Shipboard Global Health Engagement Missions: Essential Lessons for Military Healthcare Personnel

Abstract

Introduction Global health engagement missions are conducted to improve and protect the health of populations worldwide. Recognizing the strong link between health and security, the Armed Forces have increased the number of global health engagement missions over the last decade to support force health protection, medical readiness, enhance interoperability, improve host nation capacity building, combat global health threats (i.e., emerging infectious diseases), support humanitarian assistance and disaster relief efforts, as well as build trust and deepen professional medical relationships worldwide. These missions additionally support the US Global Health Security Agenda, US National Security Strategy, US National Defense Strategy and National Military Strategy. Although global health engagement missions are conducted by armed forces with numerous military units and geographical locations, military healthcare personnel assigned to US Naval hospital ships also perform a wide range of these missions. These missions comprise some of the largest global health engagement missions conducted, encompassing hundreds of subject matter expert exchanges, community health exchanges, medical symposiums, and side-by-side partnered healthcare in countries around the world. Military healthcare personnel who have completed past missions possess valuable knowledge related to ship-based global health engagement missions. Capturing and transferring this knowledge to future deployed personnel is important for future successful missions, but has remained a significant challenge. The purpose of this study was to capture and examine first-person accounts of experiential learning among active duty physicians, nurses, and hospital corpsmen who had participated in recent hospital ship-based global heath engagement missions. Materials and Methods We used the interpretive, ethnographic method of interviewing and data analysis described by Benner. Interviews elicited detailed, narrative examples of experiences from military health care personnel who had participated in previous global health engagement missions aboard hospital ships (N = 141). Our approach to gaining meaning from these narratives was guided by three central strategies: (1) identify paradigm cases, (2) identify themes within and across participant narratives of meaningful patterns, and (3) identify exemplars to represent common patterns of meaning and common situations. Additionally, we collected demographic information. Results Our findings provide firsthand descriptions of five essential elements to prepare military healthcare personnel for shipboard global health engagement missions. These essential elements are mission clarity, preparedness, experiential knowledge, lessons learned, and flexibility/adaptability. Conclusions Widespread dissemination of the lessons learned from military global health engagement missions is crucial to shaping forces that operate effectively in a rapidly changing global environment. Sharing lessons learned increases efficiency, adaptability, and agility, while decreasing variance in processes and the need to relearn mission-specific lessons.

Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis

“…A total of 53 literatures were analyzed and divided become three groups, which included classical era (Basil, 1888; Bradford, 2016; Domville, 1881; Elliot, 1896; Nightingale, 1860; Rogers, 1849; Sanders, 1916; Scanlan, 1886), modern (Bardsley et al, 1964; Bliss et al, 1967; Burston et al, 1950; Carpendale, 1974; Cope, 1939; Exton-Smith, 1961; Matheson & Lipschitz, 1956; Newell Jr et al, 1970; Silver, 1967; Souther et al, 1973), and research (Beeckman et al, 2013; Berman et al, 2010; Bours et al, 2002; Carpenito, 2013; DeWit & Williams, 2013; Diepenbrock, 2011; Eckman & Aldinger, 2013; EPUAP, 2009; EPUAP/NPIAP/PPPIA., 2019; Hall & Clark, 2016; Jocelyn Chew et al, 2018; Kozier et al, 2018; Langemo et al, 2015; Lewis et al, 2016; Lynn, 2010; Lynn, 2018; Manderlier et al, 2017; Miles et al, 2013; Mogotlan, 2015; Moore & Cowman, 2015; Moore et al, 2011; Morton et al, 2017; NPUAP/EPUAP/PPPI, 2014; O’Neil, 2004; Potter et al, 2013; Rhoads & Meeker, 2008; Saliba et al, 2003; Samuriwo & Dowding, 2014; Soban et al, 2011; Springhouse, 2006; Tayyib & Coyer, 2017; Tayyib et al, 2016; Treas & Wilkinson, 2012, 2013; White, 2011; Wilkinson & Van Leuven, 2016; Yarkony, 1994).…”

“…Literature that compound these words are textbooks used in teaching and hold in the title “fundamental of nursing” (Burton & Ludwig, 2014; DeWit & Williams, 2013; Kozier et al, 2018; Nugent & Vitale, 2014; Potter et al, 2013; Suresh, 2017; Wilkinson & Van Leuven, 2016; Wilkinson, 2016; Yoost & Crawford, 2019) or “foundation of nursing” (Cooper & Gosnell, 2014; White, 2011). Therefore, passing these terms from writing and several revisional rounds reveals that the ambiguity of defining repositioning (or mixing it with turning) might be a stream in nursing science.…”

“…Therefore, passing these terms from writing and several revisional rounds reveals that the ambiguity of defining repositioning (or mixing it with turning) might be a stream in nursing science. Nevertheless, it appears as moving, positioning, and changing patient posture to refer to the same meaning (Kozier et al, 2018).…”

“…The analysis noticed the presence of colored pictures combined with written texts (Burton & Ludwig, 2014; Kozier et al, 2018; Nugent & Vitale, 2014; Potter et al, 2013; Wilkinson & Van Leuven, 2016; Yoost & Crawford, 2019). That denotes that the words cannot explain the repositioning practice alone and so the photos were required (Moore et al, 2015).…”

“…Nevertheless, the evidence shows disagreements in defining repositioning either based on frequency (Jocelyn Chew et al, 2018), quality (Gunningberg et al, 2017), techniques (Weiner et al, 2017), or even the used term (Jocelyn Chew et al, 2018). However, it is used in combination with the term “turn,” such as “repositioning and turning” (Kozier et al, 2018) or “turning and repositioning” (White, 2011).…”