College of Nursing

Permanent URI for this collectionhttp://hdl.handle.net/10342/117

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Open Access
CRNA Airway Assessment in Patients with Obesity: A Quality Improvement Project
(2024-12-02) Powell, Lauren M.
Over 40% of adults in the United States are categorized as obese. Although obesity alone is not an independent risk factor for difficult airway, CRNAs may have more difficulty with perioperative airway management due to changes in physiology and development of comorbidities. There are many different techniques that can be used to properly assess the airway in the preoperative period, but no single source succinctly incorporates this information for managing potential difficult airways in patients with obesity. The purpose of this quality improvement project was to assess CRNAs’ perception of adequacy of a quick reference guide (QRG) as a useful tool for their practice as it pertains to assessment of the airway of patients with obesity. CRNAs at an outpatient center were asked to complete a pre-implementation survey, watch an educational video, use the QRG for two weeks, and complete a post-implementation survey. Results revealed that almost all CRNAs were already using at least two preoperative assessment techniques when assessing the airway of patients with obesity, currently recommended by the literature. The overall perception of the QRG was mostly positive, as all respondents to the post-implementation survey found the QRG to be at least mostly useful. Limitations of this project include a small sample size and lack of full participation in the pre-and post-implementation surveys. Recommendations for future studies include a larger number of participants and a longer implementation period.
Open Access
Nurse Anesthetists’ Perceptions of the Airway Assessment of Patients with Obesity and the Impact of an Educational Intervention: A Quality Improvement Project
(2024-12-02) Sarah Elizabeth McGuire
As the prevalence of obesity increases, there are more patients with obesity presenting for surgery requiring anesthesia. The increased adiposity in obese patients alters anatomy and physiology and places them at higher risk for a difficult perioperative airway. There are a variety of techniques to properly assess these risks; however, no single source could be found that succinctly incorporated predictive scales for properly identifying and managing potential difficult airways in obese patients. This quality improvement project aimed to better understand CRNA perceptions of airway assessment techniques for patients with obesity. Perceptions of nurse anesthetists regarding methods for assessing the airways of patients with obesity before and after receipt of an educational resource and presentation were assessed using Qualtrics pre- and post-surveys. Results from the project showed increased access to education on airway assessment for obese patients, better awareness of evidence-based practices supported by AANA and ASA, more efficient access to clinical guidelines, and increased confidence among CRNAs in their knowledge of airway assessment. CRNAs also indicated a higher likelihood of using various airway assessment methods. Improving airway prediction accuracy can reduce prolonged PACU stays, hospital days, and postoperative intubations, lowering healthcare costs. The primary limitations of this quality improvement project were its small sample size and brief implementation period. Knowledge gained from this pilot project could be used in future quality improvement and policy efforts aimed at improving anesthesia care of obese patients.
Open Access
Implementation of a Standardized Handoff Report for Nurse Anesthetists in the Intraoperative Setting: A Quality Improvement Project
(2024-12-02) Courtney Warner
The handoff report represents a pivotal point in patient care, during which vital information is communicated between providers. Incomplete handoffs can result in negative consequences, such as patient harm, compromised safety, and dissatisfaction across the healthcare team. This quality improvement project focused on the perceptions of the adequacy of the ‘PATIENT’ mnemonic to facilitate standardized handoffs of anesthetized patients. A pre-intervention survey was distributed to participating CRNAs at a partnering facility and then a standardized handoff tool was introduced that was to be used for two weeks. After the implementation period was completed, the CRNAs were sent a post-intervention survey addressing their perceptions of the handoff tool. Overall, there were differing levels of satisfaction with the handoff tool, and concern of time consumption may have contributed to levels of satisfaction. Limitations were a low number of participants and a short implementation period. A future suggestion is to create a customized handoff tool that is tailored to CRNAs’ specific needs in order to streamline reports and prevent lengthy documentation.
