Chapter 1: INTRODUCTION
Effects of war deployment
Taking part in war have intense outcome for the mental health and welfare of the soldiers and other military personnel. According to the American Society of Registered Nurses (2007), women serve as nurses in the battlefield, laundresses, water bearers, and casualty care providers. For instance, during the Civil War (1861-1865), women served as nurses, providing care to the soldiers sick with malaria, typhoid, and yellow fever (American Society of Registered Nurses, 2007). Working in battlefields is different from working with civilians since these nurses tend to witness acts such as torture, killings, and devastation, which are devastating for the soldiers and nurses alike. Moreover, witnessing such actions have a substantial influence on the mental health of the military personnel. “Witnessing death, destruction, and torture; experiencing unexpected and at times continuous threats to one’s life; or participating in hostilities and killing can potentially lead to mental health problems” (Pols & Oak, 2007, pg. 2133). As a result, psychiatrists offered their assistance during the 20th century as a technique of modifying the effects of these actions as well as other traumatic experiences prevalent in war. However, most of the military officials have shown a strong uncertainty involving psychiatrists in war as soldiers with psychiatric symptoms were branded as cowards and lacking moral fiber. Other officials expressed that psychiatrists have a positive contribution in war as they positively add to the principal aim of providing medical services as a way of conserving the fighting strength of the soldiers.
The figure of veterans, service members, and military families faced with mental health needs tend to rise in most of the federal and civilian healthcare institutions. This trend has become famous after commencing the Global War on Terrorism (GWOT) in 11th September 2001 where a swing in attention from straight mission to training and supporting in hazardous areas (Westphal & Convoy, 2015). As such, there is a need to understand the military culture, especially injuries. Most people identify pain experience as a professional menace for the army personnel. In most of these cases, Westphal and Convoy (2015) claim that these sufferings create a dialogue concerning the post-traumatic stress together with traumatic brain injury as the side effect of post-war experience. Examining these experiences, health policy leaders, healthcare professional, and public identify gaps in preventing the mental illness after assessing these disorders and illnesses while at the same time identifying appropriate approaches to supporting mental health. In this case, Westphal and Convoy (2015) recommend that nurses operating with veterans and their families should first evaluate the initial signs of stress injury, generate prospects for addressing these stresses, and justify for the influence of stress injuries during the treatment plans. It is imperative for the civilian nurses to appreciate the pressure that nurses experience while working at the warfare. In most of the instances, patients directly arrive at the unit where it is common that two or three of the injured soldiers arrive simultaneously.
Roles of CRNA nurses
The history of nurse anesthesia is long and full of success and trials. Nurse anesthetists are of crucial role in both the health care centers and battlefields. Nurse anesthetists as an advanced practice of registered services in the United States for approximately 150 years before it became a health care profession (Nurse Anesthetist, 2016). The longevity and continued growth of this practice have been attributed to the commitment to the patient safety and excellence that nurse anesthetists have together with their willingness to provide their services whenever and wherever needed at a reasonable price. Since World War I, Certified Registered Nurse Anesthetists (CRNAs) have played a vital role in providing the anesthesia care to the wounded soldiers on the forward-facing line of the U.S. military activities abroad (AANA, 2015). However, Malina and Izlar (2014) claim that the practice of the nurse anesthetist has experienced dynamic and planned resistance from external bodies concerning their practice and scope of their training and knowledge. “Opposition to nurse anesthetists practicing to the full scope of their education and training is present in the clinical arena and educational milieu (Malina & Izlar, 2014, pg.1).”
