Accounts of Care partnerships with Service Members from Iraq and Afghanistan Wars

Background: Since the September 11th terrorist attacks, 2.2 million U.S. military service members have been deployed to Iraq and/or Afghanistan, 6,845 service members have been killed in action, and 900,000 service members have been injured in 3 million tours of duty (DeBruyne, 2017; Fischer, 2013, 2015; Institute of Medicine [IOM], 2010). Healthcare services have changed dramatically, directly related to: advances in scientific knowledge generated during the wars; increased use of evidenced-based methods of medical care delivery; and increased use of advanced technology. These 21st century advances have led to the unprecedented survival of injured service members who will live longer with complex injuries that were once lethal. We know that with the increase in complex trauma patients who require a multifaceted plan for recovery, healthcare professionals will need to provide rehabilitation and reintegration services that support both the injured service members and their caregivers. In addition, they will need to incorporate caregivers’ input and participation in care planning for injured members. Injured service members frequently require multiple specialty services and assistance that can lead to fragmentation in care and service members’ being lost in attempting to manage their appointments. The proposed project is based on our previous research interviews of injured service members who described classic symptoms of PTSD, as well as Traumatic Brain Injury related memory problems, and other war related injury symptoms. Anecdotal caregiver feedback involved statements such as, “this is not the person I knew before their deployment” and, “I am not prepared to help.” The premise of the proposed study is that including the caregivers’ perspectives in care planning for service members will decrease fragmentation, healthcare costs, and stress and will improve injured service members’ healthcare outcomes; and document the knowledge of caregiving firsthand. This proposed study seeks to determine whether the behaviors and concerns of military/Tricare caregivers are reflective of what is currently known about traditional caregivers as documented in the literature. Thus, the proposed project addresses the Surgeon Generals’ priorities of “Readiness, Health, and Partnerships” and the TriService Nursing Research Program’s priority area of “Force Health Protection- Care for all entrusted to our care.”

Research Questions/Specific Aims: The purpose of this research is to gather first person accounts from caregivers of injured service members from the Iraq and Afghanistan Wars who receive their healthcare and benefits within the Department of Defense Healthcare System or who are covered through Tricare Insurance.

Research Question: What are the experiences of caregivers of injured service members from the Iraq and Afghanistan Wars? Aim 1: To capture caregivers’ experiences regarding healthcare delivery for injured service members. Aim 2: To collect accounts of service members’ care needs and coordination of care from the caregivers’ perspective. Aim 3: To analyze accounts of caregivers’ experiences to provide future direction for patient-centered care for both injured service members from the Iraq and Afghanistan Wars and their caregivers.
Research Design: This qualitative research study will employ interpretive phenomenological methodology. Descriptive demographics, caregiver characteristics and narrative interviews will be obtained from individual or group interviews of caregivers of injured service members from the Iraq and Afghanistan Wars (military friends, children, spouses, partners, parents, and parents-in-law; N = 45) from the Walter Reed National Military Medical Center (WRNMMC) in the National Capital Area (NCA). Recruitment efforts will include use of electronic and print media, if needed direct mail advertising relevant to military caregivers. The research team and panel of experts will review, code, and classify interviews and identify major themes/exemplars according to the primary concern or nature of the incidents described.

Nursing and DoD Healthcare Impact: This study will result in knowledge gained from caregivers of injured service members from the Iraq and Afghanistan Wars about their experiences in providing care and facilitation of their service members’ healthcare benefits and services use. This knowledge will assist in: improving cost effective care practices; developing programs for injured service members, their caregivers, healthcare providers and executives; and identifying best practices and areas where practice and services can be improved.