I Serve 2: Identifying and caring for military-connected children in civilian primary care settings.

Military children make tremendous sacrifices in support of a parent(s) military service. More than two million children have a parent who is serving or has served in the Armed Forces. Research shows that military-connected children are at higher risk of physical, psychological, and behavioral health issues. While "resilient" is the word used to describe most military children, it is important to recognize the stresses/stressors of military life- that military children serve too-to support and care for them.

Do I take the job?: Assessing fit with the organization.

PURPOSE: A good 'fit' with an organization is critical to a leader's success yet when searching for a new position assessment an evaluation of many aspects may be overlooked, such as culture. This paper presents key considerations around 'fit' that applicants for leadership positions should consider prior to, during, and after the interview. Suggestions are provided on how to approach an evaluation of 'fit'. CONCLUSION: The importance of assessing individual fit with an organization prior to accepting a leadership position cannot be over-emphasized.

"I Serve 2": Meeting the needs of military children in civilian practice.

The American Academy of Nursing launched the "Have You Ever Served in the Military?" campaign in 2013 in conjunction with the Joining Forces campaign spearheaded by First Lady Michelle Obama and Dr. Jill Biden. The "Have You Ever Served in the Military?" campaign provides guidance and resources for nurses outside the Military Health System and Veterans Health Administration where upwards of 80% of veterans receive care. However, most military personnel do not serve alone. More than half of the 2.2 million active duty, National Guard, and Reserve service members currently serving in the armed forces have families and many military children experience stress and anxiety secondary to parental military service. Although strides have been made to improve identification and treatment of the visible and invisible wounds of war for service members, little to no information exists regarding the impact parental service has on the physical, psychological, and behavioral health of military children. In addition, there is no mechanism in place to identify military children in civilian practice nor resources providing evidence-based best practices when caring for these children.

Reliability of the Deployment Resiliency Assessment.

This article describes the reliability of the instruments embedded in a mental health screening instrument designed to detect risky drinking, depression, and post-traumatic stress disorder among members of the Armed Forces. The instruments were generally reliable, however, the risky drinking screen (Alcohol Use Disorders Identification Test-Consumption) had unacceptable reliability (α = 0.58). This was the first attempt to assess psychometric properties of a screening and assessment instrument widely used for members of the Armed Forces.

Factors associated with psychiatric evacuation among service members deployed to Operation Enduring Freedom and Operation Iraqi Freedom, January 2004 to September 2010.

OBJECTIVES: To calculate the annual rate of psychiatric evacuation of U.S. Service members out of Iraq and Afghanistan and identify risk factors for evacuation. METHODS: Descriptive and regression analyses were performed using deployment records for Service members evacuated from January 2004 through September 2010 with a psychiatric diagnosis, and a 20% random sample of all other deployers (N = 364,047). RESULTS: A total of 5,887 deployers psychiatrically evacuated, 3,951 (67%) of which evacuated on first deployment. The rate increased from 72.9 per 100,000 in 2004 to 196.9 per 100,000 in 2010. Evacuees were overrepresented in both combat and supporting duty assignments. In multivariate analysis, Army active duty had the highest odds of evacuation relative to Army National Guard (adjusted odds ratio [AOR] 0.852, 95% confidence interval [CI] 0.790-0.919), Army Reserve (AOR 0.825, 95% CI 0.740-0.919), and all other components. Accessions in 2005 had the highest risk (AOR 1.923, 95% CI 1.621-2.006) relative to pre-2001 accessions. CONCLUSIONS: Risk for psychiatric evacuation is highest among the Army Active Component. A strong link between multiple deployments or combat-related exposure and psychiatric evacuation is not apparent. Increased risk among post-2001 accessions suggests further review of changes in recruitment, training, and deployment policies and practices.

Factor analysis of the modified Sexual Adjustment Questionnaire-Male.

BACKGROUND AND PURPOSE: The Sexual Adjustment Questionnaire (SAQ) is used in National Cancer Institute-sponsored clinical trials as an outcome measure for sexual functioning. The tool was revised to meet the needs for a clinically useful, theory-based outcome measure for use in both research and clinical settings. This report describes the modifications and validity testing of the modified Sexual Adjustment Questionnaire-Male (mSAQ-Male). METHODS: This secondary analysis of data from a large Radiation Therapy Oncology Group trial employed principal axis factor analytic techniques in estimating validity of the revised tool. The sample size was 686; most subjects were White, older than the age 60 years, and with a high school education and a Karnofsky performance scale (KPS) score of greater than 90. RESULTS: A 16-item, 3-factor solution resulted from the factor analysis. The mSAQ-Male was also found to be sensitive to changes in physical sexual functioning as measured by the KPS. CONCLUSION: The mSAQ-Male is a valid self-report measure of sexuality that can be used clinically to detect changes in male sexual functioning.

The intentional development of nurses as leaders: a proposed framework.

In their 2010 report on The Future of Nursing, the Institute of Medicine called for nurses to be prepared to lead in all areas of healthcare. However, the nursing profession lacks consensus on a framework to guide the development of nurses as leaders and has yet to define essential leader competencies. This article reviews the Army's intentional, sequential, and progressive leader development program that is grounded in essential leader competencies. The applicability of this model to nursing is discussed, and examples of how it could be applied are highlighted. This article proposes the use of the military framework as a successful model for the intentional development of nurses as leaders to meet the triple aims of better care for patients, better health for populations, and reduced costs of care through more efficient use of resources.

