• A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English‐speaking countries

      Currie, Jane; orcid: 0000-0002-8721-089X; Thompson, Cristina; orcid: 0000-0002-4369-0940; Grootemaat, Pam; Andersen, Patrea; Finnegan, Alan; Carter, Michael; Halcomb, Elizabeth; orcid: 0000-0001-8099-986X (Wiley, 2022-02-10)
    • Accelerated resolution therapy: an innovative mental health intervention to treat post traumatic stress disorder

      Finnegan, Alan; Kip, Kevin; Hernandez, Diego; McGhee, Stephen; Rosenweiz, Laney; Hynes, Celia; Thomas, Mike; University of Chester (British Medical Journal, 2015-07-03)
      Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces’ fighting capability.
    • Assessment and treatment of cutaneous leishmaniasis in the emergency department.

      McGhee, Stephen; Finnegan, Alan; Unversity of Miami; University of Chester
      Cutaneous leishmaniasis is endemic in more than 70 countries worldwide. It is a non-fatal disease caused by the Leishmania parasite that is transmitted to humans via bites of infected female sandflies. Cutaneous leishmaniasis causes skin lesions on areas of exposed skin, such as the face and limbs, which often produce scarring and atrophy. If untreated, cutaneous leishmaniasis can develop into mucocutaneous leishmaniasis, which is potentially life-threatening. Furthermore, patients with cutaneous leishmaniasis commonly experience psychosocial issues such as anxiety, distress, stigma and rejection. Cutaneous leishmaniasis is spreading outside of its traditional endemic areas because of the effects of environmental changes such as urbanisation and climate change. In the UK, healthcare professionals may encounter the disease in migrants from endemic areas, members of the armed forces, tourists and expatriates. Therefore, emergency nurses need to be able to assess and support patients who present with symptoms suggestive of cutaneous leishmaniasis. This article provides an overview of the epidemiology, aetiology, pathophysiology, clinical presentation, diagnosis, treatment and prevention of the disease.
    • The biopsychosocial benefits and shortfalls for armed forces veterans engaged in archaeological activities

      Finnegan, Alan; University of Chester (Elsevier, 2016-03-19)
      Background Organised outdoor activates are advocated as promoting multiple benefits for a veteran's wellbeing, of whom up to 50% have suffered either/both physical and mental health (MH) problems. This has resulted in significant investment in a growing number of outdoor events, one of which is the Defence Archaeology Group (DAG) which utilise the technical and social aspects of field archaeology in the recovery and skill development of injured veterans. Objective To advance knowledge within veterans MH and wellbeing through an understanding of the potential long term psychological benefits and shortfalls for veterans undertaking DAG activities. Design A constructivist grounded theory approach was used to enable identification of the issues from the participant veteran's perspective. Setting: DAG archaeological excavations in April and August 2015. Method Semi-structured interviews with 14 veterans. Results The qualitative coding resulted in the indication of 18 categories subsumed within four clusters: motivation and access; mental health; veteran and teamwork; therapeutic environment and leadership. Discussion The psychological benefits were improved self-esteem, confidence, a reduction in stigma and motivation to seek help. The reduction in situational stressors associated with difficult life conditions also appeared to improve mood, and there was a clear benefit in being in a caring environment where other people actively paid an interest. There were extended social benefits associated with being accepted as part of a team within a familiar military environment, which presented an opportunity to establish friendships and utilise military skill sets. Conclusion Organised outdoor activities offer multi-factorial hope for veterans searching for ways to ease the transition to civilian life and recover from military stress and trauma. The relaxing and reflective environment within a military setting appears to construct a sense of personal safety and thereby offers therapeutic value.
    • Burden of illness of progressive familial intrahepatic cholestasis in the US, UK, France, and Germany: study rationale and protocol of the PICTURE study.

