College of Science and Health Theses and Dissertations

Date of Award

Summer 8-20-2017

Degree Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Julia Feczko, DNP, CRNA

Second Advisor

Susan Krawczyk, DNP, CRNA

Abstract

Background: Non-technical skill deficiency can increase the chance of error, which can result in adverse events. While the traditional anesthesia teaching plays a significant role on knowledge acquisition and development of technical skills, non-technical skills have been identified to be the key determinant of successful anesthesia particularly during crisis management (Yee et al., 2005). Task-related non-technical skills, such as recognition, prioritization, and decision-making are essential for safe administration of anesthesia (Wunder, 2016). Purpose: The purpose of this study is to improve three non-technical skills (recognition, prioritization, and decision-making) in SRNAs new to the clinical setting with the use of an instructional video demonstrating the appropriate management of an airway obstruction during monitored anesthesia care (MAC). Methods: A quasi-experimental pre-test and post-test and critical action survey design were used to investigate the effect of a pre-recorded instructional video demonstrating proper task-management skills, specifically recognition, prioritization, and decisionmaking of the SRNA during airway obstruction in MAC anesthesia. A convenience sample approach was used to obtain student volunteers in their second or third year of graduate school as SRNAs at NorthShore University HealthSystem School of Nurse Anesthesia, Evanston, IL. Results: Using a sample of 23 SRNAs, the effect of an instructional video on the taskmanagement skills of recognition, prioritization and decision-making in airway obstruction during MAC anesthesia was evaluated. Wilcoxon Signed Ranks Test demonstrated statistically significant differences in the participants' level of comfort in recognition and prioritization, pre and post-instructional video [Z= -3.507; p = .000 (2- tailed).] A positive correlation was demonstrated between comfort, with use of the postvideo survey, and confidence, with use of the Critical Action Survey, by using Spearman’s r. Results demonstrated a significant positive relationship, where increases in comfort with non-technical tasks was associated with increased critical action mean scores for confidence both in the pre test mean score of comfort (r=0.843; p=<0.001) and post-test mean score for comfort (r=0.931; p=<0.001) characterized by very strong positive correlations (correlation being significant at the 0.01 level). The highest mean score was achieved for the variable, placing a facemask: venti mask, rebreather and nonrebreather at a mean of 4.57 and the lowest mean score for the variable, performing induction, intubation, and mechanical ventilation if needed at a mean of 4.13. Conclusions: The findings demonstrate the effectiveness of an instructional video on task-management skill training, with the focus on airway obstruction during MAC anesthesia, for SRNAs. Using an integrated pre-recorded instructional video, there was an improvement in comfort and confidence levels of the following task-management skills: recognition, prioritization and decision-making of SRNAs during airway obstruction in MAC anesthesia.

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