Nurse Anesthesia Department
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Item A Review of the Existing Evidence-based Protocols/guidelines on Oxytocin Dosing during Elective Cesarean Section to Prevent Post-partum Hemorrhage--A Creation of a Class A Pharmacology Continuing Educational Module for Certified Registered Nurse Anesthetist(2023-01-15) Lyons, Khadijah; Martinez, EuniceOxytocin is an endogenous hormone, and Pitocin is its synthetic analog often administered in the parturient patient to induce labor and further dilate the cervix. Per the American College of Obstetricians and Gynecologists (ACOG) and American Society of Anesthesiologists (ASA), there are standard dosage and administration guidelines to ensure safe delivery and decrease postpartum hemorrhage (PPH) (2020). Anesthesia providers must understand these administration guidelines to ensure more favorable health outcomes in the laboring woman. Globally, PPH is the leading cause of maternal mortality. A literature review suggests Pitocin via intravenous administration during active labor can significantly reduce postpartum hemorrhage, thus leading to more favorable health outcomes in the parturient patient (Salati et al., 2019). Education is a method of affecting change. A 60-minute evidenced-based Class A pharmacology continuing education (CE) module on the appropriate use of Pitocin to prevent PPH during elective cesarean section was developed for Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs). The goal of the module is to discuss the role of oxytocin in the parturient patient, to provide evidence-based recommendations for intravenous Pitocin dosing during elective cesarean section to prevent PPH, and to understand the physiological changes associated with increased levels of oxytocin.Item Academic Self-Efficacy in Student Registered Nurse Anesthetists(2024-02-18) Hueneke, Sara; Rademaker, Alex; Smith, EllenAdvanced learning strategies can help augment academic success in graduate-level academia. The level of synthesis and metacognition required by graduate education is generally not learned at the undergraduate level and presents a need to shift learning styles. While many studies exist on this topic, few directly relate to Doctor of Nurse Anesthesia Practice (DNAP) program students. This scholarly project aimed to determine if education on learning techniques early in a program is associated with improved academic self-efficacy (ASE). Interviews with key players have identified three topics that are particularly useful for building ASE: discovering new study strategies, managing procrastination, and strengthening time management. This scholarly project used a quasi-experimental design with convenience sampling with a maximum sample size of 30 to identify learning strategies suited for the DNAP population. A validated instrument, the Motivated Strategies for Learning Questionnaire (MSLQ) was utilized to assess perceptions of ASE before and after reviewing the module during the first didactic DNAP trimester (see appendix D). Utilizing the Statistical Package for Social Sciences software version 21, the results provide strong evidence (α=0.05) to reject the null hypothesis, indicating a statistically significant increase in participants' ASE before and after the intervention, as supported by the Wilcoxon Signed-Rank test results for both the MSLQ control of learning beliefs component and total scores (p=0.0412 and p=0.0431, respectively). Given the findings, correcting maladaptive educational behaviors and introducing new learning techniques early in the program could have a significant impact on DNAP learning methods.Item Active Learning in Nurse Anesthesia Didactic Education(2022) Giffin, Rice; Sweet, CaalaActive learning is an innovative pedagogical approach to teaching where instructional methods other than lecture allow students to become active participants in their education during didactic sessions. Many disciplines within graduate-level medical and healthcare education report positive outcomes with active learning implementation; however, a gap in the literature exists regarding nurse anesthesia educators' understanding and use of active learning in the didactic setting. An online anonymous survey, including demographics, qualitative questions, and ordinal quantitative questions, was performed by the American Association of Nurse Anesthetists. Data analysis revealed how nurse anesthesia didactic faculty were implementing active learning prior to and after the COVID-19 pandemic began, with frequency distribution for the pre-pandemic period, and an assessment for pandemic-induced modifications to active learning strategies/implementation. Study findings included quantitative evidence on the implementation of question and answer, computer-based interaction systems, peer-teaching, formative quizzes and surveys, cooperative learning, case