      Ruiz-Casas, Leonardo; O'Hara, Sonia; Mighiu, Claudia; Finnegan, Alan; Taylor, Alison; Ventura, Emily; Dhawan, Anil; Murray, Karen F.; Schattenberg, Jorn; Willemse, Jose; et al. (2021-01-07)
      : Progressive familial intrahepatic cholestasis (PFIC) is an ultra-rare disease with a considerable burden on pediatric patients and their caregivers, impacting quality of life (QoL). The mortality rates highlight a significant need for efficacious treatments. Real-world data on associated costs and QoL are needed to gauge the potential impact of new pharmacological treatments. : Clinical and socio-economic burden of PFIC on patients/caregivers, health systems, and society will be assessed. Patient/caregiver- and physician-level retrospective cross-sectional data will be collected from the US, UK, France, and Germany, for PFIC types 1, 2, 3. A representative sample of physicians will provide clinical and resource utilization information using an electronic Case Report Form (eCRF). Patient/caregiver surveys will collect socio-economic and QoL data, enabling assessment of PFIC impact on QoL. Mean costs (direct medical/non-medical, indirect) will be calculated. The study materials were reviewed by medical professionals and patient representatives and received ethical approval from the University of Chester. : The study aims to reveal the unmet medical need, disease burden, resource utilization, and costs of PFIC, to raise awareness with policymakers and healthcare professionals, and provide support for the patient/caregiver community. As novel PFIC therapies recently emerged, this study will yield quantifiable data for health technology assessments.
    • The Challenges and Psychological Impact of Delivering Nursing Care within a War Zone

      Finnegan, Alan; Lauder, William; McKenna, Hugh; University of Chester; University of South Florida; University of Ulster (Elsevier, 2016-06-03)
      Background. Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the psychological impact of delivering nursing care in a War Zone hospital. Purpose. To explore the challenges and psychological stressors facing military nurses in undertaking their operational role. Method. A Constructivist Grounded Theory was utilised. Semi-structured interviews were conducted with 18 British Armed Forces nurses at Camp Bastion Hospital, Afghanistan, in June - July 2013. Discussion. Military nurses faced prolonged periods of caring for seriously injured poly trauma casualties of all ages, and there were associated distressing psychological effects and prolonged periods of adjustment on returning home. Caring for children was a particular concern. The factors that caused stress, both on deployment and returning home, along with measures to address these issues such as time for rest and exercise, can change rapidly in response to the dynamic flux in clinical intensity common within the deployable environment. Conclusion. Clinical training, a good command structure, the requirement for rest, recuperation, exercise and diet were important in reducing psychological stress within a War Zone. No formal debriefing model was advocated for clinical staff who appear to want to discuss traumatic incidents as a group and this may have contributed to stigma and nurses' feeling isolated. On returning home, military nurses reported being disconnected from the civilian wards and departments. The study raised the question of who cares for the carers, as participants reported a perception that others felt that they should be able to cope without any emotional issues. It is envisioned that the results are transferable internationally to nurses from other Armed forces and will raise awareness with civilian colleagues.
    • Characteristics and Values of a British Military Nurse. International Implications of War Zone Qualitative Research

      Finnegan, Alan; Finnegan, Sara; McKenna, Hugh; McGhee, Stephen; Ricketts, Lynda; McCourt, Kath; Warren, Jeremy J.; Thomas, Mike; University of Chester; Heath Lane Medical Practice; University of Ulster; University of South Florida; British Army; University of Northumbria; University of Chester; UCLan (Elsevier, 2015-08-01)
      Background. Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the effectiveness of the military nurses’ operational role and no papers naming the core values and characteristics. This paper is the only qualitative nursing study completed in this period where data was collected in the War Zone. Objective. To explore the characteristics and values that are intrinsic to military nurses in undertaking their operational role. Design. A Constructivist Grounded Theory was utilised. The first author designed the interview schedule, then following a pilot study, conducted and transcribed the discussions. Informed consent and UK Ministry of Defence Research Ethical Committee approval was obtained. Setting. Camp Bastion Hospital, Afghanistan, in 2013. Method. Semi-structured interviews were conducted with 18 British Armed Forces nurses. Results. A theoretical model was developed that identifies the intrinsic characteristics and values required to be a military nurse. Nursing care delivered within the operational environment was perceived as outstanding. Nurses consciously detached themselves from any legal processes and treated each casualty as a vulnerable patient, resulting in care, compassion and dignity being provided for all patients, irrespective of their background, beliefs or affiliations. Conclusion. The study findings provides military nurses with a framework for a realistic personal development plan that will allow them to build upon their strengths as well as to identify and ameliorate potential areas of weakness. Placing nurses first, with a model that focusses on the requirements of a good nurse has the potential to lead to better patient care, and improve the quality of the tour for defence nurses. These findings have international implications and have the potential for transferability to any level of military or civilian nursing practice.
    • Conducting qualitative research in the British Armed Forces: theoretical, analytical and ethical

