Diane Padden

Stress, Coping, and Well-Being in Military Spouses During Deployment Separation

This study examined the relationships between stress, coping, general well-being, and sociodemographic characteristics using Lazarus and Folkman’s theory of stress and coping. A descriptive correlational design was used. The sample consisted of 105 female spouses of currently deployed active duty military members. Instruments included the Perceived Stress Scale, the Jalowiec Coping Scale, and the RAND-36. Perceived stress was the best predictor of both mental and physical well-being, accounting for 51.7% and 25.4% of the variance, respectively. Evasive and optimistic coping contributed an additional 1.9 % and 4.3%, respectively, to the variance in mental well-being. Differences in coping use were found among rank groups, those who grew up in a military family, and those with a previous deployment separation. Nurses are in an ideal position to identify military spouses at risk and provide education on effective coping behaviors shown to positively affect well-being during deployment separation.

Determinants of Health-Promoting Behaviors in Military Spouses During Deployment Separation

The purpose of this research was to describe predictors of participation in health-promoting behaviors among military spouses. A total of 105 female spouses of currently deployed active duty military members were surveyed to determine their perceived stress and participation in the health-promoting behaviors of exercise, diet, checkups, substance use/avoidance, social behaviors, stress management/rest, and safety/environmental behaviors. Demographic and deployment information was also collected. Regression analyses showed perceived stress was predictive of several health behaviors including exercise, social behaviors, stress management/rest, and safety/environmental behaviors. Increased perceived stress was associated with decreased participation in these behaviors. Deployment factors predicted only dietary behaviors and stress management/rest. As the minimum anticipated length of the deployment increased, healthy dietary behavior decreased. Likewise, as the number of deployments experienced increased, stress management and rest decreased. Stress brought on by military deployment may have detrimental effects upon participation in a health-promoting lifestyle.

Coping behaviors used by Army wives during deployment separation and their perceived effectiveness

Purpose: The purpose of this descriptive correlational study was to describe the coping behaviors used by Army wives during deployment separation, the perceived effectiveness of the coping behaviors used, and the correlation between the two variables. Data sources: A secondary analysis was conducted to examine coping use and perceived effectiveness, measured by the Jalowiec Coping Scale (JCS), in a sample of 102 Army wives surveyed during deployment separation. Conclusions: The most used coping subscales from the JCS were the optimistic and supportant and the most effective were the supportant and confrontive. The strongest correlations between coping use and effectiveness were found in the supportant subscale, which measures use of support systems (r= 0.77, p < .00), and the confrontive subscale, which includes behaviors of constructive problem solving (r= 0.62, p < .00). The use and effectiveness of individual behaviors are also identified. Implications for practice: Identifying effective and ineffective coping behaviors of spouses of deployed troops can potentially reduce stress and improve well‐being. Primary care providers should encourage military spouses to engage in optimistic thinking, seek out spiritual support, talk to others in a similar situation, and participate in physical activity. Disclosure The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Defense, or the United States government.

Self-assessment of trauma competencies among army family nurse practitioners.

The objective of this descriptive study was to determine whether Army family nurse practitioners perceive themselves as competent in providing trauma care. Using an adaptation of trauma competency outcomes from various trauma courses, all Army family nurse practitioners were asked to evaluate self-perceived level of trauma competence and self-perceived importance of trauma skills. Results (n = 96) indicate a general agreement that all skills identified in the questionnaire were important in the management of a trauma patient. The respondents considered themselves trained/somewhat competent or higher in 50% of the skills identified. Mann-Whitney U analysis was used to compare various groups within the sample. Significant differences on self-perceived competency were noted with intensive care/emergency room, Advanced Trauma Life Support, and deployment experience. Trauma Nursing Core Course experience was not significant to self-perceived trauma competency. Findings support the need for additional trauma training, such as Advanced Trauma Life Support and hands-on trauma experience.

A framework for guiding health literacy research in populations with universal access to healthcare.