Open Access
Assessing Anesthesia Providers' Perceptions of Ultrasound-Guided Arterial Catheterizations: A DNP Project
(2024-12-01) Paige Chase
CRNAs frequently perform perioperative arterial catheterizations. Despite multiple studies supporting the advantages of ultrasound guidance, no formal processes are consistently followed, leaving CRNAs to use clinical judgment and personal preferences when selecting methods for arterial catheterization procedures. Currently, there is a lack of understanding regarding CRNA knowledge of and preference for utilization of ultrasound technology for perioperative arterial catheterization. The purpose of this DNP quality improvement project was to develop, implement, and evaluate the perceived adequacy of an educational resource designed specifically for CRNAs for improving awareness of and preference for utilization of ultrasound for arterial catheterization. The project was implemented at a large academic hospital in the southeastern United States. Educational materials, including a PowerPoint presentation and handout, were provided to participating CRNAs to utilize in their clinical practice. Review of pre- and post-implementation surveys demonstrated increased awareness of the advantages of ultrasound and improved confidence in ultrasound utilization. The perceived barrier to ultrasound utilization in arterial catheterizations was reported by 100% of respondents as the lack of available ultrasound machinery. Data analysis was limited by the small sample size, partial CRNA participation, and uneven number of respondents to the pre- and post-implementation surveys. Future projects should incorporate a larger sample size, a hands-on ultrasound training and skills workshop, and a thorough assessment of cost-related factors that impact perioperative arterial catheterizations including procedure duration, material costs, surgical delays, and ultrasound equipment.
Open Access
Implementing the PATIENT Mnemonic During Intraoperative Hand-Offs Between CRNAs: A Quality Improvement Project
(2024-12-02) Jordan Maxwell Price
Patient hand-offs, the exchange of information during the transfer of patient care, are essential in anesthesia practice, particularly during the intraoperative period when provider changes occur due to breaks or shift changes. In 2017, the Joint Commission identified ineffective communication as a persistent issue among healthcare providers, which increases the risk of adverse outcomes and sentinel events. For Certified Registered Nurse Anesthetists (CRNAs), the ability to communicate effectively during intraoperative patient hand-off is often hindered by interruptions and time constraints, underscoring the urgent need for improved hand-off protocols to enhance patient safety and continuity of care. This quality improvement project completed a single Plan, Do, Study, Act cycle to assess anesthesia providers' perceptions of adequacy of the PATIENT Mnemonic to facilitate standardized hand-offs of anesthetized patients. Implementation of the project took place at a level 1 trauma center and teaching hospital in the southeastern United States. Data was collected from eight CRNA volunteer participants using pre- and post-implementation surveys created and accessed via QualtricsTM. Following implementation, eighty-six percent (6/7) of responding participants reported they have received hand-off reports that could have been more comprehensive, and all (7/7) reported that implementing a standardized hand-off tool could improve completeness of anesthesia provider reports.
Open Access
Anesthesia Providers’ Perceptions of Ultrasound-Guided Arterial Line Placements: A DNP Project
(2024-12-02) Pearce, Laura
Current evidence shows the use of ultrasound guidance is advantageous for arterial line placements in reducing complications and increasing efficiency. Despite this evidence, no formal guidelines have been established regarding ultrasound-guided arterial line placements, leaving anesthesia providers to use their clinical judgment and personal preferences when placing these invasive lines. At this time, there is a lack of understanding regarding anesthesia provider preference for utilization of ultrasound technology for perioperative arterial catheterization. The purpose of this DNP quality improvement project was to develop, implement, and evaluate the perceived adequacy of an educational resource designed specifically for anesthesia providers to improve awareness and utilization of ultrasound for arterial line placement. This project took place at the main operating suite of a large medical facility in eastern North Carolina. CRNAs at this site were provided information on the basics of ultrasound use, troubleshooting tips, and the current research regarding ultrasound-guided arterial line placements. The results showed that confidence level and likelihood of using ultrasound-guidance for arterial line placements increased following the implementation period. Participants also identified a lack of equipment as a barrier to using ultrasound in their practice. Future projects should focus on increasing access to ultrasound equipment and the addition of a hands-on ultrasound workshop to further increase confidence and skill.