      Finnegan, Alan; University of Chester (British Medical Journal, 2014-01-24)
      The aim of qualitative research is to produce empirical evidence with data collected through means such as interviews and observation. Qualitative research encourages diversity in the way of thinking and the methods used. Good studies produce a richness of data to provide new knowledge or address extant problems. However, qualitative research resulting in peer review publications within the Defence Medical Services (DMS) is a rarity. This article aims to help redress this balance by offering direction regarding qualitative research in the DMS with a focus on choosing a theoretical framework, analysing the data and ethical approval. Qualitative researchers need an understanding of the paradigms and theories that underpin methodological frameworks, and this article includes an overview of common theories in phenomenology, ethnography and grounded theory, and their application within the military. It explains qualitative coding: the process used to analyse data and shape the analytical framework. A popular four phase approach with examples from an operational nursing research study is presented. Finally, it tackles the issue of ethical approval for qualitative studies and offers direction regarding the research proposal and participant consent. The few qualitative research studies undertaken in the DMS have offered innovative insights into defence healthcare providing information to inform and change educational programmes and clinical practice. This article provides an extra resource for clinicians to encourage studies that will improve the operational capability of the British Armed Forces. It is anticipated that these guidelines are transferable to research in other Armed Forces and the military Veterans population
    • Cost of non-alcoholic steatohepatitis in Europe and the USA: The GAIN study.

      O'Hara, Jamie; Finnegan, Alan; Dhillon, Harpal; Ruiz-Casas, Leonardo; Pedra, Gabriel; Franks, Bethany; Morgan, George; Hebditch, Vanessa; Jönsson, Bengt; Mabhala, Mzwandile; et al. (2020-07-15)
      Non-alcoholic steatohepatitis (NASH) leads to cirrhosis and is associated with a substantial socioeconomic burden, which, coupled with rising prevalence, is a growing public health challenge. However, there are few real-world data available describing the impact of NASH. The Global Assessment of the Impact of NASH (GAIN) study is a prevalence-based burden of illness study across Europe (France, Germany, Italy, Spain, and the UK) and the USA. Physicians provided demographic, clinical, and economic patient information via an online survey. In total, 3,754 patients found to have NASH on liver biopsy were stratified by fibrosis score and by biomarkers as either early or advanced fibrosis. Per-patient costs were estimated using national unit price data and extrapolated to the population level to calculate the economic burden. Of the patients, 767 (20%) provided information on indirect costs and health-related quality of life using the EuroQOL 5-D (EQ-5D; n = 749) and Chronic Liver Disease Questionnaire - Non-Alcoholic Fatty Liver Disease (CLDQ-NAFLD) (n = 723). Mean EQ-5D and CLDQ-NAFLD index scores were 0.75 and 4.9, respectively. For 2018, the mean total annual per patient cost of NASH was €2,763, €4,917, and €5,509 for direct medical, direct non-medical, and indirect costs, respectively. National per-patient cost was highest in the USA and lowest in France. Costs increased with fibrosis and decompensation, driven by hospitalisation and comorbidities. Indirect costs were driven by work loss. The GAIN study provides real-world data on the direct medical, direct non-medical, and indirect costs associated with NASH, including patient-reported outcomes in Europe and the USA, showing a substantial burden on health services and individuals. There has been little research into the socioeconomic burden associated with non-alcoholic steatohepatitis (NASH). The GAIN study provides real-world data on the direct medical, direct non-medical, and indirect costs associated with NASH, including patient-reported outcomes in five European countries (UK, France, Germany, Spain, and Italy) and the USA. Mean total annual per patient cost of NASH was estimated at €2,763, €4,917, and €5,509 for the direct medical, direct non-medical, and indirect cost categories, respectively. [Abstract copyright: © 2020 The Author(s).]
    • Defence Committee: Armed Forces and Veterans Mental Health Inquiry. Part One

