Preface

Deborah J. Kenny, PhD, RN, Lieutenant Colonel, US Army (retired) Guest Editor

Bonnie M. Jennings, DNSc, RN, FAAN, Colonel, US Army (retired) Guest Editor

There are 3 military services in the United States—the Army, the Navy, and the Air Force. Nurses who join the military wear the uniform of their respective service. Nurses may also join the United States Public Health Service (USPHS). They wear the uniforms of the USPHS and, as such, they are a part of the uniformed services although they are not part of the military.

Although nurses in the uniformed services have responsibilities similar to nurses who work in civilian settings, nurses in uniform also have unique roles in caring for unique patient populations in distinctive care environments. The patients are typically people who need health care because they have experienced extreme conditions. The conditions could be the result of natural disasters, such as earthquakes, hurricanes, or tsunamis, in which case the nurses are a part of a humanitarian mission. The conditions could be the result of decisions to engage in conflicts throughout the world, as in Iraq or Afghanistan, in which case nurses are working in a war zone or a combat setting. The care environments can range from facilities that look and function like civilian hospitals to tents or even open-air setups. Equipment can range from state-of-the art, highly effective field equipment to older or even more makeshift paraphernalia. Either way, training is required for nurses to learn how to use the equipment.

At the outset of humanitarian or combat missions, nurses find themselves working in a primitive environment. Nurses have described trying to care for patients in blowing sand, in extreme heat and cold, and while protecting themselves and their patients as they heard rocket fire overhead. As time goes on, the environment “matures” and becomes less austere, better organized, and better equipped. Despite the range of environments and maturation, uniformed nurses have a remarkable sense of duty when asked to perform whatever roles they are assigned; these roles are sometimes different from those in which they have specialized. This issue of Nursing Clinics of North America illustrates some of the roles that uniformed nurses fulfill and their dedication to those for whom they care.

Although joined by the bond of serving their country, each of the US uniformed services has its own culture, which includes a language that may be difficult to understand by those not familiar with it. This is more than a uniformed/civilian dichotomy. These are cultural and language issues that make it difficult for the various uniformed services to understand one another's policies, language, and acronyms. For instance, those serving in the Army are called soldiers; Air Force personnel are referred to as airmen; and those in the Navy are sailors. Collectively, military personnel are called service members. Each service also has its own names and abbreviations for different ranks.

There are 2 large clusters of military personnel: officers and enlisted. Individuals who have a minimum of a baccalaureate degree may choose to become commissioned as officers. As they progress in rank, officers are given increasing leadership roles, beginning with small groups and often culminating in positions in which they are in charge of thousands of service members. Nurses are officers. Individuals who join the military after high school enlist; these individuals are referred to as “enlisted” personnel while they are in the most junior ranks. Once enlisted personnel are promoted to a certain rank, regardless of service affiliation, they become known as noncommissioned officers (NCOs). The NCOs have more responsibility and are often in charge of a group of enlisted service members. They also assist the officers and are regarded as the backbone of military units. Some NCOs continue their education and have various college degrees. Unless they choose to embark on the process to become an officer, however, they remain NCOs. The USPHS comprises entirely commissioned officers and they provide a distinctive service for the United States. Their missions are usually more related to humanitarian efforts and maintaining security within the United States rather than serving in combat zones.

Distinctions among the military services continue into the combat environment, also called the theater of operations. Ill or injured members from any service, however, including the Marine Corps, may be treated at a facility or by the staff from any service. Army hospitals are called Combat Support Hospitals (CSH); the acronym is pronounced, “cash.” Military health care personnel in a CSH treat service members with minor wounds and return them to duty; they stabilize service members with serious injuries or illness for evacuation out of theater. Air Force mobile hospitals are called field hospitals. Although the Air Force has hospitals on the ground in combat zones, their primary mission in a war zone is to evacuate patients to Europe or the United States for definitive care and rehabilitation. Critically injured patients are escorted from the theater of operations by a critical care air transport team (CCATT), called a C-Cat. Most CCATT members are Air Force, although infrequently some team members may be Army. The Navy also has units on the ground, called military hospitals. The primary Navy operations take place on ships, such as the US Navy Ship (USNS) Comfort or the USNS Mercy. These ships are located near the theater of operations. In Iraq and Afghanistan, as well as the major military hospital in Europe, it is common to see a mixture of Army, Navy, and Air Force personnel working side by side, in one hospital, regardless of its name, mixing their different cultures. Everyone shares the goal of providing the best care possible for ill and injured service members.

This issue of Nursing Clinics of North America is dedicated to the nurses in the uniformed services. It highlights some of the unique roles uniformed nurses play that put them in unique circumstances. Within this issue, the nurse authors of some articles discuss personal accounts of the situations they were in as a result of their uniformed responsibilities. Knebel and colleagues speak to the role of USPHS nurses in the rescue and recovery operations after the 9/11 attack on the World Trade Center. The authors reveal many of the sensory phenomena they encountered. Poole and Lacek discuss how, as nurses who specialized in obstetrics and gynecology, they quickly accommodated to very different roles when they deployed to Iraq. They portray how they coped with learning to care for severely injured patients and the pride they felt in their accomplishments.

Because uniformed nurses often deploy to assume responsibilities other than those in their area of expertise, 2 articles in this issue address competencies needed to perform these unique duties. Ross describes competencies and skills needed for nurses who deploy. Debisette and colleagues offer examples of some of the missions and roles with which the nurses in the USPHS are involved.

Other articles in this issue discuss common conditions that have unique implications for uniformed nurses. For instance, Wilson and Brothers address iron deficiency anemia; McCarthy and colleagues describe calcium losses. These common conditions take on a unique set of considerations when viewed from a military perspective. Likewise, Crumbley and Kane discuss the relatively common occurrence of pressure ulcers. They do so, however, from the perspective of young, healthy men and women who have been injured and develop pressure ulcers due to the injury or ischemia associated with blood loss or because of the field conditions during the initial insult. Vane and colleagues put a new perspective on the common problem of infection control by commenting on ways to minimize the transmission of infection in austere field conditions.

In another group of articles, the authors describe systems that augment care for military members injured in combat zones. Steele and colleagues describe the care provided for service members as they make their way from the battlefields, through Germany, to definitive care in the United States. Serio-Melvin and colleagues discuss care for severely burned service members, with attention to ways continuity is ensured across the care continuum.

Although most of the articles written for this issue are by uniformed nurses from the United States, 2 articles were included to offer a voice from military nurses abroad. Chou and colleagues discuss what military nurses in Taiwan endured, physically and psychologically, during the 2004 severe acute respiratory syndrome epidemic. Lamb describes how nurses managed the pain experienced by injured British soldiers as they were air evacuated by the Royal Air Force from the theater of operations.

This broad range of articles offers a good look at what nurses in uniform are called to do and under what conditions they must practice. Readily apparent in each of these articles is the intense loyalty these nurses felt toward their patients and their mission. Like those who served before them, these nurses are continuing the legacy of uniformed nurses called to work in war zones and disaster areas. They do so proudly and with courage. We are honored to present their work to you.