Influencing leadership in nursing education and practice: A qualitative study of military nurse officers.

BACKGROUND: The potential positive impact military nurse officers (MNOs) make on the nursing profession, as well as lessons learned, often is unknown beyond inner military circles. PURPOSE: Describe the experiences of MNOs in the advancement of the profession of nursing and nursing education, and how military service influenced nurse leaders' impact on civilian practice. METHOD: A descriptive-interpretive qualitative study using semistructured interviews of MNOs (N = 21). FINDINGS: Analysis revealed three themes: Deliberately developing personal leadership capacity, Building bench strength through team investment, and Balancing people and systems to achieve the mission. DISCUSSION: Leader development in the military afforded participants the necessary skills to advance the profession of nursing and nursing education in multiple ways that span individual, group/team, and organizational impact. Transferability and application of these skills to civilian settings may enhance leader development in nurses without military service.

The relationship between managerial coaching and role ambiguity among nurses in the military health system.

Managerial coaching may be an effective strategy to reduce role ambiguity among nurses. Although the benefits of coaching relationships have been demonstrated outside of nursing, there is a lack of evidence about this career development relationship in nursing. A cross-sectional design was used to determine the relationship between managerial coaching and role ambiguity among military and civilian nurses who work in the Military Health System (MHS). Nurses who worked at a large academic medical center in San Antonio, Texas were asked to participate by completing a survey to examine the variables of interest. Among the 382 nurses that responded, perceived role ambiguity was low and managerial coaching was seldom perceived from first-line supervisors. However, there was a significant negative relationship between managerial coaching and role ambiguity. This study provides foundational knowledge about the relationship between managerial coaching and role ambiguity for nurses working in the MHS.

Social network analysis: Exploring connections to advance military nursing science.

BACKGROUND: Military nurse scientists are embedded in service-affiliated branches (Army, Navy, Air Force) with different missions, but with the singular purpose of generating and disseminating research impacting the health and well-being of DoD beneficiaries. PURPOSE: This project examines collaboration among TriService Nursing Research Program (TSNRP) members, seeking opportunities to strengthen, diversify, and expand research collaboration. METHOD: Social network analysis (SNA) is the empirical inquiry of relations among social actors at different levels of analysis. An electronic SNA assessment and total enumerative sampling were used to explore current collaborations among PhD-prepared military nurse scientists (N = 136). FINDINGS: The TSNRP collaboration network has a complex service-driven structure with high status actors whose advice, knowledge, or skills are sought by others, and who function as connectors or bridges across service branches. DISCUSSION: For military scientists, SNA is instrumental in identifying influential individuals, visualizing opportunities for intraservice mentoring, designing responsive policy, and directing career opportunities for novice scientists.

[From corpsman to rescuer, the missed nurse's ideal towards the end of italian Risorgimento]. / Da portaferiti a soccorritore, l'ideale mancato di infermiere militare sul finir del Risorgimento italiano.

INTRODUCTION: Military corps have always been supported by healthcare providers who took care of the injured and sick soldiers. Traditionally the military nurse's figure has never been fully appreciated to the point that, even nowadays, it is still searching for its own identity. AIM: The aim of the study is to describe the military nurse's role from the Second War for Italian Independence (1859) to the conquest of Rome (1870). METHODS: Historical investigation. Secondary sources were consulted to carry out a geopolitical and historical contextualization of the reference period, while to trace the military nurse's evolution the team referred to primary sources. All the mentioned sources were analyzed according to Chabod's methodology (2012). RESULTS: The military nurse was born as a corpsman. The Risorgimento wars contributed to highlight the major contribution that nurses could give to military healthcare. In 1863 the Ministry of War elaborated a new and innovative profile for military nurses which foresaw particular physical and moral requirements, but also specific competences. Even though a new ideal of nurse was created, the Military Nurses Corp did not experience any changes: the nurses' activities remained transporting the injured and assisting doctors. CONCLUSIONS: Primary sources analysis highlighted an important attention towards the military nurse's role and education after national unity, although the gap shown by the military healthcare service during the Risorgimento battles was evident. Such condition facilitated the development of the first rescue committees which became, at a later time, the International Red Cross. The committees popularity allowed the volunteers to gain higher fame and social prestige than military nurses.

A pilot study to evaluate the utility of live training (LIVEX) in the operational preparedness of UK military trauma teams.