studies, application activities, and cooperative case work. Qualitative analysis demonstrated methods prior to the pandemic closely aligned with this evidence, while exhibiting varying degrees of student involvement. Continued analysis showed many nurse anesthesia educators had attempted to adapt active learning techniques/implementation due to pandemic-induced teaching restrictions and that most of those educators did not previously have methods in place to ease the transition. The implications of this study are profound when the concept of engagement is considered, where engaging students is constructing knowledge, allowing for further discussion and exploration, enhanced implementation, and future innovations in active learning within nurse anesthesia didactic education.Item Adhesive Tape Cross-Contamination in the Operating Room(2024-02-17) Jimenez, Izamar; Reames, Danielle; Verbal, JurneeThe use of adhesive tape in the operating room serves multiple purposes for the anesthesia provider. Most importantly, is its use in securing the patient's airway, specifically the endotracheal tube. There are a lack of policies and procedures to prevent the cross-contamination of adhesive tape rolls during those critical moments, leading to the tape's exposure to bodily fluids and blood. The inability to properly clean and sterilize tape makes it a reservoir for pathogens and blood to spread, placing patients at risk during airway securement. The primary aim of this scholarly project was to reveal the need to initiate cleaner handling and storage of tape rolls, as evidenced by the presence of bacteria and blood on tape utilized for securing the endotracheal tube in the operating room. To support this innovation, a data compilation was performed after collecting samples of three different types of adhesive tape used by anesthesia providers in the operating room, along with a control group of packaged, clean tape. A total of 33 samples were obtained from ten different operating rooms in a large hospital located in the Southeastern United States. Furthermore, P levels <0.05 were considered significant, which demonstrated the need for cleaner practices of tape storage and utilization to ensure patient safety and protection against nosocomial infections.Item Advancement of the Nursing Honor Society and Development of Sigma Theta Tau Internatioinal Chapter at Adventist University of Health Sciences(2015) Tucker, Ffion; Silas, BlessyThe Honor Society of Nursing, Sigma Theta Tau International (STTI), was founded by six nurses from Indiana School of Nursing, Indiana, in 1922. The purpose or mission of the STTI is to assist the learning, knowledge and professional advancement of nurses devoted to making a difference in global healthcare. The Adventist University of Health Sciences (ADU) established the Nursing Honor Society (NHS) in 2013 and is in the process of becoming a chapter of STTI. The ADU honor society has already completed the first two phases of STTI chapter development and is now operating in the third phase. The process of establishing an STTI chapter at ADU was started in 2012 by two nurse anesthesia students from the class of 2013 and was followed by another student from the class of 2014 who helped the chapter to proceed into the third phase. The goal of this project was to advance this chapter to its next phase and recruit needed members (50) to apply for the STTI chapter. This project needed to be done in order to help promote the NHS and to build membership so that the goal of achieving STTI status can come to fruition. This was necessary so that the mission of ADU and the STTI to build healthcare and advance nursing professional excellence can continue to be met, not only in the Florida Hospital community and its environs, but also globally. Advancing the ADU NHS to STTI chapter would be a great achievement and would provide for inter professional collaboration on an international level. This project has implications for nurse anesthesia practice in that membership by the nurse anesthesia students will deepen the roots of education by providing continuing education in the form of conferences, meetings, and online or in journal articles, and encourages growth by improving the leadership skills. These organizations will help nurses learn the refined values and priorities that are not learned from the classroom. It is of vital importance to help cultivate in these nursing professionals, soon to be CRNA’s, the drive to always strive for excellence and to align themselves with certain organizations that can help to facilitate this growth and development. This growth and development of leadership skills along with the continued drive for excellence by these student nurse anesthetists can also transcend into the work place and affect anesthesia practice.Item Anesthesia Care Implications of Paragangliomas and Pheochromocytomas(2017) Pak, Soomee; Nielsen, MignonPheochromocytomas (PHEO) and paragangliomas (PGL) are rare conditions that an anesthesia provider may or may not encounter in his or her career. However, due to the life-threatening nature of these conditions and the critical anesthetic implications in the perioperative periods, the authors deemed it a must to present a lecture to the group of student registered nurse anesthetists (SRNAs) at Adventist University of Health Sciences. The educational lecture was provided with the goal of bridging the SRNAs’ knowledge gaps regarding PHEO and PGL in general, and of helping them to be more familiar with PGL in particular. A convenience sample of 34 SRNAs was utilized after informed consents were obtained. For the purpose of analyzing the effectiveness of the PowerPoint lecture, the pre-test and post-test scores were compared. A paired t test revealed p value of < 0.05, affirming the statistical significance. The pre-test scores had shown the lack of knowledge in general, as evidenced by the low average test scores (3.47/11). The mean post-test scores (6.32/11) were definitely improved after the lecture, albeit the average was still less than optimally anticipated.Item Anesthesia Preceptorship and Standardized Methods(2023-03-27) Walton, Caval; Bennett, ZacharyClinical learning is critical for developing students and graduate advanced practice nurses. Clinical education affects self-awareness, critical thinking, and hands-on skills. Graduate students develop their practice by being precepted by advanced practice preceptors. Clinical learning, however, is negatively impacted by preceptors who may lack appropriate, evidenced based training. Thus, preceptors and their knowledge base play a significant role in this development and could potentially influence future patient outcomes. This scholarly project aimed to address knowledge gaps of advanced practice preceptors by creating an online continuing education module regarding evidence-based precepting approaches for certified registered nurse anesthetists and attempted to submit to the American Association of Nurse Anesthesiology (AANA) for approval which was denied. While developing this module, the current process for creating Continuing Education (CE) modules at AdventHealth University (AHU) was optimized through the application of a Find Organize Clarify Understand Select (FOCUS) Plan-Do-Check-Act (PDCA) cycle to create a protocol that outlines requirements, optimize facilitators and minimize barriers. The FOCUS PDCA cycle is a quality improvement model that will provide a structure for problem-solving. The FOCUS portion of this cycle was addressed in this project and future improvements could be made by future cohorts through implementing the PDCA portion. This project aimed to create a CE module but was denied for lack of evidence to support its creation. A protocol was developed for improving the process of CE module creation with the AdventHealth University’s continuing education division, Echelon.Item Anesthesia Provider’s Preception on Preserving Asepsis at the Epidural Catheter Hub(2023-04-06) Barcelow, Travis; Dominique, KindraEpidural catheter infections occur despite best practice guidance. The incidence of positive infectious cultures obtained from epidural catheters is approximately 23%. While most infections are superficial, the incidence of infection within the deeper epidural space can result in permanent and irriversable neurologic damage. The epidural catheter hub is a potential route of contamination that can occur with repeated injections. There is very little literature focusing on the epidural catheter hub and the contamination with repeated injections. The objectives of this scholarly project is to examine the current practice of anesthesia providers and to evaluate whether the current evidence-based best-practice standards, regarding epidural hub mainenance are being applied consistently. Further investigation is needed and will be conducted by surveying providers to determine if there are inconsistencies among practice. The survey findings may suggest the need for further education regarding need for consistent evidence-based best-practice standards to help reduce the risks for epidural catheter infections.Item Anesthesia Requirements for Redheads(2016) Classon, NathanAs the melanocortin-1 receptor gene was not discovered until 1995, only anecdotal observation supported that redheads had an increased anesthetic requirement. Utilizing relatively recent research, this project aimed to enhance the knowledge regarding the anesthetic requirements for redheads among student registered nurse anesthetists (SRNAs). Interestingly, there was a decided perspectival shift in the opinion of literature reviewed between 2004 and 2015. Earlier studies were supportive of an increased anesthetic requirement of redheads, while more recent studies discouraged such an approach. It