Medical simulation is needed in anesthesia training to achieve patient's safety

Many medical schools and hospitals throughout the world are equipped with a simulation center for the purpose of training anesthesiologists to perform both technical and non-technical skills. Because induction, maintenance, and emergence of general anesthesia are critical to patient welfare, various simulation mannequins and tools are utilized for the purpose of training anesthesiologists for safer patient care. Traditionally, anesthesia residency training mostly consisted of didactic lectures and observations. After completion of "traditional" training, anesthesia residents were allowed to perform procedures on patients under supervision. However, simulation would be a more effective training tool for which to teach anesthesiologists the skills necessary to perform invasive procedures, such as endotracheal intubation, central venous catheter insertion, and epidural catheter insertion. Recently, non-technical skills, such as the Anesthesia Non-Technical Skills developed by anesthesiologists from Aberdeen University, have been emphasized as an important training resource. Technical skills and non-technical skills can be learned by anesthesiology residents through a standardized and organized simulation program. Such programs would be beneficial in training anesthesia residents to work efficiently as a team in the operation room.ope

Objective Structured Clinical Evaluation for Volume Control and Pressure Control Ventilator Modes

The purpose of this doctoral project was to create a tool to teach student registered nurse anesthetists (SRNAs) in The University of Sothern Mississippi’s (USM’s) anesthesia program about pressure control and volume control ventilator modes, and how to use them. To accomplish this goal an Objective Structured Clinical Examination (OSCE) was developed. The framework used for creating this OSCE was Kolb\u27s Theory. Kolb\u27s Theory uses a four-stage learning cycle in which the learner encounters a new experience, reflects on the observations of said new experience, conceptualizes or modifies a concept based on this experience, and then applies their idea to the world around them (Kurt, 2020). Kolb’s Theory was applied to this doctoral project by the learner first encountering and reflecting on the topics of pressure control and volume control modes of ventilation in didactic teaching and assigned readings. After being introduced to the material, the student could reflect on how they might use the two modes in a practice setting. The learner was then provided with a scenario to practice what was learned in a controlled environment. Lastly, the student could reflect on their performance and repeat the process as many times as needed for mastery of the concept. A template that laid out the material that needed to be reviewed before completing the OSCE and provided a guide to evaluate the student’s performance was created. A video that reviewed the two modes and provided a scenario for practice was also produced. A survey was sent out to a group of peers to evaluate the effectiveness of the OSCE, and all participants agreed that the OSCE was beneficial to learning about and practicing the use of volume control and pressure control ventilator modes

Uniform Clinical Evaluation for Video Laryngoscopy in Nurse Anesthesia Training: A Policy Proposal

At The University of Southern Mississippi’s (USM) Nurse Anesthesia Program (NAP), no standardized clinical evaluation for video laryngoscopy (VL) use exists. To address the gap in standardized evaluation of VL, an evidence-based, objective structured clinical examination (OSCE) will be developed and proposed to the USM NAP. The intervention to this need is the evaluation of the OSCE and supporting documents by the panel of experts. The aim of the OSCE would be to teach SRNAs in a step-by-step process how to properly handle a video laryngoscope and the necessary techniques to ensure both patient and student safety (Wunder et al., 2014). The study of the intervention will be conducted through an anonymous survey with mixed methods, as the quantitative aspect would be data collected and the qualitative aspect would be feedback from the panel of experts on the OSCE. The responses yielded that 100% of participants agreed that the report of findings (Appendix E), OSCE template (Appendix D), and OSCE video presentation was sufficient for completion of the OSCE and the Qualitative analysis returned two out of five responses suggesting there was no adjusting or editing needed. From results gathered, this OSCE has the potential to decrease stress in the SRNA as they are entering the clinical setting as well as, provide standardized teaching and evaluation of VL that would instill proper handling and techniques necessary for student and patient safety

Implementation of a GlideScope Educational Program for Novice Student Registered Nurse Anesthesiologists

