Sociodemographic and occupational aspects associated with burnout in military nursing workers.

OBJECTIVES: to analyze association between burnout and sociodemographic and occupational features of military nursing workers. METHODS: a cross-sectional study, developed in five military hospitals of the Army of Rio Grande do Sul State, among 167 workers from military nursing from December 2015 to May 2016. Sociodemographic and occupational questionnaires and the Maslach Burnout Inventory were applied. For the analysis, it was used descriptive statistics, Chi-Square Test and Poisson Regression. RESULTS: the majority of participants were female; temporary military personnel, nursing technicians, with a median age of 34 years old. Burnout was related to the variables: Military Health Organization, time of practice in military nursing and accomplishment of leisure activities. CONCLUSIONS: burnout assessment may contribute to the Brazilian Army Command in organizing plans for prevention and handling of occupational diseases in military nursing, improving quality of life at work.

Sociodemographic and occupational aspects associated with burnout in military nursing workers / Aspectos sociodemográficos y ocupacionales asociados al burnout en trabajadores de enfermería militar / Aspectos sociodemográficos e laborais associados ao burnout em trabalhadores da Enfermagem Militar

ABSTRACT Objectives: to analyze association between burnout and sociodemographic and occupational features of military nursing workers. Methods: a cross-sectional study, developed in five military hospitals of the Army of Rio Grande do Sul State, among 167 workers from military nursing from December 2015 to May 2016. Sociodemographic and occupational questionnaires and the Maslach Burnout Inventory were applied. For the analysis, it was used descriptive statistics, Chi-Square Test and Poisson Regression. Results: the majority of participants were female; temporary military personnel, nursing technicians, with a median age of 34 years old. Burnout was related to the variables: Military Health Organization, time of practice in military nursing and accomplishment of leisure activities. Conclusions: burnout assessment may contribute to the Brazilian Army Command in organizing plans for prevention and handling of occupational diseases in military nursing, improving quality of life at work.

RESUMEN Objetivos: analizar las asociaciones entre el burnout y las características sociodemográficas y laborales de los trabajadores de enfermería militar. Métodos: un estudio transversal, desarrollado en cinco hospitales militares del Ejército de Rio Grande do Sul, con 167 trabajadores de enfermería militar desde diciembre de 2015 hasta mayo de 2016. Se aplicaron cuestionarios sociodemográficos y laborales, y el Maslach Burnout Inventory. Para el análisis, se utilizaron estadísticas descriptivas, prueba de Chi Cuadrado y regresión de Poisson. Resultados: en la mayoría, los participantes fueron mujeres, militares temporales, técnicos de enfermería, con una mediana de edad de 34 años. El burnout se asoció con las variables organización militar de salud, el tiempo dedicado a la enfermería militar y la realización de actividades de ocio. Conclusiones: la evaluación del burnout puede contribuir al Comando del Ejército Brasileño en la organización de planes de prevención y manejo de enfermedades profesionales en Enfermería Militar, favoreciendo una mejor calidad de vida en el trabajo.

RESUMO Objetivos: analisar associações entre burnout e características sociodemográficas e laborais dos trabalhadores da Enfermagem Militar. Métodos: estudo transversal, desenvolvido em cinco hospitais militares do Exército do Rio Grande do Sul, com 167 trabalhadores da Enfermagem Militar no período de dezembro de 2015 a maio de 2016. Foram aplicados questionários sociodemográfico e laboral, e o MaslachBurnoutInventory. Para a análise, utilizaram-se a estatística descritiva, Teste Qui-Quadrado e regressão de Poisson. Resultados: na maioria, os participantes eram do sexo feminino, militares temporários, técnicos de enfermagem, com mediana de idade de 34 anos. O burnout foi associado às variáveis organização militar de saúde, tempo de atuação na Enfermagem Militar e realização de atividades de lazer. Conclusões: a avaliação do burnout poderá contribuir com o Comando do Exército Brasileiro na organização de planos de prevenção e manejo de doenças laborais na Enfermagem Militar favorecendo uma qualidade de vida melhor no trabalho.