is possible that the later studies relied on self-reported hair phenotype, rather than analysis of genetic makeup of the MC1R genotype. Given this, it is plausible that there is a significant difference in the anesthetic requirements of redheads, depending on whether they are homozygous, heterozygous, or compound heterozygous. Therefore, current literature was reviewed, synthesized, and presented simultaneously to two cohorts of SRNAs at Adventist University (ADU). The project’s efficacy was determined by comparing the scores of an identical pre- and post-test.Item Anesthesia Workstations as Intensive Care Ventilators During a COVID-19 Surge(2023-02-07) Jordan, Jasmin; Estima, BellySARS-CoV-2 is an extremely transmittable virus that causes coronavirus disease 2019 (COVID-19). In the last 20 years, COVID-19 is the third coronavirus pandemic to occur. The SARS virus of 2002, while highly virulent, was not rapidly transmitted and thus did not create a significant strain on healthcare infrastructure. In early 2009, Influenza A (H1N1) like COVID-19 transmitted rapidly throughout the world and increased hospitalizations at an exponential rate but was still treatable with available medical resources. The surge created by COVID-19, however, resulted in an increase in hospitalizations that created such a strain on hospital infrastructure, it became necessary to implement alternative patient care solutions to treat the surge of critically ill patients. As COVID-19 spread, patients showed rapid decline with many requiring respiratory support via mechanical ventilation. This rise in intensive care ventilator use, outstripped available resources and generated an imminent need for unconventional solutions. Anesthesia workstations were rapidly identified as a viable alternative to address the demand for mechanical ventilation devices created by COVID-19. The use of anesthesia workstations within the intensive care environment however, resulted in a knowledge gap for critical care nurses who had no prior exposure to the equipment. Thus, creation of an evidence based online continuing education module in collaboration with Echelon, AdventHealth University's (AHU) professional education division will help decrease critical care nurse knowledge gap regarding the use of anesthesia machines as intensive care ventilators. With a secondary aim of constructing an SRNA guidance protocol that clarifies and improves the CE module development at AHU.Item Anesthetic Implications for Implanted Cardiac Devices in Patients Undergoing Non-Cardiac Surgery(2018) Saladino, Brittni; Tulenko, ValerieA scholarly project presentation for Anesthetic Implications for Implanted Cardiac Devices in Patients Undergoing Non-Cardiac Surgery was executed to the Adventist University of Health Sciences Nurse Anesthesia Program Student Registered Nurse Anesthetist (SRNA) cohorts of 2018 and 2019. This particular project and topic was of interest because there was a noticeable deficit in understanding regarding anesthetic management of implantable cardiac device education in the Nurse Anesthesia Program. The objective of this project was to enhance the knowledge base for future clinical encounters. After obtaining informed consent, a completely anonymous pre-test was administered to the research subjects. The researchers then provided a research-based PowerPoint presentation. After the presentation, an anonymous post-test was given. The researchers aimed to see evidence of enhanced baseline knowledge by observing an increase in mean scores from the pre-test to the post-test. The presentation, was, in fact, effective, as there was in increase in mean scores of 34.18% on the pre-test, to an average of 76.83% on the post-test. The conclusion can be drawn that the researchers were successful in their aim to increase knowledge base in this population, and the method of a PowerPoint presentation was effective at achieving the goal.Item Anesthetic Implications of Obstructive Sleep Apnea (OSA) in the Adult Population(2018) Burrington, Jeffery; Stanga, JosephThe intent of this project was to assess the student nurse anesthetist’s level of understanding on the anesthetic implications of patients with obstructive sleep apnea (OSA). The researchers aimed to educate this cohort on the best evidence-based practice in managing patients with OSA. There is a very high correlation between OSA and increased body mass index (BMI). As the prevalence of obesity rapidly rises in the United States, health care clinicians find themselves caring for more patients with OSA. Due to the increased prevalence of OSA, it is imperative that new clinicians have a sound knowledge of the comorbidities and the anesthetic implications that are directly related to this disease. The literature review revealed that OSA is largely under diagnosed. The literature also revealed common strategies that should be implemented