Archive for the ‘Combat nursing’ Category

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The Ethics of a Nurse’s Refusal to Force-Feed Guantanamo Hunger-Strikers

July 18, 2014

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

The Miami Herald reported this week that a U.S. Navy nurse and officer refused to take part in force-feeding hunger-striking detainees at Guantanamo Bay.

There’s much we still don’t know about this story, but the force-feeding of prisoners at Guantanamo has been a contentious issue for some time. The practice has been compared by some to torture, and ethicists in the medical literature have urged the physicians involved to refuse to participate, while the U.S. government and President Barack Obama defend the practice on humanitarian grounds of preventing the deaths of the detainees.

Whether or not one feels that nurse participation in the force-feeding is justified, this officer, whose identity has not been released, appears to deserve the profession’s praise for taking a moral stand in an extraordinarily difficult circumstance. All nurses have the right of conscientious objection, of refusing to participate in practices that they find morally objectionable—assisting in abortions is another practice that some nurses have opted out of on moral grounds—and officers in the U.S. armed services are bound to consider the legality and morality of orders they carry out.

Much is at stake for this nurse. Not only do officers risk their careers when refusing an order on moral grounds, but they must breach a sacred principle of effective military operation: obedience to the chain of command except by an officer in extraordinary circumstances.

Further, the officer deciding to refuse an order must make this determination alone and accept severe consequences if the further consideration of the higher chain of command, the courts, or history does not support her or his assessment. Read the rest of this entry ?

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As Another June Is Forgotten, Some Notes on Nurses and Normandy

July 3, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

A pause before the 4th of July: Nurses were at D-Day too.

NormandyNursesLanding

Nurses coming ashore at Normandy/AJN archive

Last month, there were a number of D-Day remembrances in the media—June 6 was the 70th anniversary of the 1944 Allied forces landing along the beaches of Normandy and what many believe to have been the single largest tactical maneuver ever launched.

I was especially interested in the D-Day events—I’ll be visiting the Normandy beaches in October. My father was a World War II army veteran and landed at Normandy, though not in the first wave. He arrived days later with Patton’s 9th Armored Division after the beaches had been secured. (His unit would go on to fight in the Battle of the Bulge and finally into Germany after securing the Bridge at Remagen, the only bridge across the Rhine River into Germany not destroyed during the German retreat.)

ItalyNursesLanding

AJN archive

One thing I was surprised to learn is that nurses landed at Normandy and other invasion beaches within only a few days of the first wave. The photos here are from the AJN archives—the above photo shows nurses landing at Normandy. And the one to the right predates Normandy and shows nurses disembarking in April, 1944, in the harbor at Naples, Italy. (According to this article from the AJN archives, which describes nurses coming under fire while treating wounded troops at the Anzio Beachhead, nurses arrived shortly after troops landed on Italy’s shores in the fall of 1943. For the best version, click the link to the PDF in the upper- right corner of the article page.) Read the rest of this entry ?

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Memorial Day Weekend: Thanks to the Nurses Who Served

May 23, 2014

By Jacob Molyneux, senior editor/blog editor

AJN wishes all of our U.S. readers (and everyone else too) a safe, restful Memorial Day weekend, whether you are driving to the shore or the hills, staying put and having a barbeque, finishing a dissertation, running a 10K, working all weekend in the emergency department, gardening, or binge-watching episodes of a TV show on Netflix (you know who you are).

And lest we forget: a heartfelt thanks to all nurses, present and past, who are or have served in the military in any capacity, in some cases losing their lives as they tried to save other lives and heal the wounded. And to their families. Read the rest of this entry ?

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Acknowledging Nightingale’s Pervasive Influence on Medicine as We Know It

March 4, 2014

By Jacob Molyneux, senior editor

Florence Nightingale in Crimean War, from Wikipedia Commons

Florence Nightingale in Crimean War, from Wikipedia Commons

There’s a very good article about Florence Nightingale in the New York Times right now (“Florence Nightingale’s Wisdom”)—and it’s by a physician.

The author, Victoria Sweet, writes that Nightingale was the last person she wanted to know about or identify with when she was in medical school. Then she gradually began to realize Nightingale’s extraordinary influence on modern medicine as it’s now practiced. As Sweet point out,

So much of what she fought for we take for granted today — our beautiful hospitals, the honored nursing profession, data-driven research.

It’s a good piece, and though you may already know some of what it covers, it’s well worth reading. For those who want to learn more about Nightingale, let me point out a series of short posts we ran back in the summer of 2010 on this blog. In Florence’s Footsteps: Notes from a Journey, written by Susan Hassmiller, senior advisor for nursing at the Robert Wood Johnson Foundation, detailed the stages of a trip she took that summer as she retraced Nightingale’s steps through England and all the way to the Crimea, all the while contemplating her legacy.