Open Access
Assessing CRNAs’ Perceptions of the Adequacy of a Quick-Reference Guide for Evaluating Airways of Patients with Obesity: A Quality Improvement Project
(2024-12-02) Craney, Tyler
Obesity (BMI > 30 kg/m2 ) has increased to over 40%, and morbid obesity (BMI > 40 kg/m2 ) to more than 9% of the United States population. Subsequently, there are more patients with obesity presenting for surgery and anesthesia. The increased adiposity in obese patients alters anatomy and physiology and places them at higher risk for difficult perioperative airway management. There are a variety of techniques to properly assess these risks, however no single source could be found that succinctly incorporated predictive scales for properly identifying and managing potential difficult airways in patients with obesity. The purpose of this Doctor of Nursing Practice quality improvement project was to assess CRNAs’ perception of a newly developed quick reference guide as a useful tool for their practice as it pertains to airway assessment in patients with obesity. The CRNAs used the provided quick reference guide for a period of two weeks and were surveyed before and after regarding their current assessment practices and patient populations. None of the providers reported using ultrasound in their assessments, despite receiving education of its high specificity and sensitivity in predicting difficult airways in patients with obesity and some CRNAs still reported patients with obesity are more difficult to intubate, which contradicts current literature. Limitations to this project are the small sample size and unequal pre- and post-implementation survey responses. Knowledge gained from this pilot project could be used in future quality improvement and policy efforts aimed at improving anesthesia care of patients with obesity.
Open Access
Implementation of a Standardized Handoff Report for Nurse Anesthetists in the Intra-Operative Setting: A Quality Improvement Project
(2024-12-02) Pierce Do
Handoffs amongst anesthesia providers are complex, rapid, and frequent. The responsibilities of a nurse anesthetist consist of providing safe and effective anesthesia before, during, and after surgery. While individual anesthesia providers often use systematic methods for giving report, anesthesia departments typically do not use common reporting tools, which may improve the quality and continuity of information, perception of patient safety, and healthcare worker satisfaction. This Doctor of Nursing Practice (DNP) project aimed to assess anesthesia providers' perceptions of adequacy of the PATIENT Mnemonic to facilitate standardized handoffs of anesthetized patients. This quality improvement project was completed at a Level I trauma center located in the southeastern region of the United States. A pre- and post-survey design was utilized to complete a single Plan, Do, Study, Act cycle to assess user perceptions of the PATIENT Mnemonic amongst a non-randomized group of CRNAs. Based on project data, a shorter version of the PATIENT Mnemonic tailored to anesthesia providers at the project site would do well. Eliminating aspects reported to be redundant or unnecessary would shorten the time it takes to give report, may make the handoff process more seamless, fluid, and similar to how most CRNAs already give report. Two limitations of this quality improvement project were the small sample size and limited time for implementation. Overall, continuing this quality improvement project would be a low cost, low risk, and high reward since it has the potential to reduce patient harm and improve patient outcomes.
Open Access
Anesthesia Providers’ Perceptions of Ultrasound-Guided Arterial Line Placement: A Doctor of Nursing Practice Project
(2024-11-23) Allison Rogers
Despite multiple studies supporting the advantages of ultrasound guidance, no formal processes are consistently followed, leaving anesthesia providers to use clinical judgment and personal preferences when selecting methods for arterial line placement. The goal of this project was to identify the perceptions of anesthesia providers regarding ultrasound guided arterial line placement in their current practice and after utilization of an educational resource. Pre- and post-implementation data were collected over a two-week period using Qualtrics software and analyzed using Excel. Anesthetists reported several barriers towards implementation including inadequate education and training on ultrasound-guided arterial catheterization, lack of available ultrasound equipment, and prolonged procedure set-up and duration. The anesthetists’ confidence and likelihood of using ultrasound for arterial line placement increased, suggesting that these anesthetists are willing to attempt ultrasound for arterial line placement in future cases. Further education on ultrasound techniques for arterial line placement may increase provider confidence and prevalence for utilization of ultrasound. Several limitations were identified, including a small sample size (n=9), resulting in only 6 participants completing the pre-implementation survey and 5 participants completing the post-implementation survey. The smaller sample size limited statistical significance, and the ability to generalize the results to the overall population of CRNAs. If this quality improvement project was to be replicated, an ultrasound workshop conducted by the project lead would greatly benefit overall CRNA comfortability and confidence with using ultrasound, and therefore, participation.
