Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Kevin J. Maxwell, PhD, DNP, FNP-BC, RN

Abstract

Introduction: The ability to predict and manage difficult intubations is a critical component of airway management in clinical practice.

Background: Ultrasound airway assessment has emerged as a valuable tool in predicting difficult intubation, yet its integration into routine clinical practice remains limited. This Doctor of Nursing Practice (DNP) project aimed to educate healthcare providers, specifically nurse anesthetists, on the use of ultrasound to assess airway anatomy and enhance prediction of difficult airways.

Methods: An evidence-based airway assessment, the Difficult Airway Evaluation with Sonography (DARES), was implemented during a single-day skills fair. Participants received both didactic instruction and hands-on training focused on key sonographic airway measurements, including distance from skin to epiglottis (DSE), hyomental distance (HMD) and tongue thickness (TT). Pre- and post- intervention self-assessment surveys were used to evaluate changes in knowledge, confidence, and perceived clinical applicability.

Results: The educational intervention resulted in significant improvements in participants’ self-reported confidence across all domains, including airway structure visualization, measurement proficiency, and clinical decision making. The greatest gains were observed in ultrasound acquisition and measurement skills, particularly among participants with limited prior ultrasound experience. Years of practice and prior exposure to ultrasound did not significantly influence outcomes, suggesting broad applicability of the training.

Clinical Implications: Focused, hands-on ultrasound education may enhance provider confidence and readiness to incorporate airway ultrasound into clinical practice. Participant feedback highlighted the need for continued practice and exposure to complex airway scenarios to support skill retention and integration.

Conclusions:  A concise, single-day educational intervention using the DARES protocol effectively improved CRNA confidence in airway ultrasound assessment. Incorporating targeted training into continuing education may facilitate adoption of this emerging skill. Further research is needed to evaluate long-term skill retention, clinical utilization, and impact on patient outcomes in difficult airway management.

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