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American Academy of Nursing Spotlights Veteran Health Care, Names New ‘Living Legends’

October 24, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

served For me, the annual meeting of the American Academy of Nursing (AAN) is a great venue for networking and connecting with old friends (including some from nursing school days 40 years ago). And there are always interesting sessions such as the Living Legends awards and a presentation about veterans’ health.

Few schools of nursing teach nursing history anymore, and unless you’re plugged into a professional association you won’t know about the accomplishments of those who’ve shaped the profession. That’s a shame. Nursing has been rich with women and men of action who’ve forged new ways of thinking about, practicing, and teaching nursing. At this year’s AAN meeting, four nursing movers and shakers were added as “living legends” (the Academy’s highest honor) during the event that’s always a highlight at the annual meeting. This year’s “class” includes:

(Ret.) General Clara Adams-Ender, whose army career began as a private and ended as a brigadier general (she was the first nurse to become a general!) and chief of the Army Nurse Corps.

Hattie Bessent, a staunch advocate and leader in creating opportunities in nursing for minority groups.

Margaret Miles, a pioneer in pediatric nursing whose research and work with parents of critically ill children has led to family-centered care practices in ICUs.

Jean Watson, whose ground-breaking theory development, research and practice around the science of caring is known around the world.

The health needs of veterans. Another highlight was the presentation by Linda Schwartz, the nurse who is the commissioner of Veterans Affairs for Connecticut, who spoke eloquently about the health needs of veterans. She noted that there are currently 22.3 million living veterans, 2.2 million of whom are women. She stressed the importance of knowing whether a patient has a military service history because many health issues may be service associated. For example, toxic effects from depleted uranium and heavy metals such at those found in ordinance or from exposure to agents like Agent Orange may not manifest themselves for years. Read the rest of this entry ?

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Taking Flight: A Nurse Recharges Her Batteries

September 9, 2013

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

interior, BK 117 medical helicopter

interior, BK 117 medical helicopter

You’re part of a fixed-wing flight transport team called to pick up a 32-year-old male who’s been involved in a paragliding accident in Puerto Rico. Upon landing, you see an ambulance at the end of the tarmac. As you exit your plane, the ambulance pulls up and the crew opens the back door of the rig. They pull the patient out on a stretcher and hand you a folder of X-rays, saying, “He’s all yours.”

After four days of intensive training in the Air Medical Crew Core Curriculum course, my team was given that scenario as a group assignment on the last day of class. We were given a folder of radiology films and briefed on our patient’s vital signs and our assessment findings. We conducted a quick “field interpretation” of his X-rays and presented our interventions, along with our concerns and specific accommodations for transporting this unstable patient to Florida in a Learjet.

This was no ordinary class. Offered to nurses and other medical personnel interested in flight medicine—either on emergency response helicopters or fixed-wing transports—it included safety briefings, aircraft orientation, and worst-case-scenario land survival instructions. Among other activities, we visited with a helicopter crew and watched someone try to ignite a Nomex flight suit with a magnesium fire (it really will not burn). Lectures included transport considerations for specific patient populations including trauma, shock, neurologic injury, and burns. Flight physiology was discussed in depth. All in all, it was probably the coolest class I’ve ever taken—and I learned far more than I’d ever expected.

Just a few of the things I didn’t know:

  • At altitude, because of Boyle’s law, a simple pneumothorax may become a tension pneumothorax.
  • Pneumocephalus can be detrimental—or fatal.
  • The pressure in an endotracheal tube (ETT) cuff will increase, potentially resulting in airway ischemia.
  • Because of Dalton’s law, the fraction of inspired oxygen (FiO2) required by your patient will change and can be precisely calculated based on altitude and barometric pressure.

I’m certain the patient in our scenario made it back to the United States safely. My team, which was comprised of two nurses and three paramedics, caught the important injuries on the X-ray films we’d been provided. We knew, based on our assessment findings, which problems were emergent and required intervention before the flight, as well as how our various scopes of practice would dictate the actions taken. We knew exactly how much oxygen we’d need for the flight, based on the elevation we’d be flying at, and how many canisters that would require. Read the rest of this entry ?

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Sexual Assaults: Is the Military Finally Starting to Get It?