The future of nursing and the health of North Carolinians: The North Carolina summit.

Nurse leaders in North Carolina convened the Statewide Summit for Creating the Future of Nursing and Health Care in North Carolina on April 11, 2011. This article summarizes the summit and lays out the way ahead for implementing, in North Carolina, recommendations from the report on the future of nursing recently published by the Institute of Medicine of the National Academies (IOM). A synopsis of the commentaries composing the policy forum of this issue of the NCMJ follows, linking them to the IOM report.

Ovarian cancer survivors: qualitative analysis of the symptom of sexuality.

PURPOSE/OBJECTIVES: To better understand treatment-induced changes in sexuality from the patient perspective, to learn how women manage these changes in sexuality, and to identify what information they want from nurses about this symptom. RESEARCH APPROACH: Qualitative descriptive methods. SETTING: An outpatient gynecologic clinic in an urban area in the southeastern United States served as the recruitment site for patients. PARTICIPANTS: Eight women, ages 33-69, receiving first-line treatment for ovarian cancer participated in individual interviews. Five women, ages 40-75, participated in a focus group and their status ranged from newly diagnosed to terminally ill from ovarian cancer. METHODOLOGIC APPROACH: Both individual interviews and a focus group were conducted. Content analysis was used to identify themes that described the experience of women as they became aware of changes in their sexuality. Triangulation of approach, the researchers, and theory allowed for a rich description of the symptom experience. FINDINGS: Regardless of age, women reported that ovarian cancer treatment had a detrimental impact on their sexuality and that the changes made them feel "no longer whole." Mechanical changes caused by surgery coupled with hormonal changes added to the intensity and dimension of the symptom experience. Physiologic, psychological, and social factors also impacted how this symptom was experienced. CONCLUSIONS: Regardless of age or relationship status, sexuality is altered by the diagnosis and treatment of ovarian cancer. INTERPRETATION: Nurses have an obligation to educate women with ovarian cancer about anticipated changes in their sexuality that may come from treatment.

Peripheral neuropathy in patients with gynecologic cancer receiving chemotherapy: patient reports and provider assessments.

PURPOSE/OBJECTIVES: To analyze the incidence of chemotherapy-induced neuropathy in a set of patients with gynecologic cancer who were treated with known neurotoxic agents, to identify correlative factors related to patients' experience of neuropathy, and to analyze providers' assessment and treatment of neuropathy. DESIGN: Observational descriptive study of patient-reported neuropathy using a retrospective chart analysis. SETTING: A hospital-based outpatient infusion center in the southeastern United States. SAMPLE: A convenience sample of 171 patients with gynecologic cancer for a total of 302 chemotherapy treatments. METHODS: A mixed model and compound symmetry covariance matrix was used to adjust for correlations between neuropathy treatment scores and patients who completed more than one chemotherapy cycle. Backward elimination method was used to determine the final model. MAIN RESEARCH VARIABLES: Functional Assessment of Cancer Treatment/Gynecologic Oncology Group-Neuropathy Treatment scores, patients' demographic information, past medical history, and chemotherapy history. FINDINGS: Patients who were physically shorter and heavier than the average population had the highest rating of neuropathy. Patients who were treated with nontaxane and platinum therapies had less neuropathy than patients who were treated with first-line taxanes and platinums. Neuropathy was noted by providers early in the course of treatment, and providers' grading was consistent with the patients' scoring. CONCLUSIONS: First-line treatments for gynecologic malignancies resulted in the highest neuropathy scores; however, patients who had received previous treatment with taxane and platinum therapies had lower neuropathy scores than patients currently receiving taxanes and platinums, suggesting that neuropathy improved after completion of first-line therapy and that second-line therapies were not necessarily correlative with worsening scores. IMPLICATIONS FOR NURSING: Nurses must educate patients about symptoms of neuropathy and the need to report symptoms. Nurses must recognize patients at highest risk for neuropathy and advocate use of validated assessment tools.

Sexuality: a critical component of quality of life in chronic disease.

Nursing is a science and an art. The science aspect of including sexuality in nursing practice requires knowledge about "normal" sexual functioning, an understanding of the pathophysiology and pharmacotherapies that may cause changes in sexuality, and knowledge about assessing and treating sexual difficulties. The art of including sexuality into nursing practice comes from awareness of one's beliefs and values, and comfort in talking about sexuality. The nurse will find that most patients will be pleased that he/she has taken the time to broach this important concern with them. This article provides an overview of the relationship among sexuality, chronic disease, and quality of life. Two frameworks are suggested that are useful in operationalizing sexuality in nursing practice.

The readiness estimate and deployability index and psychometric properties in army reserve nurses and medics.

The Readiness Estimate and Deployability Index measures the level of individual deployment readiness in Army Nurse Corps officers. The primary purposes of this pilot study were to determine the psychometric properties of the measure for Army Reserve component nurses and enlisted medical personnel and to compare the reliability between groups. The convenience sample consisted of 92 subjects. Internal consistency reliability for three of the six competencies and construct validity using the contrasted-groups approach were examined. Nurses reported greater competency than enlisted personnel in clinical and operational nursing skills but were lower in their self-assessment of soldier and survival skills. Findings suggest that more training in warrior tasks and drills is needed for both groups and that enlisted soldiers must enhance their clinical and operational skills. Unit commanders can use the Readiness Estimate and Deployability Index to measure individual readiness.