Propuesta de un diseño de carrera profesional para la enfermería militar / A proposal for military nursing career design

Introducción: En ausencia, en la actualidad, de un modelo de carrera profesional para enfermería militar se propone un diseño que, buscando la excelencia profesional, dé respuesta a las necesidades de la organización. Objetivo: Diseñar una propuesta de carrera profesional para la enfermería militar. Material y Métodos: Se diseñó un modelo de carrera profesional basado en tres variables, contempladas por la Ley de Carrera Militar: capacitación para asumir puestos de mayor responsabilidad, ascenso a sucesivos empleos militares y ocupación de destinos. Población y muestra: Personal en activo en la Escala de Oficiales Enfermeros (E.O.E.). Recogida de datos: Se obtuvieron datos, a través de la Dirección General de Personal, de la situación actual de la E.O.E. (años de servicio, empleos, efectivos/empleo, años/empleo). Se realizó una búsqueda de información en relación con todos los modelos propuestos en España por las Comunidades Autónomas (CC.AA.), así como, la legislación militar y civil de aplicación en este ámbito. Resultados: Se propone un modelo de carrera profesional en base a cinco grados correspondiendo con otros tantos empleos militares. Se describen las funciones y tipo de destino a ocupar de acuerdo al nivel de desempeño profesional. Conclusiones: Es preciso desarrollar un modelo de carrera profesional para la enfermería militar que oriente la trayectoria individual de sus componentes, la catalogación de puestos, los sistemas de evaluación y la formación precisa para alcanzar diversos niveles competenciales en base a las necesidades de las Fuerzas Armadas

Introduction: Due to the current inexistence of a specific professional career for the military nurses, this paper aims to propose a design that both stresses professional excelence and meets the needs of the organisation. Objectives: To design a proposal for the military nursing career. Materials and Methods: This new model for professional career was based on the three dimensions considered by the "Ley de Carrera Militar" (Military Career Law): abiltation to assume positions of higher responsibility, promotion to successive military positions and destination occupation. Population and Sample: Serving staff in the Official Military Nurse Scale (OMNS). Data gathering: Data were obtained through the "Dirección General de Personal" concerning current situations (service years, positions, effectives/ position, years/position). An information search was conducted through all the models proposed in Spain by the Autonomous Communities, and the relevant legislation, both military and civil. Results: The proposed model of nursing professional career is based on five degrees corresponding to the same number of military positions. The functions and type of destination are described according to the level of professional performance. Conclusions: It seems necessary to introduce a new model of professional career useful to guide the individual trajectory of the military nurses, the position lists, the evaluation systems and the required training to reach the different performance levels according to the needs of the Armed Forces

Monthly variation of unfinished nursing care at the US Army Burn Center.

OBJECTIVE: To describe the monthly variation in the prevalence and patterns of unfinished nursing care and to determine the relationships between the system of nursing care and unfinished nursing care at the US Army Burn Center. METHODS: This was a repeated measures, descriptive study. For one week per month for six months, all nurses providing direct patient care on two inpatient burn units (intensive care and progressive care) were asked to complete an anonymous paper survey, which contained the Perceived Implicit Rationing of Nursing Care instrument, to estimate the prevalence of unfinished nursing care on their unit. Unit administrative data also were collected from the unit nursing leaders each month. Descriptive statistics and multilevel modeling were used in the analysis. RESULTS: Most (80.5%) eligible nurses participated at least once; 46.6% participated three or more times. A high proportion (85.7-100%) of nurses left at least one element of care unfinished; the mean number of activities left unfinished over each 7 shift period per nurse was 16.2. Only nursing care hours provided by float staff significantly predicted nurse estimates of unfinished nursing care, ß=.008, SE=.001, p<.05. CONCLUSIONS: The prevalence of unfinished nursing care at the US Army Burn Center was high and generally consistent with other studies of unfinished nursing care in non-burn settings. The inability to meet the demand for nursing care, as evidenced by the presence of unfinished nursing care, may be the result of a limited surge capacity. Implications for research, policy, and practice were discussed.

