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REPORT DOCUMENTATION PAGE | SSacvorcarese rem ERERTRT TYE RR RTE POPP ten 05 MAJOR RLPOKT PERSPECITVLS OF RLNIRED ADR FORCE NINUSR ANESTHESIA, ILESDERS/CO-AUTLIOR DAVID L, PERKINS CAPT ELAND ROBERT E 7 BEER DERE TNT RAGA AND AORTIC, EERE SRE TROGIR ec IPDUMED SERVICRS UNTY OF HEALTH SCIENC ero muNEER ciosser PTS TROT ORT AGE TERY AN OORT "SFOS RSTO ThE DEPARTMWAT OF Tile ADR FORCE ‘AGRHEY REPORT MUNN | Armirci4, OLDO 128 ss P STREET PAF O# 45405 Fes ESRI TGNT AVHICREUY STE TE BTA Co iid dieing to Ascordunor Wi AFL S-20S:A 1 Sap + SUEY TERS pe Ror | a fecmeetoee ——] FR TOW 1-SESTRITY TH ASSERTOW 5" SECO COARSTICA Of URTRTION OF RESTART Perspeutives of Retired Air Force Nurse Anesthesia Leailers David L, Perkins, Capt, USAF.NC Robert E, Bland, Cupt, USAF.NC. Griduate Sehool of Nursing Unilinmed Services University of Fealth Seieace 20050125 151 PRESSED IN THIS ARTICLE ARE AUTHOR AND DO NOT REFLECT THE OFFICTAL POLICY OR POSITION OF THE UNITED STATES ATR FORCE, DEPARTMENT OF DEFENSE, OR TILE U.S. GOVERNMENT, Abstact ‘Current military aod civilian CRNA. history papers do nt haven United Stati Air Feros Tus, This fudy expanded the cument history of oles, relationships, and tshniqua ofthe CRNA professiouils, The purpore ofthis quaiativesady was to histocally describe the eels, professional relationships, and techniques among uupse anesthetists in the Ai Force since 195 CRNAs who served on active duty in the Unites States Air Forec were insloded in the sample, These interviews gated intieration eegarding the history af the Ait Force, ‘Descriptive infarmation from these interviews deseribed the changing role, achniques, und relationships ofthe target population, ‘fhe structured interview toebnique, with focused ‘questions and probes, was utilized as the instrument for data collection. Relibillsy and valicity woncemns wore aédressed by using the accepted qualitative standards of confirmability, wansierabiity, eonsiaumey, and fruth-valuc, The dita wore unalyzod by chronology and topic in order to describe the progression of roles, relationships, and techniques. ‘The eleven telephone interviews wore completed fiom CRNAB who serve on active duty in the Air Foros. Taped recordings were made ofthese interviews and transctibed. Both researchers looked for comman themes, progression of voles, relaionships, and techaiques in atl interviews, “The vesuts Aenvemstratel ual connmnimalily oF experience wa ir evident fm De CRNAs imerviewed, ‘these commonalities ineuded autouomy' of practice, lack of sunderstanting ofthe rales anil responsibilities of the CRNA from other health care professionals, and advances in technologies in patient monitoting and anesthetic delivery over dm: Ievodverion The leo the muni anehetisl deserves he penpetiveof tine aad the enefit consideration of seolars te assess the impact and ebctivenss i providing anesthesia inthe Ait Force, Nuse anesthetists has bora integral inthe advancement ofthe United Slates Ast Force (USAT) and USAF Nurse Cargs a leer and intovators, in addon tothe putnary dies of providing anesthesia caro to the nefive duty tman, miliary retiree and fependent, The experiences of rune umesthelins pussesy a unique perspective regarding the c lenge of providing anesthesia in wartime and peacetine. Although the profeesion of nurse anosthesia has existed for over a century, the career field bis cxisted in the U SAK since 1951. Sinec ther inoorporatian into the Air Fore, Certified Registered Nurse Anesthetists (CRNAS} have served in a least three major conflits, numerous pensions ant wountlest minions her than war. Unfoctunutly, there isu neucly’of recone reguring the opie of urseanesthsi history in the USAR, “The purpose this study was to describe the roles, relationships and cochuiques of ORNau by answering he research questions 1. Who were the inluental men snd women with respousibiliies and duis as CRNA? 2, What vce the eomiihutoy ant nieve f Air Pars ORNS in wat and peacetime? 