      Kiernan, Matthew; Finnegan, Alan; Hill, Mick; University of Northumbria (Crown, 2018-07-12)
      Executive Summary • MoD provides an occupational military mental health service, where clinical decisions are safety critical due to the environment in which armed forces personnel operate. • Statistics provided from defense are accurate, however, trying to contextualise them by comparing them with the wider population is problematic, as the threshold for referral is much lower. • Only 8% of UK veterans were correctly registered at a PHC practice. • Military mental health practice is unique, and to understand the issues facing current service provision, the statistical data needs to be annually supplemented with purposeful qualitative data from those working in defence mental health. • A priority should be afforded to the inclusion of veteran peer researchers within studies to improve sample selection, interpretation and understanding of results. • There needs to be an agenda to broaden methodological expertise and cooperation within the sector and a move away from a predominately one-dimensional research approach. The only way that the questions in this enquiry will be answered, is through a multiple methods and multiple institution collaboration.
    • Defence Committee: Armed Forces and Veterans Mental Health Inquiry. Part Two. The Provision of Care

      Finnegan, Alan; University of Chester; University of Northumbria (Crown, 2018-09-11)
      Executive Summary * Effective Military Mental Health care requires practitioners with extensive knowledge of service provision and structures, and who have the correct clinical competencies that are underpinned by academic qualification/s and experience. * Veterans are a heterogeneous group, differing by factors such as age, gender and length of service. These factors are extremely important during transition, and initiatives to support ex-Service personnel and their families are hindered through a lack of understanding of the veteran community. * NHS Mental Health care provision is extensive and comprehensive, although is areas such as Northern Ireland, it is Combat Stress that provide bespoke veteran care options, funded through charitable contributions. * Many veterans are unaware of their entitlement to priority medical services, or the wider provisions available to them. * Veterans are unwilling to disclose problems associated with their former military life, often believing that civilians, including healthcare professionals, do not appreciate military culture and “cannot understand” their experiences. * Receiving quick, appropriate support requires GPs and other healthcare professionals having sufficient awareness of the NHS and veteran specific services, and on the patients MH condition being correctly identified. * Stressors identified during the transition period are just as likely to negatively impact on the spouse and family. * There is an assumption that the small local veteran charities may be doing harm, although there is limited evidence to substantiate this view, and there is a requirement to understand why some veterans prefer this option
    • Editorial. Nurse Education Today Veterans' Special Issue

      Finnegan, Alan; University of Chester (Elsevier, 2016-07-25)
      Editorial from the Nurse Education Today Military Veterans Special Issue
    • Educating nurses to deliver optimum care to military veterans and their families

      Finnegan, Alan; Di Lemma, Lisa; McGhee, Stephen; University of Miami; University of Chester
      The aim of the project was to help prepare the future nursing workforce to provide optimum care for the Armed Forces Community. Structured evidenced-based educational sessions were designed and then delivered at two Universities in England. This educational model included a flipped approach, didactic classroom teaching, blended learning, and information technology. Educational sessions were provided to 468 first year Bachelor of Nursing undergraduate students in 2017 and 2018. A mixed methods evaluation included a quasi-experiential design with pre and post-test data followed by research interviews conducted by student nurses and analysed using a modified Grounded Theory. Post session evaluation demonstrated a significant improvement in students' knowledge. 93% agreed that the training was useful, 95% felt that nurses should be aware of the healthcare needs of the Armed Forces Community, and 89% indicated that the subject matter should be included in the undergraduate curriculum. A qualitative theoretical model was built from four major clusters: the military community; student's identity, clinical engagement, and future practice. These educational sessions are being introduced into a growing number of United Kingdom Universities to create future nursing leaders with a better insight into the large and diverse Armed Forces Community.
    • Educating nurses to provide better care for the military veteran and their families