Informe sobre la actuación del Oficial Enfermero en la misión Tritón de los Buques Oceánicos de la Guardia Civil / Report on the performance of the Nursing Officer in the mission Tritón of the Oceanic ships of the Civil Guard

La colaboración de la Guardia Civil con la Unión Europea a través de FRONTEX ha incrementado el número misiones de los Buques Oceánicos de la Guardia Civil en el Mediterráneo para aumentar el control de los flujos migratorios, lo que hace que, además de una función policial, sus operaciones se conviertan en misiones humanitarias, rescatando a miles de personas. En cada uno de estos buques va un Oficial Enfermero cuya labor es tan importante como la del resto de los miembros de la tripulación

The cooperation of Guardia Civil with the European Union through FRONTEX has increased the number of missions of the Oceanic Vessels of the Civil Guard in the Mediterranean sea for a better control of migration flows. Therefore, in addition to a police role, its operations turn into humanitarian missions, rescuing thousands of people. Into each vessel there is a Nurse Officer whose work is as important as that of the rest of the crew members

Critical Care Performance in a Simulated Military Aircraft Cabin Environment.

BACKGROUND: Critical Care Air Transport Teams care for 5% to 10% of injured patients who are transported on military aircraft to definitive treatment facilities. Little is known about how the aeromedical evacuation environment affects care. OBJECTIVES: To determine the effects of 2 stressors of flight, altitude-induced hypoxia and aircraft noise, and to examine the contributions of fatigue and clinical experience on cognitive and physiological performance of the Critical Care Air Transport Team. METHODS: This repeated measures 2 × 2 × 4 factorial study included 60 military nurses. The participants completed a simulated patient care scenario under aircraft cabin noise and altitude conditions. Differences in cognitive and physiological performance were analyzed using repeated measures analysis of variance. A multiple regression model was developed to determine the independent contributions of fatigue and clinical experience. RESULTS: Critical care scores (P = .02) and errors and omissions (P = .047) were negatively affected by noise. Noise was associated with increased respiratory rate (P = .02). Critical care scores (P < .001) and errors and omissions (P = .002) worsened with altitude-induced hypoxemia. Heart rate and respiratory rate increased with altitude-induced hypoxemia; oxygen saturation decreased (P < .001 for all 3 variables). CONCLUSION: In a simulated military aircraft environment, the care of critically ill patients was significantly affected by noise and altitude-induced hypoxemia. The participants did not report much fatigue and experience did not play a role, contrary to most findings in the literature.

Factors That Affect Pain Management in Aeromedical Evacuation: An Ethnographic Approach.

BACKGROUND: Pain management is a challenge in the transport setting, but actual factors that influence pain have not been assessed systematically. OBJECTIVE: To describe the environmental factors and social context that affect pain management in military aeromedical evacuation. METHODS: Field notes were taken throughout flight, including observational measures of pain, environmental factors, and interactions between the patient and crew. Data collection was completed on 8 missions and 16 patients; common themes were identified that should be considered in the management of pain in aeromedical evacuation. RESULTS: Communication was a key problem primarily to aircraft noise, the reluctance of patients to speak with crew members while they were wearing headsets, and limited time to assess for pain and provide patient education. Seating and litters appeared to be uncomfortable for ambulatory and litter patients, and preparatory guidance on pain management did not address the stressors of flight or transportation phases. Another compounding factor was the psychological distress, particularly among those leaving a combat zone before the anticipated end of a deployment. Throughout the flight, the military culture of independence, stoicism, and camaraderie also was clearly evident. CONCLUSIONS: Barriers to communication, comfort, and patient education are well known to transport nurses, but it is important to understand the overall effect they have on the management of pain. Developing solutions to address these factors should be a priority to ensure pain is adequately managed throughout transport.

