An Educational Module on a Formalized CRNA Preceptorship Workshop to Enhance Teaching and Communication Skills

Background/Purpose/Question CRNA preceptors have minimal exposure to adult learning principles and educational theory and have not received instruction related to precepting. The clinical experience can have a direct impact on student development in self-awareness, critical thinking skills, and professionalism. In order to educate and train students, preceptors need to be knowledgeable about the various methods of supervision and learning processes. The goal of a formalized preceptor training program is to enhance existing precepting skills of experienced providers by providing evidence-based teaching principles. This evidenced based practice project aims to answer: will a formalized preceptorship workshop increase the knowledge, perception and attitude of the CRNA preceptor on teaching and learning strategies, effective communication and a positive preceptor-preceptee relationship? Methods/Evidence Search The databases utilized in the search include: Pubmed, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ProQuest. Inclusion criteria for the chosen studies include, studies that are written in English with full-text availability. All studies reviewed are related to a preceptorship within nursing or nurse anesthesia. Exclusion criteria includes studies greater than 20 years old and studies that are based on precepting in a different job field. The search keywords: preceptor, preceptee, preceptorship, nursing, nurse anesthesia, student registered nurse anesthesia, education and training were entered in varying combinations throughout the search process. Thirteen articles were chosen for this review based on the inclusion and exclusion criteria. The study designs of the articles are mixed methods studies, qualitative studies, and descriptive studies. Synthesis of Literature/Results/Discussion There are four key themes formulated from the review of the articles. The first theme assesses the preceptors’ perception of their role and their needs. Bengtsson and Carlson found that preceptors want concrete tools on effective teaching of students and an understanding of preceptorship. The second and third themes include teaching strategies and learning needs. Meyers et al evaluated the perception of new RNs and found that learning occurs from receiving feedback, having a nurturing relationship with their preceptor and a positive orientation environment. A study by Forneris and Peden-McAlpine determined that preceptors felt that their precepting skills were enhanced after the initiation of a contextual learning intervention. Effective communication is the fourth theme and was ranked by SRNAS as highly important. A preceptor should be knowledgeable in effective adult teaching strategies, have an understanding of the learning needs of students and have effective communication skills. It was found that factors that negatively effect students’ education are a disempowering preceptor-student relationship, and not utilizing teaching strategies. Whether or not a preceptor training program increases preceptors’ knowledge of teaching and learning strategies needs further explanation. Future research should focus on screening of preceptors, preparation and reward for preceptors. Conclusion/Recommendations for Practice The role of the preceptor is to support the student during the transition from the classroom into clinical practice through enhancement of critical thinking and problem-solving skills. Preceptors are expected to provide an effective learning environment and facilitate a constructive clinical learning experience. An effective preceptor should possess the skills to provide constructive feedback, have knowledge about various teaching and learning principles and be able to evaluate student outcomes. The themes discussed in the articles can be used in the development of a formalized preceptorship workshop to help improve the preceptorship experience and assist in the preparation of preceptors. The standardization of a preceptor program will help new and experienced preceptors effectively transfer high quality patient care and patient safety skills to SRNAs

The Effectiveness of Single Dose Intraoperative Methadone Reducing Post-Operative Opioid Consumption at 24-48 Hours: A Quality Improvement Project