perioperatively to reduce post-op complications in this specific group of patients. Research indicates that patients with OSA may be more sensitive to opioids, thus should be used sparingly. Another focus of this project was to improve screening for OSA and to better manage their anesthetic care. A pretest was administered to the participants before an educational presentation, then a posttest after the presentation was completed to measure the increase in knowledge. The pre-and posttests were graded and the statistics were analyzed utilizing a paired t-test. From the data, the researchers determined the t value is -13.347 (p < .001) which is statistically significant. Therefore, it can be concluded that there is a significant increase in the mean percentage values between pre-test and post-test.Item Are Cannabinoids Effective in Treating Non-Malignant Chronic Pain in Adult Patients(2018) Luk, Kenneth W.; Tokash, Terry L.A large component of anesthetic practice incorporates pain management, and a growing contingency of patients whom anesthesia providers encounter each day have chronic pain. Multimodal pain regiments and their use in the management of chronic pain in adults have increased as a result. One alternative that has shown potential for pain management is cannabinoids, which work through the endocannabinoid system (ECS). With the legalization of medicinal marijuana in Florida, an increased knowledge base is needed to better drive care. A literature search of CINAHL, PubMed, Cochrane Databases, MEDLINE, and Google Scholar was done to discover the current knowledge of cannabinoids in treating chronic, non-malignant pain. There have been mixed results as to the efficacy of cannabinoids in this population, but they are well tolerated with rare serious adverse effects. A 30-minute presentation was created to better familiarize the master’s level Nurse Anesthesia Program’s students enrolled at AdventHealth University (AHU) with the current findings. A ten-question evaluation was conducted before and after the PowerPoint presentation. The results were analyzed using a paired sample t-test with a predetermined significance level of p<.05 using Statistical Package for the Social Sciences (SPSS). The pre-test mean was 26.19% and post-test was 55.24%. With a pvalue < 0.001, statistical significance was achieved, demonstrating the efficacy of the educational module in expanding the knowledge base of current AHU student nurse anesthetists regarding the use of cannabinoids in the treatment of chronic, non-malignant pain.Item Assessment and Management of the Opioid Tolerant Patient During the Perioperative Period(2015) Rauch, Karla; Bautista, ClaireCurrently, management of chronic pain patients in a perioperative setting continues to be a challenge for every anesthesia provider. The challenges faced include opioid-induced hyperalgesia, patient satisfaction with their pain control, prevention of long-term disability, and issues of delayed mobilization due to uncontrolled pain. These challenges may occur due to under medication or lack of balanced analgesia techniques. Conversely, overmedication can lead to postoperative respiratory insufficiency with prolonged ventilator dependence and associated complications increasing length of hospital stay. These challenges are complicated for experienced providers; therefore, student registered nurse anesthetists (SRNAs) beginning their clinical rotations will find managing these patients an even greater challenge. The goal of this project was to provide tools for use in the care of patients with chronic pain. Tools that were provided included introducing the new SRNA to an in-depth preoperative pain assessment, a thorough understanding of the pathophysiology of acute and chronic pain development, dosing and regimens of analgesic adjuncts to be utilized concomitantly with opioids, and the use of equi-analgesic opioid dosing to plan appropriate interventions to improve the future health of their patients. Case scenarios were discussed to emphasize multimodal analgesia techniques to reduce the negative side effects of a pure opioid analgesia technique.Item Barriers and Determinants that Influence Membership in the American Association of Nurse Anesthetists(2021) Samons, David; Samons, JisselThe American Association of Nurse Anesthetists (AANA) have a significant role in providing various benefits to their members and advancing the profession. However, membership percentages have decreased within the last 10 years. A review of the literature was conducted to identify the determinants that influence decision making regarding professional association membership. It was discovered that Florida was among the states with the highest percentages of non-members. For that reason, a scholarly project was developed and implemented to examine the factors that influence decision making regarding professional association