Effect of Practitioner Self-Care and Anxiety on Relationships within the Context of Organizational Change

Introduction

Healthcare in the United States (U.S.) is in the midst of an information explosion. New technologies are introduced to the healthcare system almost daily that bring more information to clinicians and patients. Technologies in healthcare are primarily aimed at improving quality as well as streamlining and sharing of health information. One of the technologies, the electronic healthcare record (EHR) is aimed at sharing information through interconnected health information technology (HIT) systems. It is well known that while new technology may improve healthcare practice, it is often a cause for increased anxiety (Kossman & Scheidenhelm, 2008; Zuzelo, Gettis, Hansell, & Thomas, 2008). What is not known and, in fact, is vitally important in healthcare is what effect increased anxiety has on the ability of practitioners to engage in effective therapeutic relationships with both patients and other practitioners and whether specific interventions mediate partially or fully the effect of anxiety on those relationships.

Relationships between individuals and their healthcare practitioners are of vital importance. They provide the means for exchange of communication, sharing of feelings, emotions, and concerns, and are at the core of human needs (Manning-Walsh, Wagenfeld-Heintz, Asmus, et al., 2004). It is within the connectedness of relationships that meaning and purpose in life are derived. Healthcare practitioners often find satisfaction and gratification from relationships that they establish with patients (Lampe & Snyder, 2008). Effective relationships among practitioners in healthcare are essential to attend fully to the multiple factors that affect healthcare delivery and quality outcomes such as exchanging information, allocating resources, arriving at a correct diagnosis, choosing treatments and interventions, and evaluating outcomes of care (Beach & Inui, 2006).

Over the past five decades, there exists an expansive body of literature that defines caring as an ontological perspective of being (Watson & Smith, 2002). Caring is a manifestation of being in the world and interacting with others rather than a set of tasks and skills that require knowledge, ongoing exploration, and learning (Watson, 2008). There has long been a focus on the primacy of relationships within caring nursing practice. Caring is more than a behavioral, technical or mechanistic approach to delivering healthcare. Rather, caring focuses attention on a holistic approach which includes the mind, body, and spirit of the self and the other in a relationship (Manning-Walsh et al., 2004). While caring is an essential human attribute and a way of being for practitioners, it remains an elusive construct to measure. Relationship-centered Care (RCC) moves caring one step beyond the mere human attribute and emphasizes the importance of relating and interacting among individuals as essential to, and for, therapeutic healing activities regardless of healthcare setting or discipline. Healing is defined as the seeking of wholeness and balance along physical, mental, social and spiritual domains (Dossey & Keegan, 2009). Clinical practitioners build relationships amongst patients and themselves, using their knowledge and methods to invoke healing. Healing is strengthened when caring relationships between practitioners and patients are encouraged, developed, and nurtured.