Introduction

Looking at the Collaborative aspect of the Professional Attributes of the Nurse Anesthetist, one would expect that as baseline, the Nurse Anesthetist should be equipped with tools do their job efficiently. Keeping that basic tenet in consideration, this paper in alignment with the Interpersonal Relationships steps of the Adventist Health CREATION Health rubric explores ways of developing the interpersonal skills of Certified Nurse Anesthetists. It focuses on multiple aspects of Interpersonal Relationships in Des Cummings Jr and Monica Reed’s Creation Health Discovery, looking at how using the basic tools in life. As gratifying and satisfying as it may be taking care of patients as a CRNA, it could also drain one physically and emotionally. Creating a healthy relationship between the CRNA, patients and co-workers is important to get the best results. This paper examines the role that interpersonal relationships play within the members of a healthcare team, including the CRNA and how that affects their results especially in the areas of communication, patient safety and team performance.


Synthesis of literature

Working as a Certified Registered Nurse Anesthesiologist (CRNA) requires rigorous training to equip the candidate with all the tools required to function adequately. One of such crucial skills required is having a strong interpersonal relationship with patients and coworkers. The quality of our relationships determines the quality of our lives and are most nurturing when we take time to form that bond (Cummings (2014). Kornhaber et al. (2016) in their study also state that developing therapeutic interpersonal relationships between healthcare professionals and patients can help the patient navigate their care better. Medical errors and negative events tied to poor communication between healthcare providers leads to compromised patient safety. Communication among healthcare providers is affected by human factors such as interpersonal relations (Lee et al, 2017)


Implications for evidence-based practice

God’s grace and emotional healing happens when family and friends pull together for loved ones, providing that social comfort and sense of self control especially in times of challenges (Cummings, 2014). To Cummings (2014), there is also scientific support to show that strong interpersonal relationships have been found to increase the individual’s pleasure as well as enhancing their ability to heal. This is corroborated by findings on cancer patients from Dr David Speigel at Stanford University and investigators at UCLA which show that a structured group intervention for patients reduced mortality and cancer recurrence for the participants.

Also, in their paper therapeutic and non-therapeutic interpersonal interactions: the patient’s perspective, Williams, A.M and Irurita, V. (2004); additional insight was provided to help in understanding the therapeutic effect of the psychosocial aspects of patient care. Their study highlighted the importance that patients place on all the interpersonal interactions that they experience in hospital from their providers. Establishing a good interpersonal relationship with patients is vital. Using the AANA’S code of Ethics attribute of “Responsibility to Patient” as a guide, the CRNA should greet the patient, explain what they will be doing, review plan of care with the patient, involve them in decision making, listen to patient preferences and above all the CRNA should display confidence and professionalism. These are some basic attributes in the AANA journal that have shown to improve interpersonal relationships between CRNA and patients hence improving patients’


outcomes. The professional attribute of Collaborative- the nurse Anesthetists works with others to develop shared solutions (AANA, 2018) can only be effective if the CRNA has good interpersonal relationships with team members.

Lee, C.T, et al (2017) proposed a theoretical framework explaining how interpersonal relations among healthcare team members affect communication and team performance, such as patient safety. They went on to identify two relevant theories: framework on interpersonal processes based on social relation model and the theory of relational coordination. In synthesizing their theories, they posit that varying team-member relationships lead to varying collaborative behavior, which affects patient-safety outcomes through a change in team communication. The professional attribute of “Collaborative” where the nurse Anesthetists works with others to develop shared solutions (AANA, 2018) can only be effective if the CRNA has good interpersonal relationships with team members.

