Archive for the ‘Combat nursing’ Category

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Widespread Support for Nurse’s Refusal to Force-Feed: Grounded in Ethical Principles

November 24, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

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

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

Last week, reports hit the news media of a nurse in the U.S. Navy facing possible discharge for refusing to participate in force-feeding a hunger-striking prisoner at Guantanamo Bay. An early discharge, two years shy of the 20-year mark, could cost him his pension and other benefits.

The nurse had initially volunteered for duty at the Guantanamo facility, but then, as we noted in a blog post examining the ethics of his decision back in July, decided he could not continue to participate in force-feeding detainees in violation of professional ethics.

In a letter to Chuck Hagel, U.S. secretary of defense, the American Nurses Association has supported the decision of the naval nurse. ANA president Pam Cipriano reaffirms that a nurse’s primary commitment is to the patient and “in addition, this commitment is present regardless of the setting in which nursing care is provided. The military setting does not change the nurse’s ethical commitments or standards.” Read the rest of this entry ?

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As the VA Regroups and Recruits, The Words of Nurses Who Served

November 14, 2014

By Amanda Anderson, a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. The AJN articles linked to in this post will be free until the end of December.

Vietnam Women's Memorial, courtesy of Kay Schwebke

Vietnam Women’s Memorial, courtesy of Kay Schwebke

A scandal earlier this year about suppressed data related to long wait times for appointments tainted the credibility of the Department of Veterans Affairs. On this Veterans Day week, the new secretary of Veterans Affairs has been using incentives and promises of culture change to promote new hiring initiatives for physicians and nurses. The focus as always should be on the removal of the barriers many veterans face in obtaining timely, high quality care. Naturally, a number of these veterans are nurses themselves.

To commemorate those who have bravely cared for our country, and who deserve the best of care in return, we’ve compiled a few quotations from nurse veterans who’ve written for or been quoted in AJN about their experiences in successive conflicts through the decades. Thank you for all your service, and for what you carry daily—as nurses, veterans, and patients.

World War II
“I remember walking through cities leveled by bombs, looking at the hollow eyes and haunted faces of a devastated civilian population. Since September 11, I see those same hollow eyes and haunted faces on the nightly news.”
—Mary O’Neill Williams, RN, “A World War II Army Nurse Remembers,” as told to her daughter. Published September 2002

Korea
“The challenges and responsibilities of combat nursing far exceeded the normal scope of nursing practice. Army nurses independently triaged casualties, started blood transfusions, initiated penicillin therapy, and sutured wounds. They monitored supplies and improvised when necessary. . .They often cared for 200 or more critically wounded soldiers in a standard 60-bed MASH; off duty, they provided food and nursing care to the local populace. Some managed to be innovators on the cutting edge of nursing practice. The nurses of the 11th Evacuation Hospital helped to pioneer the use of renal dialysis nursing and were among the first to support patients who had hemorrhagic fever using a first-generation artificial kidney machine.”
—Mary T. Sarnecky, DNSc, RN, CS, FNP, “Army Nurses in ‘The Forgotten War,’” November 2001

Nurse Lynne Kohl during Vietnam War. For more information, see article link to right.

Nurse Lynne Kohl during Vietnam War. For more information, see article link below.

Vietnam
“The guys loved the helicopters because, whenever the helicopter was coming in, their lives were going to be saved. . . But helicopters to the nurses meant, ‘Oh my God, how many are coming in?’. . . That’s when we had to run to the ER, get them out of the chopper, get them triaged, get them to where they needed to be. So for us, helicopters meant that people’s lives were at stake. We needed to move fast.”
—Diane Carlson Evans, RN, as told to Kay E. Schwebke, MD, MPH, in “The Vietnam Women’s Memorial: Better Late Than Never,” May 2009. (See also a collection of free podcasts on AJNonline.com that include short poems written and read aloud by nurses who served in Vietnam and an author interview about the creation of the Vietnam Women’s Memorial.) Read the rest of this entry ?

