Nursing By Another Name: Nursing Science Impact on Special Forces Clinicians in Prolonged Evacuation Situations

Parallel to burgeoning nursing science throughout the mid-20^thcentury, President John F. Kennedy decreed the creation of a new brand of soldiers, with the ethical mandate that these Special Forces (SF) (“green berets”) would be liberators of the foreign oppressed, not purveyors of American aggression (Bank, 1986; Prados, 2015). Similar to nursing in its infancy, Special Forces medics’ advanced-level practice and education is dictated by physicians; medics struggle to deliver holistic, evidence-based care to vulnerable populations under this current medical model (Rocklein, 2014). Within current geopolitical climates, SF medics continually deploy to third-world environments devoid of traditional patient care platforms or evacuation resources to transfer the critically ill/wounded to higher echelons of care (Rocklein-Froede, 2011b). Deprived of essential assets to evacuate and care for oppressed peoples and wounded warriors, SF medics are now tasked with maintaining and stabilizing patients days beyond the “golden hour” of immediate resuscitation (Blackbourne, Baer, Eastridge, Kheirabadi, Kragh, Cap, ... & Kotwal, 2012; Hetzler & Risk, 2009; Risk & Hetzler, 2009), forcing these practitioners to become de-facto nurses absent the benefit of vital nursing practice models.

Historically, nursing science is underutilized by medical science to improve care outcomes; in the civilian sector, this dearth of evidence translation between the disciplines is now recognized and measures are underway to rectify it (Baumbusch, Kirkham, Khan, McDonald, Semeniuk, Tan, & Anderson, 2008). In an all-male military clinical environment composed solely of independently-practicing SF medics and their physician superintendents (collectively, “clinicians”), interplay between nursing and medical science was virtually nonexistent (Rocklein, 2014). Despite coalition defense entities’ extraction from protracted combat engagements, SF medics repeatedly return to the most hostile and unstable hotspots around the globe (Rocklein-Froede, 2011a) and care for military brethren and oppressed civilians without preference or prejudice (Cooke, 2012). To provide prolonged care in the field, senior SF medics exited their entrenched position under medicine’s purview and approached civilian nursing science in efforts to improve patients’ survivability from critical injury and illness.

Evidence of the impact of nursing science and practice in war, on soldier survivability, and in critical care evacuation from combat is well-documented throughout nursing and interdisciplinary literature (Blaz, Woodson, & Sheehy, 2013; Choron, Wang, Van Orden, Hunger, & Seamon, 2013; Currie & Chipps, 2015; Eastridge, Hardin, Cantrell, Oetjen-Gerdes, Zubko, Mallak,... & Bolenbaucher, 2011; Galvagno, Dubose, Grissom, Fang, Smith, Bebarta, ... & Scalea, 2014; Lairet, King, Vojta, & Beninati, 2013). Examination of the impact of nursing science translation to special operations medicine is uncharted territory and of paramount importance to patient outcomes. Models and theories wholly assimilated in nursing science were translated to SF clinicians’ practice to design models for prolonged care, briefly: paradigms built upon disruptions in health via catastrophic events (Newman, 1997 as cited by Alligood, 2013), care that incorporates systems constantly changing from baseline (Neuman, 2011b as cited by Fawcett & DeSanto-Medeya, 2013), and care emphasizing nutrition, hygiene, comfort, and sanitation (Davies, 2012; Nightingale, 1858; Nightingale, 1860).

To mitigate stress inherent in acquiring nursing knowledge foreign to SF medics, Copell’s utilization of Foucaultian poststructural theory (2008) was adopted as framework to connect knowledge with empowerment, and empirical and esthetical knowledge were delineated (Carper, 1978). The designed practice guidelines for prolonged care are immediately identifiable as thoroughly based in nursing science and built on the nursing process; among congregations of SF clinicians, their preferred taxonomy is “prolonged field care” (PFC) versus “nursing care” (Ball & Keenan, 2015). Despite this rebranding, the impact of nursing science on Special Forces clinical practice is unprecedented and extraordinary. Proximal effects include a new appointment of a nurse corps officer at the SF medics’ special warfare medical school and now, involvement of military nurse scientists in PFC. Anticipated distal implications include substantial changes to policy and practice, enhanced opportunities for women and nurses within Special Operations, curricular revision, and translation of these initiatives and knowledge to non-governmental organizations caring for refugees and displaced persons, such as models depicted by Schmidt, Allotta, Penhaligon, Kay, & Lee (2014).