      Finnegan, Alan; McGhee, Stephen; Leach, Johathan; University of Chester, University of South Florida, NHS England (Elsevier, 2017-05-03)
      Reports that military veterans do not divulge details of their military experiences because others “do not understand” has been accepted for too long. Veterans and their families require a nursing workforce that are knowledgeable of the specific demands associated with a military life, and who are educated and empowered to discuss these issues in a language that the veteran population understand. USA have taken steps to address this challenge through academic programmes that systematically teach nurses how to be pro-actively engaged in improving veteran’s health and wellbeing. These lessons are being absorbed into fully evaluated under-graduate nursing sessions being developed at the University of Chester that will ensure under-graduate nursing students gain the requisite knowledge and understanding of veteran health and social care.
    • Effective Support for Serving Personnel

      Finnegan, Alan; Thomas, Mike (Adjacent Government, 2014-05-23)
      The British Armed Forces aim to provide a capable workforce, able to undertake military duties without mental health (MH) problems. This is achieved by maximising the psychological support afforded to soldiers by providing immediate and effective MH care wherever they are serving. The most common MH disorders affecting UK Armed Forces are depression, alcohol misuse and anxiety. Military Mental Health (MMH) provides an occupational MH service that makes recommendations regarding a service person’s suitability for service. In a peacetime setting, this is delivered through a clearly defined integrated care pathway between Primary Health Care, military Departments of Community Mental Health (DCMHs) and Secondary Health Care. DCMHs consist of multi-disciplinary clinical staff, providing service personnel with a medium for sharing problems, whilst utilising recognised treatments such as Cognitive Behavioural Therapy (CBT) including Eye Movement Desensitisation and Reprocessing. Hospital care is provided within the NHS through a defined contract. Performance indicators and military satisfaction surveys indicate that the British Armed Forces MH service is of a very high standard
    • Evaluating serious stress in military veterans, their carers and families: a protocol

      Finnegan, Alan; Di Lemma, Lisa; McGhee, Stephen; Watson, Roger; University of Chester; University of Chester; University of Miami; University of Hull
      In 2018, the Armed Forces Covenant Fund Trust (ACFT) allocated approximately £4M to seven UK projects to address serious stress in military veterans, their carers and families. These programmes commenced between May and October 2019 and will conclude in August 2021. This paper outlines the protocol for the evalu- ation of the Serious Stress programme and the novel support provided to grant holders. Entry into the programmes was through multiple routes, including self-referrals with an antic- ipated sample of approximately 2000 partic- ipants. A common outcomes framework was designed to measure outcomes. Grant holders accepted ownership for data collection and quality and were supported through accompa- nying guidance material. Veterans were often reluctant to seek support, and the anonymous and confidential nature of the evaluation plus the study team’s mili- tary background helped address this. Partic- ipants’ voices were a key part in developing the protocol, leading to results to inform policy and highlight success, efficiency and cost effectiveness, and providing markers for future development. The study provided a reservoir of informa- tion. Interim reports indicated compliance with performance indicators and provided timely evidence. Shared learning provided grant holders with an indication of what was helping the beneficiaries and what needed to be improved. The combination of all data sets provided the ACFT with a resource to demonstrate success and insight into projects where improvement was required, and indi- cators of how to redress these problems. The study protocol provided a platform for building lasting partnerships.
    • An evaluation and critical analysis of the impact of the Aged Veterans Fund

