Nurses' knowledge, attitudes, and practices on CLABSI prevention in the Intensive Care Unit: An observational study.

BACKGROUND: Management of central venous catheters (CVC) is a frequent procedure in intensive care units (ICUs) and the risk of bloodstream infections (CLABSI) is found to be high. The literature provides healthcare professionals with guidelines to prevent the risk of CLABSI infections. The aim of this study was to observe the knowledge, attitudes, and practices of ICU nurses on the prevention of CLABSI. METHODS: A multicenter cross-sectional study was conducted between March 2023 and September 2023; the research was carried out among six ICUs in Bari both on the web and in paper mode. The survey consisted of multiple-choice questions structured in two sections: demographic sample data and the 2017 Esposito MR questionnaire, drawn up based on the 2011 guidelines of the Centers for Disease Control and Prevention, consisting of four dimensions: knowledge, attitudes, practices, information. RESULTS: 121 nurses (57.1%) participated in the study. 72% were unfamiliar with the guidelines, especially nurses aged 41-50 years (RR = 1.88; CI = 0.78-4.51; p = 0.13) and more than 10 years' work experience (RR = 1.56; CI = 0.76-3.23; p = 0.20). Regarding attitudes, nurses were aware of the usefulness of the guidelines (Me = 10; IQR = 8-10) and the importance of hand washing for prevention (Me = 10; IQR = 10-10) despite 39.7% (n = 48) believing that gloves replace hand washing, and there were no statistically significant differences in comparing scores with age, work experience, and educational qualification. 96.7% always substituted dressing for CVC; 120 nurses (99.2%) were always replacing infusion sets and 71.2% always sanitized the access ports before infusions. Finally, 102 participants (84.3%) felt the need to get more information about the prevention of CLABSI. CONCLUSIONS: We observed a reduced knowledge of the guidelines for the prevention of CLABSI despite the attitudes and practices of the nurses being satisfactory. In addition to implementing training, strategies for disseminating guidelines should be adopted.

Challenges for Nurse Anesthetists Reentering Practice Following Substance Use Disorder Treatment.

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared with other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of certified registered nurse anesthesiologists (CRNAs) to obtain or maintain employment after treatment for SUD treatment is not well documented. The purpose of this qualitative study was to explore challenges encountered by CRNAs in recovery as they attempt to reenter practice following SUD treatment. The phenomenon was explored through multiple-case study, using qualitative semistructured interviews with participants in four cases: CRNAs in recovery, CRNA colleagues, CRNA employers, and professional health program employees. Thirty-six participants conveyed their perspectives about challenges that CRNAs in recovery face upon reentry into practice following SUD treatment. The Worker Well-Being conceptual model was used to guide this study. The study revealed that more SUD education is a key facilitator for reentry, risk of relapse was a major concern, and stigma was the most significant barrier for CRNAs in recovery. Stigma persists as a considerable barrier in many facets of SUD, contributing to an increase in shame associated with having the disease.

Working experience of nurse anesthetists with beneficence for patients.

BACKGROUND: Nowadays, patients in Thailand have easier access to public health services, resulting in an increased number of patients undergoing surgery. Therefore, the Royal College of Anesthesiologists produces nurse anesthetists to reduce the shortage of anesthesiologists who can perform general anesthesia under the physician's supervision. As a result, nurse anesthetists must have the consciousness to work on the basis of ethics and professional standards. Nurse anesthetists have work experience that aims to benefit patients and make them as safe as possible. OBJECTIVE: To investigate the working experience of nurse anesthetists with beneficence for patients. METHODS: This study employed qualitative research using in-depth interviews. The sample consisted of 33 nurse anesthetists who volunteered to participate in the research project with more than ten years of work experience and worked in tertiary care hospitals. The researcher used a qualitative content analysis method.Ethical considerations: Study after approval and certification of the research project from the Human Ethics Committee of Mahidol University, and Naval Medical Department. RESULTS: The working experience of nurse anesthetists with beneficence for patients involves communicating and listening with compassion, being considerate, knowledgeable, and standard operations, team communication, and awareness of patient safety, as a productive and non-harmful work experience. DISCUSSION: Nurse anesthetists working in situations of beneficial approaches to patient care need experience in appropriate communication, professional knowledge and skills to thoroughly assess patients, pass critical information to the team, and be aware of potential risks. Make patients receive care in a more suitable and safe way. CONCLUSION: Working experience of nurse anesthetists with beneficence for patients exists with communication and listening with compassion, being considerate, communicating and forwarding the patient's necessary information to the team to be aware of abnormalities, knowledgeable and standard operations, and awareness of patient safety in every phase of the performance consistently.

