Management of Ethical Issues in Military Nursing Practice during Wartime


Name: Janice Blair Agazio

Rank: LTC (Ret)

Organization: The Catholic University of America

Performance Site: The Catholic University of America, Washington, DC; Walter Reed National Military, Bethesda, MD

Year Published: 2011

Abstract Status: Project Completed


Ethical issues emerging from the current conflicts in Iraq and Afghanistan have mainly considered those encountered by medical officers in triage and most recently with enemy prisoners of war. Aside from anectodatal accounts, less is known about the ethical issues encounterd by military nurses in wartime.  Studies prior to the current conflict have focused upon military nursing advocacy and moral distress. One study, conducted prior to the current conflicts detailed the frequency and distress associated with issues emerging from Operation Desert Storm/Desert Shield and humanitarian missions, is dated in light of the intensity and duration of the Iraq and Afghan wars. The purpose of this study is to address the research question: How do military nurses identify, assess, manage, and personally resolve ethical issues occurring in nursing practice during wartime deployments?  Subquestions will be directed at addressing specific compents of the overall research question. Using a grounded theory design, military nurses from all three services will be interviewed to elicit their experiences with ethical issues while deployed in support of Operation Iraqi Freedom or Operation Enduring Freedom.  Using the constant comparative method, data collection and data anlaysis will occur simultaneously in order to build a theory of ethical issuesmanagement during wartime. A sampling grid will be used to recruit nurses representative of the demographics deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom.  Using a focused interview guide responsive to emerging themes and developing theory, interviews will be conducted until theoretical saturation is achieved.  Data analysis will be conducted using methods detailed by Strauss and Corbin (1998) to identify a core construct or category to detail proposed relationships and concepts.  Rigor will be maintained in study methods and analysis using tenets from Lincoln and Guba (1985) and Morse et al's (2002) verification strategies. 

Relevance:  Unresolved ethical issues have been linked to ongoing moral distress, burnout, dissatisfaction with nursing, and decreased quality care delivery.  This study will provide a comprehensive overview of ethical issues encountered by military nurses for use by military leadership and development of a "toolkit" for military nurses of strategies to use in managing ethical issues in deployed environments.

 Final Report is available on NTRL: