Post-deployment social support and social conflict in female military veterans

textBACKGROUND: There have been prevailing gender differences in negative mental health outcomes for U.S. female service members (FSMs) returning from combat deployments with rates of depression and post-traumatic stress nearly twice that of their male peers. AIM: The aim of this research study was to examine the extent to which the absence or presence of social support, social conflict, and stressful life events either facilitated or hindered optimal mental health during the post-deployment period and shaped FSMs’ mental health in the context of the post-deployment experience. RESEARCH QUESTIONS: What was the nature of the relationship between social support, social conflict, and stressful life events and mental health symptoms (PTSD, depression, anxiety, and alcohol abuse) in FSMs after deployment to Iraq? And was the degree of social support or the degree of social conflict more highly associated with negative mental health symptoms (greater PTSD symptoms, greater depression symptoms, greater anxiety symptoms, and greater alcohol abuse symptoms) in FSMs after deployment to Iraq? THEORETICAL FRAMEWORK: The theoretical framework for this study was derived from Vaux’s theory of social support (Vaux, 1988) and from a model developed by Berkman and Glass (2000) that hypothesized how social support and social networks have direct effects on an individual’s physical, mental, and social health. These two frameworks were viewed from a feminist standpoint perspective. METHODS: This descriptive, correlational, cross-sectional design used a convenience sample of 150 active duty FSMs who were 6-12 months post-deployment from Iraq and stationed at Fort Campbell, Kentucky. FINDINGS: During preliminary exploratory data analyses and statistical assumption testing, significant between group differences were found between the officer and enlisted FSMs on four variables: annual household income, stressful life events, education, and prior exposure to violence (physical assault, sexual assault, or domestic violence). Additionally, significant differences emerged in bivariate correlations between the predictor and outcome variables when the 13 officer FSMs were separated out from the original sample during statistical analyses. These findings suggested these were two distinct populations; therefore, the sample was divided into two groups based on rank. For the officer FSMs, there were no significant bivariate correlations between social support, social conflict, or post-deployment stressful life events and any of the mental health outcomes although a one-tailed analysis was conducted due to low sample size (n = 13). In contrast, the two-tailed analysis of the enlisted FSMs (n = 137) showed significant positive bivariate correlations (p < .01) between social conflict and stressful life events and the outcome variables depression, PTSD, and anxiety symptom severity. Furthermore, the analysis demonstrated a significant inverse correlation between social support and the outcome variables depression, PTSD, and anxiety symptom severity. Hierarchical linear regression of the enlisted FSM group showed that depression symptom severity was best explained by the presence of comorbid PTSD symptoms and the absence of social support. The presence of social conflict was excluded in the final model, and stressful life events were not found to be significant in explaining depression symptom severity. Overall, comorbid PTSD symptom severity and the absence of social support accounted for 71% of the variance in depression symptom severity in this group of enlisted FSMs. In contrast, greater PTSD symptom severity in the post-deployment period was best explained by greater comorbid depression symptom severity, the presence of social conflict, and greater stressful life events. The absence of social support did not significantly contribute to the model for PTSD symptom severity. Comorbid depression symptom severity, stressful life events, and the presence of social conflict, which were entered in three steps, accounted for 74% of the variance in PTSD symptom severity reported by this group of enlisted FSMs. And finally, greater anxiety symptom severity was best explained by greater comorbid depression symptom severity, the presence of social conflict, and the absence of social support. The presence of social conflict had a stronger relationship with anxiety symptom severity than the absence of social support in the final model. In addition, the presence of more stressful life events did not significantly contribute to the overall variance in anxiety symptom severity. Comorbid depression symptom severity, the absence of social support, and the presence of social conflict accounted for 68% of the variance in anxiety symptoms reported by this group of enlisted FSMs. The implications and recommendations based on these findings span strategic planning for the military, nursing practice, and future research.Nursin

Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice

Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia care to thousands of patients each year. Despite increased anesthetic safety, low-frequency, high-risk perioperative critical events still occur. Although CRNAs have been expected to rely on memory alone to manage the spectrum of these critical events, the use of an emergency manual (EM) may improve CRNA performance. At one Army community hospital, recent experiences with similar critical events led to the development of the following question: Will the use of high-fidelity simulation training with the staff CRNAs on the use of EMs produce both increased performance in key tasks and positive satisfaction scores related to the use of the emergency manual during critical events now and in the future? Twenty staff CRNAs participated in high-fidelity simulated scenarios involving low-frequency, high-risk critical events before and after training on the use of an EM based on a change strategy developed by Goldhaber-Fiebert and Howard in 2012. Changes in performance after training were evaluated using a tool designed by Arriaga et al. Before EM training, CRNAs completed 46.05% of key tasks in the simulated scenario. After EM training, CRNAs completed up to 94.02% of key tasks in simulated scenarios. The observed increase in the completion of key tasks by CRNAs during simulated critical events after EM training and increase in satisfaction scores demonstrates how a well-constructed training program facilitates the implementation of an evidence-based EM into practice and can improve the quality and consistency of CRNA performance during low-frequency, high-risk perioperative events

The effect of pulsed electromagnetic frequency therapy on health-related quality of life in military service members with chronic low back pain

Background In the U.S. military, chronic low back pain is among the most frequent complaints for medical visits, lost work time, and attrition from active duty and the deployed setting by service members. Purpose The aim of this pilot study was to determine whether adjunctive treatment with pulsed electromagnetic frequency (PEMF) produced significant variability in chronic low back pain symptoms and secondary health-related quality of life, mental health and disability outcomes. Methods Prospective, randomized pilot study with repeated measures at baseline, post-treatment, and 1 month follow-up for two groups: usual care (UC) vs. UC + PEMF. Findings In a convenience sample of 75 service members, health-related quality of life mental and physical component scores were significant: F(2, 104) = 4.20, p =.018 (η2 =.075) and F(2, 104) = 4.75, p =.011 (η2 =.084), respectively; as was anxiety symptom severity: F(2, 104) = 5.28, p =.007 (η2 =.092). Discussion and Recommendations Adjunctive treatment with PEMF demonstrated improvements in service members’ overall physical health-related quality of life with expected, yet statistically nonsignificant improvements in reported pain and LBP-related disability. There were significant between group differences in anxiety symptom severity with higher symptoms reported by the UC + PEMF group, surprising findings that warrant further investigation. © 201