Interventions to Maximize Nursing Competencies for Combat Casualty Care

Military nurses are fighting their own battles to manage the number of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom. Service members' psychosocial needs for support to manage their stress and combat injuries are immense. Therefore, the specific aims of this study are to: (1) Determine the needs of military nurses to provide competent psychosocial care to combat casualty patients; (2) Further develop and modify the Stress Gym internet intervention program and a Military Nurses' Coaching Guide as one specific intervention to assist these nurse to provide psychosocial care to combat casualty patients in the Navy, Air Force, and Army Military Treatment Facilities (MTFs); (3) Determine if utilization of the Military Nurses Coaching Guide and the Stress Gym is feasible and effective in helping nurses provide psychosocial care to combat casualty patients; and (4) Examine the effects of the Stress Gym program, utilizing a military nurse as a coach to combat casualty patients, as compared to patients just receiving the Stress Gym, and patients who receive usual care in Navy, Air Force, and Army military MTFs. In Phase 1, focus groups will be conducted with military nurses to assess their competency needs and interviews with combat casualty patients. Results will be used to develop further the Stress Gym internet intervention and the coaching guide. Through 10 tailored modules, the current version of the Stress Gym educates participants on stress reactions and depression, in addition to providing strategies for developing awareness and coping strategies. In Phase 2, a minimum of 90 military nurses will be recruited in the MTFs (30 nurses each in Navy, Air Force, and Army MTFs. The utility and effectiveness of the Stress Gym Internet Intervention for military nurses will be examined. Also 225 combat casualty patients will be recruited from the respective MTFs (75 patients in each MTF). The patients will be randomly assigned to one of three groups: (1) Stress Gym with a military nurse coach; (2) Stress Gym only; and (3) usual care. Outcomes for the combat casualty patients will be studied including depressive symptoms, perceived stress, interpersonal factors, physical and emotional health, PTSD symptoms, coping, and life satisfaction. Data will be examined using ANOVA and pre-post analysis. The proposed intervention uses a process that will aid in early intervention; it uses a cost effective method and can become a critical approach in helping military nurses to prevent long-term effects of stress and depression in combat casualty patients.