Military nurses' experiences returning from war

Lived experience of critical care nurses serving in a war zone: A phenomenological study

BACKGROUND

War has always been a part of human life, and nurses are among the first people to attend to the battlefield alongside the soldiers. Nurses' experiences of being in war zones have long been of interest to researchers. In the conflicts in Syria, Iranian nurses have played a crucial role in saving the lives of many people.

AIM

This qualitative study aims to explore the lived experience of Iranian critical care nurses deployed to battlefields in Syria between 2014 and 2020.

STUDY DESIGN

This qualitative study adopted a hermeneutic phenomenology approach using Van Manen's methodology. The data was obtained through semi-structured in-depth interviews with 15 nurses who experienced war zones. Purposive sampling was used and interviews with the participants were conducted at the agreed place. Interviews were recorded, wrote verbatim and analysed with MAXQDA10 software. COREQ, a 32-item checklist, guided method selection, data analysis and the findings' presentation.

RESULTS

The four main themes that emerged include 'blossoming of talents on the battlefield', 'capable nurses at war', 'nursing jihad' and 'mental preoccupations'. These themes include 12 subthemes and 32 primary subthemes that explain the meaning of Iranian nurses being in war zones in Syria.

CONCLUSIONS

Nurses in the war zones of Syria gained valuable experiences of the blossoming of talents in themselves and others. The lived experiences of the nurses revealed that working in the war zones of Syria is a concept of nurses' capabilities. They considered being in the war zones of Syria as a form of nursing jihad. In spite of the many positive aspects of their experience, the nurses expressed their mental preoccupations during their deployment.

RELEVANCE TO CLINICAL PRACTICE

Nursing care in a war zone for the critically wounded is a unique experience. The experience and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders who are planning future deployments.

Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis

BACKGROUND

Nurses play an important role in the treatment of war wounds on the plateau, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the altitude emergency rescue experience and training needs of nurses in military hospitals and provide them with targeted assistance.

METHODS

We critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM) were searched for relevant studies published from the establishment of the database to May 2023. Additionally, we conducted a manual search of the references of the identified studies. Registered on the PROSPERO database (CRD42024537104).

RESULTS

A total of 17 studies, including 428 participants, were included, and 139 research results were extracted, summarized into 10 new categories, and formed 3 meta-themes. Meta-theme 1: mental state of military nurses during deployment. Meta-theme 2: the experience of military nurses during deployment. Meta-theme 3: training needs for emergency care.

CONCLUSIONS

Emergency rescue of high-altitude war injuries is a challenging process. Leaders should pay full attention to the feelings and needs of military nurses during the first aid process and provide them with appropriate support.

Reintegration of crisis services employees: a systematic literature review

Purpose

Crisis services personnel are frequently deployed around the globe under highly demanding conditions. This raises the need to better understand the deployment process and more especially, sustainable reintegration after deployment. Despite recent research efforts, the study of the post-deployment stage, more specifically the reintegration process, remains fragmented and limited. To address these limitations, this review aims at (1) describing how reintegration is conceptualised and measured in the existing literature, (2) identifying what dimensions are associated with the reintegration process and (3) identifying what we know about the process of reintegration in terms of timing and phases.

Design/methodology/approach

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol, the authors identified 5,859 documents across several scientific databases published between 1995 and 2021. Based on predefined eligibility criteria, 104 documents were yielded.

Findings

Research has primarily focused on descriptive studies of negative individual and interpersonal outcomes after deployment. However, this review indicates that reintegration is dynamic, multi-sector, multidimensional and dual. Each of its phases and dimensions is associated with distinct challenges.

Originality/value

To the authors’ knowledge, this is the first research that investigates reintegration among different crisis services and provides an integrative social-ecological framework that identifies the different dimensions and challenges of this process.

Learning from critical care nurses' wartime experiences and their long-term impacts

BACKGROUND

The history of critical care nursing is intertwined with that of battlefield nursing, where for almost 200 years, nurses worked to save injured soldiers' lives, risking their own physical and emotional injuries. Today, with nurses increasingly deployed to provide critical care during natural, man-made and public health crises that can resemble battlefield situations, there is much to learn from battlefield nurses.

