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Research Article

Critique
Military Nursing Care of Iraqi Patients

Introduction
Godman, P., Edge, B., Agazio, J., & Prue-Owens, K.
(2013).
Military
Nursing Care of Iraqi
Patients. Military Medicine, 178(9), 10105

Credential of researchers.
All are current or former Army nurses.
Two of the researchers were deployed to Iraq
during the time frame of the study.
Three had experience in conducting focus groups
and evaluate findings.
One of the researchers had extensive experience
in qualitative methodology and had training in
phenomenology

Problem statement
The purpose of the study was to
understand the concept of nursing care
of Iraqi patients
for military nurses who served in Iraq
from 2008 to 2009.
Problem: There is limited literature that
discuses military nursing care of host nation
patients.
Problem: Care of Iraqi patients has been
based on mostly trial-error based and
unscientific in nature to this time.

Purpose and Research


Questions
The authors stated purpose was to understand
phenomenon of nursing care of Iraqi civilians as
perceived by nurses providing the care
(Goodman, Edge, Agazio, & Prue-Owens, 2013,
p.1011).
The research question this study was supposed to
answer what it is like to provide nursing care to
Iraqi patients during 2008-2009 from the
perspective of a military nurse
Qualitative study, phenomenological inquiry to
evaluate nurses experience when providing care.
The research question is directly addressing the
purpose as presented

Appropriate format since the study was

Literature Review
None provided in the study
scant literature describing military nursing
care of host nation patients.

Goodman, Edge, Agazio, & Prue-Owens, 2013, p.1010).

Did my own literature search


-19 Journals
-No study that directly discusses host nation
patients.
Filliung & Bower, (2010) was cited
statistics only actual hade discussion on nursing
challenges with host nation patients.

Frame of Reference
Phenomenological Inquiry
Phenomenological inquiry is focused on what human
experiences during a particular event (phenomenon) were
the authors are asking human participants to describe this
experience. (Burns, 2011).

Sampling and Sample


Nurse corps Officers (RN) and LPN (enlisted) (n =
15)
Same facility in Iraq
All had direct patient care responsibility with Iraqi
patients.
All active duty with 6 to 12 month deployments to
Iraq
No documentation if any exclusion or
refused to take part in the study
Small sample, but did provided ample data.

However, to include staff from a different of the several


CSH during the study could bring a broader picture!

Research Tradition
Natural objects, for example, must be experienced
before any theorizing about them can occur.
Edmund Husserl (n.d.)

The methods in study is consistent with Husserls view of


describe experiences as they are lived, or in
phenomenological terms, to capture the study participants
lived experience (Burns, 2011)

Data Collection
4 Focus groups with 5 participants each
Lasting up to 2 hrs.
Data generating open ended question guided the process.
generate richer descriptions of experiences because of the interaction effects of
a group discussion
(Goodman, Edge, Agazio, & Prue-Owens, 2013, p.1011).
One interview, no indication that additional information could be
provided later

Data collection process


Recorded
Note taking during interview
Verbatim transcription

Protection of Human
Participants
Interviewers removed rank before entering the
room.
Confidently
Able to speak freely
Will not get in trouble for participating in this
study.
No need for any counselors and there was no
indications of any of the interviewees had PTSD.

Data Management and


Analysis

Thematic Analysis Thematic analysis is a method


for identifying, analyzing and reporting patterns
(themes) within data (Braun & Clarke, 2006, p.
79).
Each researcher analysis the data themselves to
establish teams and patterns.
Then investigators corroborate the themes,
the investigators compared themes with
previously extracted items and refined them to
reflect the intent of the participants experiences
(Goodman, Edge, Agazio, & Prue-Owens, 2013,
p.1011).

Data Management and


Analysis cont.
Rigor mas maintained by credibility, conformability,
dependability, and transferability (Goodman, Edge,
Agazio, & Prue-Owens, 2013, p.1011).
Comments on data analysis
Two of the researchers was co-located at the same
location, but not in the same chain-of-command
On researchers own deployment
Positive: You can see yourself there and understand
were they
are coming from.
Negative: Risk for bias compered to your experience,
and play down the human subjects experience
Thematic Analysis --beneficial for this study, since
they were
looking for base of further research in the
topic escribed

Findings
Did address purpose
First study that focus on host nation patients
Foundation for larger studies

3 themes
expanding practice
ethical dilemmas
cultural divide
No tracking or study data was provided.
One graph-nurses education level, experience.

the data presented is sufficient evaluated and presented in a easy to


read format.

Quotation-to provide perspective


All Described as nurses, no pseudonym or age.
One was singled out as an LPN.

Discussion
The initial issue the participant pointed out:
how ill prepared the nurses felt about treating patient with multiple, complex,
and traumatic health problems (Goodman, Edge, Agazio, & Prue-Owens, 2013,
p.1013).

This correlates with prior studies from Vietnam to


today
Ethical dilemma need to be addresses, to include
awareness of ethical guidelines, laws and regulation.
Feelings of guilt, despair, self blame, for patients
transferred out to
Iraqi hospitals.
Lack of cultural awareness need to be also addressed.
Language, culture, customs are the items that need to be
addressed.

Authors did link their findings to other studies


Provided suggested solutions to problem
described
Serve as a body of knowledge for a larger study in the

Logic and Form of Findings


With the use of direct questions you can hear the
voice of the nurses.

This gives the reader an opportunity to place themselves


in the nurse position with the dilemma presented.
Well organized and easy to read
All major parts have headings to include the three major
themes that the authors presented.

Evaluation Summary
The data collected and was presented in a format that it was easy form
the reader to place themselves in the nurses position.
Expanding PracticeNurses stated that they were not ready to manage the
complex patients initially; however they were thankful for the opportunity to
expand their practice.
Ethical Dilemmasbiases against the provision of care for Iraqi patients,
lack of trust in interpreters, and distress regarding the inability to ensure
continuity of care [for Iraqi patients] (Goodman, Edge, Agazio, & PrueOwens, 2013, p.1012).
Cultural DivideThe difference between nurses and host nation patients
were very different such a simple item as diet to more complex as values.
Values, especially gender. The last and most problematic, language.

Evaluation Summary cont.


Weakness of this study
Small sample (n = 15)
One location
Literature search

Strength of this study


Accurate picture of deployed nursing
Highlighted need for improvement with suggestions.
Need for more training
Direct Questions
The

translator would not tell the patient that it doesnt look like he will have a
good life and he wouldnt be able to talk. The interpreter believed since it is what
Allah thinks or it is Gods will; it is going to happen anyway, so the patient does
not need to know
(Goodman, Edge, Agazio, & Prue-Owens, 2013, p.1013).

Conclusion
A value study that should be recommended
reading for all deploying nurses, also should be on
the reading list for nurses that wants to work with
different cultures or planning to work oversees.
Granted small sample, larger study would be
beneficial to obtain a better foundation to develop
evidence based practice recommendation that
would work with host nation patients in the
different parts of the world.

References

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