Certified Registered Nurse Anesthetists (CRNAs) have been mandated to provide anesthesia care in the U.S. for approximately 150 years (Matsusaki & Sakai, 2011). Before the practice became a profession, skilled nurses under the direction of surgeons delivered anesthesia care for most of the surgical patients. Nevertheless, all 50 U.S. states have embraced CRNAs by allowing them to perform various anesthesia care with or without medical supervision. Significantly, there is a shortage of the anesthesia care providers, which has the potential of delaying surgery or leading to a cancellation of surgery. As a result, CRNAs in the U.S. have been integrated into the workforce of the anesthesiologists to provide care. Moreover, the shortage of these care providers forced the surgeons to train their nurses to provide anesthesia care to their patients, which was more convenient for them. As a result, most of these nurses provided care to the wounded soldiers during the World War I. With their critical role in most of the health care institutions, 16 States in America has abolished the supervision of their practice. “… Surgeons are typically no more reliable for a CRNA’s actions that they are for those of an anesthesiologist, regardless of whether supervision is required (Pfeifer, 2010, pg. 15).” As such, the practice of the CRNAs has their abilities challenged. This follows the questioning of their practices and skills in the attempts to block their effort at providing independent practices.
However, despite the increased resistance of the CRNA practices, their contribution to the health care institution is of significant role. According to Paul (2007), Air Force (AF) CRNAs play a crucial role in supporting the global war on terror following the care practices that they provide to the troops in the warfare. As a result, AF CRNAs should respond willingly to work in any environment by expeditiously responding to their needs and providing accurate and effective services (Paul, 2007). Despite the increased need for these professionals, Pearson, Fallacaro, and Pellegrini (2009) noted that there is a shortage of the CRNAs. Out of the 240,000 troops deployed to warfare in 2006, 24,000 were wounded. The healthcare provider heavily relies on the CRNAs practices, revealing the important role that these professionals play in the military operation (Pearson, Fallacaro, & Pellegrini, 2009). CRNAs provide safe and quality anesthesia care in most of the harshest environments to both the militants and civilians; thus deployed in various settings apart from the combat zones such as natural disasters and humanitarian disorders. CRNAs are independent practitioners in the battlefield as they administer anesthesia care to their patients at any time irrespective of the conditions of the battlefield (AANA, 2015). As such, it is essential to retain these assets since it is hard to meet the anesthesia prerequisites for the U.S. military without them.
Despite the crucial roles that these practitioners play in the combat zones, it is important to consider the repercussion of their role. As noted by Pols and Oak (2007), taking part in the warfare whether direct or indirect have consequences on both the military personnel and care providers. Witnessing torture and killings may have a mental health care effect that obscures the conduct and care provision of the CRNA practitioners. As such, it is important to evaluate the conduct of the CRNAs in the battlefield as well as the after war effect on these practitioners. Therefore, it is the goal of this paper to assess the experience of the CRNAs while on the battlefield as well as the stress factors affecting them. Besides, the paper evaluates the impact of these effects and the way they contribute to the care provisioning in the warfare while analyzing how CRNAs cope with their post-deployment experiences.
Significant Effects of war on CRNA Mental Health
Military medicine is critical for the injured during wartime. However, research has it that mental health effects of deployment fluctuate depending on factors such as intensity of combat, the length of deployment, and frequent tours. Combat roles or support roles related to combat requires medical personnel who might be affected by the deployment during or after the combat (Cawkalin, et al., 2015). Civilian paramedical practitioners, when exposed to single combat incidents such as bombings, sniper shootings, or terrorism acts, report high levels of depression, burnout, stress, suicidal ideation, and post-traumatic stress symptoms. This necessitates the urge of using experienced personnel ready to work under such situations and afford to provide quality care to the military personnel. Ekfeldt, Osterberg, and Nystrom (2015) add that providing care in such environment is a way of developing stress disorders. As a result, it is important to identify the suitable practitioners to provide such care. CRNAs are suitable staff to provide such care in this environment following their commitment to providing quality and safe care to the soldiers at the front line. Nevertheless, due to the short supply of CRNAs, reserve CRNAs are often called to deployed in dangerous areas to take care of the injured. These deployed nurses are expected to quickly uproot their civilian life and transform to a military role. Because the importance of nurses is often overlooked, it is imperative that the health of these reserve CRNAs is considered with optimum seriousness (McCauley, Liebling-Kalifani & Hughes, 2012). It has been noted that critical care nurses often go through post-traumatic depression among other experiences. Because the services that reserve CRNAs provide are critical to the mission and because they are hard to replace, their well-being has to be considered.
