Prática Clínica Do Enfermeiro Anestesista Nos Estados Unidos Da América

O objetivo deste trabalho foi descrever o perfil profissional do enfermeiro anestesista nos EUA (Estados Unidos da América) e descrever as atribuições do enfermeiro anestesiologista. A pesquisa é uma revisão bibliográfica de abordagem descritiva e qualitativa. Foi realizada nos bancos de dados da SciELO (Scientific Electronic Library Online), Google Acadêmico e BVS (biblioteca virtual em saúde) e com a seguinte pergunta de pesquisa: como é a prática clínica do enfermeiro anestesista nos Estados Unidos? Foram inclusos os artigos acadêmicos publicados entre 2011 à 2021, disponíveis de forma gratuita, em língua inglesa ou portuguesa. Foram excluídos os artigos inferiores a 2011, em outros idiomas, resumos, periódicos que não contemplavam nenhum dos objetivos, que não respondessem à pergunta de pesquisa e artigos repetidos encontrados nas bases de dados citadas acima, no qual resultou em uma amostra final de 18 artigos. Os Certified Registered Nurse Anesthetists (CRNAs) são profissionais aptos a desenvolverem práticas avançadas de enfermagem e em muitos estados norte-americanos praticam sem supervisão médica. São responsáveis por fornecer anestesia segura com alta qualidade e com melhor custo-benefício para o paciente, além de ter um perfil profissional que assume grande responsabilidade. A prática de enfermagem em anestesiologia não existe no Brasil, pois é uma área da medicina privativa ao profissional médico. A enfermagem nos EUA é bem avançada, não só para o enfermeiro anestesista, que possui autonomia para realizar a anestesia de um paciente, mas para as demais especializações da área. Os profissionais de práticas avançadas devem se especializar e estudar muito para desenvolver estas atividades, assim como se manterem atualizados.

Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery

Objectives: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. Methods: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. Results: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Conclusion: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.

The French Pre-Deployment Advanced Course in Anesthesia and Resuscitation: Development and Future Prospects

ABSTRACT Introduction Military anesthesiologists from the French Military Medical Service (FMMS) are part of the Forward Surgical Teams deployed in overseas military operations. The practice of anesthesia in combat zones requires specific skills that are not taught during the initial curriculum for French civilian anesthesiologist. The Pre-Deployment Advanced Course in Anesthesia and Resuscitation (DACAR) program was developed to prepare military anesthesiologist from the FMMS before their deployment in overseas military operations. Methods Created in 2013 by the French Military Medical Academy, the DACAR program is divided into two modules and carried out once a year. The DACAR program trains all military anesthesiologist residents at the end of their curricula. Since 2019, a number of Certified Registered Nurse Anesthetists have completed the DACAR program. The DACAR program is organized around the main axes of experience feedback from previous deployments in combat zones as well as didactic learning and practical training using high-fidelity simulation. Results Since 2013, a total of 99 trainees completed the DACAR program during six complete cycles of two modules. The DACAR program has gradually been enriched from 14 courses in 2013 to 28 in 2019. Participants’ reported satisfaction rates have increased steadily since 2016, when 88% of courses were rated as “interesting” or “very interesting,” and only 4% as “not very interesting.” By 2019, those figures had improved to 96% and 2%, respectively. Conclusion The DACAR program is a structured and adapted military medical course aimed at completing the curriculum of military anesthesiologists from the FMMS before deployment in overseas military operations. Regular audits and updates ensure that the DACAR training program maintains the highest standards of quality and rigor.

The Key to Combat Readiness Is a Strong Military–Civilian Partnership

ABSTRACT Introduction In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents <0.5% of military hospital admissions and not all team members have daily clinical responsibilities. Military surgeon clinical experience has been described, but no data exist for other members of the FRST. We test the hypothesis that the clinical experience of non-physician FRST members varies between active duty (AD) and Army reservists (AR). Methods Over a 3-year period, all FRSTs were surveyed at one civilian center. Results Six hundred and thirteen FRST soldiers were provided surveys and 609 responded (99.3%), including 499 (81.9%) non-physicians and 110 (18.1%) physicians/physician assistants. The non-physician group included 69% male with an average age of 34 ± 11 years and consisted of 224 AR (45%) and 275 AD (55%). Rank ranged from Private to Colonel with officers accounting for 41%. For AD vs. AR, combat experience was similar: 50% vs. 52% had ≥1 combat deployment, 52% vs. 60% peri-deployment patient load was trauma-related, and 31% vs. 32% had ≥40 patient contacts during most recent deployment (all P > .15). However, medical experience differed for AD and AR: 18% vs. 29% had >15 years of experience in practice and 4% vs. 17% spent >50% of their time treating critically injured patients (all P < .001). These differences persisted across all specialties, including perioperative nurses, certified registered nurse anesthetists, operating room (OR) techs, critical-care nurses, emergency room (ER) nurses, licensed practical nurse (LPN), and combat medics. Conclusions This is the first study of clinical practice patterns in AD vs. AR, non-physician members of Army FRSTs. In concordance with previous studies of military surgeons, FRST non-physicians seem to be lacking clinical experience as well. To maintain readiness and to provide optimal care for our injured warriors, the entire FRST, not just individuals, should embed within civilian centers.

The Psychometric Analysis of an Instrument to Measure the Perceived Workload for Certified Registered Nurse Anesthetists

Background and PurposeIn a previous study, the CRNA Workload Perception Scale (CWPS) was developed. The purpose of this article was to investigate the psychometrics of the CWPS.MethodsThe CWPS was tested in a population of CRNAs. This study was conducted in two phases. Phase I consisted of classical psychometrics; the 12-item instrument was piloted in a sample of 265 CRNAs. Phase II consisted of qualitative analysis to provide feedback on items that did not perform well.ResultsPhase I: Instrument demonstrated good reliability (r = .77). Parametric and nonparametric analysis indicated 6 of 12 items were good fit to measure perception of workload. Phase II: Qualitative analysis resulted in refinement of four items, addition of one item, and elimination of two items.ConclusionsA revised 11-item CWPS was developed.

Impact of Clinical Nurse Specialist Roles on COVID-19 Pandemic Care

Advanced practice nurses including nurse practitioners, clinical nurse specialists (CNS), certified registered nurse anesthetists, and certified nurse midwives contribute in many ways to improve care in the intensive care unit. This article reports on the roles of the CNS at an academic medical center and how they contribute to improving patient outcomes and support critical care nursing practice during the COVID-19 pandemic.