Thesis (Ed. D)--College of Saint Mary -- Omaha, 2009. / A dissertation submitted by Daniel D. Moos in partial fulfillment of the requirement for the degree of Doctor in Education with an emphasis on Health Professions Education. This dissertation has been accepted for the faculty of College of Saint Mary by: Peggy Hawkins, RN, PhD, chair ; Patricia J. Morin, RN, PhD, committee member ; Sharon Hadenfeldt, CRNA, PhD, committee member. Includes bibliographical references.

Thesis (Ph.D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Nurse Anesthesia. Bibliography: leaves 90-101. Available online via the Internet.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2006. / Title from title screen (site viewed May 16, 2007). PDF text: v, 282 p. ; 3.67Mb UMI publication number: AAT 3237556. Includes bibliographical references. Also available in microfilm and microfiche formats.

Approximately 40,000 certified registered nurse anesthetists (CRNAs) are included in the anesthesia workforce in the United States. They provide a critical portion of anesthesia care throughout the country often practicing in rural and underserved areas of America. CRNAs are educated and trained to provide high-quality, cost-effective care for patients. Policy makers and health care organizations consistently call for policies to enable these providers to deliver care to the full extent of their education and training. The National Academy of Medicine (former Institute of Medicine) recommends in their seminal report, The Future of Nursing: Leading Change, Advancing Health, that CRNAs practice to their full potential as full partners with physicians. In order to promote CRNA ability to practice to the full extent of their training and education and assure that patients have access to safe anesthesia services, both policy and organizational influences on their care provision and should be taken into account. Whereas focus has been paid to policy restrictions and their influence on CRNA care, little is known about organizational influences on CRNA care or organizational structures that are present in the employment settings of CRNAs. Organizational climate, which is employees’ perceptions of and experience with organizational structures within their employment settings, has been studied in healthcare settings. Studying organizational climate in healthcare settings is important because research concludes that organizational climate of healthcare settings impacts providers and patients. Registered nurse (RN) organizational climate has been well studied, and researchers identified that important aspects of RN organizational climate include autonomy, control over practice, teamwork, and collaborative relationships with physicians and staff. When RN organizational climate is favorable, job satisfaction and nurse retention improve, and patients receive high-quality care. Researchers have also studied nurse practitioner (NP) organizational climate and have identified climate characteristics that enable NPs to function to their full capacity, while promoting job retention, decreasing costs, and improving access to care. Whereas evidence is clear that organizational climate is an important concept to study within healthcare organizations, little is known about CRNA organizational climate or how it impacts CRNA outcomes or patient outcomes, nor do we know how to measure organizational climate and further asses it. Therefore, this dissertation investigates CRNA organizational climate and adapts a tool to measure CRNA organizational climate. In Chapter 1, a background on CRNA contributions to anesthesia care in the United States is presented. In addition, challenges and restrictions affecting CRNA practice are discussed, and studying the concept of CRNA organizational climate is introduced. The theoretical and empirical underpinnings guiding the dissertation are presented, and the three aims of the dissertation are stated. In Chapter 2, aim one of the dissertation is addressed. Aim one of the dissertation is achieved by systematically reviewing and synthesizing evidence regarding CRNA working conditions and outcomes. This evidence lays the foundation for studying CRNA organizational climate. In Chapter 3, aim two of the dissertation is addressed. This aim is achieved by selecting an instrument to adapt to measure CRNA organizational climate. In this chapter, the processes of content validity testing and reliability testing of the Certified Registered Nurse Anesthetist Organizational Climate Questionnaire (CRNA-OCQ), the adapted instrument to measure CRNA organizational climate, are presented. In Chapter 4, aim three of the dissertation is addressed. This aim is achieved by the further psychometric testing of the CRNA-OCQ, which is presented in this chapter. In this chapter, the CRNA-OCQ is refined and finalized through conducting exploratory factor analysis. In addition, the internal consistency reliability of CRNA-OCQ subscales is assessed. In Chapter 5, results from the three included studies are discussed and synthesized. In addition, practice, policy, and research recommendations are presented. Lastly, the strengths and limitations of the dissertation are discussed before the conclusion.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Thesis (M. Nurs.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 150-173). Also available in print.