In most of the instances, the deployment of the military mental health providers (MMHP) is a key factor for establishing a firm troop (Miller & Warner, 2016). Similarly, CRNAs deployed during military action are assessed for post-traumatic stress disorder and traumatic brain injury as the major health impacts of traumatic experiences. MMHP deployment is essential to both the military personnel and CRNA practitioners as a way of helping these groups to effectively manage their deployment experiences. These nurses, after encountering traumatic experiences on the battlefield, can suffer the consequences of post-traumatic stress disorder along with other psychological conditions such as depression during deployment or even when transitioning home. Nurses may also use drugs or alcohol in an attempt to deal with their hardship situations (Lester, et al., 2015). Some nurses have reported suicidal thoughts, and some have committed suicide as an extreme result of their traumatic experiences. Despite these hardship scenarios, the nurses may be required to remain resilient irrespective of the difficulties that they encounter. Because CRNAs are specialized and in short supply, often they may be the only one available in their surrounding area. It is thus their professional responsibility to ensure that they try to avoid potential burnout and prevent the effects of such burnout on the combat team (Rivers, et al., 2013). To achieve this, the impact of the combat exposure should be countered by addressing the post-traumatic stress disorders (PTSD) as well as traumatic brain injury (TBI) (Wilson & Pokorny, 2015). In most of the cases, it is apparent that CRNAs who sustained TBI revealed signs and symptoms of PSTD as well as being prone to emerging from anesthesia in an ecstasy state.
Among the most common side effects of deployment of CRNAs in military action are mental disorders and other mental conditions. PTSD has been recorded as the most prevalent disorder among nurses returning from deployment from 2002 after serving in the Iraq and Afghanistan conflicts (Hermann, Shiner, & Friedman, 2012). Long-term deployment may also have an effect on a lasting health of the CRNAs. Some nurses have complained of having flashbacks of traumatic events that they experienced in deployed areas. Others have complained of reduced tolerance to other situations upon return from deployment (Rivers, Gordon, Speraw & Reese, 2013). High stress coupled with other mental issues are most common among nurses who are particularly active as CRNAs. Other nurses face difficulties in readjusting from the deployed areas to family life (Hermann, Shiner, & Friedman, 2012). These are among the symptoms of the PTSD that CRNAs face after deployment. As such, understanding the causes of PTSD together with determinants increasing this risk is critical to the policy makers, resource allocation as well as to the efforts made to control this challenge.
Deployed nurses seem to experience PTSD symptomatology more than as compared to those not deployed. Herman, Shiner, and Friedman (2012) assert that, “At the individual level, PTSD negatively impacts the quality of life, as well as physical and psychological health functioning (pg. 2)”. The most common stressors are related to uncertainty associated with workload, environments, and timelines. Such issues tend to exacerbate mental well-being issues. For example, although the deployed CRNAs are expected to demonstrate higher rates of depression and anxiety symptoms, the other common personnel do not necessarily lead a life in which the disquiets related with deployment are a way of life are a day-to-day encounter. Instead, the careers of deployed nurses entail balancing the competing demands of a military career with that of a civilian career which would be a difficult endeavor for anyone. An additional stressor factor is a worry on vagueness about whether the civilian jobs CRNAs left will be accessible when they return from deployment. This is because the gaps in health care created by the deployment have to be filled quickly. Moreover, it is difficult to tell how long the deployment will take. This can also create major disturbances between the deployed staff and the new staff members, thus adding to the uncertainty experienced during the entire deployment period. Besides, the development of early stress symptoms especially high arousal after a combat exposure has potential to increase the risk of successive PTSD.
Previous Studies on CRNA
Poor pain management has the potential of contributing to the nervous system diseases, which can lead to the lifelong disability as well as morbidity consequences. As a result, CRNAs has recognized this fact and has improved the way they serve the military personnel by improving their pain management techniques. According to Buckenmaier, et al. (2010), a significant change in the military medicine is the improvement in pain management, which begins at the instance of injury. This realization has been extended from the battlefield to the civilian rehabilitation, Veteran’s Administration, and into the veteran’s life. Moreover, CRNAs adopts various levels care used to denote the progressive medical capability from the point of injury to their treatment (Buckenmaier, et al., 2010). The first level of care takes place at the battalion aid station where self-aid; battalion, advanced trauma life support, and combat medicare provided (Baker, et al., 2007). The second level involves the surgical team whose roles include stabilization or resuscitation surgery while level three is provided by the combat support hospital. At this level, the patient is operated at full operating rooms (Baker, et al., 2007). The fourth level takes place at the regional medical center where patients are provided with full hospital services (Buckenmaier, et al., 2010). The final level involves the reconstruction and restoration care-taking place at the tertiary medical center. The result of each of these levels depends on the services that patients receive from CRNAs. As such, CRNAs should possess high quality skills and expertise while being aggressive to treat pain.
With such great emphasis on the role of the CRNAs as well as the difficulties facing them, it is important to consider the training of the CRNAs. In most cases, reserve CRNAs do not receive sufficient support or resiliency training (Matsusaki & Sakai, 2011). Because of this, there is the danger that the nurses may fail to administer the required care as they would in a normal environment. The conditions that they may develop may bar them from conducting their activities effectively. Effects include hyperactive motor behavior, disruptive behavior and withdrawal from activities due to trauma. However, upon a successful completion of CRNA training, a practitioner should execute the roles of a professional anesthetist (Matsusaki & Sakai, (2011). Among the key functions of the CRNA, include managing the patient’s pulmonary and airway status, implementing chronic and acute pain management modalities, and responding to emergencies.
Deployment time is yet another factor determining the way CRNAs respond to their duties. “Perceived combat preparedness at deployment has, in turn, been found to moderate the link between combat (Herman, Shiner, & Friedman, 2012, pg. 2)”. In many circumstances, the nurses are deployed within a short time of notification. Therefore, the period for preparation is limited. This is another hardship that CRNAs have to face along with the separation from their families and loved ones (Pokorny, 2012). The duration of the deployment may be another challenge, especially in long-term deployment cases. In addition, CRNAs typically face deplorable work conditions characterized by a lack of meal options, lack of privacy, as well as inadequate personal hygiene facilities. At times, the nurses will lack time to rest, a problem made worse by the fact that they often have to live in crowded tents (Pokorny, 2012). Besides, preparedness time has a direct impact on the PTSD as it accounts for the combat exposure that one has (Herman, Shiner, & Friedman, 2012).These are among many of the factors that can affect CRNAs following their change of environment, especially if they are deployed in an area with unfavorable conditions.
Another important concern is the impact that CRNA deployment has on families and children. Esposito-Smythers, Wolff, and Lemmon (2011) add that three out of five service members preparing to be deployed or already deployed have either spouses or children. In return, stresses allied with the deployment cycle can as well lead to behavior problems, anxiety, and depression, to the children and psychosomatic suffering in the military spouse. With most of the CRNA practitioners being women, most of these deployment stresses are prevalent to the children leading to the increased distress levels affecting their mental health. Also, deployment to a child implies a prolonged alienation from a parent, which in turn increases the sense of danger and uncertainty levels (Flake, et al., 2009). On the other hand, women left behind by their spouses tend to incur more responsibilities of taking care of their families (Kgosana & Dyk, 2014). This, in consequence, contributes to the dichotomization of their profession as well as their family life, which leads to unwanted effects on career and family.
Research Gap
It is vital to assess the outcomes of post-deployment of CRNAs after military action. Among the most significant findings of previous studies is that the CRNAs suffer attrition due to the stressors that are presented by their deployment situation (McCauley, Liebling-Kalifani & Hughes, 2012). Such stressors include the isolation of the personnel from their families as well as the hardship circumstances encountered in the scenarios. Research needs to assess the stressors that CRNAs encounter from the moment they are deployed, during the entire deployment, and after going back home following the completion of the deployment. Also, indicators of stressors and mental disorders should be assessed in different populations of CRNAs.
