Educating SRNAs on Barriers and Facilitators of Clinical Learning

A national survey of 143 Student Registered Nurse Anesthetists (SRNAs) conducted by Clancy and Bruinius (2022) revealed that factors impeding effective SRNA clinical education include unstable preceptorship, hostile environments, limited autonomy, and heavy didactic burdens. Clancy and Bruinius (2022) also found that facilitators of SRNA clinical education include rapport with preceptors, effective feedback, strong clinical site orientation, and beginning of day discussions. This project aimed to enhance second-year SRNAs\u27 clinical success by mitigating these evidence-based barriers and employing these evidence-based facilitators by developing a presentation for SRNAs and assessing its effectiveness through a pre-implementation survey and post-implementation survey. The literature review and survey results indicated that a preclinical educational intervention on barriers and facilitators of SRNA clinical success may improve SRNAs’ clinical comfort, rapport with preceptors, feedback interactions, and management of stress and anxiety

Introduction of Osteoporosis Screening within Orthopedic Clinics

Abstract Osteoporosis affects millions of Americans, causing life life-altering medical issues and an economic burden estimated to be over 17 billion dollars. Primary care providers are responsible for screening and early detection of osteoporosis; however, gaps have been identified. Orthopedic surgeons can screen during clinic visits to help close the gap. The purpose of this project was to introduce the usage of a screening tool in a large orthopedic clinic to improve detection. Participants were provided with education regarding osteoporosis and the screening tool with continued support throughout the 8-week study. Using the Simplified Calculated Osteoporosis Risk Estimation (SCORE) tool, patients meeting the criteria were screened, and referrals were placed if the patients were not already undergoing treatment. A post-study questionnaire was provided to the surgeons and clinic staff to evaluate the screening tool and the importance of screening in their clinic. Overall, 103 patients were screened, resulting in 22.3% referrals to primary care, bone density screening, or the osteoporosis clinic for further evaluation and treatment. Additionally, 67% of the high-risk patients screened refused a referral, 50% of patients screened were already undergoing treatment, and 23% were low-risk non-referrals. Survey results showed increased knowledge regarding screening, and all respondents reported they felt screening in the orthopedic clinic is essential. Limitations for this study included provider non-participation, providers out of the office, and convenience of the screening tool

Implementing Pain Management Policies and Procedures at a Rural Pain Clinic

The United States is facing an uprising in opioid use disorder and a rise in overdoses due to the disorder. Due to the high addiction potential of opioids and the potential for overdose, providers must be cautious and conservative in their opioid prescribing practices. In 2022, the Centers for Disease Control (CDC) updated the Clinical Practice Guidelines for Prescribing Opioids for Pain to help in prevention of developing opioid use disorder and unintentional overdoses. The lack of an opioid use disorder risk screening tool, random urine drug screens, and clear pain management contracts were identified as issues at one rural pain clinic which placed patients at higher risk of developing opioid use disorder. Multiple interventions were implemented at this clinic which included the opioid risk tool (ORT) to screen patients for their level of risk for developing opioid use disorder, increasing the number of random drug screens, pain management contracts, and consistent use of the prescription drug monitoring system (PDMS). During the project implementation phase 218 ORTs were completed, the PDMS was accessed 288 times, 80 pain contracts were signed, 25 random drug screens, and 10 yearly urine drug screens were completed. Pain clinic staff quickly adopted the interventions of administering the ORT and checking the PDMS. Pain contract administration was slowly accepted but completing random and yearly drug screens was not fully implemented by clinic staff

Human Trafficking and Resources Provision in the ED

Human trafficking is both a human rights violation and a national health crisis. Despite nearly 165,000 identified cases in the United States since 2007, studies hypothesize that many more victims remain undetected despite up to 88% of trafficked persons interacting with the healthcare system during the time they are being trafficked. The lack of identification of these victims has often been attributed to healthcare providers\u27 lack of knowledge regarding human trafficking indicators and lack of confidence in how to address trafficking situations when they are encountered. Emergency department care providers of a 500-bed central Illinois hospital received education and resource binders containing screening tools, action steps, and contact information for local human trafficking resources. A statistically significant increase in the confidence of the participants about identification and knowledge of how to care for human trafficking victims was observed. Increased awareness encouraged the identification of two possible victims of human trafficking and the development of an organization policy about how to care for potential human trafficking victims. Further recommendations for continued work would include a computer-based learning module to ensure completion of education, education provision to affiliate hospitals, and customization of education for areas offering outpatient services. Swift and easy access to protocols for actions to be taken and accessible support resources for trafficked persons appear to be the most impactful intervention of this quality improvement project

The Relationship Between Eating Disorders, Attachment Styles and the Uses of Art Materials

Previous studies showed that both eating disorder (ED) behaviors and attachment styles (ASs) could reflect on individuals’ uses of art materials. This mixed methods study aimed to explore the correlation between ED diagnoses and ASs, investigate clients’ selection of and familiarity with art materials, as well as understand how clients’ self-reports of media interactions match clinical observations. Participants were adults receiving residential care in an ED facility in Midwestern United States. Data were collected through surveys, chart reviews, and discussions with the participants’ therapist. The results of this study found a high prevalence (85%) of insecure attachment in the population. Participants with different ED diagnoses and ASs demonstrated distinct ways of using art materials and experienced separate modes of information processing. Discrepancies among subjective experiences, the therapist’s observations, and literature were discussed. Clinical applications include designing informed treatment plans to meet clients’ need and gaining a holistic view of the population

