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