Utilizing And If I Perish: Frontline U.S. Army Nurses in World War II to Examine Past, Present, and Future Military Nursing Readiness: A Thematic Analysis.

Abstract

Introduction: In the last 2 decades of counterinsurgency operations in Iraq and Afghanistan, the United States experienced its lowest number of battlefield casualties. Although lessons learned in recent counterinsurgency operations may be relevant for large-scale combat operations (LSCO), it is prudent to revisit the lessons learned from LSCO of World War II medical personnel. This project explored the perceptions and experiences of present-day military nurses to understand readiness as it relates to future LSCO through the historical lens of military nurses' experiences serving in World War II, as told in And If I Perish: Frontline U.S. Army Nurses in World War II.

Materials and methods: This project was determined exempt from an institutional review board. A panel discussion examined the parallels of past, present, and future readiness considerations for military nurses preparing for LSCO. A panel of 6 military nurses discussed the book and their own experiences as military nurses. Because the dataset consisted of a single interaction between the authors and panel members, thematic analysis was used to examine the panel discussion transcript. Initial coding framework was supported by prominent themes relating to readiness found throughout the book (Table 1).

Results: Additional coding identified 8 patterns (Table 2). Three key themes emerged: (1) there is a mismatch between the concept and the operationalization of readiness, (2) nurses require digital and data literacy for integrating medical support technology, and (3) mindset must be recognized as a skillset.

Conclusion: Training and decision-making in well-resourced environments do not always translate to performance in austere environments. The autonomy, and teamwork, of nurses in deployed environments can be greater than executing similar work within a medical treatment facility. Military nursing leaders should seek to determine if the needs of individual nurses are the same in a resource-rich environment versus an austere environment, which could impact readiness. Further, the lack of comparable combat-like injury exposure in the medical treatment facility hinders readiness. Additionally, the intersection of health care, tactics, and cyber advances in warfare place technology at the forefront of the battlefield. Information is a commodity and those who can receive, rapidly interpret, and utilize data for action will have a greater potential of success. However, digital and data literacy are not tracked as metrics for readiness. Finally, the neuroplasticity of the brain fosters cognitive growth, and challenging multiple assumptions of knowledge, skills, and attributes (KSA) could be beneficial for military nurses. The military is accustomed to thinking about performance and readiness from a KSA standpoint, creating a solid foundation for the inclusion of theoretical models, such as cognitive readiness, as another form of readiness measurement. This model moves beyond psychomotor skill assessment and includes mindset and cognitive skills as a more comprehensive measure of readiness. Overall, the future operating environment suggests that while technical competence is important, it should not be the sole determinant of military nursing readiness.