Postgraduate Developments Among Perianesthesia-Trained Nursing Graduates in Japan: A Cross-Sectional Survey.

PURPOSE: To elucidate the postgraduation situation of those who have completed a perianesthesia nurse (PAN) educational course offered in master's degree programs in Japan. DESIGN: This cross-sectional study used an anonymous self-administered questionnaire. METHODS: Of the 42 individuals who completed a PAN educational course offered in master's degree programs in Japan by March 2021, 41 were targeted, excluding the author of this study. The questionnaire was distributed by mail between November 20, 2021, and January 14, 2022, and the participants were asked to return the completed questionnaire by mail. Those working as PANs were asked about their work content, work satisfaction, and thoughts on their prospects in the perianesthesia nursing field. Those not working as a PAN were asked about their future intentions to do so. FINDINGS: The response rate was 95.1% (39/41). PANs are involved in various perianesthesia tasks, and there were no respondents who answered "No" to the question of whether they were glad to have become a PAN. However, of those working as PANs, only 16 (53.3%) indicated that they would like to continue working in that role. Few respondents (n = 3; 10.0%) considered future PAN prospects to be "good," while eight (26.7%) respondents answered "poor," and many (n = 19; 63.3%) stated "neither." CONCLUSIONS: Under the current situation, PANs in Japan do not necessarily have a positive outlook for the future, the causes for which must be analyzed to make the necessary improvements.

California Certified Registered Nurse Anesthetist Workforce Study.

BACKGROUND: Nurse anesthesia in California has been instrumental in shaping Certified Registered Nurse Anesthetist (CRNA) practice nationally, but to date, no workforce data has been published on this group of Advanced Practice Registered Nurses. PURPOSE: The purpose of this workforce study was to explore the demographic information, education, and practice patterns of CRNAs working in California. METHODS: Survey methodology was conducted to gather workforce data from a sample of licensed CRNAs working in California. DISCUSSION: California CRNAs provide anesthesia services in very diverse settings among different anesthesia delivery models, including independent practice. CRNAs practice in a majority of California counties and are the sole anesthesia providers for four underserved counties. CONCLUSION: The CRNA workforce in California is comparatively young, highly educated, and desires more education. CRNAs improve access to care for California patients; however, more ethnically diverse CRNAs and CRNAs with Non-Surgical Pain Management Certification are needed.

Examination of a Nurse Anesthesia Program's Teaching Assistant Model and Its Impact on Increasing Nurse Anesthesia Education Capacity.

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.

Effect of a smartphone-based online electronic logbook to evaluate the clinical skills of nurse anesthesia students in Iran: a randomized controlled study.

PURPOSE: This study was conducted to evaluate a smartphone-based online electronic logbook used to assess the clinical skills of nurse anesthesia students in Iran. METHODS: This randomized controlled study was conducted after tool development at Ahvaz Jundishapur University of Medical Sciences in Ahvaz, Iran from January 2022 to December 2022. The online electronic logbook involved in this study was an Android-compatible application used to evaluate the clinical skills of nurse anesthesia students. In the implementation phase, the online electronic logbook was piloted for 3 months in anesthesia training in comparison with a paper logbook. For this purpose, 49 second- and third-year anesthesia nursing students selected using the census method were assigned to intervention (online electronic logbook) and control (paper logbook) groups. The online electronic logbook and paper logbook were compared in terms of student satisfaction and learning outcomes. RESULTS: A total of 39 students participated in the study. The mean satisfaction score of the intervention group was significantly higher than that of the control group (P=0.027). The mean score of learning outcomes was also significantly higher for the intervention than the control group (P=0.028). CONCLUSION: Smartphone technology can provide a platform for improving the evaluation of the clinical skills of nursing anesthesia students, leading to increased satisfaction and improved learning outcomes.

Registered Nurse Anesthetists' Perceptions of Providing Care Within a Global Health Framework: A Qualitative Study.