Background: Inadequate post-operative analgesia continues to pose a significant challenge in healthcare. Despite the expansion and application of innovative analgesic approaches over the past decades, more than 50% of patients experience moderate to severe pain, even after minor surgical procedures. The trend in anesthesia has been the utilization of rapid-acting opioids such as fentanyl or shorter-acting opioids such as hydromorphone. The administration of methadone exerts powerful analgesic effects through potent μ-receptor agonism, N-methyl-D-aspartate receptor antagonism, and the inhibition of serotonin and noradrenaline reuptake. It has also been used in several procedures to reduce post-operative pain and post-operative opioid consumption. Methodology: This quality improvement project composed of 15 randomized control trials reviewed whether the intraoperative use of methadone lowers post-operative pain scores and opioid consumption in comparison to other short-acting opioids commonly utilized intraoperatively. An educational module intervention composed of a pre-assessment survey, a narrated presentation, and a post-assessment survey will assess anesthesia provider knowledge. Results: The empirical evidence demonstrated that the administration of single-dose intraoperative methadone reduced post-operative pain scores and post-operative opioid consumption 48 hours after surgery compared to other short-acting opioids. Overall, the results reflect an improvement in methadone knowledge based on the pre-assessment and post-assessment survey results. Knowledge showed an average improvement of 11%. Conclusion: This quality improvement educational module seeks to assess anesthesia providers’ knowledge regarding the clinical effects of single-dose intraoperative methadone. Anesthesia providers receiving the educational intervention will include Anesthesiologists and Certified Registered Nurse Anesthetists (CRNA). The sample will include approximately 5 to 10 participants. The quality improvement project will involve three phases, a pre-assessment survey, an online educational presentation, and a post-assessment survey. Pre-assessment and post-assessment surveys will be used to evaluate the effectiveness of the educational module. Statistical analysis will be applied to assess the knowledge of the educational intervention. It is projected that the provider’s education will improve regarding the clinical effect of single-dose intraoperative methadone

An Educational Module on the Utilization of Haloperidol as a Pharmacological Complement for Postoperative Nausea and Vomiting Prophylaxis in Adult Surgical Patients

Postoperative nausea and vomiting (PONV) commonly influence the perioperative experience of general anesthesia patients. Although current guidelines suggest the use of combination therapy for PONV prophylaxis, there is diminished application in practice. A potentially efficacious and under-utilized medication being studied in combination with anti-emetics is haloperidol. The main foci of this quality improvement project are to assess anesthesia provider knowledge and attitudes regarding utilization of haloperidol for PONV prophylaxis in adult surgical patients. This quality improvement project provides a segue to enhance anesthesia practice by diminishing PONV using haloperidol. The primary methodology of the quality improvement project is to implement an online educational module to anesthesia providers that focuses on the significance of PONV in anesthesia practice and the impact of combination PONV prophylaxis utilizing haloperidol. Qualtrics pre- and post-test surveys were employed to gauge the efficacy of the educational module and to evaluate the influence on anesthesia provider knowledge and attitudes. Findings pointed to a significant increase in anesthesia provider knowledge about haloperidol PONV prophylaxis, and overall attitudes. The results showed an increase in anesthesia provider knowledge and attitudes through implementation of the educational module that presents the utilization of haloperidol as a pharmacological complement for PONV prophylaxis

Total Intravenous Anesthesia to Reduce Metastasis and Recurrence Rates in Patients Presenting for Breast Cancer Surgery: An Educational Intervention

Background: Surgical intervention for breast malignancy is the treatment of choice for the breast cancer patient population. Extensive research has established the correlation between the mode of anesthetic delivery and breast cancer recurrence and metastasis in patients undergoing surgical intervention for breast cancer. Researchers have identified the implications of volatile anesthetic agents (VAA), or inhalational agents, on the suppression of the immune response throughout the perioperative period; thus, cultivating an environment that is ideal for cancer cell proliferation, migration, and eventual metastasis via systemic circulation. Although the standardization of the anesthetic management for this patient population has not been declared, total intravenous anesthesia (TIVA) has been identified as the optimal anesthetic method to reduce the risk of breast cancer recurrence and metastasis in patients undergoing breast surgery, due to the immunologic protectant effects proffered by the drugs utilized in TIVA anesthetic administration. Methods: PubMed, Google Scholar, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) search engines were accessed via the Florida International University (FIU) library database to compose a comprehensive search for peer-reviewed research studies within the last 10 years that examined the effects of VAA or TIVA anesthetic on breast cancer recurrence and metastasis in patients undergoing surgical intervention for breast cancer. Results: Eight high-level research articles were selected for appraisal and inclusion of this review due to novelty and relevance. The articles included in this review evaluate the long-term effects of VAA or TIVA anesthetic delivery on breast cancer recurrence and metastasis in the breast cancer patient surgical population and identify the existing research-to-practice gap that must be addressed in the anesthesia community to yield the best possible outcomes for the aforementioned target population. Conclusion: Current evidence-based research has illuminated the impactful role that anesthesia providers may have on the long-term outcomes of patients with breast malignancy presenting for surgical intervention via the selection of a TIVA-based anesthetic approach. It is anticipated that the implementation of a QI project will enhance the anesthesia providers’ capacity to improve the quality of life and reduce the risk of life-altering implications with the selection of their anesthetic approach in breast cancer patients