The physical function of the individual is a major factor that can influence the lived experiences of the medical practitioner (McCauley, Liebling-Kalifani & Hughes, 2012). To date, little research has focused on health care providers ‘experiences on the battlefield, and no study has examined the reserve CRNAs stress experience on the battlefield. An in-depth description of their experience during deployment on the battlefield will help the military understand what it is like for the reserve CRNA on the battlefield. This study will also provide an in-depth understanding of reserve CRNA deployment stress experiences from their perspectives. The results of this study, therefore, may be used to promote more sensitive and supportive deployment experiences for reserve CRNA serving on the battlefield.
Aim of the research
The objectives of this phenomenological study are:
- What are the overall lived experiences of deployed CRNAs?
- What are the care experiences of deployed CRNAs?
- How do CRNAs cope with and resilient from post deployment integration into society?
Significance of the study to the nursing field
The study majors on providing a deeper understanding of the condition of the battlefield. Narrowing the picture of this condition, the study evaluates the role and practices of the CRNA practitioners in this environment. Majoring on this aspect of warfare, the study discusses the importance of these practitioners and why they should take part in the provision of anesthetic care to the military personnel. Moreover, the study evaluates the challenges that these nurses encounter while administering care to the military personnel. The evaluation, in this case, is done during the warfare and after the war. To achieve this goal, the study evaluates the mental health of these practitioners by assessing the stress conditions of these nurses. Therefore, the study assesses the post-deployment experiences among the CRNA practitioners by evaluating the hardship that these nurses go through after the war. In conjunction with this evaluation, the study assesses the impact that deployment of the CRNAs has over their families. Upon a successful description of the deployment experience of the CRNAs, study aims at understanding the remedies that can be implemented to curb these challenges. As a result, the study will be of great importance to the policy makers, resource allocation, and health care bodies aiming at reducing the side effects of the deployment process. This will facilitate the coordination of these bodies with the goal of controlling the mental health challenges facing the CRNA practitioners during and after deployment.
Research Design
The study employs narrative inquiry qualitative methodology. According to Mitchell and Egudo (2003), narrative inquiry refers to a term umbrella netting both human and personal proportions of knowledge while taking into consideration the relationship between cultural context and individual experience. Through this methodology, stories told by people are gathered, analyzed, and represented; thus, challenging the traditional and modern perception of truth and reality. Consequentially, the methodology is appropriate in investigating real life problems since the methodology explores the experience of an individual in the form of stories (Mitchell & Egudo, 2003). The researcher in this methodology listens to the narratives and then representing in writing.
The study’s participants will be CRNA nurses, reserve component, male and female with at least one deployment. These participants will include those from any branch of the military. They will be 18 years or older and speak English. Any participant with active symptoms of PTSD or any other mental issues linked to deployment will be excluded from the study as interviewing could trigger adverse effects. Participants were asked during the initial telephone contact and then again before signing consent if they were experiencing any mental health or PTSD related symptoms that they felt would impede them in completing the interview. The instrumentation to be used in the study will be a direct interview. It will be the researcher and participant to agree on the place that one is comfortable with for the interviewing to take place. During these interviews, the participants will be allowed to pronounce their experiences during deployment by the researcher. To facilitate the entire process of collecting data, the researcher will agree with the participant both the meeting time and place. During the interview, the participants will not use their names for confidentiality purposes. Each participant will be interviewed using semi-structured questions whose focus is to describe and ascertain their experience after deployment. The entire interview session will take approximately 45 minutes. Recording during these interviews will be facilitated using digital recorders where the recorded files will be uploaded to Verbal Ink, an online transcription service.
Theoretical Framework
This study will be directed by the philosophy of Martin Heidegger as the framework. Heideggerian phenomenology is suitable in nursing in the provision of insightful understanding of most of the nursing phenomena especially lived experiences, which fits this study following its narrative inquiry methodology. In contrast to the Husserlian phenomenology, which focused on the description of a phenomenon, Heideggerian phenomenology focuses on the role of interpretation in uncovering reality that is often not unearthed by description (Johnson, 2000; Heidegger, 1962). This phenomenology is based on the “ontological question of being” or Sein. Heidegger postulates that humans understand themselves regarding the existence and therefore are uniquely ontological (McConnel-Henry, Chapman, & Francis, 2009). Five major conceptual underpinnings of phenomenology have been used in the development of this study from data collection to interpretation of the results. These include (a) Dasein, (b) “being in the world”, (c) structures of being, four existential and (d) hermeneutic circle (Speziale & Carpenter, 2007).