PURPOSE: The purpose of this study was to investigate how Registered Nurse Anesthetists (RNAs) who have been working for nongovernmental organizations in low- and middle-income countries perceive their role in global health. DESIGN: A qualitative design was used in this study. METHODS: Data were collected by means of semistructured interviews with 11 participants who met the inclusion criteria, and qualitative analysis of the interview content was performed. FINDINGS: The analysis resulted in three categories and six subcategories. Of the categories, "Using skills" includes the respondents' varying levels of responsibility, tasks, and perceptions of how far they are applying their expertise. "Encountering new cultures" is about adapting to new cultural norms in nursing, education, and cooperation in the international team. "Promoting change through volunteerism" comprises personal and professional development, and impact - both local and potentially global. CONCLUSIONS: This study highlights the relevance of RNAs in global health and emphasizes the cultural encounters, exchanges, and challenges associated with volunteer medical missions. RNAs' knowledge of, and humble approach to the host country's culture are essential for their ability to provide nursing care, engage in cooperation and training, and promote global health in a high-quality, sustainable and effective way.

Evaluating the Utilization of a Perioperative Hyperglycemic Protocol: A Quality Improvement Project.

PURPOSE: The purpose of this project to evaluate adherence to the perioperative hyperglycemic protocol among Certified Registered Nurse Anesthetists (CRNAs) at a large academic hospital. A secondary objective of this project is CRNAs' perceptions of barriers to point-of-care (POC) testing and the protocol. DESIGN: A quality improvement project. METHODS: Using Donabedian's conceptual framework, a Phase 1 retrospective chart analysis of 297 patients with diabetes undergoing noncardiac surgery before and after implementing POC testing for intraoperative glucose control was performed. Only patients with preoperative BG ≥ 180 mg/dL were included in this phase of the project, which involved a comparison of the protocol utilization before and after implementation of POC testing. Phase 2 included an assessment of CRNA's perceptions of the protocol. FINDINGS: The final sample included 91 (37 preimplementation; 54 postimplementation) participants. There were no significant demographic differences between the groups. Overall, 52.7% of patients had intraoperative glucose checks, and only 16.5% received insulin. Preoperative BG levels decreased 11.4-points, and postoperative BG levels increased 20.4 points when comparing pre- and postimplementation groups. However, there were significant differences in postoperative glucose levels, pre- and postimplementation. The survey showed that the majority (65.5%) of CRNAs identified difficulty locating the protocol as the primary barrier to utilization. CONCLUSIONS: Although all patients included in this project qualified for an intraoperative glucose check, findings revealed that only half of the patients had a glucose check and less than one fifth of the patients received insulin treatment, indicating poor adherence to the protocol. Thus, while implementing protocols is essential, utilization and adherence to the protocol are critical to improving patient outcomes. Recommendations for continued improvement include increasing protocol accessibility, staff training, compliance monitoring, and a more simple protocol structure.

Prevalence survey of position management of anesthesia specialist nurses in tertiary hospitals in China / 中华麻醉学杂志

Objective:To evaluate the status of position management of anesthesia specialist nurses in China.Methods:From January 2022 to March 2022, a cross-sectional survey was conducted using a self-made questionnaire through convenience sampling to assess the current situation of position management of anesthesia specialist nurses in tertiary hospitals in mainland China.Results:A total of 154 questionnaires were distributed, 137 of which were recovered, the response rate was 89%, and 36 questionnaires were excluded. The survey involved 101 tertiary hospitals in 25 provincial administrative regions in China, and 90% of hospitals were general hospitals. Eighty-three percent of hospitals had separate anesthesia care units, anesthesia specialist nurses accounted for ≥ 10% of nurse anesthetists in 53% of hospitals. Ninety-four percent of hospitals had the position management system of specialist nurses, more than 50% of hospitals had position responsibility and hierarchical management systems and showed difference in position benefits. Less than 50% of hospitals had employed and full-time anesthesia specialist nurses. Fifty percent of hospitals conformed to the advocacy scope of anesthesia specialist nurse service. Fifty-five percent of hospitals carried out the qualification certification of anesthesia specialist nurses, and 37% of hospitals were the training bases for anesthesia specialist nurses. Ninety-six percent of hospitals formulated the development plan of anesthesia specialist nurses.Conclusions:The position management of anesthesia specialist nurses has begun to take shape in tertiary hospitals in China at present, but the institutional system of position management and specialized management need to be strengthened.