June 10, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

March 26, 2010: A poster supporting the Sexual Assault Prevention and Response (SAPR) program. (U.S. Navy photo illustration/Released)

March 26, 2010: A poster supporting the Sexual Assault Prevention and Response (SAPR) program. (U.S. Navy photo illustration/Wikimedia Commons)

On June 7, the U.S. Air Force command named Maj. Gen. Margaret H. Woodward director of its Sexual Assault Prevention and Response Office. She replaces her predecessor, Lt. Col. Jeffrey Krusinski, who was charged with sexual assault in early May.

Announcement of his arrest came the day before the Department of Defense was to hold a press briefing to tout changes intended to improve the handling of sexual assaults. Also on June 7, the U.S. Army command suspended Major General Michael T. Harrison, the commanding general of the U.S. Army in Japan for failing to “to report or properly investigate an allegation of sexual assault.”

At the press briefing, Secretary of Defense Chuck Hagel said he was “outraged and disgusted” at the allegations against Krusinki. Hagel also asserted that “[a]ll of our leaders at every level in this institution will be held accountable for preventing and responding to sexual assault in their ranks and under their commands.” But will commanders really be forthcoming? Will they be willing to report crimes that could make them look like they can’t manage troops effectively, thereby potentially endangering their own chances for promotion?

Congress has launched an investigation into how the military is handling sexual assaults. According to the Washington Post, the hearings were precedent setting in that it was the first time the entire Joint Chiefs of Staff had testified together as witnesses; the hearings were also marked by the significant presence of women on the Senate Armed Services Committee—seven in all. Read the rest of this entry ?

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Redeemed by M*A*S*H

June 3, 2013

Greg Horton is a widely published freelance writer and an adjunct professor at Oklahoma City Community College. With a new generation of veterans struggling to deal with emotional and physical wounds from their experiences in Iraq and Afghanistan, and to find meaningful work in a challenging economy, this story of a father’s 30-year nursing career after his return from the Vietnam War is particularly relevant today.

MASH-dioramaMy father started us on M*A*S*H soon after his return from Korea in 1973. The Vietnam War was nearing its end, although we did not know it at the time. A combat medic during his tour of duty in Vietnam early in the war, on this most recent tour my father had been stationed in Korea for a year at a hospital that received the grievously injured. “Spaghetti and meatball surgery,” he called it.

Our family had moved to Maud, Oklahoma, in 1972 to be near my mother’s family while my dad was in Korea. The endless countryside around our small town, combined with the local dump, gave us more than enough adventures to keep our minds off the war in a country of which we knew little.

M*A*S*H, the legendary television show featuring Alan Alda as the sarcastic antihero, started the year my father left for Korea. We were not a television-watching family, as such. My mother’s Pentecostal background instilled a deep-rooted distrust for the medium, unless Oral Roberts or Rex Humbard was preaching.

However, on my father’s return, that changed. I was nine years old when he got back, so I know I wasn’t aware of the political statement Larry Gelbart, the program’s creator, was making. My father would later explain to a 12-year-old me that it was only ostensibly about Korea; really, it was about Vietnam.

Every week, the family gathered around to watch. Many of the laughs required no intricate knowledge of the military or war or medicine, but my father, whose experience as a medic in Vietnam and doing triage in Korea lent him special insight, functioned like an expert annotator, dispensing information that opened up new vistas of meaning in the politics of war, gender, sex, death, and dying.

We were used to the motions of life required of a military family: relocation orders, moving without notice, upended friendships, new schools, new housing, new temporary friends. We had suffered all of it with aplomb, so my father’s newfound cynicism about war was disturbing to our routine.

I am almost certain he decided to be a nurse in the wake of Vietnam. Discontented with the calculus by which countries go to war and horrified to the point of nightmare by what he’d seen, he looked instead for a way to heal rather than harm.

My family did not survive the 1980s intact. The diagnosis later known as PTSD was unheard of at the time, but my father had it. An attempt to view Apocalypse Now led to a near breakdown; he shouted and cried out in the middle of the night for days afterward. Except for his U.S. Army work in the hospital, he couldn’t keep any of the two dozen side jobs he attempted. His attempt to help us understand M*A*S*H was his way of trying to help us understand what it had really been like, but like any war virgins, we were dealing with abstractions, not spaghetti and meatballs.

After my parents’ divorce, my father devoured nursing school. An early pregnancy and enlistment in the Army had delayed the application of his intelligence to academic work. Once exposed to it, he thrived. He used his retirement benefits to live on—he’d completed 20 years in service—while the old G.I. Bill helped pay for his education. He retired from the military at 37, and achieved his BSN before 40.

The next step was also difficult. His experience with medicine had been limited to two milieus: U.S. Army hospitals and war. What do you choose when the choices aren’t limited to what your commander tells you you must do?