3, What are the ponamal experiemexs ofthe CRNAx serving inthe USAT? Mndet ‘The Benner novice to cxpert model formod the basis Zor ths historien: perspective of ‘nurse anesthesia in the USAT and allowed the examination of nursing skil co be manifested with its cmphasis ou the va of experience. The aumsing theorist Paticia Benner believed that uring knowledge and experience needed tobe captured Unough the use the Cilia Lacideace ACCis defined as siuaton-bascd descrincions of pailenc care episodes (Homer, 1984), Pavia enmerftreduoe the Novice to Tapert Mode describe the progression of pat eare xpitise that can result from professional musing experience. See' Table I for novo to expert rel dewerpton Jn documenting the histry oman anesthe in th Air Fore he sory a marin ik boing made public. The purpose of recording the contibutins oP CRNAS in service tothe ‘USAF was to cipuné and futher catalog ther Crit Ineidemecs within thr histone and cfixial content, Hurae CRNAs wil b abet fam from past expesienced and be better prepare to et the challenges of service inthe USAF Detistions ~ Comosptal and Operation The targst population of this andy was CRNAs who served on active diy inthe UBLAF, The hinory, which was cofleted through: Dn ierview poe, feral ust human ‘experiences specifi to the porson’s fim during active duty service, CRNAs arc those reyistensd nzses who hold a postion fmarse anesthetist and carved ou those duties specific to this profesion, The CRNA sls fu to ps fhe: iol extificatiom bowl cna in hi specially. Asaunepons Several sgompfions ground this study duet the natuc of sing an ox history inreview process. The primacy assumption was that interviewees told the truth wit sega 10 ‘ir personal experiences and they reclll he’ experienees accurntey, MH was assured shat persons participating inthe snedy wished Lo share their experiences and thut those whe perticinuted were represcutative of the target populacion, Reseanth Methods Tn this quate sty, to simple 11 CRNAs who ser om ative day in che USAP in therole of CRNAS, After obtaining fastuionel Review Boal approval, «saraple representing the study popslation wes rerued through «eocbinating ofnetwarkand scowball smppling methods. fer intial contact to establish imterest in the study, pactioipanrs were ‘ruled study materials to inslude a consent form and demographie deta shect, Once the ‘participant returned the material and signed consent, the principal investigator conducted a tape= recorded interview by phone after veifving informed consent, Lnterviews continued wat saturation ofthe cmerging themes, Verbatin transotiptions were made ftom interview tecordings. Coding was used to maintain participant snanyenity, Instrancat Identification A sire imzrview guile provided the foundation of predetermined xe res epaing role echnigues, and protevionalrltimahips. Open-ended quien quer perisinnts én her background snd cxpevienes during their years spoud on aie duty in the USAPanaCRVA. Appriprine pb were ws l explore: emerging themes Turing Ihe Interviews, An expott panel composed of military CRNA’s and methods experts reviewed tho ‘ovused interview guide to insure mulerstandabiity un! comprehensiveness of he iil questions. Al ictersiows were tape reeerdd with he participants permission and txmssibod verbatint. An audit nil wus established Lo document nding deviian and verification a idcutified thames, ‘Iranscriptious were coded to protect anonymity of parttelpants, Analysis, Analysis of the interview cansetipts began as a historical scarch of voles, professional relationships and techniques among the CHNAs, Historical researc isa ecllection of subjective date covaposed! and related through human dy:amios and experiences, The data were listed in chronological order and related hy copie. These deccviptive findings were supported by their quotes. Thess quotes were then grouped and connocied togsther by somimonalty te aplure the ‘ha expetionce deseribed by Benner (1987). An accurate description of the role, relationships and techniques of CRNAs was generated bared oa these inenviews. Desetiptive statistics wore used to prescat the demographics of the sample to include the verge ge ding setve diy service msgnment, es, mexico