membership among Florida’s licensed nurse anesthetists. An online survey was developed and sent to all Florida Certified Registered Nurse Anesthetists (CRNAs) with the help of the Florida Association of Nurse Anesthetists (FANA). The results of the survey revealed barriers to membership included dissatisfaction with the new National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) Continued Professional Certification (CPC) requirements, cost of membership, and a lack of education about the AANA. Determinants to membership identified included the benefit of CEUs and tracking, professional promotion, and the political advocacy the AANA provides. There was insufficient power to compare responses between FANA members and non-members due to a low non-member response rate. However, sufficient information was derived to suggest implications and recommendations to help improve future research efforts and better understand the issue.Item Best Practice for Anesthesia for ECT: Quality Improvement Review and Guideline Development for ADU SRNAs at Florida Hospital(2017) Nguyen, Thu-Hien; Calcetto, PatriciaElectroconvulsive Therapy (ECT) is a safe and effective treatment for various psychiatric disorders. ECT treatment entailed the delivery of an electrical current via electrodes applied to the scalp that produce a generalized therapeutic seizure. Due to the nature of the procedure and for patient safety and comfort, the anesthetic of choice is general anesthesia. Unlike other general anesthesia cases, the anesthetic goals for ECT are a rapid induction, deep muscle relaxation without interference with seizure quality and length, and a rapid emergence. Due to the fast pace, multiple providers, and a multitude of distractions during ECT procedures, new providers, such as Student Registered Nurse Anesthetists (SRNAs), are at an increased risk for committing a medication error. This lack of knowledge and understanding of the ECT procedure and clinical setting can potentially impact patient care. Henceforth, the primary purpose of this project was to design a protocol intended to establish a safe process for preparing and labeling high-risk medications commonly used during ECT treatments by SRNAs. The sample population utilized in this project was the Adventist University of Health Sciences’ Nurse Anesthetist Program SRNAs class of 2018. The intervention used to address the problem is through a pre-test, a 30 to 45 minute PowerPoint presentation, and a post-test. The anticipated outcome of the PowerPoint presentation was an increase in the level of knowledge and understanding of the participants as demonstrated by improved post-test scores, indicating an effective PowerPoint presentation. The statistical analysis results of the pre- and post-test indicated significant increase in the level of knowledge of SRNAs after the PowerPoint presentation.Item Best Practices for Prevention of Perioperative Ocular Injuries(2018) Best, Amy; Englehardt, AmyAnesthesia providers are entrusted with the responsibility of providing competent health care and maintaining patient safety. This includes minimizing potential injury a patient may face during the perioperative period. Safe standards of practice may be derived from the most current body of research data. A literature review regarding preventative measures of perioperative ocular injury (POI) has demonstrated that, while having a low incidence, these occurrences may inflict devastating and possibly permanent vision impairment and discomfort upon patients. Research varies on which method of ocular protection is superior. Student registered nurse anesthetists (SRNA) have limited experience with management of POIs. The intent of this scholarly project was to increase the knowledge base of a sample size of 48 SRNAs at one nurse anesthesia program about POIs. The fundamental goal of this study was to increase the SRNAs’ awareness of evidence-based practice to assist with prevention of future POIs. SRNAs completed a pre-test consisting of 10 questions regarding pertinent POI information immediately prior to receiving education about POIs via a PowerPoint presentation. SRNAs then completed a post-test consisting of the same 10 questions presented in the pre-test. A correlation between scores utilizing statistical software determined an increase in the knowledge base of the SRNAs was achieved. POI education was successfully implemented and resulted in an increase in SRNA knowledge base. POI is relevant to the anesthesia profession. Therefore, a thorough understanding of POI incidence, prevalence, etiology, risk factors, evidence-based prevention and treatment, may be advantageous in possibly reducing its occurrence.Item Capnography Monitoring in PACU for High Risk Patients(2018) Brown, LeeAnn; Smith, KiAnneThe American population is becoming sicker, increasing the risk of respiratory complications such as