School of Nursing, The Catholic University of America, Washington, DC, USA.
Clarksville, Maryland, USA.
J Nurs Scholarsh. 2024 Nov;56(6):854-866. doi: 10.1111/jnu.13011. Epub 2024 Aug 23.
The War on Terrorism, which included Operation Enduring Freedom (OEF) in Afghanistan from 2001 to 2014 and the concurrent Operation Iraqi Freedom (OIF) from 2003 to 2011, exposed military nurses to situations and challenges for which many reported feeling unprepared. Clinically, nurses faced multi-trauma injuries and devastating wounds suffered by military troops and civilians alike. Cultural issues and harsh living conditions added further complications to the care environment. The purpose of this study was to address the research question: How do military nurses identify, assess, manage, and personally resolve ethical issues occurring in nursing practice during wartime deployments?
Qualitative grounded theory provided the design for this study.
Using the constant comparative method, data collection, and data analysis occurred simultaneously to build a theory of ethical issues management during wartime. Using a focused interview guide responsive to emerging themes and developing theory, interviews were conducted until theoretical saturation was achieved. Participants represented primarily Army (55%) active duty (83%) female nurses (71%) who had deployed to Iraq (52%), Afghanistan (32%), or both (16%). A sampling grid was used to recruit nurses representative of the demographics deployed in support of OIF and OEF. Data analysis used grounded theory methods to identify a core construct to detail proposed relationships and concepts. Rigor was maintained in study methods and analysis using established tenets to support trustworthiness.
The nurses shared stories regarding their experiences during deployment. Many struggled to find internal resolutions regarding the care of detainees, cultural differences, end-of-life decision-making, pain management, and care of civilian casualties.
The study described the ethical issues military nurses encountered during wartime and the strategies used to mitigate moral conflict. By better understanding how nurses define, assess, and manage ethical situations, we can better prepare our deploying nurses for future conflicts.
Military nurses returning from wars with unresolved moral conflicts are at risk for moral distress. Moral distress has been associated with burnout, dissatisfaction with and leaving the nursing profession, compassion fatigue, and disinterest in the provision of quality patient care. In the interest of preserving the health of military nurses, steps need to be taken to provide resources for helping them prepare for, encounter, and cope with the ethical situations inherent in wartime nursing care.
从 2001 年到 2014 年的反恐战争（包括在阿富汗的持久自由行动（OEF）和 2003 年到 2011 年的伊拉克自由行动（OIF））使军事护士面临许多情况和挑战，许多人报告说对此准备不足。在临床方面，护士面临着军人和平民遭受的多发性创伤和毁灭性伤口。文化问题和恶劣的生活条件使护理环境更加复杂。本研究的目的是解决研究问题：军事护士如何在战时部署中识别、评估、管理和个人解决护理实践中的伦理问题？
定性扎根理论为这项研究提供了设计。
使用恒比比较法，同时进行数据收集和数据分析，以构建战时伦理问题管理理论。使用响应新兴主题和发展理论的重点访谈指南，进行访谈，直到达到理论饱和。参与者主要代表陆军（55%）现役（83%）女性护士（71%），他们曾部署到伊拉克（52%）、阿富汗（32%）或两者兼而有之（16%）。使用抽样网格招募支持伊拉克自由行动和持久自由行动的部署人员的护士。数据分析采用扎根理论方法，确定一个核心结构，详细说明拟议的关系和概念。研究方法和分析中采用既定原则来保持可信度。
护士们分享了他们在部署期间的经历。许多人在对待被拘留者、文化差异、临终决策、疼痛管理和民用伤亡护理方面努力寻找内部解决方案。
该研究描述了军事护士在战时遇到的伦理问题以及用于减轻道德冲突的策略。通过更好地了解护士如何定义、评估和管理伦理情况，我们可以更好地为未来的冲突做好派遣护士的准备。
从带有未解决道德冲突的战争中返回的军事护士有道德困扰的风险。道德困扰与倦怠、对护理专业的不满和离开、同情疲劳以及对提供优质患者护理的兴趣降低有关。为了保护军事护士的健康，需要采取措施为他们提供资源，帮助他们为战时护理护理中的伦理情况做好准备、应对和应对。