Elvira López Maurín, la primera enfermera militar de la aviación sanitaria española. La historia de un acto heroico olvidado / Elvira López Maurín, the first female soldier of Spanish healthcare aviation. Story of a heroic, forgotten act

La noche del día 1 de noviembre de 1922 marcaría el inicio de las actividades de la Aviación Sanitaria de España. En esta noche se desplazaría por primera vez un equipo quirúrgico completo, en tres aviones de guerra, desde el aeródromo de Nador (Melilla) hasta Dar-Drius con el propósito de atender a los múltiples heridos que acudían después de los combates en el frente de Tizzi Azza. A la importancia histórica de este vuelo se sumó el hecho de presentarse voluntaria la enfermera Elvira López Maurín, que por su condición de mujer, no tenía la obligación de volar en un avión de guerra en esta época. Esta valerosa actitud junto con su afán por socorrer a los heridos más allá de su deber fueron recogidos como una acción heroica en todos los medios de comunicación. En los días posteriores fue felicitada en distintas audiencias por el Rey Alfonso XIII, la Reina Victoria Eugenia, el presidente del Gobierno, Ministro de la Guerra y Comisario Regio de la Cruz Roja, distinguida y recompensada por dicha acción. Por este hecho heroico el impacto en los medios de comunicación del comienzo de esta nueva forma de trasporte sanitario fue mayor. La trayectoria de esta enfermera coincide con el comienzo de la enfermería profesional en España. Este suceso transcendente para la historia de la Medicina, la Aviación y la Enfermería española ha quedado en el olvido por los profesionales sanitarios de esta disciplina no habiéndose recogido en profundidad en ninguna publicación

The night of November, 1 1922 represented the starting point of Healthcare Aviation in Spain. Fort the first time, a full surgical team travelled, by three military aircraft, from the aerodrome of Nador (Melilla) to Dar-Drius in order to attend the numerous wounded resulting from the combats along the Tizzi Azza front line. The historic importance of the flight was coupled by the fact of counting on the voluntary nurse Elvira López Maurín who, due to her gender, did not have to fly in the aircraft at that time. Her brave attitude and her eagerness to help the wounded beyond the limits of duty were considered a heroic action by the media. Some days later, she was both congratulated in several ceremonies (by their Majesties King Alfonso XIII and Queen Victoria Eugenia, the President of the Government, the Ministre of War and the Red Cross Royal Deputy), distinguished and rewarded. Her heroism was directly responsible for the increasing impact in the media of this new way of transportation. The vital trajectory of this nurse coincides with the initial development of professional nursing in Spain, this event being essential for the Spanish History of Medicine, Aviation and Nursing although it has remained obscured and forgotten by healthcare professionals for it has not been recorded in any publication so far

Grace Under Fire: The Army Nurses of Pearl Harbor, 1941.

OBJECTIVE: Much has been written about the military events of December 7, 1941; however, little has been documented about the nurses' work and experience at Pearl Harbor, Hawaii. The aerial assault on Pearl Harbor was the first time in US history that Army nurses had been on the front line of battle. Nurses quickly triaged and stabilized those who could be saved, and provided compassion and comfort to those who were dying, in an environment where the nurses were unsure of their own survival. METHODS: Traditional historical methods and a social history framework were used in this investigation. Primary sources included oral histories from the US Army Medical Department Center of History and Heritage and the State of Hawaii's website, Hawaii Aviation. Secondary sources included published books, newspaper articles, military websites, and history texts. RESULTS: Due to the limited bed capacity, Hickam Field Hospital converted to an evacuation hospital. Nurses, physicians, and medical corpsman triaged, stabilized, and transported those likely to survive, while staging the dead behind the building. The emergency room at Tripler Hospital was quickly flooded with patients from the battlefield, but the staff was able to sort patients appropriately to the wards, to the operating room, or provide comfort care as they died. At Schofield Hospital, collaboration between tireless doctors, nurses, and corpsmen was key to providing life-saving surgery and care.