AIM

This qualitative study aims to explore the lessons of the experiences of civilian nurses deployed to Israeli battlefields in three wars between 1967 and 1982.

METHODS

Qualitative, semi-structured, in-depth interviews were conducted with twenty-two former military nurses who were deployed in three wars between 1967 and 1982. We analysed interview transcripts using a content analysis approach. COREQ, a 32-item checklist, guided method selection, data analysis and the findings' presentation.

FINDINGS

Data analysis revealed three main themes, with ten related subthemes: Field Service Challenges, Coping with Challenges, and Nurses' Need for Recognition.

CONCLUSION

The findings identify mental, emotional, and organizational issues resulting from nurses' wartime experiences, revealing numerous opportunities for better preparing and supporting critical care nurses before, during, and after crises.

RELEVANCE TO CLINICAL PRACTICE

Critical care nursing during crises, such as wartime, is unique but increasingly common. The memories and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders planning for future deployments during wartime or other disasters such as the COVID-19 pandemic and the Russo-Ukrainian war.

A concept analysis of nurses in conflicts after World War II

AIM

We analysed nurses' experiences during military conflicts since World War II.

BACKGROUND

Nurses have successfully reduced morbidity and mortality in populations affected by wars; despite centuries of nurses' global involvement in wars, there is limited knowledge about their experiences.

METHOD

We used Rodger's evolutionary concept analysis methodology to understand the antecedents, attributes, consequences, context and implications of nurses' war-related experiences. We analysed data from quantitative and qualitative research, media reports, editorials, historical reviews and published accounts of nurses' experiences in many locations, including Afghanistan, Bosnia, Croatia, Korea, Kosovo, Iran, Iraq, Israel, Palestine, Russia, Somalia, Ukraine and Vietnam.

FINDINGS

Two antecedent conditions preceded nurses' war involvement: actively responding to human suffering and having resources for readiness. Nurses were defined by five attributes: sacrifice, resourcefulness, tunnel-vision, survival mindset and comradery. We also found evidence for seven consequences; nurses saved lives (reduced morbidity and mortality), however, some nurses faced professional burnout/disillusionment, restricted practice authority, isolation and post-traumatic stress after war. In addition, growth and pacifism were consequences for some nurses who were exposed to war.

CONCLUSION

The findings of our concept analysis illustrate how nurses have fulfilled critical life-saving roles, but some nurses' post-war experiences were debilitating, stigmatized and unsupported. We conclude that research about the resourcefulness, innovations and resiliency nurses have developed during wars is essential, and professional support mechanisms must be developed to prevent post-traumatic stress, burnout and attrition from the profession. Governments can use utilize the knowledge nurses developed during wars to expand emergency preparedness skillsets and promote nurses as the leaders of international efforts to promote peace.

NO PATIENT OR PUBLIC CONTRIBUTION

Patients, service users, caregivers and members of the public were not involved in conducting this concept analysis or preparing the manuscript.

IMPACT STATEMENT

By understanding nurses' involvement with post-WWII conflicts, we have demonstrated the significant public health contributions, challenges and personal and professional growth experienced by nurses. Nurses' war-related knowledge should be utilized to innovate healthcare practices during disasters and to advise policymakers in developing, implementing and evaluating peace-promoting operations.

Training of volunteer nurses during the Spanish Civil War (1936-1939): A historical study

BACKGROUND

The Spanish Civil War (1936-1939) is an example of a historic event involving nurses, with the participation of professional and volunteer nurses from Spain and other countries. In this context, nurses were trained over short periods of time and recruited to work at hospitals serving the two warring camps.

OBJECTIVES

To identify the characteristics of the training received by volunteer nurses on both sides in the Spanish Civil War and compare it with previous experiences in the history.

DESIGN

Historical research.

METHODS

Heuristic and hermeneutical analysis of nurse training manuals and news articles from 1936 to 1939. Spanish primary sources were consulted at the Red Cross Documentation Centre Archive in Madrid, the General Military Archive in Ávila, the Municipal Newspaper Archive in Madrid, and the archives of Spanish daily newspapers ABC and La Vanguardia. The following variables were analysed: duration, entry requirements, and theoretical content of the training courses. Consolidated Criteria for Reporting Qualitative Research (COREQ) has been used.

