.3% [confidence interval {CI}, 0.3%-2.50%]) out of 400 were successful. Performance improved after education and self-regulated practice (16% successful cycles [CI, 7.8%-25%]), and performance during the last 4 of 30 cycles was 45% (CI, 33%-58%). The odds of success increased over time (odds ratio, 1.1; P < .001). By cumulative sum analysis, however, no subject crossed the h0 line, indicating that no one achieved proficiency of the predefined target forces., Conclusions: At baseline, performance was poor at achieving target forces specified by national guidelines. Simulation-based training improved the success rate, but no participant achieved the predefined threshold for proficiency.

High-fidelity simulation (HFS) operating room (OR) inter-professional team training improves healthcare students' team-based attitudes and behaviours. Such improvements can diminish tribalism among the professions in the OR by overcoming entrenched perceptions of team members. We investigated whether simulation-based interprofessional student OR team training impacts students differently based on their professional background. From 2010 to 2013, HFS OR interprofessional student team training sessions were conducted involving senior medical students, senior undergraduate nursing students, and nurse anaesthesia students. The training involved a two-scenario format, each followed by a structured debriefing focusing on team-based competencies. Before and after each session, students completed a 15-item teamwork competencies self-efficacy survey as well as, from 2012-2013, the Readiness for Interprofessional Learning Scale (RIPLS). At the end of each session, they also completed a 6-item rating scale assessing overall team function during the session. Mean scores were calculated for each student professional group, post/pre mean differences were determined, and student t-test and ANOVA analyses were employed to compare within and between-group differences, respectively. Response rates were over 80% for each scale used. Medical students and undergraduate nursing students had significant improvements in team-based attitudes post- to pre-session. Medical students and nurse anaesthesia students had significant improvements in RIPLS scores. Statistically significant improvements from post- to pre-session were seen overall for both team-based attitudes (effect size = 0.83) and RIPLS (effect size = 0.37). The difference between the team-based scores between professions was significant; RIPLS differences were not. No significant difference existed between professions related to overall teamwork scores. HFS OR team training of healthcare students has beneficial but variable benefits for each professional group.