Transcutaneous Electrical Acupoint Stimulation to Decrease Opiate Utilization in Surgical Patients: An Evidence Based Education Module

ABSTRACT Impact Statement: Improve provider knowledge on the use of transcutaneous electrical acupoint stimulation (TEAS) as an adjunct to anesthesia to decrease levels of pain and opiate usage in patients. Background: A non-pharmaceutical method of analgesia can decrease the amount of opioid analgesia required during the perioperative period. TEAS is noninvasive, affords no risk of infection, and is inexpensive. Disposable electrodes are placed on acupoints on the body and stimulated with an electrical current. TEAS has been shown to decrease perioperative opioid use and pain in surgical patients. The purpose of this evidence-based project was to answer the following clinical question: (P) For surgical patients in the perioperative period (I) does an educational module on transcutaneous electrical acupoint stimulation (C) compared to no educational module (O) increase the anesthesia provider’s knowledge in decreasing perioperative analgesia, nausea, vomiting, post-operative recovery time, pain, and increase patient satisfaction? Methods: After receiving IRB exemption, anesthesia providers at Mt. Sinai Medical Center, Miami Beach, FL were invited to participate in the study. An evidence based educational narrated video PowerPoint module and a pre- and post-test were created and distributed via email to potential participants. Responses and demographic data was collected via Qualtrics software. Results: A total of seven certified registered nurse anesthetists (CRNA) participated in the study. Results from the pre- and post-tests show that there was an average of 25.7% increase in test scores after viewing the evidence based educational module. There was also an improvement in providers’ attitudes towards TEAS. Conclusion: An evidence based educational module discussing TEAS increases anesthesia providers’ knowledge in decreasing perioperative analgesia, nausea, vomiting, post-operative recovery time, pain, and increasing patient satisfaction through the use of TEAS

Patterning of the cell cortex by Rho GTPase Dynamics

The Rho GTPases — RHOA, RAC1 and CDC42 — are small GTP binding proteins that regulate basic biological processes such as cell locomotion, cell division and morphogenesis by promoting cytoskeleton-based changes in the cell cortex. This regulation results from active (GTP-bound) Rho GTPases stimulating target proteins that, in turn, promote actin assembly and myosin 2-based contraction to organize the cortex. This basic regulatory scheme, well supported by in vitro studies, led to the natural assumption that Rho GTPases function in vivo in an essentially linear matter, with a given process being initiated by GTPase activation and terminated by GTPase inactivation. However, a growing body of evidence based on live cell imaging, modelling and experimental manipulation indicates that Rho GTPase activation and inactivation are often tightly coupled in space and time via signalling circuits and networks based on positive and negative feedback. In this Review, we present and discuss this evidence, and we address one of the fundamental consequences of coupled activation and inactivation: the ability of the Rho GTPases to self-organize, that is, direct their own transition from states of low order to states of high order. We discuss how Rho GTPase self-organization results in the formation of diverse spatiotemporal cortical patterns such as static clusters, oscillatory pulses, travelling wave trains and ring-like waves. Finally, we discuss the advantages of Rho GTPase self-organization and pattern formation for cell function