Shattered, Suffering, and Silenced: Sharon's Story.

This chapter presents a case study of a 30-year-old female news reporter in Albuquerque, New Mexico, named Sharon Fullilove. The case is presented as a personal narrative by her mother, who is a critical care nurse, former chief nurse, Level I trauma unit commander, and colonel in the U.S. Air Force. The narrative is followed by excerpts from Sharon's chart that confirm a series of decisions made by both the hospital and the providers. The subsequent narrative is meant to give the reader an opportunity to reflect on the variety of clinical ethics questions that emerge when a patient enters into a contract with a physician and hospital for care. The goal is not to perform a thorough ethical analysis of the case but to let the reader experience what it is like when best practice standards, attention to patient care, and compassionate concern for family members are set aside. The case concludes with a set of broad questions that can be used for further discussion. Hopefully, this case will bring to the forefront the centrality of ethics in professional decision-making within the context of medical care.

Military Serving at What Cost? The Effects of Parental Service on the Well-Being Our Youngest Military Members.

Since the onset of war in Iraq and Afghanistan in April 2002, much attention has been given to the effect of war on servicemen and servicewomen who have now been serving in combat for over thirteen years, the longest sustained war in American history. Many service members have served multiple tours in Iraq and Afghanistan and suffered from the visible and invisible wounds of war. Much work has been done in the Veterans Administration, the Department of Defense, and the civilian sector after observing the effects of multiple deployments and overall military service on the service member. A survey of the literature revealed that the ethics of conducting research on programs to assist these brave men and women is fraught with ethical concerns based on a military culture that often precludes autonomy and privacy. While strides have been made in developing strategies to assist service members deal with their military service issues, a serious lack of information exists on the impact of a parent's service on the health and well-being of military children. A discussion of current research on services for children is presented with an analysis of the ethical problems that have precluded adequate study of those who need society's help the most.

Combat health care providers and resiliency: adaptive coping mechanisms during and after deployment.

The purpose of this investigation was to understand the varied health care provider responses to traumas by identifying perceptions of control and self-efficacy, appraisal styles, and postevent coping strategies in active duty military nurses and physicians deployed to combat/terrorist regions. Twenty purposively sampled military health care providers completed a descriptive questionnaire, the Posttraumatic Stress Disorder Checklist, the General Self-Efficacy Scale, and a recorded semistructured interview that was later transcribed and content analyzed. Cognitive-behavioral determinants of healthy response to trauma were used to frame this descriptive interpretive study and to assist with developing a model for healthy adaptation in trauma-exposed health care providers. Participants felt they had the greatest control over their health care provider role in theater, and most expressed a belief that a sense of control and a sense of purpose were important to their coping. All used some form of social support to cope and many found calming activities that allowed for self-reflection to be helpful. Results from this analysis can be used to inform interventions and promote postevent coping behaviors that increase social support, strengthen important bonds, and enhance involvement in activities that elicit positive emotions. Health care providers experienced positive outcomes despite considerable traumatic exposure by using coping strategies that map closely to several principles of psychological first aid. This suggests a need to train all medical personnel in these concepts as they appear helpful in mitigating responses to the stress of combat-related exposures.

How do deployed health care providers experience moral injury?

Combat deployments put health care providers in ethically compromising and morally challenging situations. A sample of recently deployed nurses and physicians provided narratives that were analyzed to better appreciate individual perceptions of moral dilemmas that arise in combat. Specific questions to be answered by this inquiry are: 1) How do combat deployed nurses and physicians make sense of morally injurious traumatic exposures? and 2) What are the possible psychosocial consequences of these and other deployment stressors? This narrative inquiry involves analysis of ten deployed military nurses' and physicians' aversive or traumatic experiences. Burke's dramatist pentad is used for structural narrative analysis of stories that confirm and illuminate the impact of war zone events such as betrayal, disproportionate violence, incidents involving civilians, and within-rank violence on military health care provider narrators. Results indicate cognitive dissonance and psychosocial sequelae related to moral and psychological stressors faced by military medical personnel. Discussion addresses where healing efforts should be focused.

Conducting ethically sound disaster nursing research.

Health care professionals have always faced the threat of catastrophic disaster and pandemic infectious illness but have continued to practice without adequately considering the ethical consequences of many of the decision-making tools we currently have in place. Lack of research on these ethical decisions in the face of disasters regarding the 3Rs-rationing (triage and allocating scarce resources), restrictions (quarantine and the denial of care based on some criteria or the magnitude of the disaster), and responsibility (duty to treat and duty to report for work)-will leave nurses to make decisions in the throws of disaster rather than before the crisis occurs. This chapter focuses on conducting ethically sound nursing research in disasters. A survey of the literature on the topic to include current research on the 3Rs, frameworks, and methodological problems will be examined. This chapter concludes with a call to action for the nursing profession to accept their role as patient advocates and drive the research necessary to avoid the ethical pitfalls seen in recent disaster decisions and scenarios.