The term ‘Dasein’ is a German word that means “the entity that each of us is”. According to Heidegger, the construction of Dasein is unique to each and can only be understood through ontological interpretation (Johnson, 2000). Therefore, the meaning of being is a core concept in his interpretive phenomenology whose aim according to the McConnel-Henry, Chapman, & Francis (2009) is to unravel and uncover the meaning of being. The second concept is “being in the world”. Although hermeneutics refers to the art of interpretation, Heideggerian hermeneutics also involve self-comprehension of “Dasein” by understanding the world we live in. An understanding of a person’s experience or behaviors is thus dependent on whether the researcher has put context to the behavior (Heidegger, 1962). McConnel-Henry, Chapman, and Francis, (2009) add that Heidegger claimed the researcher in this case should have prior knowledge and fore-structure before conducting a hermeneutic inquiry. As such, following the Heidegger’s postulations, the experiences of reserve CRNAs will be examined within the context, which they occur, including the familiar, historical, and cultural context.
The next major facet of the phenomenology guiding this study is the “fore-structures of Dasein”. Fore-structures are what the researcher knows in advance. This is the knowledge that the researcher utilizes to interpret the experiences of others. Heidegger contends that researchers have prior knowledge (for having) that is used to predict before interpretation (fore sight), which researchers grasp before interpreting (fore-conception) (Leonard, 1994). Heidegger argued that fore-structures are essential in the comprehension of human experiences. On the hermeneutic circle of understanding, Heidegger notes that researchers must acknowledge prior knowledge (fore-structures of Dasein) when interpreting in order to achieve true meaning. The fore-structures allow the research to enter into the level of meaning because, without some pre-existing knowledge, the researcher would not have any idea about what is needed (McEwan & Willis, 2007). However, Heidegger cautions researchers to ensure that this aspect do not predetermine the understanding of the human experiences.
The last facet is the four essentials. According to Heidegger, “Dasein” can be understood through four essentials: (a) time, (b) space, (c) body, and (d) human relations (Lopez & Willis, 2004). On time, Heidegger argues that interpretation must consider the impact of the past, the current, and the future of human experiences. Experiences can only be comprehended through consideration of the time in which they occurred. Heidegger argues that spaces influence the experiences of individuals; therefore, it is essential to understand the space in which events occur. Furthermore, Heidegger posits that the body is what individuals use to conceal and share our true meaning. Therefore, understanding body language is essential to any interpretation of experiences. Lastly, Heidegger argues that human relations are an essential part of human experiences (Mackey, 2005). Therefore, one has to consider the relationships between individuals to truly interpret their experiences.
Scope/Delimitations
The goal of the study is to gain an insight of the experience of the reserve CRNA as well as the impact of working at a battlefield environment has on their life. As such, the study is constrained on the CRNA practitioners, reserve component, and any gender in America who have been affected or participated in combat.
Biases and Assumptions
To adhere to the guidelines of the interpretative phenomenological method, a beginning understanding of the phenomenon of interest will be documented by noting the primary investigator’s (PI) current biases and assumptions.
First, it is important to let the reader know that the PI has been in the reserves for 25 years and a CRNA for ten years. I have been mobilized twice to military hospitals: Once on an overseas deployment at a hospital in Germany and once in the USA. I have never performed anesthesia on the battlefield. Through continuous contact with reservists in my civilian life and various military duties, I have encountered a plethora of nurses who have been deployed numerous times since our recent wars in Afghanistan and Iraq.
