Dissertation
Implementing Cognitive Aids to Enhance Crisis Management in Non-Operating Room Settings
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
Abstract
Background: The rapid expansion of non-operating room anesthesia (NORA) has introduced substantial and increasingly recognized patient safety challenges. NORA accounted for 35.9% of anesthesia cases in the United States in 2014 and is projected to exceed 50% in the coming decade. Despite this growth, patient outcomes in NORA settings remain disproportionately adverse, with mortality rates more than twice those observed in traditional operating rooms (54% vs. 24%, p = .003). These risks are driven by systemic and environmental constraints, including limited resources, infrequent exposure to high-acuity events, and the absence of role-specific crisis guidance for non-anesthesia staff. Purpose: This project aimed to improve non-anesthesia staff confidence, preparedness, and role clarity during perioperative crises through implementation of an adapted cognitive aid reinforced with simulation-based training. Methods: Guided by the Iowa Model of Evidence-Based Practice, a cognitive aid adapted from the Stanford Emergency Manual was customized for nurses and surgical technologists in a high-volume ambulatory gastrointestinal unit. Twelve participants completed simulation training and a retrospective pre/post survey assessing confidence, preparedness, and checklist usability on a 5-point Likert scale. Data were analyzed using descriptive statistics and Wilcoxon signed-rank tests. Findings: Confidence and preparedness improved significantly (mean increases 2.00 and 2.25 points, respectively; p < .001). Median scores increased from 2.5 to 5.0 for confidence and from 2.0 to 5.0 for preparedness. Checklist usability ratings exceeded 4.5/5 across domains. Discussion: Implementation of a structured, role-specific cognitive aid supported by simulation significantly improved perceived readiness among non-anesthesia staff, supporting integration of tailored cognitive aids to enhance role clarity, team coordination, and safety culture in NORA environments.
Details
- Title: Subtitle
- Implementing Cognitive Aids to Enhance Crisis Management in Non-Operating Room Settings
- Creators
- Judith Elwell - University of Iowa
- Contributors
- Cormac O'Sullivan (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Nurse Anesthesia
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2026 Judith Elwell
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9985217825202771
Metrics
1 Record Views