BACKGROUND: With the end of UK military operations in Iraq and Afghanistan, it is essential that peacetime training of Defence Medical Services (DMS) trauma teams ensures appropriate future preparedness. A new model of pre-deployment training involves placement of formed military trauma teams into civilian trauma centres. This study evaluates the benefit of 'live training during an exercise period' (LIVEX) for DMS trauma teams. METHODS: A cross-sectional questionnaire-based survey of participants was conducted. Quantitative data were collected prior to the start and on the final day. Written reports were collected from the coordinators. Thematic analysis was used to identify emergent themes in a supplementary, qualitative analysis. RESULTS: Each team comprised 13 personnel and results should be interpreted with knowledge of this small sample size. The response rate for both the pre-LIVEX and post-LIVEX questionnaire was 100%. By the end of the week, 89% of participants (n=23) stated LIVEX was an 'appropriate or very appropriate' way of preparing for an operational role compared with 40% (n=9) before the exercise (p<0.01). However, completing LIVEX made no difference to participants' personal perception of their own operational preparedness. Thematic analysis suggested greater training benefit for more junior members of the team; from Regulars and Reservists training together; and from two-way exchange of information between DMS and National Health Service medical staffs. CONCLUSIONS: Completing LIVEX made no statistically significant difference to participants' personal perception of their own operational preparedness, but the perception of LIVEX as an appropriate training platform improved significantly after conducting the training exercise.

Nurturing a positive research culture: the Academic Department of Military Nursing perspective.

The structure and quality of nurse education in the UK has been scrutinised for many decades, culminating in a significant shift from ward-based learning at certificate level to that at diploma or degree level being delivered in higher education institutions. This professionalisation of nursing in the last decade of the 20th century was influenced by major changes in Department of Health policy, which demanded that a sound evidence base must be applied to nursing practice thereby replicating the model of evidence-based medicine. The requirement for care delivery to be evidence based is built on the premise that a continual research programme to investigate, disseminate and implement findings will enhance decision making in the clinical environment, thereby improving standards of care and patient outcomes. However, for this to be achieved there is an organisational responsibility to drive a positive research culture in order to effectively generate new knowledge and expertise. This paper explores the nursing research culture in the NHS and the strategies employed by the Defence Medical Services for supporting its nurses to generate the high-quality evidence that informs best practice.

Training critical care nurses in trauma care.

Trauma is the commonest cause of death in people aged under 40 years. Despite review and debate, the quality of trauma training and care varies. This article examines the literature relating to trauma training in UK military and civilian environments to identify current practice and recommendations for training. It also discusses the British Association of Critical Care Nurses Military Region's one-dayraum trauma critical care skills workshop.

Nursing competencies in aeromedical transport in the Brazilian Air Force: a descriptive study.

OBJECTIVE: To analyze nursing skills in military aeromedical transport of the Brazilian Air Force. METHOD: Descriptive, qualitative research, carried out in three Brazilian Air Force hospitals in Rio de Janeiro, involving 64 military nurses. Discursive textual analysis identified competencies in healthcare, communication and decision-making. RESULTS: After characterizing participants, it was possible to understand the reality experienced by nursing professionals in air medical transport, highlighting the skills related to healthcare, communication and management, essential in all phases of air medical transport. CONCLUSION: It was evident that nursing assumes unique skills in caring for airborne patients, using diverse knowledge and experiences in solving problems encountered in the aeromedical work process. The need to implement continuing education strategies was also highlighted. The findings serve as support for professionals and managers to identify gaps in knowledge, performance and management of professional schedules in aeromedical transport.

Strengthening the Psychological Health and Readiness of Military Critical Care Nurses for Disaster and Future Combat Environments.

Critical care nursing is a highly dynamic and demanding field, and critical care nurses play a vital role in the US military health care system. Although many critical care nurses are resilient to myriad occupational exposures, for some nurses the job leads to adverse psychological effects, including compassion fatigue and burnout. This article describes the evidence used to develop a psychoeducation program designed to mitigate burnout among health care professionals, particularly critical care nurses. Implementation considerations (including those in the context of disaster response) and future battlefield are discussed. Ultimately, supporting the psychological health of the US military's critical care nurse force is vital to ensure their well-being, the readiness of our armed forces, and the security of our nation.

An analysis of the factors affecting the transition period to professional roles for newly graduated nurses in Turkey.

