Elsevier

Nurse Education Today

Volume 36, January 2016, Pages 86-95
Nurse Education Today

Characteristics and values of a British military nurse. International implications of War Zone qualitative research

https://doi.org/10.1016/j.nedt.2015.07.030Get rights and content

Highlights

  • This paper presents findings from the only British Armed Forces qualitative nursing research conducted during the Afghanistan conflict (2001–1014). It provides an insight into the characteristics and values that military nurses recognise as integral to War Zone nursing.

  • Military nurses consciously detached themselves from any legal processes and treated each casualty as a vulnerable patient. This resulted in care, compassion and dignity for all patients, irrespective of their background, beliefs or affiliations.

  • Findings provide military nurses with a framework for a realistic personal development plan to build upon their strengths and identify limitations.

  • The results provide selection panels with an additional tool to help the recruitment process, where choice of the best candidates will ensure the greatest chance of future success.

  • Placing nurses first, with a theoretical model focussed on the requirements of a good nurse should lead to better patient care. The findings have transferability to other Armed Forces and civilian practice on an international scale.

Summary

Background

Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the effectiveness of the military nurses' operational role and no papers naming the core values and characteristics. This paper is from the only qualitative nursing study completed during this period where data was collected in the War Zone.

Objective

To explore the characteristics and values that are intrinsic to military nurses in undertaking their operational role.

Design

A constructivist grounded theory was utilised. The authors designed the interview schedule, and then following a pilot study, conducted and transcribed the discussions. Informed consent and UK Ministry of Defence Research Ethical Committee approval was obtained.

Setting

Camp Bastion Hospital, Afghanistan, in 2013.

Method

Semi-structured interviews were conducted with 18 British Armed Forces nurses.

Results

A theoretical model was developed that identifies the intrinsic characteristics and values required to be a military nurse. Nursing care delivered within the operational environment was perceived as outstanding. Nurses consciously detached themselves from any legal processes and treated each casualty as a vulnerable patient, resulting in care, compassion and dignity being provided for all patients, irrespective of their background, beliefs or affiliations.

Conclusion

The study findings provide military nurses with a framework for a realistic personal development plan that will allow them to build upon their strengths as well as to identify and ameliorate potential areas of weakness. Placing nurses first, with a model that focusses on the requirements of a good nurse has the potential to lead to better patient care, and improve the quality of the tour for defence nurses. These findings have international implications and have the potential for transferability to any level of military or civilian nursing practice.

Introduction

Modern nursing was ignited by public concern for the welfare of wounded young British Army soldiers. It was while attending wounded Servicemen in the hostile territories and under dangerous conditions in the Crimea that Nightingale began to frame her concepts about nursing (Nightingale, 1859). Nightingale's focus on the triad of the person, health and the environment, remain central to modern definitions of nursing and military health doctrine. Nightingale's nursing leadership drove improvements in the care of soldiers; advancements that have had a significant impact in modern nursing in the areas of infection control, hospital epidemiology, and hospice care (Gill and Gill, 2005). During World War 1, military nurses demonstrated extreme flexibility and resilience at clinical, physical, psychological and environmental levels, including caring for local nationals (Gerolympos, 1995).

Nurses themselves were at risk. Allied forces clinical faculties, including trains or ships, were regarded as fair game to the enemy (Harper and Brothers, 1918, Hay, 1953). Badly injured troops were positively influenced by the unruffled way the military nurses went about their duties, whilst the nurses were inspired by the performance, fortitude and cheerfulness of their patients (Hay, 1953). Not least, while providing direct care for wounded Service personnel and managing the healthcare environment, military nurses were confronted with challenging ethical dilemmas. These issues remain part of the challenges facing military nurses and how they are addressed, and the nursing lessons learnt from the battlefield, can have significant positive influences on military and civilian nursing on a truly international scale.

Section snippets

Background/Literature

Within the British Armed Forces Defence Medical Services (DMS), military nurses form the largest registered clinical group (Development, Concepts and Doctrine Centre (DCDC), 2013). They are utilised from the point of wounding and throughout the rehabilitative pathway. In Afghanistan, the major hub for medical activity was Camp Bastion Hospital, which contained multi-national British, American and Danish clinical staff under British command.

AIM

The aim of the study was to explore the characteristics and values that are intrinsic to military nurses in undertaking their operational role.

Theory

A constructivist grounded theory was selected (Charmaz, 2006, Silverman, 2013) to collect data secured in the samples world (Punch, 2010) to enable identification of the issues from the participant nurses' perspective. Constructivist theory indicates that the factors influencing a person's perception are not a uniform phenomenon, but take on a particular meaning influenced by environment, media, political views, local contexts and cultures (Silverman, 2001). This constructivist perspective

Method

The research sample was a convenience cohort drawn from the 59 UK nurses based at Camp Bastion Hospital, Afghanistan during June and July 2013. Semi-structured interviews were conducted to collect information from 18 military nurses. The intent was to interview senior nurses in each department/ward as it was felt that they would provide the most insightful information due to their experience and role, including their ability to compare and contrast with previous operational tours.