It took nearly 10 years for my father to work through the options: coronary care, intensive care, post-critical care, ER, oncology, pediatrics, OB-GYN, and every other floor available at every hospital he worked. He even worked a stint at a state mental health facility, back when such things existed. Four broken ribs and a superstitious fear of full moon night pushed him out of mental health care, but that’s another story.

Serendipitously, he found his niche. He was scheduled to work a shift on a drug and alcohol rehabilitation unit in Norman, Oklahoma, in 1987. I was a freshman at the University of Oklahoma at the time, following my stint in the United States Air Force—he’d threatened an “ass-kicking” if I joined the Army. My father had secured me employment on the hospital switchboard at the same hospital to help pay for school.

He worked his shift, which, as I recall, was to help a friend who needed off. While on the floor, he discovered that many of the patients were military veterans. Their experience had driven them to abuse alcohol, cocaine, heroin, pills, as well as other types of escapism. Alway a nurturer, my father found in those men and women the opportunity to apply an ancient principle—redemption, to bring something good and whole out of something ugly and broken.

From then on, my father never worked another unit. He was a drug and alcohol rehab nurse until he retired 25 years later.

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AJN’s Growing Collection of Podcasts

February 19, 2013
Look for the AJN podcast icon

Look for the AJN podcast icon

A note from AJN’s editor-in-chief, Maureen Shawn Kennedy: Why not head over to our Web site and check out AJN’s podcasts and video collections? Just put your mouse over the MEDIA tab at the top and choose podcasts or one of the video series in the drop-down menu.

We’ve got a variety of podcasts to choose from:

  • monthly highlights, in which editors discuss the articles in each issue
  • “Behind the Article” podcasts are interviews with authors to discuss their work or provide additional context about the article
  • and in “Conversations,” listen to, well, conversations with nurses and other notable and interesting people (there’s even one with former president Jimmy Carter!)

We also have special collections, one of which contains music from Liyana, a group of disabled African singers who graced the cover of the August 2009 issue. (See “On the Cover” from that issue to read about them.)

The other collection contains poems written by nurses who served in the Vietnam War. They were collected by Kay Schwebke, author of “The Vietnam Nurses Memorial: Better Late Than Never” in the May 2009 issue. The short poems are heartbreaking and very much worth hearing.

One final option, if you prefer to save podcasts for listening to at a more convenient time: you can subscribe to AJN‘s podcasts in the iTunes store. Just search for AJN and the podcasts should show up on your screen. Or click this link.

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The Patient With No Name: When Nursing Illuminates Literature

November 16, 2012

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN. She doesn’t usually write about books in her posts, so we hope you enjoy this change of pace.

I didn’t know much about The English Patient when I picked it up recently at a library book sale—I only dimly recalled that the novel had been made into a movie I’d never seen. Since it was published by Michael Ondaatje in 1993, I can hardly blame a lack of time for my lapse. Yet I found myself glad I hadn’t read it until now, as my own nursing experiences suffused my reading of it, leaving me more deeply moved than I might have been otherwise.

The novel is set in the final days of World War II, in a bombed Italian villa that had served as a war hospital. As the story opens, the makeshift hospital has been recently evacuated, with patients and medical staff relocating to Pisa. One nurse remains, though—a young Canadian named Hana. Described as “shell-shocked” due to her experiences during the war, she refuses to leave the damaged hospital or a nameless English patient, who she insists is too fragile to be moved.

Other characters come into the story and are pivotal to the themes of loss, love, and redemption, but I felt most personally connected to Hana, the English patient, and their relationship. As an ICU nurse, I felt like I knew the English patient, a man who’d been burned beyond recognition in a plane crash and couldn’t recall his identity.

Although my hospital defers burn injuries to a nearby burn center, I’ve cared for patients very much like him—patients who, after devastating injuries, are left physically altered in ways that can’t be fixed. I often have patients who can’t express themselves in any depth, on ventilators and sedated, probably experiencing life much as the English patient—as bits of reality intermingled with flashes of memory and desire.

I’ve cared for patients whose injuries have rendered them too fragile to touch, patients in unrelenting pain, and those whose deaths are known to be inevitable. Like Hana and the English patient, I know the merciful nature of morphine—and, sometimes, the merciful nature of death.

While I don’t share the history of Hana, a war nurse who’s been exposed to more tragedy than she can bear, I can attest to the emotional toll of difficult days in nursing. I know how caring for someone who’s critically ill can overtake everything else. Sometimes it’s hard to leave the hospital at the end of the day, then strangely hard to get out of the car after arriving home . . . I do understand—instinctually—Hana’s decision to stay at the derelict hospital to care for the man she refers to several times as her “despairing saint.”

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