Open Access
Assessing Anesthesia Providers’ Perceptions of Ultrasound Use with Arterial Line Placement and the Impact of an Educational Resource: A DNP Project
(2024-12-02) Breanna Nicole Love
Ultrasound guidance with arterial line placement is associated with increased success rates while lowering the risk of complications related to multiple attempts. Despite multiple studies supporting the advantages of ultrasound guidance, no formal processes are consistently followed. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to develop, implement, and evaluate the perceived adequacy of an educational resource designed specifically for anesthesia providers for improving awareness and utilization of ultrasound for arterial line placement. A literature search and synthesis was performed, a single Plan-Do-Study-Act cycle was implemented, and an educational handout and PowerPoint Voiceover were created. Surveys were created using Qualtrics, and nine participants were emailed instructions, educational resources, and individualized links to the surveys. Participants were asked to utilize the resources during a two-week implementation period and then complete a post-survey. Following data analysis using Microsoft Excel there was an increase in awareness of the advantages of ultrasound-guided arterial line placement and an increase in perceptions that ultrasound use with arterial line placement is superior to traditional palpation techniques. Barriers the participants faced may be why they are unlikely to use ultrasound-guidance despite their positive perceptions of the technique. In the future, evaluating perceived barriers of anesthesia providers related to ultrasound use with arterial line placement may allow the implementation of ways to decrease barriers and improve utilization of ultrasound with arterial line placement. This QI project improved anesthesia providers' knowledge and raised awareness of barriers related to ultrasound use with arterial line placement.
Open Access
Implementation of a Standardized Handoff Report for Nurse Anesthetists in the Intra- Operative Setting: A Quality Improvement Project
(2024-12-02) Grace Elizabeth Mook
The anesthetic period is a dynamic moment in patient care, and the role of anesthesia providers during anesthesia handoff carries a tremendous amount of responsibility. The operating room environment offers an additional layer of complexity and distractions during anesthesia handoff. The purpose of this Doctor of Nursing Practice project was to assess anesthesia providers' perceptions of adequacy of the PATIENT mnemonic to facilitate standardized handoffs of anesthetized patients. The goal was to gain a better understanding of CRNA perceptions of this method in order to assess its usefulness as a handoff checklist in the transfer of care. This quality improvement project was conducted in the operating rooms of an outpatient surgery center located in the southeastern region of the United States. A pre-and post-survey design was used to complete a single plan, do, study, act cycle to assess perceptions of a standardized anesthesia handoff checklist among a nonrandomized convenience sample of CRNAs who volunteered to participate in the project. The CRNAs reported in the post-implementation survey that the PATIENT mnemonic was easy to use but not more efficient, comprehensive, or appropriate in length compared to their personally used handoff methods. There was a net neutral response regarding whether the tool was more time consuming, lent itself to errors, and overall satisfaction using the mnemonic. Limitations included a small sample size and number of survey responses. Recommendations for future study involve CRNA collaboration in the creation of an anesthesia handoff checklist as well as anesthesia handoff project champions.
Open Access
Assessing Certified Registered Nurse Anesthetists’ Perceptions of the Adequacy of a Quick-Reference Guide for Evaluating Airways of Patients with Obesity: A Quality Improvement Project
(2024-12-02) Amy Lee Nygren
Obesity is a growing health concern and increases the risk of a difficult airway. Recent evidence indicates a combination of airway assessment techniques may be most effective in predicting difficult airways in patients with obesity, but determining which combination to use is difficult. The purpose of this project was to assess the perceptions of adequacy of the quick-reference guide format as a useful tool for CRNA practice when assessing the airways of patients with obesity. A literature review was conducted to identify the airway assessment techniques that are most accurate in predicting difficult airways in patients with obesity. Then, a quick-reference guide was created to present these techniques together. Ten CRNAs were asked to complete a pre-implementation survey, use the quick-reference guide for two weeks, and complete a post-implementation survey. Comparison between the pre- and post-implementation surveys showed that perceptions of usefulness of the STOP-Bang score, Mallampati score, and thyromental distance increased during the project. Perceptions of usefulness of neck circumference and thyromental distance to neck circumference ratio changed little. Overall perceptions of usefulness of the quick-reference guide were moderate. The results from this project could indicate that a quick-reference guide may act as a helpful addition to the pre-anesthetic assessment. However, this project was conducted for a short period of time with few participants, so further investigation needs to be conducted to better understand what alterations to the quick-reference guide may improve utility.