Lack of Benefit of Adjusting Adaptively Daily Invitations for the Evaluation of the Quality of Anesthesiologists' Supervision and Nurse Anesthetists' Work Habits.

Introduction Whenever a department implements the evaluation of professionals, a reasonable operational goal is to request as few evaluations as possible. In anesthesiology, evaluations of anesthesiologists (by trainees) and nurse anesthetists (by anesthesiologists) with valid and psychometrically reliable scales have been made by requesting daily evaluations of the ratee's performance on the immediately preceding day. However, some trainees or nurse anesthetists are paired with the same anesthesiologist for multiple days of the same week. Multiple evaluations from the same rater during a given week may contribute little incremental information versus one evaluation from that rater for the week. We address whether daily evaluation requests could be adjusted adaptively to be made once per week, hopefully substantively reducing the number of evaluation requests. Methods Every day since 1 July 2013 at the studied department, anesthesia residents and fellows have been requested by email to evaluate anesthesiologists' quality of supervision provided during the preceding day using the De Oliveira Filho supervision scale. Every day since 29 March 2015, the anesthesiologists have been requested by email to evaluate the work habits of the nurse anesthetists during the preceding day. Both types of evaluations were made for interactions throughout the workday together, not for individual cases. The criterion for an electronic request to be sent is that the pair worked together for at least one hour that day. The current study was performed using evaluations of anesthesiologists' supervision and nurse anesthetists' work habits through 30 June 2023. Results If every evaluation request were completed by trainees on the same day it was requested, trainees would have received 13.5% fewer requests to evaluate anesthesiologists (9367/69,420), the maximum possible reduction. If anesthesiologists were to do the same for their evaluations of nurse anesthetists, the maximum possible reduction would be 7.1% fewer requests (4794/67,274). However, because most evaluations were completed after the day of the request (71%, 96,451/136,694), there would be fewer requests only if the evaluation were completed before or on the day of the next pairing. Consequently, in actual practice, there would have been only 2.4% fewer evaluation requests to trainees and 1.5% fewer to anesthesiologists, both decreases being significantly less than 5% (both adjusted P <0.0001). Among the trainees' evaluations of faculty anesthesiologists, there were 1.4% with very low scores, specifically, a mean score of less than three out of four (708/41,778). Using Bernoulli cumulative sum (CUSUM) among successive evaluations, 72 flags were raised over the 10 years. Among those, there were 36% with more than one rater giving an exceptionally low score during the same week (26/72). There were 97% (70/72) with at least one rater contributing more than one score to the recent cumulative sum. Conclusion Conceptually, evaluation requests could be skipped if a rater has already evaluated the ratee that week during an earlier day working together. Our results show that the opportunity for reductions in evaluation requests is significantly less than 5%. There may also be impaired monitoring for the detection of sudden major decreases in ratee performance. Thus, the simpler strategy of requesting evaluations daily after working together is warranted.

Chronic Opioid Use After Surgery: An Exploratory Study Examining Rural Certified Registered Nurse Anesthetist Strategies to Mitigate Chronic Opioid Use and Their View of Their Role in the Opioid Crisis.

Certified registered nurse anesthetists (CRNAs) provide most of the anesthesia care in the rural United States. Rural regions of the US also have the highest opioid prescribing rates and opioid-related hospital admissions and deaths. Although CRNAs are the primary anesthesia providers in these regions, little research examines the strategies CRNAs may use to mitigate the development of chronic opioid use after surgery. The purpose of this study was to assess the views of rural CRNAs regarding their role in mitigating chronic opioid use after surgery and to determine what, if any, preventative strategies they may use. A survey was developed and distributed to CRNAs practicing in rural areas of the US with the highest opioid prescribing rates. Of the 160 CRNAs who responded, 73% agreed that they could influence whether their patient developed chronic opioid use after surgery. Those who agreed were more likely to be involved in policy development to decrease opioid use. The survey also found that CRNAs with a doctoral degree, compared with those with master's level preparation, were more likely to report that they could influence whether their patient developed chronic opioid use after surgery.

Organizational Readiness for Implementing Change for Mentorship in Nurse Anesthesia Programs.

