Archive for the ‘Combat nursing’ Category


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 ?


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 ?


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.


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.)


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 ?


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 ?


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 ?


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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