A qualitative inquiry was launched to explore occupational stress among Certified Registered Nurse Anesthetists (CRNAs). Four research questions were posed: 1) What are the roles and responsibilities of the CRNAs as they see them? 2) What are the CRNAs perceived stressors encountered on the job? 3) What are their coping strategies related to the perceived stressors? 4) What is the relationship between CRNA job stress and interpersonal work connections? Twenty CRNAs, with varying anesthetic backgrounds, and 15 of their co-workers from North Carolina and Tennessee participated in the study. Semi-structured interviews, clinical observations, and artifact data (i.e., photographs) were employed to answer the research questions. The perceived occupational-related stressors that were recognized by the CRNAs pertain specifically to patient care, anesthesia work in general, interpersonal job relationships, inadequate surgical preparation, the operating room environment, and physical stressors. Staying focused upon the task at hand (i.e., patient care), the use of humor, verbalization and internalization of concerns, along with adopting personal hobbies were identified by the anesthetists as coping mechanisms to combat work-related stress. The participants take their professional duties to their patients and devotion to their fellow colleagues seriously - so much so that they rarely take vacation time or sick leave. After data analysis, six major themes surfaced: the role of being an attentive, reliable co-worker alleviates the antagonism found within OR relationships; maintaining open lines of communication is an effective way to address concerns and prevent staff conflict; among the CRNAs, occupational-related stressors create concern for patient safety; interpersonal work relations cause more stress than any of the other perceived job stressors; engaging in personal hobbies assists the CRNA in coping with work-related stress; and the nurse anesthetists' work lives are not as stressful as their personal lives. The answers to the research questions and the themes underscore the necessity that the shortage of Registered Nurses and anesthetists needs to be addressed in order to more effectively tackle the participants perceived stressors. In addition, employers can adopt concrete measures in assisting CRNAs with handling occupational stress, such as offering mandatory in-servicing and adequate time to attend in-servicing. / Ph. D.

Thesis advisor: Patricia Tabloski / Fatigue is a factor in human error particularly on tasks requiring sustained attention (Dinges, 1995). Work-hour studies of staff nurses have demonstrated that the risks of making an error increased when nurses worked longer shifts (Rogers, Hwang, Scott, Aiken, and Dinges, 2004. Workload in anesthesia care can vary widely with diverse cognitive and physical demands (Gaba and Lee, 1990; Weinger, Herndon, Zornow, Paulus, Gaba, and Dallen, 1994; Weinger, Reddy, and Slagle, 2004; Weinger and Slagle 2001). The purpose of the study was to examine the influence of work hours and workload on fatigue in certified registered nurse anesthetists (CRNAs). A predictive, correlational design was employed and utilized an electronic survey of 10,000 active certified and active recertified CRNAs. A total of 928 CRNAs completed the survey which included a self-report of work hours. Workload was measured by the NASA Task Load Index and fatigue by the Checklist Individual Strength (CIS-20). Hierarchical multiple regression analysis was applied to the data to test the hypotheses that 1) after controlling for demographic variables, the number of work hours and workload will positively influence post-shift fatigue in nurse anesthetists and 2) after controlling for demographic variables, there will be an interaction between work hours and workload in nurse anesthetists. Work hours and workload explained 19 % of the variance in fatigue in nurse anesthetists with the greatest contribution being from the number of work hours and the workload dimension of performance satisfaction. The study findings suggest that increasing hours of anesthesia time and increasing workload, particularly dissatisfaction with meeting the goals of the anesthetic (performance dimension) increase fatigue in nurse anesthetists. The implications for practice, policy, and research are discussed. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background: Acute postoperative pain can develop into chronic pain if not managed well. Nurse anesthetists consider many factors when developing an anesthetic plan to provide optimal postoperative pain management. Multimodal pain management is recommended for managing pain in the perioperative period and this may include administering medications such as intravenous (IV) acetaminophen and IV non-steroidal anti-inflammatory drugs (NSAIDs) to the patients if not contraindicated. Even though these are valuable and daily considerations for nurse anesthetists, there is not a standard of care for addressing postoperative pain management in adult abdominal surgical procedures. Objective: The purpose of the project is to determine the perspectives of nurse anesthetists for developing postoperative pain management in adult patients having abdominal surgical procedures. Design: This is a descriptive study designed to determine if current nurse anesthetist practices are being guided by evidence-based practices and if the findings can be used to develop a standard of care. Participants: Nurse anesthetists from a local Tucson, AZ health care facility Measurements: Nurse anesthetists were interviewed in-person. They were asked six semi-structured questions and the answers were recorded and transcribed into the program NVivo. Each answer was then coded and compared for emerging common themes. Results: Five out of eleven nurse anesthetists participated in this project. Thirty-five themes were discovered and three main categories developed: 1. Nurse anesthetists consider multimodal pain management an integral part of the anesthetic plan. IV acetaminophen and IV NSAIDs are considered for every surgical patient if they are not contraindicated; 2. IV acetaminophen is used more frequently for abdominal procedures compared to IV NSAIDs because of risks for bleeding associated with IV NSAIDs; and 3. Each anesthetic plan is individualized to safely address both the patient and surgical factors. Conclusion: A multi-center study should be considered for a future project to determine if these common themes would be found consistently across health care facilities. Eventually, this information could be used to develop a standard of care for managing postoperative pain in adults having abdominal surgery. Other methods for addressing multimodal pain management such as regional blocks should be considered for future studies as well.