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Focusing Nurses on Long- and Short-term Health Needs of Veterans and Their Families

November 11, 2014

By Shawn Kennedy, AJN editor-in-chief

I’m always humbled when I speak with veterans or families of veterans. The commitment to duty of the military and the sacrifices their families make—long periods of being single parents; nerve-racking times wondering after the well-being of a spouse or child; missed birthdays, graduations, and milestones—never cease to amaze me.

served2Last October, nurse Linda Schwartz, at the time commissioner of Veterans Affairs for Connecticut, spoke at the American Academy of Nursing (AAN) meeting about the health needs of veterans.

As we pointed out in a blog post about the meeting, she emphasized “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 as 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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AJN in November: Palliative Care, Mild TBI, the Ethics of Force-Feeding Prisoners, More

October 31, 2014

AJN1114.Cover.OnlineAJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

Palliative care versus hospice. For many seriously ill, hospitalized older adults, early implementation of palliative care is critical. These patients often require medically and ethically complex treatment decisions. This month’s original research article, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults,” found that staff nurses often confuse palliative and hospice care, a fact that suggests a need for increased understanding and knowledge in this area. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Mild traumatic brain injury (TBI) can have profoundly negative effects on quality of life and can negatively affect relationships with family and caretakers. This issue’s other CE feature, “Mild Traumatic Brain Injury,” reviews the most commonly reported signs and symp­toms of mild TBI, explores the condition’s effects on both patient and family, and provides direction for devel­oping nursing interventions that promote patient and family adjustment. Earn 2 CE credits by taking the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, in our iPad app, by tapping the icon on the first page of the article).

Medication safety. While preparing medications in complex health care environments, nurses are frequently distracted or interrupted, which can lead to medication errors. “Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit,” an article in our Cultivating Quality column, describes how nursing staff at one facility implemented five medication safety interventions designed to decrease distractions and interruptions during medication preparation. Read the rest of this entry ?

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The Gaza Conflict, Through the Lens of Nursing

August 13, 2014

By Jacob Molyneux, AJN senior editor

In 2005, AJN published an article looking at the experiences of nurses in Israel and in the Palestinian territories (free until September 15; choose ‘full text’ or ‘PDF’ in upper-right of the article landing page). Here’s an excerpt:

“[N]urses in the region have many of the same problems American nurses have: disparate educational levels, struggles for professional recognition and workplace representation. The nurses I met came into the profession for diverse reasons and are working in a remarkable variety of settings, carrying on in the face of political, professional, economic, military, and personal difficulties. Yet I was amazed at the things these nurses have in common with each other—and with us. As I listened to them describe their motivations and aspirations and watched them work, the seemingly impenetrable barrier created by the ongoing military and political conflict melted away.”

Photos and captions from 2005 article about Palestinian and Israeli nurse. Courtesy of Constance Romilly.

Photos and captions from 2005 AJN article. Courtesy of Constance Romilly. Click to expand image.

The current conflict between Israel and those living in the Palestinian territories is another chapter in a long story. Our focus at AJN is not on the politics of the situation or the rhetoric of blame coming from supporters of both sides. Most of our readers already have opinions on the topic, and there are other, more appropriate places you can engage that argument.

The stress and suffering, deaths, injuries, and loss of infrastructure have been well documented. We see lots of images of bombed-out concrete buildings that seem always to have been ruins in some nameless place, with little evidence of the lives only recently played out there. Still, one at times stumbles upon photos of people caught in the shelling, the scarred, maimed, or dead lying in rows on stretchers. These are hard to look at or forget.

As has been noted by many international aid groups and the UN, the health care system in Gaza is under great strain and in urgent need of donations, with a number of hospitals destroyed and others without power or basic medical supplies. In shelters where many are seeking refuge from the bombing, the overcrowding and lack of adequate sanitation is giving rise to disease. A number of groups are mobilizing teams of surgeons and nurses to travel to Gaza and treat the wounded. Others are gathering medicines and medical supplies to send. Read the rest of this entry ?

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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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