GlideScope Video laryngoscopy carries a higher risk of injury to the pharyngeal cavity than direct laryngoscopy. Verathon is aware of this risk and has developed a proprietary “Four-step method” to mitigate it. This project aimed to reduce injuries related to GlideScope video laryngoscopy by providing first-year nurse anesthesiologists at Southern Illinois University Edwardsville with didactic and simulation education related to GlideScope video laryngoscopy and injury prevention. Didactic education was provided via a pre-recorded PowerPoint presentation. Simulation education was provided with the GlideScope and airway trainer manikins. The participants completed an identical 8-question pre-test and post-test to assess for knowledge gain and operator confidence after the educational intervention. Our results indicate increased knowledge gain and operator confidence

Procedural sedation: Policy, practice & knowledge

Diagnostic and invasive procedures performed outside of the operating room with nurse- administered procedural sedation are increasing. As procedural sedation practice national guidelines are evolving, there are inconsistent state regulations and a great deal of variability in staff training. These challenges lead to potential knowledge gaps and practice variation that create unsafe patient environments. A local hospital has continued to experience near miss events when procedural sedation is administered. In an attempt to investigate this issue and create improved practice, an organizational policy analysis was conducted. The aims of this project were to: 1) analyze current hospital policy content compared with AORN\u27s Guideline for Care of the Patient Receiving Moderate Sedation/Analgesia; 2) propose policy changes based on content gaps and barrier analysis; 3) assess current team members\u27 knowledge with hospital policy for procedural sedation patient monitoring and knowledge of common procedural sedation medications; and 4) develop a plan for implementing policy changes and knowledge deficits identified. The Knowledge to Action framework activation cycle was used to guide policy analysis and practice change. The institution\u27s Procedural Sedation Committee served as the discussion forum and decision making body regarding policy change. A staff survey yielded information specific to medication knowledge and procedural sedation. Policy analysis identified the following gaps in the organizational policy: a lack of objective patient assessment scoring for discharge readiness; the need for potential extended recovery times for specific patient populations; patient monitoring with capnography; pre-procedural patient education components; nurse knowledge expectations and nursing involvement in performance improvement activities. Results of the project include implementation of the Aldrete discharge readiness assessment tool, a change in policy specific to extended recovery for specific patient populations and implementation of a decision tree to determine when procedural sedation was occurring. During this project, it was discovered that additional exploration is needed regarding nurse’s procedural sedation medication and practice knowledge in order to create the next intervention that will lead to best practice

Using Simulated Human Models in Radiologic Technology Education

One of the challenges of modern medical schools is finding a way for students to practice their patient care skills before they interface with a live patient. Human simulated patients are realistic manikins that act like real patients in both sounds and actions. The technology these manikins offer needs to be supported by a well developed lesson plan that insures a student\u27s transfer of learning. In this project, the researcher provides a scenario based lesson plan that allows the students to practice patient care skills safely, using simulated patients in a realistic environment. The use of such a curriculum allowed students to stop the simulation, ask questions, and receive immediate feedback from a qualified instructor. Also, it provides the students with the opportunity to improve their psychomotor skills since they are allowed as many repetitions as needed until basic skill levels have been attained

Nurse Anesthesia Program Administrator\u27s Decision-Making in Determining Interventions for a Student Exhibiting Unsatisfactory Clinical Performance

The purpose of this grounded theory study is to define the process that nurse anesthesia program administrators use to determine if a student nurse anesthetist’s unsatisfactory clinical performance warrants intervention by the program. There is little room for error in anesthesia practice as mishaps typically result in significant injury and death. Students who exhibit unsatisfactory clinical performance may pose an immediate risk to patient safety as well as a future risk if allowed to progress in the program. The lack of guidance in the form of clearly articulated expectations and processes contribute to the emotional strain nurse anesthesia faculty and administrators experience when observing unsatisfactory clinical performance. From the data collected in the interviews with ten nurse anesthesia program administrators, a five-phase decision-making model entitled the Nurse Anesthesia Program Administrator Decision Making Model was developed. The five phases of the model include: receiving the feedback, validating the concern, assessing accountability and planning for remediation, removing the student from clinical training and moving to dismissal, and notifying the student of the decision. The guiding principle of this model is the importance of following institutional and program policies throughout the process. This study is intended to provide guidance to nurse anesthesia program administrators who are faced with a student demonstrating unsatisfactory clinical performance regarding what behaviors may require an intervention by the program