CRNAs working conditions and job outcomes have been found to have a strong correlation with their interpersonal relationships. In his study comparing the effect of stress and relationship style on student and practicing nurse anesthetists, Kendrick, P. (2000) observed that the personality of an individual determines to a large extent how he or she will perceive or react to a stressful situation. Among the methods used in this study was the use of Interpersonal Communication Inventory which was developed to measure the process of communication as an element of social interaction while identifying patterns, styles and characteristics of communication. One of the findings of this study shows that subjects experiencing high levels of stress communicate less effectively than those experiencing less stress, which shows in their interpersonal relationships. Nonetheless the outcome of this study, the CRNA’s Code of Ethics requires CRNAs to uphold the “Responsibility as a professional” and by so doing maintain professional boundaries in all communications and actions (AANA, 2018)

Another dimension that leads to understanding how interpersonal relationships are key to the CRNA’s work is in the way the CRNA interacts with other professionals in the field. In their study of different literature relating to working conditions and outcomes for CRNAs, Boyd, D. and Poghosian, L. (2017) in their review the work on Alves in 2005 examined how scope of practice and collaboration were related to occupational stress of CRNAs practicing in Anesthesia Care Teams. They also reviewed the 2006 study by Jenkins et al of Army Civilian and Army Nurse Corps which identified conflicts in the nurse-physician or other professional relationships as the most commonly experienced ethical issue among all CRNAs. In that study, it was observed that civilian CRNAs ranked conflicts in this relationship as the third most frequently experienced ethical issue whereas for the military CRNAs, this was ranked as the most frequently experienced ethical issue. Their review also indicated that CRNA outcomes such as incivility, professional burnout and workplace aggression that involve dysfunctional behaviors and interprofessional work relations involving a variety of providers could be reduced through factors of good health, work satisfaction and personal support and good interpersonal relationships


CREATION Health Model and AANA Code of Ethics

Adventist Health System has outlined the six key steps to growing and maintaining success in interpersonal relations. This is all captured in the book, Creation Health Discovery by Des Cummings. These steps though very simple, encourage us to build on strong family relationships, cultivate good friendships, be good neighbors, participate in organizations and churches and strive to be excellent co-workers.

Looking at the AANA Code of ethics, one can pinpoint to some of professional attributes of the Nurse Anesthetist such as being collaborative (I), willing to Lead (IV) and being a Teacher (VII), all of which are attributes that help enhance interpersonal relationships. These along with the rest of the professional attributes of the Nurse Anesthetist combine the responsibilities of the anesthetist both to their patients as well as their colleagues and ensures that they thrive in an environment where interpersonal relationships are enhanced. Building these successful relationships make it easy for the CRNA to meet all the responsibilities of the profession as stipulated in sections one through six of the Code of Ethics of the CRNA.

Combining the steps of the CREATION Health Model with the professional attributes of the Nurse Anesthetist keeping in mind the responsibilities as outlined above will help the CRNA develop exemplary interpersonal skills and make their job much more fun.


Conclusion

We conclude that interpersonal relationships between CRNA and patients greatly enhances the healing process and creates that trust between patients and CRNA. We also see in the literature reviews above that when there are good interpersonal relationships between nurses and the rest of the medical team, this leads to less stress and improved patient care. The results as can be seen are evident in-patient satisfaction and overall improved healing. Lastly, we observe that applying the six steps to success in the interpersonal skills of the CREATION health model can easily complement the professional attributes of the Nurse Anaesthetist as well as enforce the responsibilities of the Nurse Anaesthetist as outlined in the ANA code of ethics.


References

  • Cummings, D., Jr., Reed, M., & Chobotar, T. (2014).

    CREATION health discovery

    :

    Your path to


    a healthy 100

    (2

    nd

    ed). Altamonte Springs, FL: Florida Hospital Publishing.
  • Boyd, D & Poghosyan, L . (2017).

    Certified Registered Nurse Anesthetist Working Conditions and Outcomes: A Review of the Literature.

    AANA Journal.
  • Kendrick, P. (2000).

    Comparing the effects of stress and relationship style on student and practicing nurse anesthetists

    . AANA Journal, 68(2), 115.
  • Kornhaber, K. &Walker, K. (2016).

    Enhancing adult therapeutic interpersonal relationships in the acute care setting: an integrative review.

    Journal of Multidisciplinary Healthcare
  • Williams, A.M & Irurita,V.F (2004).

    Therapeutic and non-therapeutic interpersonal interactions: the patient’s perspective.

    Journal of Clinical Nursing.
  • Lee, C.T. & Doran,D.M (2017).

    The Role of Interpersonal Relations in Healthcare Team Communication and Patient Safety: A Proposed Model of Interpersonal Process in Teamwork.

    Canadian Journal of Nursing.


 

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