Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Vigilance of certified registered nurse anesthetists (CRNAs) is an integral component of the care they provide patients under general anesthetic. the practice of CRNas is important as the official seal of the American Association of Nurse Anesthetists (AANA). on the seal, Morpheus, the god of dreams, is shown holding the Lamp of Learning, by the light of which he keeps vigil (Hirter & Van Nest, 1995). as the patients remain unconscious under general anesthesia, CRNas remain the patients' eyes and ears remains responsive to their needs. the CRNa must remain attentive to the patient's needs by continuously monitoring the patient in the operating room and constantly communicating with the operating room staff. Complete focus must be maintained to avoid any mishaps or adverse events. in essence, CRNas must remain focused and vigilant when caring for their patients. the importance of vigilance is essential and undeniable for optimal patient outcomes, but the process has yet to be defined and understood. Fourteen CRNas participated in phone interviews in this study. CRNas practicing in both hospital and ambulatory settings were included. Through data analysis, using constant comparison, a model emerged that explained vigilance in the CRNa process. the core category was Using Senses, and the model had seven subcategories. the categories below reflected stages in the process model. the process begins with the CRNA's care of the patient (Being Alert). This is when the CRNa assumes care of the patient, maintains a high level of alertness, and does not get mentally fatigued. Being alert allows the CRNa to be ready to care for their patients. When CRNas are alert, they are attentive and engaged (Being Attentive and Engaged) in watching over their patients. This allows the CRNa to be constantly aware and pay attention to their patients. Being attentive and engaged allows the CRNa to be focused (Focusing) on every aspect of patient care. Unfortunately, the operating room is a dynamic environment, where distractions, such as music, conversation, and technology can distract clinicians from being engaged in the care of their patients. These distractions can, but do not always, occur. When they do occur, the CRNa redirects their attention and begins to focus, which allows CRNas to use their senses to look, listen, and feel (Looking, Listening, and Touching). Using the senses of looking, listening, and feeling, the CRNa can pick up on events or look for cues that can help continue or improve care by anticipating changes at random intervals during the case. by using their senses and picking up on cues, the CRNa knows what is going on with the patient (Know What Is Happening). the findings of this study have implications for nurse administrators. This theory will be informative and helpful for hospital administrators, as they may want to implement a policy similar to that which the aviation industry developed for pilots reporting for duty. in regards to nursing research, the Institute of Medicine ([IOM], 2003) has used the phenomena of vigilance and surveillance interchangeably, but the processes are not interchangeable. There is a distinction between these two concepts. This study provides a link between the two phenomena. Vigilance is a link to the process of surveillance and studying it will help the researcher expound upon the previous surveillance research in nursing.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Included in

Nursing Commons