BACKGROUND: For the majority of newly graduated nurses, the transition to professional roles in their lives may be stressful. Common reasons for this include feelings of insufficiency with regard to clinical skills, fears of making mistakes, increased responsibilities and insufficient guidance. AIM: To identify the factors affecting the transition period of newly graduated nurses. METHODS: This study was designed and carried out as a descriptive and a cross-sectional study of three cohorts of newly graduated students. The study was implemented at a military education and research hospital in Ankara, Turkey. The population consisted of 234 (89%) of newly graduated nurses. For evaluating data, the SPSS 15.0 program was used. The paired samples t-test and the Mann-Whitney U-test were employed to compare the participants' perceptions about the transition period based on certain variables. RESULTS: It is found that 54.7% of nurses surveyed have the intent to quit the profession. More than half of the participants stated that their expectations were met through working with a preceptor nurse (58.73%). Furthermore, almost half of the newly graduated nurses experienced and expressed disappointment in the first year of their professional lives. CONCLUSIONS: The findings indicate that newly graduated nurses experience some difficulty during this period of transition, but assistance from experienced nurses facilitates the transition period. IMPLICATIONS FOR NURSING PRACTICE AND RESEARCH: In order to increase work quality and satisfaction levels of new graduates, support programs must be initialized and their effectiveness must be evaluated regularly by clinical administrators and educators.

Military sexual trauma: a silent syndrome.

This article examines an age-old problem-sexual assault-through the lens of its occurrence within the military culture. Specific cases as well as U.S. Department of Defense responses to better handle these issues are offered to educate psychiatric-mental health nurses of the potential differences in symptomatology and presentation of military sexual trauma (MST). This appears to be an increasing problem with the predicted cohort of returning veterans appearing both in the U.S. Department of Veterans Affairs system as well as in civilian locations, hospitals, community centers, and especially the workplace. It will be critical to develop training materials and pursue further research to identify this silent syndrome of MST to better meet the needs of our returning veterans.

[Specificities of war surgery, and capacities of the military health service]. / Spécificité de la chirurgie de guerre et capacités du service de santé des armées.

In view of the recent evolution of military conflicts, particularly in the Afghan theater, and the conditions in which wounded warriors are managed in the field prior to hospitalization, the authors examine the technical specificities of medical teams, based on studies of avoidable mortality. War surgery has become a separate specialty, following the disappearance in France of the general surgical specialty, of which it was the military coun-terpart. The authors stress the role of hemorrhaging and its treatment, based on three strategies: damage control resuscitation, blood transfusion, and early evacuation within the "golden hour ". The French Armed Forces Health Service, in a new strategic plan, is refocusing its activity on war traumatology, through better education and training of medical-surgical teams and by opening up its scholarship structures to the French civilian public health service sector.

Assessing confidence in triage decision making: evaluation of an inventory in a sample of navy and civilian nurses.

Triage decision making and prioritizing nursing care are essential nursing skills in all clinical settings. The purpose of this study was to evaluate the psychometric properties of the Triage Decision Making Inventory in a sample of Navy and civilian nurses with diverse clinical specialties and years of clinical experience. Establishing reliability and validity allows staff development educators to evaluate training strategies that promote confidence in decision making among nurses of all specialty practices.

Experiences of military nurses in the Iraq and Afghanistan wars: review of research report.

Scannell-Desch and Doherty's (2010) research study findings are important to evidence-based nursing practice experiences of United States military nurses in the Iraq and Afghanistan wars to expand the research research findings identified common experiences and reoccurring stories and struggles of nurses pre, during, and postemployment in the Iraq and Afghanistan wars. These findings can be used for the education of future deploying military nurses and set the groundwork for further in-depth research studies on military nursing. One suggestion for future research would be a more in-depth study on the challenges faced by military nurses postemployment and interventions to assist in overcoming these challenges.

Trauma care training for National Police nurses in Colombia.