Open Access
A Review of Parental Bereavement Interventions: Implications for Clinical Practice, Research, and Policy
(2024-05-23) Floyd, Abigail Joan; Ramkumar, Rhea
The untimely death of a child is an incredibly traumatic experience for parents and their loved ones. It uproots every aspect of their life, leading the bereaved parents to be far more likely to have poorer physical and mental health outcomes. This traumatic form of bereavement should have comprehensive grief-focused, high-quality interventions available for parents and extended family members. The purpose of this rapid review was to explore and describe the bereavement interventions available for parents and family that have been published within the past 5 years. Records identified 123 full-text articles that were reviewed, and 14 of those were included for data extraction and synthesis, using Cochrane Rapid Reviews Methods Group with the addition of keyword searches. The 14 articles were analyzed by evaluating description of bereaved parents, accessibility of interventions, who delivered interventions, and the type and delivery time of interventions. Four types of interventions were identified, including Web-based, community-based, hospital-based, and psychotherapy interventions. This rapid review has implications for clinical practice, research, and health care policy that can increase the availability of support and quality of interventions for bereaved parents and family members.
Embargo
COVID-19 AND COLLECTIVE TRAUMA: A QUALITATIVE DESCRIPTIVE STUDY EXPLORING THE EXPERIENCE OF A PANDEMIC FROM A NURSING PERSPECTIVE
(East Carolina University, July 2024) Evans, Kara Hedvig
The COVID-19 pandemic can be described as a collective trauma – a shared traumatic experience that will continue to impact physical, mental and psychosocial health for years to come. For nurses, the impact was compounded by existing workplace concerns including burnout, traumatic stress, and unhealthy work environments that also contribute to poor patient outcomes. While there is broad recognition of the importance of nurse well-being to public health, prior research emphasized individual-level causes and interventions that have had limited impact. Therefore, the purpose of this study was to explore the experience of nurses in the aftermath of the COVID-19 pandemic to develop knowledge of the structural and social factors that influence nurse well-being. This qualitative descriptive study employed collective trauma as a sensitizing framework and was conducted in two phases. Phase I results indicated that two years into the pandemic, disrupted connections between nurses and their peers, patients, and the community challenged participants’ sense of meaning and purpose. Phase II data, collected two years later, extended these findings by illustrating how the pandemic’s long-term impact on collective identity and social capital intersects with systemic deficiencies in the work environment to influence nurse well-being.
Open Access
Leadership Development Supported by Scientific Tools
(2024-08-07)
Leadership requires ongoing introspection and analysis as one moves through the various stages of professional growth and development. This paper analyzes various leadership styles with the intent of understanding the impact of leadership on an environment that improves team engagement and patient experience in a very busy ED. Through the use of personality assessment tools, leader development plans were creäted and implemented for a novice manager team utilizing evidence-based leadership tactics. Outcomes improved in the areas of staff turnover, patient experience, and team engagement, validating the project’s intent that leader development is essential in today’s ED environment. As young leaders are brought into leadership roles, professional development is essential to the creation of a healthy practice environment not only for staff retention but also for the patients served.
Open Access
Developing Mentorship for Novice Sexual Assault Nurse Examiners
(2024-07-26) Katherine Wasowski
Executive summary of DNP project to fulfill the requirements of the DNP-FNP program.
Open Access
A Medication Quality Improvement Project for the Surgical Time-out: Executive Summary
(2024-07-26)
Implementation of the inclusion of medication time-outs in the surgical time-outs in operating rooms is essential. The Quality improvement project implemented at this rural North Carolina hospital warranted this need. It proved to be a beneficial step in improving the quality and safety of surgical patients.
Open Access
Improving Adherence to Treatment in Hypertensive Patients
(2024-07-26) Krista Whitley
Executive summary for the completion of the DNP program
Open Access
Transforming Health with Breast Density Insights
(2024-07-11) Williams, Sharon Kemp
Open Access
Pulmonary Prehabilitation in Patients Undergoing Thoracic Lobectomy
(2024-07-23) Ormond, Jade
An executive summary for the completion of a DNP degree.

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