[The set of wearable medical equipment for medical and nursing teams].

The kit is designed in accordance with the list of the first medical aid procedures and syndromic standards of emergency medical care providing. The kit contains modern local hemostatic agents, vent tubes, cricothyrotomy, needles to eliminate pneumothorax, portable oxygen machine, sets for intravenous and intraosseous infusion therapy, collapsible plastic tires, anti-shock pelvic girdle, and other medical products and pharmaceuticals. As containers used backpack and trolley bag on wheels camouflage colours. For the convenience and safety of the personnel of the vest is designed discharge to be converted in the body armour.

We took up the fight against Ebola.

Following the Ebola outbreak in west Africa last year, UK military nurses joined the international response. Three military nurses who travelled to the crisis zone recall their experiences of working in treatment centres in Sierra Leone to help tackle the spread of the virus.

Chapter 4 embedded metal fragments.

The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to embedded fragment wounds containing metal and metal mixtures whose long-term toxicologic and carcinogenic properties are not as yet known. Advances in medical care have greatly increased the survival from these types of injuries. Standard surgical guidelines suggest leaving embedded fragments in place, thus individuals may carry these retained metal fragments for the rest of their lives. Nursing professionals will be at the forefront in caring for these wounded individuals, both immediately after the trauma and during the healing and rehabilitation process. Therefore, an understanding of the potential health effects of embedded metal fragment wounds is essential. This review will explore the history of embedded fragment wounds, current research in the field, and Department of Defense and Department of Veterans Affairs guidelines for the identification and long-term monitoring of individuals with embedded fragments.

Chapter 9 prehospital tourniquets: review, recommendations, and future research.

The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths--the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines.

Improving the adoption of evidence-based practice among nurses in Army outpatient medical treatment facilities.

This quality improvement project implemented and evaluated an evidence-based practice (EBP) program at two Army outpatient health care facilities. The EBP program consisted of five implementation strategies that aimed to inculcate EBP into organizational culture as well as nursing practice and culture. A conceptual model of the "Diffusion of Innovations" theory was adapted to explain the application of the program. The Institutional Review Boards at Walter Reed National Military Medical Center and Duke University School of Medicine reviewed and exempted this quality improvement project. A pretest-posttest design was used with four instruments at each facility. The EBP program was successful in enhancing organizational culture and readiness for EBP (p < 0.01) and nursing staff's belief about the value of EBP and their ability to implement it (p < 0.05). Another indicator that the EBP program achieved its goals was the significant difference (p = 0.002) in the movement of the outpatient health care facilities toward an EBP culture. These results suggest that this EBP program may be an effective method for empowering outpatient nursing staff with the knowledge and tools necessary to use evidence-based nursing practice.

Psychiatric nursing liaison in a combat zone: an autoethnography.

Military mental health nurses are tasked with providing psychiatric liaison to British forces deployed to combat zones. This forms part of a wider effort to maintain the combat effectiveness of the fighting force. During a recent deployment, I maintained a reflexive journal of my experience of liaising with the British Chain of Command. I then used line by line coding via the NVIVO 9 software package to formulate the core themes that became a framework for this autoethnography. My personality and social anxieties shaped how I performed the psychiatric liaison role. I was able to develop a template for liaison that accounted for both 'me' and my need to feel authentic or credible as a nurse, yet still enabled me to communicate effectively with the Chain of Command. One template for psychiatric nursing liaison with British combat forces is to focus upon key stakeholders within the Chain of Command, specifically, the Officer Commanding, the Sergeant Major, the Trauma Risk Management co-ordinator (usually the Sergeant Major) and the embedded medical asset. Further research is needed to establish how other nurses approach psychiatric nursing liaison.

Human capital strategy: talent management.

Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.