INTRODUCTION: In response to a requirement for advanced trauma care nurses to provide combat tactical medical support, the antinarcotics arm of the Colombian National Police (CNP) requested the Colombian National Prehospital Care Association to develop a Combat Tactical Medicine Course (MEDTAC course). OBJECTIVE: To evaluate the effectiveness of this course in imparting knowledge and skills to the students. METHODS: We trained 374 combat nurses using the novel MEDTAC course. We evaluated students using pre- and postcourse performance with a 45-question examination. Field simulations and live tissue exercises were evaluated by instructors using a Likert scale with possible choices of 1 to 4. Interval estimation of proportions was calculated with a 95% confidence interval (95% CI). Differences in didactic test scores were assessed using a t-test at 0.05 level of statistical significance. RESULTS: Between March 2006 and July 2007, 374 combat nursing students of the CNP were trained. The difference between examination scores before and after the didactic part of the course was statistically significant (p < 0.01). After the practical session of the course, all participants (100%) demonstrated competency on final evaluation. CONCLUSIONS: The MEDTAC course is an effective option improving the knowledge and skills of combat nurses serving in the CNP. MEDTAC represents a customized approach for military trauma care training in Colombia. This course is an example of specialized training available for groups that operate in austere environments with limited resources.

The evidence-based practice concept: engaging interest and participation.

The TriService Nursing Research Program was chartered in 1992 to advance the science of military nursing to support mission readiness, to provide optimal evidence-based healthcare in various military settings, and to improve the health and quality of life of military personnel. In 2002, the Tri-Service Nursing Research Program created the evidence-based practice initiative to foster excellence in military nursing care through the evidence-based practice in the military healthcare system. The evidence-based practice initiative has been coherently and successfully implemented throughout the military healthcare systems largely due to strong commitment and support from all management levels across services and across components.

"Stars" aligned for evidence-based practice: a Triservice initiative in the Pacific.

BACKGROUND: Establishing system-wide evidence-based nursing practice requires the support of senior leadership as well as adherence to a model that is sensitive to the challenges of practice change. OBJECTIVE: The purpose of this study was to establish a level of skill and knowledge among Army, Navy, and Air Force nurses to develop, to implement, and to evaluate best evidence-based practices (EBPs) for improved patient care. METHODS: Using the Iowa Model to guide their work, nurses from the Air Force, the Army, and the Navy joined efforts to establish EBP as a standard of nursing practice at four different military healthcare facilities in Hawaii: one tertiary medical center and three clinics on the island of Oahu. With the support of senior leadership at all four sites, four nurse researchers and a project director facilitated the work of advance practice nurses and staff nurses. RESULTS: Twelve different EBP projects were developed, implemented, and evaluated over 18 months by more than 50 nursing personnel across the three branches of service on Oahu. The result was a positive contribution to patient care throughout the healthcare system, affecting all areas of military nursing practice. Supporting goal was the improvement in the attitudes of nurses about research and their skills in applying evidence to their practice by way of a year-long internship program. Also influenced was the development of a foundation for evidence-based clinical and administrative military nursing decision making in the Pacific. CONCLUSION: A successful EBP program requires (a) consistent long-term vision and support from senior leadership; (b) resources such as trained personnel, finances, and time; and (c) structured approach to create an environment that facilitates the process. However, the success of an EBP program relies heavily on each nurse's commitment to change designed to improve nursing care for patients.

Collaborating across services to advance evidence-based nursing practice.

BACKGROUND: Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. OBJECTIVES: The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. METHODS: A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. RESULTS: Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. DISCUSSION: Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a common mission of providing high-quality care for war-injured service members. Lessons learned from this project can be generalized to civilian facilities.

Towards evidence-based management: creating an informative database of nursing-sensitive indicators.

PURPOSE: The purpose of this paper is to describe the creation, evolution, and implementation of a database of nursing-sensitive and potentially nursing-sensitive indicators, the Military Nursing Outcomes Database (MilNOD). It discusses data quality, utility, and lessons learned. DESIGN/METHODS: Prospective data collected each shift include direct staff hours by levels (i.e., registered nurse, other licensed and unlicensed providers), staff categories (i.e., military, civilian, contract, and reservist), patient census, acuity, and admissions, discharges, and transfers. Retrospective adverse event data (falls, medication errors, and needle-stick injuries) were collected from existing records. Annual patient satisfaction, nurse work environment, and pressure ulcer and restraint prevalence surveys were conducted. FINDINGS AND CONCLUSIONS: The MilNOD contains shift level data from 56 units in 13 military hospitals and is used to target areas for managerial and clinical performance improvement. This methodology can be modified for use in other healthcare systems. CLINICAL RELEVANCE: As standard tools for evidence-based management, databases such as MilNOD allow nurse leaders to track the status of nursing and adverse events in their facilities.