A well-defined

Data

Interviews lasted between 17 and 70 min with a mean of 50 min and an SD of 12. The first author transcribed the interviews soon after the consultation, including some on the same day, thus providing an opportunity to pursue leads early. This was a time consuming activity but an advantage of the Bastion Hospital environment was the opportunity to commit totally to this study without distraction. Immediately after each interview, field notes were compiled that listed numerous factors including

Results

The qualitative coding informed by memo writing, constant comparison of the data, and supervision resulted in the indication of 41 categories. These themes produced a story that reflected the interviewees' real-time perception and opinions leading to an evolving theoretical model comprising of four major clusters: personal values, military skills, scope of practice and clinical leadership. These theoretical groupings are responsive to the dynamic mediums of manpower, experience, motivation and

Discussion

Respondents stated that the operational nursing experience is different to anything they would encounter in the UK. The nursing care delivered within the operational environment was generally perceived as outstanding for all patients. Interviewees reported a sense of self-worth aligned to strong team integration as being significant positive factors. Personal benefits included being able to concentrate on patients and performing clinical tasks rather than administrative duties. Importantly,

Limitations

This study was conducted in the austere environment of War Zone Afghanistan which inevitably led to research study limitations, including that the lead author's role as a DMS senior nursing officer may have unduly influenced responses and so introduced bias during the data collection phase. The respondent's views refer to a particular point in time, and may not be reflective of the nurses' views in different conditions or varying levels of clinical activity. Findings reflect the beliefs of

Conclusion

This paper presents findings from the first British Armed Forces qualitative nursing research study undertaken during an operational deployment. This provides an original and innovative insight into the characteristics and values that deployed defence nurses recognise as integral to military nursing. Defence nurses face challenges not generally encountered within civilian practice although it is within these areas that military nurses gain experience, learn and nurture the requirements for

Funding Statement

This is an independent research with no allocated funding source.

Acknowledgements

Col Steve Archer L/QARANC and the Defence nurses who contributed to this paper. Lt Col Phil Carter RAMC, Major Jennifer Ritchie QARANC and other Permanent Joint Headquarters (PJHQ) personnel for supporting the project and facilitating access to Camp Bastion Hospital.

References (77)

  • D. Batham et al.

    Factors affecting role 1 trauma casualty care in Afghanistan

    J. R. Army Med. Corps

    (2012)
  • R. Bennett

    What makes a marketer? Development of ‘marketing professional identity’ among marketing graduates during early career experiences

    J. Mark. Manag.

    (2010)
  • Brain Trauma Foundation

    Translating Neuroscience Into Effective Solutions

  • Care Quality Commission

    A Review of Defence Medical Services' Compliance with the Care Quality Commission's Essential Standards of Quality and Safety in Healthcare Provision. 1st June

    (2012)
  • K. Charmaz

    Grounded Theory: Objectivist and Constructivist Methods

  • K. Charmaz

    Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis

    (2006)
  • M. Crawford et al.

    Prevention of suicidal behaviour among Army personnel: a qualitative study

    J. R. Army Med. Corps

    (2009)
  • J. Currie et al.

    Mapping the field of military nursing research 1990–2013: a bibliometric review

    Int. J. Nurs. Stud.

    (2015)
  • Data Protection Act
    (1998)
  • Department of Defence

    Emergency War Surgery 3rd US Revision, Chapter 3

    (2004)
  • Department of Health

    Compassion in Practice. Nursing, Midwifery and Care Staff. Our Vision and Strategy. NHS Commissioning. 4 Dec

    (2012)
  • Development, Concepts and Doctrine Centre

    Joint medical doctrine. Joint Doctrine Publication 4-03

    (2013)
  • B. Elliott

    Military nurses' experiences returning from war

    J. Adv. Nurs.

    (2015)
  • A. Fejes et al.

    A vocational calling: exploring a caring technology in elderly care

    Pedag. Cult. Soc.

    (2010)
  • A.P. Finnegan

    Fieldwork and practical implications for conducting qualitative research in the Defence Medical Services

    J. R. Army Med. Corps

    (2014)
  • A.P. Finnegan

    Conducting qualitative research in the British Armed Forces. Theoretical, analytical and ethical implications

    J. R. Army Med. Corps

    (2014)
  • A.P. Finnegan et al.

    Influences of British Army nurses on mental health care

    Br. J. Ment. Health Nurs.

    (2012)
  • A.P. Finnegan et al.

    Mental health benefits of serving in the British Army

    Br. J. Nurs.

    (2011)
  • S.T. Fry et al.

    Development of a model of moral distress in military nursing

    Nurs. Ethics

    (2002)
  • D.M. Gaba

    The future vision of simulation in healthcare

    J. Soc. Simul. Healthc.

    (2007)
  • R.A. Gabriel et al.
    (1992)
  • B. Gardner et al.

    First British Victim of Ebola is Flown Home

    The Daily Telegraph 25 August, 1

    (2014)
  • Geneva Convention

    International Humanitarian Law

    (1949)
  • A.K. Gerolympos

    The Redesign of Thessaloniki after the Fire of 1917

    (1995)
  • C. Gill et al.

    Nightingale in Scutari: her legacy re-examined

    Clin. Infect. Dis.

    (2005)
  • B.G. Glaser et al.

    The Discovery of Grounded Theory

    (1967)
  • L. Griffiths et al.

    Warrior Nurse: duality and complementarity of role in the operational environment

    J. Adv. Nurs.

    (2008)
  • S. Hall

    Cultural identity and diaspora

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