Student registered nurse anesthetists (SRNAs) undergo enormous stress related to the lifestyle changes that are necessary to commit to full-time training in nurse anesthesia programs (NAPs). Mentorship and mentoring initiatives have proved to provide positive support to enhance SRNA wellness. This interventional study was conducted to assess the status of mentorship and mentorship initiatives in NAPs and to understand and analyze the specific constructs of organizational change from the perspective of nurse anesthesia program directors toward mentorship after viewing an educational online video regarding the topics of stress of an SRNA, mentorship and formalized mentorship programs. NAP state of mentorship information from NAPDs (n = 36) was conducted to obtain the current descriptive statistics of mentorship in NAPs. An adapted Organizational Readiness for Implementing Change survey was conducted to assess for six constructs of change by applicable study participants (n = 26). Statistically significant increases in the median scores of change commitment, change valence, task knowledge, and resource availability were noted in study participants (P < .05), reflecting that education was able to increase organizational readiness for these specific constructs.

The development and evaluation of a nurse anaesthesia model for practice in South Africa.

Objective: This article aimed to present a developed model for nurse anaesthesia practice in South Africa and then to evaluate the model by national and international anaesthetist experts. Methods: For the model development, a theory-generative research design was used as guided by Chinn & Kramer. The study included four steps to develop and evaluate the model: step one, concept analysis; step two, placing the concepts into relationships; step three, description and critical reflection of the model; step four, evaluation of the model. For evaluation of the model, data were collected using individual, in-depth interviews. Four South African medical specialist anaesthesiologists and four international nurse anaesthetists were interviewed. Transcribed interviews were analyzed using Tesch's eight steps of thematic data analysis. Results: The model was described in four phases: relationship phase, working phase, termination phase, and independent phase. The model shows a development process of a student nurse anaesthetist by a nurse anaesthetist facilitator to the mastery of the scope of practice of a nurse anaesthetist. Two themes (six categories) emerged through thematic analysis: the model and guidelines for implementation were found to be appropriate (model and guidelines for implementation are important because of the need for nurse anaesthetist, the model is applicable because it is described as comprehensive, the relationship phase was found to be important and the interdependence between disciplines is imperative, the affirmation that mastery has to be attained by nurse anaesthetists due to the complexity of services rendered), anticipated limitations to the South African nurse anaesthetist (the need to identify complex patients and limitations on the setting and refer to higher level of care, limitations due to red tape). Conclusions: This model provides fertile soil to inform and outline the education (curriculum) and practice (scope of practice) and research for nurse anaesthesia practice in South Africa.

Translation of Credentialing Examination for Providers with English as a Second Language: An Exploratory Study.

Racial and ethnic minorities disproportionately suffer the burden of adverse health outcomes in the United States. Increasing the diversity of healthcare providers may help decrease disparities in outcomes. Unfortunately, language barriers may affect performance in nursing school and credentialing examinations. The purpose of this exploratory study was to identify current practices and trends affecting the translation of credentialing examinations. Commissioned by the National Board of Certification and Recertification for Nurse Anesthetists, a survey was sent to the credentialing organizations soliciting information about their exam translation practices and considerations. Among the 27 credentialing organizations (two licensure and 25 certification organizations) that completed the survey, 63% were from healthcare. All the organizations offered their credentialing examinations in English. Some offered their examination in Chinese/Mandarin (15%), Spanish (11%), French (7%), and Arabic (7%). The majority (78%) do not translate their examinations into another language. Among the six credentialing organizations translating their examinations, 67% translate one, and 17% translate two examinations. Most use the forward and back-translation techniques. For organizations embarking on a multilingual credentialing program, it is imperative to ensure psychometric equivalence of their examinations. Translation can help ensure that candidates are tested on their intended competencies, not their language proficiency.

Moral Courage: Student Registered Nurse Anesthetist Experiences on the Operating Team.

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.

US Survey of Incidence of and Reasons for Nurse Anesthetists Leaving or Having Considered Leaving Their Jobs.