hypopnea, hypercapnia, aspiration, and apnea in the Post Anesthesia Care Unit. These problems may be going undetected too long using the current standard of monitoring. Although the implementation of capnography monitoring may prevent adverse respiratory events in the post-anesthesia care unit (PACU), its use is not a standard of care. The goal of this project was to increase SRNA knowledge base regarding postoperative respiratory issues for high risk patients recovering in the PACU and that implementation of capnography monitoring in PACU for high risk patients allows for early intervention, prevention of negative respiratory outcomes, and should be a standard of care. A quantitative pre-post test design was used to determine the effectiveness of increasing the knowledge-base of 22 SRNAs using a paired sample t-test with a pre-determined significance level of p < 0.05. There was a significant difference in the pre-test scores M=.42, SD=.17) and post-test scores (M=.80, SD=.13) Conditions; t(21)=(-12.51), p=.000. The primary implication of these results is that the education of SRNAs broadened their knowledge base of post-operative respiratory issues.Item Care Planning Process for Specialty Rotations(2014) Berrios, Jane; Chance, Elena; Kim, YuniTransitioning into a specialty rotation with minimal didactic opportunity in these areas can not only be difficult for the student nurse anesthetist, it can also cause variations of anxiousness. Having a basic understanding of the specialty rotation can be provided through preparation by developing a care plan, as well as learning how to utilize and implement the care plan. This offers the SRNA a tool to allow for an efficient transition that alleviates the anxiousness that usually occurs when starting these rotations. Research was executed regarding the benefits and barriers to utilizing and implementing the care planning process and compiling data to construct the care plans for the specialty rotations. A lecture was presented to the junior SRNAs and an anonymous pre and post likert scale questionnaire was employed to evaluate the effectiveness of the lecture. This examined the level of anxiousness for each rotation presented prior to and after the presentation. Collaboration with a statistician was exercised to identify significant findings regarding the questionnaire results. The anticipated outcomes were not achieved and unexpected results were obtained. With the exception of two items (item 1 and item 6), there were no statistically significant results in the remaining items. This could be due to the fact that the neutral category was not clearly defined and its allocation in the negative category may have skewed the significance of the results. Lack of time for the presentation and a poor evaluation tool were identified as prime areas that were likely to contribute.Item Cerebral Desaturation Events in Beach Chair Position: Optimizing the Quality of Care(2018) mzumara, Ettinas T.; Ware, ShenekaPositioning is one of many responsibilities required of anesthesia providers. A standard position utilized in surgery is called the beach chair position (BCP), an upright position. Sitting upright has many benefits such as the ability to provide the surgeon with an optimal view of the operative site; however, it has been associated with neurological complications and has been growing out of favor. The downfall of this position is with using conventional monitoring devices. The vital signs portrayed on standard monitors may not reflect actual oxygen saturation in the brain. This may lead to cerebral ischemia and neurological deficiencies. A reliable source of monitoring cerebral oxygenation is a necessity when performing anesthesia on patients at high risk for cerebral desaturation, such as with BCP. An extensive literature review was completed on fourteen articles. Research asserted positive outcomes when using cerebral oximetry in patients having surgery in BCP, among many other methods to optimize care for this patient population. The investigators aimed to explore possible monitoring solutions to provide a more reliable way of detecting and treating cerebral desaturation during surgeries in the BCP. Furthermore, the goal was to increase the knowledge base for the student registered nurse anesthetists (SRNAs) in the Nurse Anesthesia Program (NAP) at the Adventist University of Health Sciences (ADU) regarding physiological effects caused by BCP. To evaluate the response, a 30-minute evidence-based PowerPoint presentation was given to these students. Results from pre- and post-testing was analyzed utilizing a paired t-test procedure and revealed a significant increase in the students’ knowledge base following the presentation. It was concluded that the PowerPoint presentation was effective in increasing this knowledge base, which can lead to safer clinical conditions by increasing caregiver competence.