Angelique Davis

ASSIGNMENT (Questions to Consider/Module 2):

1. Thinking over your recent clinical experiences as a student nurse anesthetist, formulate two different questions that could be answered by either a literature search or a formal research study. Your questions should address any two of these four clinical question types: 1) treatment/intervention, 2) diagnosis/assessment, 3) prognosis, or 4) causation / etiology. Identify which type each of your questions is and write the questions in a PICO format (POPULATION – INTERVENTION – COMPARISON – OUTCOME).

a. Do military members with past deployments to Iraq and/or Afghanistan have a higher incidence of emergence delirium with anesthesia immediately post operatively compared to the general population?

b. For veterans with past deployments, does the use of total intravenous anesthesia reduce the risk of emergence delirium compared to the use of volatile anesthetics?

2. In the following research problems, identify the independent and dependent variables:

a. Researchers compare monitoring standard neuromuscular twitches on the ulnar nerve and facial nerve to see if there is a difference in muscle function measured by a standard myography technique.

i. Independent Variable: Neuromuscular twitches of the ulnar nerve and facial nerve

ii. Dependent Variable: Difference in muscle function

b. Are there differing pain thresholds in patients from different cultural backgrounds?

i. Independent Variable: Different cultural backgroundsii. Dependent Variable: Pain Threshold

c. Does patient body mass index (BMI) have anything to do with the frequency of postoperative peripheral nerve injuries in large academic medical centers?

i. Independent Variable: BMIii. Dependent Variable: Frequency of post-op nerve injuries

d. Is the time from admission to discharge from the PACU affected by different doses of intraoperative fentanyl?

i. Independent Variable: Different doses of intraoperative fentanylii. Dependent Variable : Time from admission to discharge from PACU

e. Does level of stress in student nurse anesthetists have anything to do with their scores on clinical evaluations?

i. Independent Variable: Stress level in SRNAsii. Dependent Variable: Scores on clinical evaluations

3. Identify one ethical issue you think is especially relevant for clinical anesthesia research and briefly defend your choice.

a. Receiving informed consent after a patient has received midazolam and or performing a time out for regional anesthesia after a patient has received midazolam.

i. I have already seen this occur in the short time that I have been in the operating room. I have only seen this issue become a problem for the time out procedure performed before regional anesthesia to insure that the patient themselves are aware of the current anesthesia plan. I have seen anesthesiologists push the preoperative nurses to enter the time out note even though the patient has already received sedation. This becomes an ethical issue and goes against the patient’s right to be fully informed.

ii. Time out procedures are designed to involve the patient, provider of procedure, and pre/intra operative nurse. The purpose is to identify the correct procedure is being done, on the correct location, allergies, and ensuring informed consents from all practices have been signed before proceeding with the planned procedure.

iii. If the patient has already received sedation, the patient’s right to full disclosure and “informed consent” becomes nonexistent. The patient could then be convinced of what the “best” anesthetic plan is by an anesthesia provider. The patient could be pushed toward receiving treatment that may or may not be needed due to the liking of the anesthesia provider, i.e. regional anesthesia.

iv. The patient is also unaware of the risks and benefits of the agreed upon procedure. This becomes more of a legal issue if an untoward event were to occur.