FINDINGS

Both sides in the conflict offered a varied training programme, which was supported by official institutions and private initiatives. The courses lasted between one week and two months. Entry requirements were influenced by education level, age, moral conduct, health status, and social and political background. Training content focused on the techniques needed in conflict settings and covered specific moral values.

CONCLUSIONS

Despite the different social and political characteristics of the two warring factions, the variety of training programmes on offer, the entry requirements, and the theoretical content of volunteer nurse training were similar on both sides. At the end of the Spanish Civil War, volunteer nurses on the Republican side suffered reprisals or had to go into exile. We now know that some countries involved in World War II provided training courses for volunteer nurses. It would therefore be interesting to ascertain whether Spanish volunteer nurses contributed their experience to these courses.

Healthcare professionals' experiences during Operation Ancient Babylon in Iraq: A qualitative study

BACKGROUND

Healthcare professionals are usually employed in civilian inpatient and outpatient settings but can also work in countries experiencing military conflict.

AIMS

To explore the lived experiences of healthcare professionals during the operation "Ancient Babylon" in Iraq to understand their feelings and problems encountered.

METHODS

Hermeneutic phenomenological study. In-depth interviews of nine nurses and one physician who took part in the operation between 2003 and 2006 were performed. Data from the collected narrations were analyzed to identify recurrent themes.

RESULTS

Seven main themes emerged: "Living in an extreme setting," "Living in a theatre of war," "Strong emotions," "The team as a family," "A professional development experience," "An eye-opening experience," and "Advice for anyone who wants to join such a mission". The experience was perceived as physically challenging and emotionally difficult. The relationship between colleagues was strong. It was based on reciprocal trust, enthusiasm, and compensated for the sense of distance that the participants felt from their own families.

CONCLUSION

Advice and recommendations for those who are interested in pursuing similar experiences: they must develop decision-making skills, be able to rely on one's own abilities, have good professional training to fall back on, participate in exercises and simulations before the mission, and also be adaptable and innovative, flexible and able to stay mentally grounded.

Exploring competencies of military nurses in general hospitals in China: a qualitative content analysis

BACKGROUND

Military nurses should possess the competency to provide quality care in both clinical and military nursing contexts. This study aimed to identify the competencies of military nurses in general hospitals.

METHODS

A qualitative study was carried out using a qualitative content analysis. We purposefully sampled and interviewed 21 nurses in general hospitals in China.

RESULTS

The data analysis revealed 40 competencies, which were categorised into four main categories according to the Onion Model. These categories were motive (mission commitment), traits (perseverance, flexibility, etc.), self-identity of dual roles (obedience, empathy, etc.), as well as knowledge, skills and abilities (clinical and military nursing knowledge and skills, basic nursing ability, professional development ability, leadership and management ability).

CONCLUSIONS

Existing knowledge of competencies of military nurses in general hospitals is limited. A detailed exploration of this topic can provide guidance for recruitment, competency assessment, and competency building.

Deployment experiences of military nurses: A systematic review and qualitative meta-synthesis

Aims

The purpose of this systematic review is to explore military nurses’ preparation, deployment and reintegration experiences in order to provide recommendations for effective management of the nursing team.

Background

Nurses provide health care in different settings including community, hospital and the disaster site. Military nurses have a long history of deploying for global health.

Method

A systematic review and qualitative meta‐synthesis of studies focusing on the preparation, deployment and reintegration experiences of military nurses was carried out.

Results

Five synthesized findings were concluded: (a) preparing and sharing experience are the key coping strategies; (b) transition from the civilian care to emergency situations; (c) teamwork contributing to team bonding and the growing role of nursing in the medical team; (d) devoting to nursing duty achieves growth; (e) reintegration is not easy and external support matters.

Conclusion

Transition from civilian care to deployment and from structured deployment environment to reintegration poses challenges to nurses, and better preparation, sufficient support enables them to gain growth.

Implications for Nursing Management

Nurse managers should consider how to sustain a competent and ready nursing team by proposing training protocols to nurses for the potential challenges during the deployment cycle when responding to disasters and public emergencies.

