Making the Hard Decisions: Ethical Issues Encountered By Military Nurses during Wartime

Aims: The purpose of this study was to address the research question: How do military nurses identify, assess, manage, and personally resolve ethical issues occurring in nursing practice during wartime deployments?

Background: 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. Little research documents ethical situations encountered primarily by nurses during a military wartime deployment. Many military members are returning from deployment suffering from compassion fatigue, burnout, and PTSD. Yet, the question is perhaps those conditions are as a result of, or compounded by, the lingering uncertainty or distress related to how one, multiple, or recurring ethical situations were resolved or handled.  Consequently, this study represents an exploration of these particular issues with a planned direction to take the findings into follow on projects for further exploration and interventions that emerge from the results s of this study.

Methods:  Using grounded theory, 34 Army, Navy and Air Force nurses were interviewed to elicit their experiences with ethical issues while deployed in support of the recent wars.  Using a focused interview guide, interviews were conducted until theoretical saturation was achieved. Data analysis was conducted using methods detailed by Strauss and Corbin (1998). Rigor was maintained in study methods and analysis using tenets from Lincoln and Guba (1985) and Morse et al's (2002) verification strategies.

Results:  Participants represented primarily Army (55%) active duty (83%) female nurses (71%) who had deployed to Iraq (52%), Afghanistan (32%) or both (16%) for at least 3 months duration.  The nurses shared stories regarding their experiences during deployment. Ethical issues occurred regarding respect for persons, justice, and beneficence. Many struggled to find internal resolution regarding care of detainees, cultural differences, end of life decision making, pain management, and care of civilian casualties. This presentation would discuss the predominant issues they faced during the deployment experiences.  

Conclusions:  The study provided a description of the ethical issues military nurses encounter during wartime and will contribute to an “ethical issues toolkit” and development of a military ethical issues instrument. By better understanding how nurses defined, assessed, and managed the ethical situations they encountered, we can better prepare our deploying nurses for future conflicts.