Never before have military and federal nurses been able to conduct research during wartime as during recent and ongoing military operations in Iraq and Afghanistan. Nurse scientists have intentionally led focused programs of nursing and interdisciplinary research and participated in a myriad of research studies that span the continuum of care from life-saving acute care on the battlefield through aeromedical evacuation to the United States to long-term rehabilitation and reintegration into society. Ultimate goals are to promote wellness, bolster fighting ability, reduce combat-related morbidity and mortality, and help injured or ill warfighters achieve best possible health outcomes.
Early during Operation Enduring Freedom and Operation Iraqi Freedom, few would have predicted nearly a decade and a half of sustained military operations and its significant demands on the Military Health System and the Veterans Health Administration. Likewise, most military and civilian medical leaders could not have foreseen the tremendous advances in combat casualty care, en route care, medical technology, psychological health, and rehabilitative care that have resulted from medical research, evidence-based practice initiatives, establishment of the Joint Trauma System and the Department of Defense Trauma Registry, and medical materiel development. Although these advances contributed to the lowest died of wounds rate in history1,2 and have transformed areas of civilian trauma care, military leaders, scientists, and clinicians work tirelessly to further improve combat casualty care, maximize survival, and improve outcomes.3 During her testimony to the Senate Committee on Appropriations, Subcommittee on Defense, Lieutenant General Patricia Horoho, a nurse and the Surgeon General of the US Army, underscored that "Combat Casualty Care is not limited to the battlefield of today, but extends to the research and development, development of leaders and doctrine that will save lives and maintains health in all future operational environments."4(p3)
Military service leaders and medical personnel aim to provide immediate combat casualty care that parallels the standard of care at American College of Surgeons-verified level I trauma centers within the United States. A formidable goal, given significant challenges in delivering this level of care to combat causalities with devastating injuries in austere environments, priorities included conducting research to develop scientific knowledge needed to optimize treatment and medical system processes. Indeed, beginning in 2005, many scientists deployed for 6 months to Iraq and Afghanistan as directors or members of the Joint Combat Casualty Research Team, the first interdisciplinary research team of its kind, to conduct original research and support other investigators. Some performed research during aeromedical evacuation flights or at Landstuhl Regional Medical Center in Germany. All research was conducted in accordance with an historic agreement between the United States Army Surgeon General and the Commander of the Multi-National Corps Iraq, which detailed requirements for (1) a Department of Defense Assurance, (2) institutional review board approval of all human subjects research that did not meet criteria for exemption, (3) scientist training, and (4) compliance oversight.5 Nurses led or participated in prospective, observational, descriptive, and survey research pertaining to topics such as, but not limited to, resuscitation of casualties with acute hemorrhage, noninvasive assessment of occult hypoperfusion, hemostatic bandages, primary blast lung injury, traumatic brain injury, posttraumatic stress, resiliency, burnout, military women's health and illness behaviors in the combat environment, detection of compartment syndrome, iron status of deployed personnel, sleep and use of energy products, oral care practices for intubated casualties, hand hygiene, use of paralytic agents during helicopter medical evacuation, pain assessment and management during aeromedical evacuation, and prevention of infection. Importantly, findings have been incorporated into evidence-based Joint Trauma System Clinical Practice Guidelines and applied to practice.
With the drawdown of military operations, research in Iraq and Afghanistan has ceased. Closer to home, nevertheless, military nurse scientists continue research that aligns with validated research gaps. The broad range of studies include total force fitness, treatment of chronic pain, pain and function in amputees, cognitive deficits associated with traumatic brain injury, ethical issues in nursing practice during wartime, sleep and mental disorders in deployed personnel, positive emotion gratitude, couple functioning, family caregiver stress, stress of parenting after deployment, impact of embedded metals, health promotion and use of a urinary diversion device for women deployers, emergence delirium, malignant hyperthermia, Reiki for management of extremity pain, qigong for traumatic brain injury, partner violence and military sexual trauma, and behavioral health of en route care nurses, to name a few. Department of Defense agencies such as the TriService Nursing Research Program, Congressionally Directed Medical Research Programs, and Joint Program Committees have funded the work.
Military retirees and veterans who sustain a deployment-related injury or illness receive life-long care from the Veterans Health Administration. As the largest integrated health care system in the country, the Veterans Health Administration serves more than 8.7 million veterans annually6 and employs more nurses than any other employer.7 To advance knowledge and promote excellence in health care practice, delivery, and outcomes,8 Veterans Health Administration nurse scientists conduct much important interdisciplinary research about topics such as wound healing, wheelchair seated posture, rural health care and program evaluation, unhealthful alcohol use, suicide prevention, prevention of disability, improvement of functional capability for veterans with chronic diseases, posttraumatic stress, medication adherence, home safety, and veteran-centric care. Various programs and services such as the Nursing Research Initiative and the Rehabilitation Research & Development Service fund the research.
Military and federal nurse scientists partner with others from federal and civilian agencies, academic institutions, and nonprofit and philanthropic organizations to achieve vital impact. Examples of these partnerships include the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the Department of Defense Blast Injury Research Program Coordinating Office, the Extremity Trauma and Amputation Center of Excellence, the National Institutes of Health, the Jonas Center for Nursing and Veterans Healthcare, and many others. Given that military personnel cared for more than 6200 Iraqi and Afghan children during 2002-2012,9,10 Uniformed Services University of the Health Sciences and Health Resources and Services Administration scientists and clinicians are working to develop national virtual training for pediatric emergency service care. Through sharing of expertise, resources, access to potential research participants, and research responsibilities, collaborative research facilitates rigorous research, increases efficiency and research productivity, enables mentoring of novice investigators, responsibly uses appropriated research funds, and minimizes unnecessary research redundancy.
Dissemination of findings is a critically important phase of the research process. Military and federal nurse scientists routinely publish findings of their scientific research in a wide variety of refereed scientific journals. Other publications pertain to application of findings to practice, research roles, state of the science, and approaches to conducting research. In addition, military and federal nurses routinely deliver podium and poster presentations of their work at military, federal, and civilian health care conferences.
Military and federal leaders have invested in the future of nursing science by ensuring that current and future generations of nurse scientists are equipped to address the unique health challenges of military members, veterans, and their family members. The Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, offers a doctor of philosophy (PhD) in nursing science degree, which prepares nurse scientists to conduct interdisciplinary and transdisciplinary research that is intended to increase readiness, enhance performance, and promote health of the military force; facilitate patient- and family-centered care; manage the cost of health care; and promote synergy among military and federal health care systems. In addition to standard PhD core content, the curriculum emphasizes health conditions distinct to military and federal beneficiaries, ethics, health policy, grantsmanship, and military and health care leadership. Accredited by the Commission on Higher Education of the Middle States Association of Colleges and Schools and synchronized with American Association of Colleges of Nursing Quality Indicators for Doctoral Programs, to date, the Uniformed Services University of the Health Sciences has awarded 30 PhD in nursing science degrees to military, Veterans Health Administration, and US Public Health Service nurses.
Congressional, military service, and Veterans Health Administration leaders have made an unprecedented commitment to research that will advance the science, propel quality, and take military member and veteran outcomes to new heights. Collectively, military and federal nurse scientists are honored to do their part in supporting soldiers, marines, sailors, airmen, veterans, and their families for a lifetime.
-Marla J. De Jong, PhD, RN, CCNS, FAAN
Interim Associate Dean for Research
Director
Faye Glenn Abdellah Center for Military and Federal Health Research
Daniel K. Inouye Graduate School of Nursing
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Senior Air Force Advisor
[email protected]
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