Hermeneutic Phenomenological Study of Military Nursing Officers

BACKGROUND

Nurses working in military trauma teams often work in hostile and remote locations. They are faced with the burden of carrying out their duties while ensuring the safety of their patients and themselves in areas of conflict and humanitarian crisis. The stories and experiences of military nurses often go untold. In a phenomenological study, six Australian Defence Force Nursing Officers share their stories of working as members of military trauma teams.

OBJECTIVES

The aim of this study was to gain an understanding of the lived experiences of nursing officers when working as a member of a military trauma team.

METHODS

A hermeneutic phenomenological approach was used to conduct this research. In-depth interviews were conducted with six participants.

RESULTS

The following themes were identified: telling their stories; the role-who we are and what we do; the environment-it is so different; training-will it ever fully prepare you; working in teams-there's no "I" in team; and leadership-will the real leader please stand up!

DISCUSSION

This study has provided an insight into the experiences of six Australian military nurses working in trauma teams-experiences that were rarely given voice outside the military. Central to this experience is the need to have these stories told.

Thematic Analysis of Management Behaviors of Civilian Nurses in Iran-Iraq War 1980-1988: A Historical Research

BACKGROUND

One of the most important roles of nurses in the war was the application of management interventions, which led to provide better services for the wounded soldiers. The purpose of this study was to explore the Management behaviors of civilian nurses in the Iran-Iraq war.

MATERIALS AND METHODS

The historical research methodology and thematic analysis using in-depth interviews were applied to gather data. This study was conducted in 2010-2012 in five big cities of Iran, and involved 18 male nurses who were selected by purposeful sampling method.

RESULTS

The interviews of the nurses revealed a main category as the management behaviors of the nurses in the war. Six subcategories were obtained, namely call up for the war, establishing emergency teams, managing the therapeutic units, managerial innovation during war operations, teamwork and variety of roles of nurses in the war.

CONCLUSIONS

This study demonstrated how the nurses adapted to the harsh a situation without any previous experience on management in crises such as wars and increased medical treatment facilities outcome using management principles.

Military nurse deployments: Similarities, differences, and resulting issues

BACKGROUND

Military nurses have a long history of deploying to combat and disaster. Much can be gleaned from their experiences.

PURPOSE

The purpose of this secondary analysis was to explore military nurses' perceptions of similarities, differences, and resulting issues of military deployments from narratives of three previous studies.

METHODS

Secondary analysis of interviews from 65 U.S. military nurses (Air Force, Army, Navy) was conducted. Line-by-line readings and Nvivo8 qualitative software were used.

DISCUSSION

Seven themes emerged. Similarities: We Have Suffered, Support Really Matters, The Chaos Is Real, and I'm a Different Person Now; Differences: We Didn't Know, The Structure Is Missing, and Disasters and War Are Not Equal.

CONCLUSION

Findings indicated potential areas for improvement in behavioral health, support, and preparedness. Nurses noted they had changed; that they were a different person, and were having difficulty fitting into postdeployment roles. Positive experiences included personal growth and pride.

The challenges and psychological impact of delivering nursing care within a war zone

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 psychological impact of delivering nursing care in a war zone hospital.

PURPOSE

The purpose of the study was to explore the challenges and psychological stressors facing military nurses in undertaking their operational role.

METHODS

A constructivist grounded theory was used. Semi-structured interviews were conducted with 18 British Armed Forces nurses at Camp Bastion Hospital, Afghanistan, in June to July 2013.

DISCUSSION

Military nurses faced prolonged periods of caring for seriously injured polytrauma casualties of all ages, and there were associated distressing psychological effects and prolonged periods of adjustment on returning home. Caring for children was a particular concern. The factors that caused stress, both on deployment and returning home, along with measures to address these issues such as time for rest and exercise, can change rapidly in response to the dynamic flux in clinical intensity common within the deployable environment.

CONCLUSION

Clinical training, a good command structure, the requirement for rest, recuperation, exercise, and diet were important in reducing psychological stress within a war zone. No formal debriefing model was advocated for clinical staff who appear to want to discuss traumatic incidents as a group, and this may have contributed to stigma and nurses feeling isolated. On returning home, military nurses reported being disconnected from the civilian wards and departments. The study raised the question of who cares for the carers, as participants reported a perception that others felt that they should be able to cope without any emotional issues. It is envisioned that the results are transferable internationally to nurses from other armed forces and will raise awareness with civilian colleagues.

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

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.