Development of Clinical Nursing Practice Guidelines for Nurse Anesthetists assisting with Tracheal Intubation and Extubation of Suspected or Confirmed COVID-19 Patients undergoing General Anesthesia

Abstract

Due to the situation during the COVID-19 pandemic, nurse anesthetists are health care workers with high risk exposure to COVID-19 because aerosol generation related to airway management procedures, such as facemask ventilation, and tracheal intubation and extubation. The purpose of this action research was to develop clinical nursing practice guidelines (CNPGs) for nurse anesthetist assisting with tracheal intubation and extubation  of suspected or  confirmed COVID-19 patients undergoing general anesthesia at Sunpasitthiprasong Hospital,  Ubon Ratchathani, Thailand. Participants were 52 nurse anesthetists and 11 COVID-19 patients who undergoing general anesthesia for surgery. The research instruments were composed of  1) the CNPG for Assisting with Tracheal Intubation and Extubation of Suspected or Confirmed Covid-19 Patients Undergoing General Anesthesia, 2) the Performance Assessment Form, and 3) the Opinion Assessment Form for Nurse Anesthetists about CNPG. The data were analyzed using descriptive statistics and Wilcoxon matched-pairs signed rank tests. The results found that the CNPG consisted of five categories as follows: 1) anesthetic drug and airway equipment preparation, 2) airborne precautions, 3) nurse anesthetist roles and responsibilities in the anesthesia team, 4) assisting anesthesiologists with tracheal intubation and extubation, and 5) transferring the patient from the operating room to the COVID-19 ward after surgery. The overall overview of the feasibility of applying the CNPG was high (73.40%); overall, 100% of the nurses conformed to; and nurse anesthetists had statistically significant higher mean of knowledge scores than before using CNPG (Z = -6.25, p< 0.01). There were no Incidents of work-related COVID-19 infection among the nurse anesthetists.