Development of High-Fidelity Simulations for SRNAs: Airway Fire and Venous Air Embolism

Student registered nurse anesthetists (SRNAs) must swiftly recognize and treat high-risk, low-incidence complications in a high-stress environment. Most SRNAs do not experience high mortality or rare emergencies throughout their training. This project involves developing and implementing two high-fidelity simulations for airway fire and venous air embolism (VAE) to help SRNAs improve their skills in a safe learning environment. Objectives for this project include examining current evidenced-based literature to determine the efficacy of high-fidelity simulation on the SRNA’s knowledge and performance post-simulation, determining the incidence, pathophysiology, and treatments for airway fires and VAE, creating two high-fidelity simulation scenarios, and integrating the scenarios into the SRNAs’ curriculum. The project was conducted at a doctoral nurse anesthesia program in southern Illinois. The project aimed to prepare SRNAs for low-incidence, high-mortality perioperative complications

Blunt Cerebrovascular Injury (BCVI): Universal CTA Neck Screening at Level 2 Trauma Center

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years old with significant blunt-force trauma activations from March 2023-January 2024 will receive CTA neck with a 128-slice computed tomography scanner during initial trauma workup. During the study period, 395 patients had level I and level II trauma activations, 210 (53.16%) of which met the criteria for BCVI screening. CTA neck was completed on 156 individuals (74.29%),11 (7.05%) of which exhibited evidence of BCVI. The variables BCVI Followed and “Positive BCVI displayed a significant correlation (r=0.97 and p\u3c0.001). A strong positive linear relationship between the two variables was observed. The implementation of universal screening with CTA neck for BCVI detection holds promise for advancing trauma care practices. This doctoral project provides evidence-based recommendations and insights to guide similar initiatives in trauma centers, improving patient outcomes and reinforcing the commitment to excellence in trauma care

Identifying SRNAs individual learning preferences utilizing the VARK Learning Inventory Tool

Abstract All graduates of a doctoral anesthesiology program are required to successfully pass the National Certifying Exam (NCE). Since 2011, the national average passage rate has decreased from 89.1% to 84.1% in 2021 (NBCRNA, 2023). Yamaguchi’s 2022 study revealed that students are positively impacted academically when they implement individual learning preferences. The purpose of this project was to identify individual learning preferences for students enrolled in the U.S. Army Nurse Anesthesiology program. The hypothesis was that students who recognize their preferred learning and incorporate preferred learning techniques would result in an increased percentage of passage rate scores for the NCE. Thirty-eight Military personnel enrolled in the U.S. Army Graduate Program in Anesthesia Nursing were administered the VARK (Visual, Auditory, Reading, Kinesthetics) learning inventory tool in the beginning of their first year in the program. The VARK learning inventory tool is a sixteen questionnaire that identifies an individual’s learning preference based on the answers that he/she selects. After identifying the individual learning preference, everyone was given a 10-page performance template that outlined the various techniques that incorporated the individual learning preference to the daily learning and retaining of educational materials. The passage rate of the group involved in the project will be compared with the national average after taking the NCE. Keywords: metacognition, VARK learning theory, doctoral education, nurse anesthesiology, self-regulated learnin

Addressing Air Quality Mitigation as a Key Factor in Asthma Management and Prevention

Asthma is the most prevalent disease in childhood and disproportionately affects African American (AA) populations in terms of prevalence and frequency of exacerbations. Air quality and environmental factors are strongly associated with the diagnosis and management of asthma and AA children are more likely to live in areas with poor air quality. An air quality flag program was implemented in a daycare located in a county with a predominantly AA population with a high prevalence of asthma diagnoses. The goal of the intervention was to increase staff awareness of air quality and the impact it can have on asthma diagnosis and exacerbations. An educational session was provided to staff regarding the asthma disease process, factors affecting air quality, and its role in the development and management of asthma. Staff were educated about the EPA’s air quality flag program and how to track the daily air quality. Air quality was monitored, and actions were taken according to the EPA’s air flag program for 6 weeks. 12 pre-surveys were completed by staff before the educational session and 8 post-surveys were completed after 6 weeks of the intervention. Post-survey results indicated an increased understanding of the role that air quality exposure plays in the development of asthma (25%) and asthma exacerbations (34%). Additionally, survey results indicated a 30% increase in respondents who agreed there were steps they could take to prevent a child from having an asthma exacerbation. Results were not statistically significant due to sample numbers, but anecdotally significant

Implementation of Electronically integrated Pediatric Screening Templates

Evidence-based clinic guidelines improve patient outcomes by providing clinicians with research-based recommendations, and when combined with the electronic health record (EHR), clinicians have the potential to improve their documentation and reduce the time it takes to document a patient encounter. A pediatric clinic in the metro-east area of Southern Illinois lacked EHR templates during patient encounters that focused on depression, anxiety, ADHD, and concussion screening. Templates embedded in the EHR were created in a SOAP note format to aid the clinicians during patient encounters and aid in documentation. Clinicians were asked to utilize the templates over a 6-week period. The intervention was evaluated before and after the implementation. Post-implementation note quality and documentation time improved by 33% after implementing the intervention. Documentation also showed a 20% increase in thoroughness and organization. A multiple-choice survey was also used to determine the provider’s current knowledge of the diagnoses and patient population being treated for depression, anxiety, ADHD, and concussions. There were many limitations in this study, including a lack of provider buy-in, limited sample size, and limited patient encounters. A larger provider buy-in and sample size would better represent the effectiveness of the templates in practice