It is evident that deployment is stressful. One assumption made in the study is that nurses are emotional beings and like to share stories. In this case, the study assumes that they will be willing to share these stories no matter how confident or sensitive they may be to provide a clear and insightful picture of the study questions. Besides, the study assumes that the impact the deployment has had on their lives was significant. This assumption takes into consideration the impacts during and after the war as a way of covering the post-deployment effects of the war. Sharing their “war stories” may be a form of stress relief and a coping mechanism.
It will be assumed that participants would be able to articulate their experiences with a relatively accurate recall due to the impact that they have made in their lives. The stories of experiences offer a warning of dos and don’ts to others preparing to deploy to war. Gaining insight into CRNAs’ experiences can afford other CRNAs a heightened awareness to support other soldiers living through similar experiences (Wands, 2011).
Biases and assumptions for this study include:
- CRNAs on deployments face numerous physical, social, and psychological challenges, to which reserve CRNAs are particularly vulnerable.
- Even though it is in the best concern of the military to offer support services and additional training for CRNAs, efforts to implement such interventions have not been effective.
- As a critical wartime shortage help, reserve CRNAs need additional military support and recognition.
- Wars are likely to prevail into the future. It is essential, therefore, to focus on improving the stress experience of the reserve CRNA to effectively help wounded soldiers.
- Understanding the experiences of reserve CRNAs can assist the military in preserving this valuable asset and provide better care for soldiers.
Key Terms
Terms that are used in this dissertation are not necessarily common language to those not serving in the Armed Forces and are thus defined below for clarity:
Military Nurse. A military nurse is a Bachelor’s degree prepared nurse, who is a commissioned officer is serving in the Armed Forces (Elliott, (2015). He or she can be on Active Duty full-time or part of the reserve component serving weekends and two weeks per year. They can be in either the Army, Air Force, or Navy.
CRNA. A CRNA is an advanced practice nurse that specializes in critical care (American Association of Nurse Anesthetists, 2010). They provide anesthesia services while working with podiatrists, dentists, anesthesiologists, surgeons, and other healthcare professionals (AANA, 2010).
Reservist. A reservist is a member of the Armed Forces who serves as part of the military on a part-time basis in the Reserve component of the military. They serve the needs of the Federal government (Bowyer, 2007).
Deployment. Deployment refers to the mobilization of a unit or an individual during wartime.
War Zone (Bowyer, 2007).
War Zone: A war zone refers to an area in which belligerents are waging war; an area marked by extreme violence (Bowyer, 2007).
Summary
It is evident that taking part in battlefield have histrionic consequences for the welfare and mental health of the healthcare providers and military personnel. The trend tends to increase with time, thus calling for an effective approach to containing the situation. In addition, the study has shown that healthcare practitioners have a fundamental role in creating a troop fit for fighting. It is with this prerequisite that the study has established the essence of involving CRNA practitioners in providing anesthetic care. Though the practice of these nurses has been opposed and questioned by the public, they have a crucial role in offering healthcare services to the military personnel during warfare. Consequently, some states have granted these nurses full power to carry their duties while others allow them to work under supervision by the surgeon.
However, taking part in a combat environment has adverse effects on the mental health for both the militants and care providers. This distinguishes between the civilian nurses and CRNAs who work under intense pressure and dangerous conditions. This forms the basis of this study whose interest is to evaluate the experience of deployment of the CRNA nurse in such environment. Correspondingly, the study aims at assessing the post-deployment experience of the CRNAs. In an attempt of achieving the primary objective of the study, narrative inquiry is exploited by using interviewing instrumentation. Likewise, the study has noted that the impact of deployment depends on various factors such as longevity of deployment, frequent tours, and intensity of combat. The success of the study depends on the assumption that the study participants (nurses) will share their experiences to the researcher.
In the coming chapter, other studies whose interest is similar or close to this study. In this case, the research findings related to the deployment experiences of the healthcare providers and military personnel. This is done in an attempt of assessing what other researchers have done or contributed to this research topic. This chapter will review a variety of literature to evaluate what other studies have done and what has been found on this study topic. This is important in enriching this topic and prove its worthiness. Upon the completion of this chapter, a research gap will be identified and as such justify why this study is important in filling in the gap.
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