Many nurse anesthetists changing positions or considering leaving their positions can give the impression that suboptimal quality of anesthesia department leadership exists. To provide nationally accurate benchmark data on annual turnovers of nurse anesthetists to assist chief nurse anesthetists who may be scrutinized for the resignation rate of nurse anesthetists at their hospital, we used the 2018 US National Sample Survey of Registered Nurses. Analyses show that, during 2017, approximately 13.6% (99% CI, 6.6%-25.8%) of survey respondents left the positions that they held as of December 31, 2016. Approximately 37.6% considered leaving but did not resign as of December 31, 2017 (CI, 26.2%-50.6%). Estimates for nurse anesthetists were comparable to those for registered nurses (ie, not unique to nurse anesthetists). With both estimates combined, approximately 53% of nurse anesthetists changed or considered leaving their primary position (CI, 37.3%-68.0%, P=.62 compared with half). The most commonly reported reason was "better pay/benefits" (P≤.0064 vs all other reasons, including burnout). Applying the results, in a department with 37 nurse anesthetists, the national incidence of 13.6% would represent a turnover of 5.0 per year. The 13.6% incidence could also result in 1 of 5 years having as many as 11 nurse anesthetists (30%) leaving.

A deep learning approach to student registered nurse anesthetist (SRNA) education.

OBJECTIVES: This manuscript describes the application of deep learning to physiology education of Student Registered Nurse Anesthetists (SRNA) and the benefits thereof. A strong foundation in physiology and the ability to apply this knowledge to challenging clinical situations is crucial to the successful SRNA. Deep learning, a well-studied pedagogical technique, facilitates development and long-term retention of a mental knowledge framework that can be applied to complex problems. Deep learning requires the educator to facilitate the development of critical thinking and students to actively learn and take responsibility for gaining knowledge and skills. METHODS: We applied the deep learning approach, including flipped classroom and problem-based learning, and surveyed SRNA students (n=127) about their learning experience. RESULTS: Survey responses showed that the majority of students favored the deep learning approach and thought it advanced their critical thinking skills. CONCLUSIONS: SRNAs reported that their physiology knowledge base and critical thinking benefited from the use of the deep learning strategy.

Nurse anesthetists' reflections and strategies when supervising master's students.

OBJECTIVE: The objective was to describe registered nurse anesthetists' reflections and strategies in relation to supervision of specialist nursing students in anesthetic care. BACKGROUND: In anesthesiology care, registered nurse anesthetists work with advanced care in a high-technology environment. The complexity of working with production requirements, time pressure and patient safety creates great challenges. Registered nurse anesthetists have a unique position and are responsible for the patient's life during surgery. At the same time, they must supervise students without risking patient safety. Little research to date has focused on the clinical supervisory role in this context. DESIGN: A qualitative design was used. METHODS: The data were collected in 2018 from qualitative interviews with a purposive sample of twelve student registered nurse anesthetists from a large hospital in Sweden. The data were analyzed using content analysis. RESULTS: The results demonstrated that the dual role of registered nurse anesthetist and supervisor was experienced as satisfying, important and promoting development, although it also involved several challenges. Creating opportunities for supervision and learning in perioperative care improved supervisors' prerequisites for supporting students and helping them develop. Being a supervisor was also rewarding, and given the interplay with students, supervision was viewed as a process of mutual growth. CONCLUSION: By focusing on students and their learning, we can help produce well-qualified registered nurse anesthetists who have positive experiences of the workplace and who want to stay in their profession.

Implementation of a Second Victim Peer Support Program in a Large Anesthesia Department.

The second victim phenomenon occurs when healthcare providers experience emotional or physical distress as a result of traumatic clinical events. Few hospitals have formalized peer support programs for second victims to navigate the postevent experience and offload associated emotional labor. This article describes the implementation of a second victim peer support program in a large academic anesthesiology practice, with the goal of augmenting emotional support for anesthesia providers. Program activations were tracked in a shared mailbox. Following peer support, second victims completed an evaluation assessing support received; trained peer supporters completed 2 evaluations assessing their comfort level and peer support encounters. From July 2018 to June 2020, ninety-one program activations (179 affected individuals) were made. A total of 130 peer support encounters were documented. Trained peer supporters were able to provide helpful support to affected colleagues nearly all (98.8%) of the time. Nearly 97% of second victims (25 of 31 evaluation respondents) reported the support as extremely or very beneficial, and 96.8% would recommend the program to colleagues. A second victim peer support program was successfully deployed in a large anesthesia department. This program was effective at a departmental level, fostering providers' well-being.