experience, The analysis and descriptive satiics were provided asa plete of CRIVAS who Juve suev in the USAF wv provide a basa fr further rear into the history oF his Rel This study shawed the chconologial and progression in cles, relationships and techniques fr USAF nunoe anesthesia Fingiog ‘The influential men and women with zespousibiitcs and dutiey 19 CRNAs hud dierent ‘educational hackgenunds, soles and perinds af service inthe USAF. See Tables 3,4, and 5. ‘The ‘eduentional development pf these CRNAs prugressel from a diploma certification through & bachelor denree ta a master’s program. All CRNA participants who iniciatly acquired a diploma verliRuior urbachélin's deyree in nurse anestheyia Jnr ucuired a higher level uf eilucation o¢ master’s degree, ‘The progression of wertficaién for CRINAS was dex in prt 1 the wvailabiity bl educalionst programas. Air Force CRNAs pursued more advanced elucutimal degrees ms These hecame avaitable, ‘Ve autonomy of this group of USAF CRNAs was cecn in vatious ways, For instance six ‘ut of eleven cespondents were Ge anle CRNAS at their assigned station, Five were fight mursos, with four serving in fying assignments doriag the Vietnam conflict, In one interview, « erligipunt spoko ef cing polled out of bis flying dues te provide smewhesis fora yererul’s soe, ‘who had received wounds during corat, Pus directors of the USAF aucse anesthesia ‘fucatiounl program, as well a advisors othe sugoon goncral participated in the study, Other Aissingunhed reso thas ilervewe inched Fels of Surgien’ Services, Chief Nurses, Actdeiie and Clinical lnstrctors, Clinical Dizectors, and 2 Hospital Group Coxumander, These roles demonstate the ladership postions and antonomous practice held by USAF CRNAs in the ast, Many ofthese respondents ha a grt influence om the vay USAF CRNVAS ae educated aud practice today. ‘The portiajpunls time in service (sew Table 5) everlapped service perils. During these cervies periods respondents reportd many different roles and arees of responsiblity previously <leserbd, The time peciod most reprscated inthe study was fom the yoats 1966 to 1985. The depictions of eluential backgrounds, oes an respnbies, a aesigrmenis nel othe study findings, profiled the men and wornea who were intent! as CRNAs in thé USAF. “The contihaion and achievements of USAT CRNAs were apparent in he evchtion of ancsthti delivery tectuiques as revealed inthe interviews, Technically, the administration of snesthosn has changed drunatically, All ofthe respondents reported adapting to the use of new car ete techniques in airway managernent, volatile agent adninisirtion, the wea udvanced ‘monitoring und pation sey doves -Anasthti agents evolved over tne from the predominantly use of voll ages to the availability al newer, more sable anesthitig egenty and administration techniques. Tur exaniple, «one pnticnt reveal the oe grime cmditionsuler wish one rat woek wisi a deployed seting, dat hightigited uot ony ieee imovsion,bucautouomots prices aswell “jl administered} Ooon drop batorkane onthe floor ofa Buddhisr temple”, Reondent E, 1961-1988) (Other walemertsrefletel the drumutie changes experiunced during atestaesia's developmsat “Rie id all sors of things, we il ape drop ethon, vinyl erkame ether. We were not allowed to imubene unless i was realy nooussary for the Spe ofprocedure, enather ‘reason was 50 you could maintain... good strength fa their arms so you could ruby ‘manage thelr airway” (Respondent 1,1957 1980) Team remember doing reser cases — furned cm hoi siden, no tube under Tote ‘(Respondent J, 1957-- 1980) "We had cyclopropane which was flamable anc explosive” (Respondent F, 1971 — 1989) Volatile umesheie willy nnd adinisralion teshnigues hve sos afer hy enn Jess nmable and decreasing he rs of aspiration wich the use of cuffed endomcheal insbation, The exposure ofthe CRNA and surgical stato volale anesthotos ins dereased th sho phasing ont af the open drop ocbnige. Tp earlier yesra, many new monitors were considered a luxury and necded a speci iftation for their use. These morisans wero standards of prnetice, Pulse oximetry was