      Di Lemma, Lisa; Howe, Sonia; Finnegan, Alan; University of Chester; Armed Forces Covenant Fund Trust.
      There has been research on the numbers and needs of an ageing society yet, relatively little is known about the specific needs of older veterans, and the effectiveness of services specifically developed to meet these needs. In 2016 and 2017, the Armed Forces Covenant Fund Trust funded invested £30 million to the Aged Veterans Fund (AVF) programme. This consisted of 19 portfolio projects to support health, wellbeing, and social care needs for older veterans (born before 1st January 1950) and their families. This report explores the impact of the AVF, with the intent of informing service providers, stakeholders and policy makers, of the lessons learned and the next steps required for the support of older veterans. A retrospective evaluation focused on both the impact of the processes adopted by the programmes, and the outcomes achieved, was commissioned. Qualitative analysis was performed on 78 eligible source documents, from which 10 recurrent themes were identified. Themes focused on the methodology and evaluations adopted by the projects, the number of beneficiaries reached, challenges encountered, associated costs and savings. In addition, the study identified projects outreach and sustainability, including staff, volunteers and clients perceptions of the services. Finally, there are results regarding the related health and wellbeing benefits, behaviour change and influences on the UK National Health Service (NHS) practice. The findings indicated that project promotion, partnership and collaboration was strong, which provides a foundation for the sustainability and outreach of some of the programmes. The AVF programmes were successfully rolled out via referrals, but this was not without challenges such as capacity, uptake, staffing and timelines issues. Two primary approaches were adopted. The first being a person-centred care approach, that takes into consideration the complex needs of the individual. The second was a skill-exchange model consisting of peers passing on their skills to beneficiaries. The results provided compelling evidence that the AVF initiatives were successful and were positively perceived by beneficiaries, staff and volunteers. Evidence was found on the impact of the fund on boosting resilience in the beneficiaries, by reducing social isolation and improving their health and wellbeing. Additionally, awareness was raised in the wider community, via the delivery of specific educational training to staff. In addition, AVF programmes influenced current health-care practice such as re-admission and discharge rates, via effective signposting and cross-referrals. The lessons learnt lead to recommendations and indicators for the next steps required to support older veterans and their families.
    • Factors affecting mental health support to the British Armed Forces: Part One

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; University of Chester (Ptm Publishers Limited, 2014-11)
      To help the British armed forces minimise mental health problems while undertaking military duties, operational psychological support is provided by military mental health nurses. This series of two articles is part of the first qualitative research completed in Afghanistan by British armed forces into the effectiveness of the military mental health nursing role. The authors aim to increase understanding of the factors that affect the delivery of nursing care during an operational deployment, including educational and clinical competency, multiprofessional and multinational boundaries, and the challenges of providing nursing care for both military personnel and local nationals. This article, the first of the two-part series, looks at the set up of the study, while the second article (featured in the next issue of JCN) will look at the study findings
    • Factors affecting mental health support to the British armed forces: part two

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; University of Chester (Ptm Publishers Limited, 2015-01)
      The first part of this series (JCN, 28(5): 30–32) provided the background to the study, which used semi-structured interviews with 18 nurses based in Afghanistan during 2013 to focus on factors affecting the delivery of mental health care in the field. This, the second part of the series, details the results of the study in the form of analysis of the interviewees’ verbatim transcripts. The study offers an insight into the role of deployed mental health nurses and examines some of the challenges they face. The findings demonstrate that managing the mental health of armed forces personnel on an operational deployment requires the ability to develop trusting relationships, identify factors leading to stress, and help staff to feel supported.
    • Fieldwork and the practical implications for completing qualitative research in the British Armed Forces

      Finnegan, Alan; University of Chester (British Medical Journal, 2014-01-09)
      This article provides direction regarding the practical implications of undertaking qualitative research within the British Army, and in particular the Defence Medical Services (DMS). Qualitative researchers must gather sufficient data to answer their research question, and guidance on using DMS healthcare professionals as the research sample is offered, including dealing with the 'gatekeepers' who control access, and the principles for creating a conducive environment to gather reliable data. Data collection is often through intensive interviewing where communication skills and personal awareness are vital to a successful study. Aids to a productive study include memo writing and listing factors that may later provide an insight into how the interviewees characterise and describe particular activities, events and groups. Guidance is offered to develop an interview schedule with questions related to each other in a seamless, meaningful way. Both the researcher's and participant's conscious and unconscious biases must be acknowledged. In this narrow and specialist field, DMS researchers need extensive knowledge of clinical practice and the military's distinctive language, characterised with nuances and abbreviations. These words portray meanings and perspectives that signpost the participants' view of their empirical world. Early identification, without having to seek clarification, means that the researcher can examine hidden assumptions in the sample's own language