• 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.
    • 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.
    • Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan Study.

      Finnegan, Alan; Finnegan, Sara; Bates, David; Ritsperis, Debra; McCourt, Kath; Thomas, Mike; University of Chester (Elsevier, 2015-01-05)
      Background: This paper forms part of the first British Armed forces qualitative nursing research study undertaken on deployment. Aim: To provide an analysis of the impact and effectiveness of the pre-deployment educational preparation and clinical placements provided for military nurses. Theory & methods: A Constructivist Grounded Theory was utilised with data collected through semi-structured interviews with 18 nurses based in Camp Bastion Hospital, Afghanistan during 2013. Results: Initial coding indicated 21 educational preparation and clinical placement categories that influenced the delivery of nursing care. Analysis of these elements led to the identification of four major clusters: Military Nursing Care; Military Nurse Education; Unique Hospital Environment and Clinical Placements. Discussion: Educational preparation consists of completing deployable operational nursing competencies, specialist training and individual tailored courses. This strategywas viewed as proving the appropriate academic requirement. However, training would be enhanced by introducing a formalised military preceptorship programme focussing on fundamental nursing skills. Caring for children was a particular concern, and it was emphasised that educational courses must be combined with a standardised clinical placement policy. Adequate clinical exposure can be challenging as nurses are not routinely exposed to War Zone levels of trauma in the UK. Clinical placements need to be standardised and harmonised, and located in areas where nurses cared for patientswith similar injury patterns to thosewitnessed on deployment. Current NHS Trust placements can reduce the opportunities for employment in suitable clinical environments and diminishing the openings for collective military training. Better use should bemade of clinical rotation programmes, including high dependency units, elective surgery, medical assessment units, paediatrics, and outreach teams such as burns and plastic surgery and pain management. Practice Educators should be utilised to provide education, mentorship, supervision and continuing personal development in the operational arena. The paper considers post-Afghanistan future options.
    • The presentation of depression in the British Army

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; Deahl, Martin; Simpson, Robin; Ashford, Robert; University of Chester (Elsevier, 2013-03-26)
      Background The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. Objectives To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. Method and Participants Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. Results Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. Conclusion Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice
    • Serving within the British army: research into mental health benefits

      Finnegan, Alan; Finnegan, Sara; McGee, Paula; Srinivasan, Mike; Simpson, Robin; University of Chester (Mark Allen Group, 2011-10-28)
      The mental health (MH) of soldiers remains extremely newsworthy and is regularly featured in high profile media forums that focus on post-traumatic stress disorder. However, the authors feel that there are distinct benefits to serving within the Army, and that it provides effective occupational medical, MH and welfare support. This research study explores potential benefits and stressors of being in the Army and provides an overview of Army mental health services (AMHS) through the perspectives of AMHS personnel, 84% of which were nurses. The study indicated that the Army can provide a protective community, sharing a bond based on common values and experiences. The Army can provide soldiers with career opportunities that are not available in civilian life, and there are opportunities to develop an employment profile, enhanced by internal and external educational training, and encapsulated within a progressive career pathway. The Army can also be seen to offer an escape route, preventing soldiers entering a life of crime, and supplying the stable family these soldiers had never experienced. The provision of leadership, within an environment where soldiers are valued and stigma is not tolerated can potentially shield against MH problems.