Dissertation
Overcoming barriers to TIVA utilization: the impact of targeted interventions on nurse anesthesia residents' practice
Doctor of Nursing Practice (D.N.P.), Drexel University
18 Mar 2026
DOI:
https://doi.org/10.17918/00011289
Abstract
Total Intravenous anesthesia (TIVA) is a method of anesthesia associated with shorter phase-I post-anesthesia care unit (PACU) recovery times and fewer postoperative complications compared with inhalational anesthesia (IA). However, TIVA remains underutilized due to provider unfamiliarity, perceived complexity, and a lack of confidence among nurse anesthesia residents (NARs). This Doctor of Nursing Practice quality improvement project is intended to evaluate the impact of a simulation-based educational intervention on NARs' decision-making and self-efficacy regarding TIVA utilization. An escape room-style simulation grounded in the Jefferies Simulation Theory and the Clinical Scholar Model was implemented using a pre-post intervention design. Surveys were administered before and after the intervention using a modified Decision Self-Efficacy Scale (DSES). Two different classes of NARs (Class of 2026 and Class of 2027) participated. All surveys were collected anonymously, all group categories were analyzed as independent samples using Welch's t-tests, and effect sizes were calculated using Cohen's-d. Statistically significant and educationally meaningful improvements in decision self-efficacy were observed in both cohorts. The Class of 2026 demonstrated a significant increase in mean DSES scores (p < .001, d = 1.54), with 100% of participants achieving high-confidence scores post-intervention. The Class of 2027 also showed significant improvement (p = .015, d = 0.88), with most participants advancing into the high-confidence range. Consistent effects across cohorts suggest the intervention was effective at least at two levels of clinical experience, indicating that simulation-based educational interventions can meaningfully enhance NARs confidence in TIVA-related decision-making.
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Details
- Title
- Overcoming barriers to TIVA utilization
- Creators
- Annie RanaMorenike Kuponiyi
- Contributors
- Jessica Ann Hessel (DNP Chair) - Drexel University, Nurse Anesthesia
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Nursing Practice (D.N.P.)
- Publisher
- Drexel University
- Number of pages
- 73 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Nurse Anesthesia; Nursing (Graduate); College of Nursing and Health Professions; Drexel University
- Other Identifier
- 991022168355904721