背景:反恐战争,其中包括2001年至2014年在阿富汗的持久自由行动(OEF)和2003年至2011年同时进行的伊拉克自由行动(OIF),使军事护士面临许多报告感到毫无准备的情况和挑战。临床上,护士面临军队和平民遭受的多重创伤和毁灭性创伤。文化问题和恶劣的生活条件进一步增加了护理环境的复杂性。这项研究的目的是解决研究问题:军事护士如何识别,评估,管理,并亲自解决战时部署期间护理实践中出现的伦理问题?
方法:定性扎根理论为这项研究提供了设计。
方法:使用常数比较法,数据收集,和数据分析同时发生,建立了战时伦理问题管理理论。使用针对新兴主题和发展理论的重点面试指南,进行访谈,直至达到理论饱和.参与者主要是陆军(55%)现役(83%)的女护士(71%),曾部署到伊拉克(52%),阿富汗(32%)或两者(16%)。使用抽样网格来招募代表为支持OIF和OEF而部署的人口统计的护士。数据分析使用扎根的理论方法来确定核心结构,以详细说明所提出的关系和概念。使用既定的原则来支持可信性,在研究方法和分析中保持了严谨。
结果:护士分享了他们在部署期间的经历。许多人努力寻找关于照顾被拘留者的内部决议,文化差异,临终决策,疼痛管理,照顾平民伤亡。
结论:该研究描述了军事护士在战时遇到的道德问题以及减轻道德冲突的策略。通过更好地理解护士是如何定义的,评估,管理道德状况,我们可以更好地为未来的冲突做好准备。
结论:因道德冲突未解决而从战争中返回的军事护士面临道德困扰的风险。道德困扰与倦怠有关,对护理行业的不满和离开,同情疲劳,对提供高质量的病人护理不感兴趣。为了保护军队护士的健康,需要采取措施提供资源帮助他们做好准备,相遇,并应对战时护理中固有的道德状况。
BACKGROUND: 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?
METHODS: Qualitative grounded theory provided the design for this study.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: 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.