Operational Readiness: Redesigning Advanced Practice Registered Nurse (APRN) Curriculum for an Evolving Battlefield.

INTRODUCTION: The Global War on Terror and the ensuing Overseas Contingency Operations has rapidly transformed the U.S. military's strategic philosophy for warfare. The paradigm shift to unconventional warfare has forced military medicine to adapt with the rapidly evolving battle space. To this end, large fixed facility hospitals are being replaced with highly mobile and austere medical platforms that serve farther forward. The transition in operational health care has challenged the role of all health care team members.Through the evolution of the modern battlefield, nursing roles have grown and expanded beyond the traditional roles and peacetime practice. Nurses are seeing greater autonomy and scope of practice in operational settings while caring for patient pathologies that are often different than at home. The expansion of practice extends beyond the registered nurse at the bedside to the Advanced Practice Registered Nurse (APRN) that serves in the provider role. Through anecdotal reports, and a growing body of literature, that APRN operational practice is different than in the traditional health care setting. MATERIALS AND METHODS: Although a variety of organizations have codified knowledge, skills and attitudes (KSAs) relevant to operational practice, no formal APRN operational curriculum currently exists. Using an adaptation of Kern's Six-Step Model of curriculum design, we describe a curriculum development process used to improve and focus educational experiences to better prepare APRNs for evolving operational roles. RESULTS: Through deliberate approaches the GSN has reimagined its operational readiness curriculum for the preparation of the military APRN on the evolving battlefield. The GSN has operationalized APRN operational readiness through the integration of operationally relevant curriculum designed around interprofessional education experiences. Through this curricular design, GSN APRN students are provided with operationally relevant experiences in the context of authentic military scenarios. Through these encounters, we believe, allows our students to successfully develop the clinical, operational and teamwork skills to successfully perform care in austere and operational settings. CONCLUSIONS: This manuscript describes a novel approach to provide operational readiness education to military APRN students. Through an evaluation of the current literature, expert reports and information of the current operational requirements, the USU GSN has developed a model and curricula for APRN operational readiness that lie beyond the traditional skills in the peacetime setting. Through this plan of instruction, USU GSN APRN students will have the requisite skills to meet the evolving operational needs of the Department of Defense.

Military Interprofessional Health Care Teams: How USU is Working to Harness the Power of Collaboration.

Despite efforts to increase patient safety, hundreds of thousands of lives are lost each year to preventable health care errors. The Institute of Medicine and other organizations have recommended that facilitating effective interprofessional health care team work can help address this problem. While the concept of interprofessional health care teams is known, understanding and organizing effective team performance have proven to be elusive goals. Although considerable research has been conducted in the civilian sector, scholars have yet to extend research to the military context. Indeed, delivering the highest caliber of health care to our service men and women is vitally important. This commentary describes a new initiative as the Uniformed Services University of the Health Sciences aimed at researching the characteristics of successful military interprofessional teams and why those characteristics are important. It also describes the interprofessional education initiative that Uniformed Services University is launching to help optimize U.S. military health care.

Management of trauma-induced coagulopathy: trends and practices.

Nearly one-fourth of all trauma admissions present in varying degrees of coagulopathy. According to a US study, 40% of trauma fatalities are due to hemorrhage and hemorrhagic shock, and nearly all patients who are alive when they reach the hospital are coagulopathic when they die. Once coagulopathy develops, patient morbidity drastically increases. Because of the clinical significance of trauma-induced coagulopathy, management strategies to reduce the morbidity and mortality have recently become of interest. This article will review the pathology of trauma-induced coagulopathy and current trends in management, as well as closely examine the data surrounding the use of recombinant factor VII for the treatment of trauma-induced coagulopathy.

Hemodynamic measurement in the operating room: a review of conventional measures to identify hypovolemia.

Direct measurement of physiologic systems is often impractical. To overcome these obstacles, indirect physiologic measures have been developed. Indirect physiologic measures such as heart rate, blood pressure, and many others are surrogates that are believed to accurately represent the function of a physiologic system. Although a powerful tool, physiologic measurement has several potential limitations and errors. This can result in erroneous instrument data. For that reason, it is the responsibility of the clinician to question and interpret monitor output and to ultimately correctly assess validity of the measurement. This article reviews commonly used intraoperative monitoring techniques and discusses their potential limitations as they relate to hypovolemia and hemorrhagic shock.