Performance of Novice Army Nurses in a Combat Casualty Stress Scenario


Name: Leigh McGraw

Rank: LTC

Organization: The Geneva Foundation

Performance Site: Madigan Army Medical Center, Fort Lewis, WA

Year Published: 2009

Abstract Status: Final


Purpose: To test the feasibility and determine the effect size of using a Mental Skills Training (MST) intervention to improve performance of Army Nurses in a simulated Combat Casualty Stress Scenario (CCSS) and explore the relevance of individual differences in performance, behavioral response and physiologic response to the stressor.   

Design: The study used a randomized, controlled, blinded design using repeated measures design to test the procedures, measures, and a simulated scenario needed to evaluate the effectiveness of ACEP training on nurse performance under stress.

Methods: The intervention group received 16 hours of MST and the control group continued to work and train on their assigned nursing units.  The CCSS employed a combination of medical triage, treatment and implementation of common soldier skills.  Before, during, and after the 10 minute CCSS, salivary alpha amylase and cortisol were collected; blood pressure and heart rate were also recorded.    

Sample: A convenience sample of 38 Army Nurses from Madigan Army Medical Center volunteered to participate in the study.

Analysis: Descriptive statistics, repeated measures analysis of variance, Pearson’s correlation, and both paired an independent t tests were used to examine the data.

Findings: Results suggest the CCSS is an effective stressor, with large magnitude increases in all physiologic parameters.  While participant randomized to the MST intervention did not perform better, examination of the cognitive mental fitness skills data and the physiologic reactivity and recovery suggests there may be improvement in imagery, mental practice, focus/refocus, and competition planning as well as differences in physiologic regulation attributable to the training.  There also appear to be individual differences associated with the magnitude of the physiological responses.  

Implications for Military Nursing: The findings suggest MST may be a useful to improve mental skills fitness and physiologic regulation in Army Nurses exposed to unpredictable, chaotic, and complex situations.


Final Report is available on NTRL: