Alan Finnegan

The presentation of depression in the British Army

BACKGROUND The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. OBJECTIVES To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. METHOD AND PARTICIPANTS Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. RESULTS Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. CONCLUSION Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Mens Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice.

Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan study.

BACKGROUND This paper forms part of the first British Armed forces qualitative nursing research study undertaken on deployment. AIM To provide an analysis of the impact and effectiveness of the pre-deployment educational preparation and clinical placements provided for military nurses. THEORY & METHODS A Constructivist Grounded Theory was utilised with data collected through semi-structured interviews with 18 nurses based in Camp Bastion Hospital, Afghanistan during 2013. RESULTS Initial coding indicated 21 educational preparation and clinical placement categories that influenced the delivery of nursing care. Analysis of these elements led to the identification of four major clusters: Military Nursing Care; Military Nurse Education; Unique Hospital Environment and Clinical Placements. DISCUSSION Educational preparation consists of completing deployable operational nursing competencies, specialist training and individual tailored courses. This strategy was viewed as proving the appropriate academic requirement. However, training would be enhanced by introducing a formalised military preceptorship programme focussing on fundamental nursing skills. Caring for children was a particular concern, and it was emphasised that educational courses must be combined with a standardised clinical placement policy. Adequate clinical exposure can be challenging as nurses are not routinely exposed to War Zone levels of trauma in the UK. Clinical placements need to be standardised and harmonised, and located in areas where nurses cared for patients with similar injury patterns to those witnessed on deployment. Current NHS Trust placements can reduce the opportunities for employment in suitable clinical environments and diminishing the openings for collective military training. Better use should be made of clinical rotation programmes, including high dependency units, elective surgery, medical assessment units, paediatrics, and outreach teams such as burns and plastic surgery and pain management. Practice Educators should be utilised to provide education, mentorship, supervision and continuing personal development in the operational arena. The paper considers post-Afghanistan future options.

Educating nurses to provide better care for the military veteran and their families

Military Veterans and their families are a diverse heterogeneous group that differ by factors such as age, gender, and length of service. In many countries, they are embedded in the fabric of nearly every layer of society. On completion of a military career, many veterans transition to a civilian community in which they thrive. The majority use the personnel growth associated with military service to forge successful careers and use their experience for the benefit of humanity. However, others may experience difficulty reintegrating into civilian life, facing housing, education, training and employment challenges with higher unemployment rates for both men and women then the general population. In addition, many of these public servants witness horrendous events, including death to friends, colleagues and civilians of all ages including children. This may result in an operationally attributable Mental Health (MH) disorder including Post Traumatic Stress Disorder (PTSD). Therefore, assisting veterans to deal with MH challenges resulting from service to their respective country has gathered pace in recent years. This being a result of the extensive demands placed on military personnel and their families during the recent campaigns in Iraq (2003-2011) and Afghanistan (2001-1014). However, many Veterans are unwilling to disclose problems associated with their former military life, often believing that civilians including healthcare professionals do not understand military culture and therefore cannot appreciate their individuality.

Accelerated resolution therapy: an innovative mental health intervention to treat post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces’ fighting capability.

Effects of snake envenomation: a guide for emergency nurses

Only one species of venomous snake, the adder, is indigenous to the UK, but many people keep venomous snakes as pets and others travel to places, such as the United States, where a wider variety of venomous snakes can be found. Emergency nurses should therefore be prepared to treat bite wounds caused by venomous and non-venomous snakes. This article offers an overview of the most common forms of envenomation in the UK and makes recommendations for the clinical care of people who have sustained snake bites.

Assessing and Managing Spider and Scorpion Envenomation

Envenomation by spiders or scorpions is a public health problem in many parts of the world and is not isolated to the tropics and subtropics. Spiders and scorpions can be unintentionally transported globally, and keeping them as pets is becoming more popular, so envenomation can occur anywhere. Emergency nurses should be prepared to assess and treat patients who present with a bite or sting. This article gives an overview of the signs, symptoms and treatment of envenomation by species of arachnids that are clinically significant to humans.

Lyme disease: recognition and management for emergency nurses.

Over the past ten years there has been a significant rise in the number of people who present to emergency departments with Lyme disease. Although some patients remain asymptomatic many present with a rash around a previous tick bite and others may present with a range of debilitating symptoms that can be problematic if left untreated. Due to the growing prevalence of Lyme disease in the UK and the US this article gives an overview of the vector-borne condition and provides emergency nurses with information about the pathophysiology, prevention, presenting signs and symptoms and management.

Editorial. Nurse Education Today Veterans' Special Issue

One hundred years ago, the World War 1 battlefields of 1916 produced some of the bloodiest scenes ever witnessed in the history of warfare. Millions of troopswere injured or killedmaking the ultimate sacrifice for their countries in the battles of attrition at Verdun, the Somme or Gallipoli. There have been many advancements in military doctrine and strategy over the last century, plus a universal desire to avoid the total wars that disfigured the 20th century. However, some things remain constant, which for military nurses include facing lifethreatening scenarios and providing care, compassion and the highest quality of clinical practice to their patients whilst on deployment. These casualties include the troops, enemy forces, and the civilian population of all ages, many often presenting with serious polytrauma injuries. Such stressors are aligned to the other, less transparent disadvantages common to all military personnel, such as being separated from family and friends, and the constant upheaval ofmoving home every two to three years. It is an honour to have the opportunity to be the Guest Editor for this military veterans special issue. It coincides with my personal transition from leaving the British Army to finding new employment at the University of Chester, England and acquiring the status of veteran. I am fortunate that I leave the forces in good health, with minimal situational stressors such as financial or housing concerns, andwith a strong family and social network. I can attest that the benefits of a military career can be considerable, and this NET special edition provides an insight into the personal growth associated with a life in the armed forces, an environment where lifelong friendships are formed. Whilst acknowledging my good fortune, however, I recognise that many experience undesirable ramifications of their service, leaving the armed forces withmental health problems, social difficulties or physical ill health. The psychological effects of serving in a war zone have been re-evaluated since the terrorist attacks of 9/11 and the subsequent military campaigns in Iraq and Afghanistan. The spotlight upon them has resulted in public support, and a concerted effort to ensure that armed forces personnel are provided with the best possible treatment and are not penalised for their service. This effort is especially focused during the huge upheaval upon leaving the military. This issue provides evidence of truly original nursing research and innovative practice which reach out to the veteran population. Nurse educators are positive agents of changewho are championing constructive activity in relation to the prevention, detection and treatment of illness, and to the support of veterans to maximise their physical health