Bakgrund: Antalet intensiv -och anestesisjuksköterskor har ökat från 87 till 111 per hundra tusen invånare de senaste tjugo åren, trots detta rapporterar SCB i sin årliga arbetskraftsbarometer en stor brist för samma personalgrupp. Forskning som identifierar trivsel respektive misstrivsel på en arbetsplats och varför personal slutar, utifrån anestesisjuksköterskors perspektiv är begränsad. Denna studie är ett bidrag som ökar förståelsen för varför anestesisjuksköterskor slutar på anestesikliniken. Syfte: Att beskriva aspekter till varför anestesisjuksköterskor slutar på sina arbetsplatser inom anestesikliniken samt vad som skulle kunna ha förändrat beslutet. Metod: Deskriptiv intervjustudie med åtta anestesisjuksköterskor. Data analyserades med kvalitativ latent innehållsanalys. Resultat: Aspekterna som påverkar anestesisjuksköterskorna att avsluta sina tjänster på anestesikliniken står i ett komplext samband till varandra. Drivkraft identifierades som en viktigt faktor för att stanna på arbetsplatsen. Den består dels av inre motivation som kommer ur arbetsglädje, givande patientmöten och möjlighet till återhämtning. Drivkraften utgörs också av den yttre motivationen som består av kompetensutveckling och lönesättning. Drivkraften försvagas om dessa faktorer inte ges tillräckligt utrymme och det finns risk för att anestesisjuksköterskor slutar. Anestesisjuksköterskornas drivkraft är beroende av en förankring för att uppnå balans och inte driva iväg för långt. För att åstadkomma förankring lyfts betydelsen av självständighet fram vilken består av rimlig ansvarsfördelning, tydliga roller och respekt för varandra. Självständigheten står i ett beroende till samarbetet på arbetsplatsen. Ur ett gott kollegialt stöd växer en sammanhållning fram som skapar trivsel och förankrar anestesisjuksköterskorna i organisationen. Konklusion: Arbetet beskrivs som odelat positivt när rätt förutsättningar för att kunna utföra det på ett tillfredsställande sätt finns. Aspekterna kring varför anestesisjuksköterskorna avslutar sina tjänster på anestesiklinikerna står i ett komplext samband till varandra.