At least one third of the US population suffers from limited health literacy, which has been linked to poorer health status, higher costs, and individuals who are socioeconomically disadvantaged. However, research and the development of theoretical frameworks to study health literacy have only recently begun to occur. The purpose of this article is to describe theoretical frameworks that have either been used or may be used to guide health literacy research and to identify implications for nursing research and practice related to an adaptation of a health literacy framework developed specifically for conducting research in populations with universal access to healthcare.

Mothers going to war: The role of nurse practitioners in the care of military mothers and families during deployment

Purpose: Many military women are being called to separate from their children to go to war. Most previous research has focused upon paternal, rather than, maternal, separation. The purpose of this article is to describe the experience of military mothers and their children during wartime deployments with clinical implications for nurse practitioners (NPs) in military or community settings. Data sources: Using grounded theory methods, 37 active duty and reserve component military women participated in a one‐time interview. Included were women who deployed for at least 4 months to Iraq or Afghanistan and had at least one child under the age of 12 during the separation. Conclusions: Military families present unique challenges for NPs. Mother deployments offer opportunities for intervention and anticipatory guidance across the trajectory of the separation. Military womens emotional and physical health must be supported before, during, and following deployment. Implications for practice: NPs are ideally positioned to support military families. During deployment, the NPs focus may shift to care of the children and their caregiver. Before and at reintegration, NPs are in a key position to intervene early for posttraumatic stress and support family readjustment.

Factors influencing a health promoting lifestyle in spouses of active duty military.

The purpose of this study was to understand the factors influencing the health promoting behaviors (HPBs) of military spouses. Penders Health Promotion Model provided the theoretical framework guiding this study. One hundred twelve female spouses were surveyed regarding their perceived health status, perceived stress, self-efficacy, social support, and participation in HPBs. Perceived health status, self-efficacy, social support, and HPBs were positively related, whereas perceived stress was negatively related. Hierarchical multiple regression analysis showed perceived stress and social support to be predictive of an overall health promoting lifestyle (HPLPII), with the full model explaining 49.7% of the variance.

Caring for military spouses in primary care.

Purpose To provide primary care providers with knowledge of unique challenges faced by military families. By understanding how military families cope with military lifestyle and deployment, providers can be more effective in their care of these patients and offer assistance in optimizing their health. Data sources Research articles, World Wide Web search of resources for military families and Department of Defense documents. Conclusions Military families are faced with many challenges and hardships such as frequent geographic relocations, social isolation, periodic deployments and separations, and risk of injury and death. Unique stressors associated with deployment include assumption of single parent role, altered finances, change in social support from family and friends, and concerns for the safety of the service member. Ineffective coping with stressors can manifest both physically and/or psychologically. Implications for practice Healthcare providers should routinely inquire about a patients possible military affiliation. Military spouses need to be assessed for current stress levels and coping behaviors used in order to provide the most appropriate recommendations and referrals. As healthcare providers, understanding the unique demands of the military lifestyle is necessary to provide effective quality care with optimal health outcomes in this population.

Moderators of access and utilization of clinical preventive services in older adults

AIM This paper reports a study exploring the relationships between potential moderators of access and utilization of clinical preventive services in a homogeneous sample of older adults with near universal health coverage. BACKGROUND Advancements have occurred in eliminating financial and structural barriers to utilization of clinical preventive services (primary, secondary and tertiary prevention) in most developed countries, but variations in utilization continue. These variations may be attributed to non-social determinants of health moderators that impact utilization in older adults. METHODS Theorized relationships were explored using questions from the United States Behavioral Risk Factor Surveillance System Survey and a homogenous convenience sample of 202 older adults (mean age 84; sd 5·23) with near universal health coverage. Data collected across a 2 year period (2007-2009) were analysed using Chi-square, Mann-Whitney U and Hierarchical Logistic Regression. FINDINGS Several logistic regression models of personal access (advised to lose weight, high blood pressure, high cholesterol); moderators (gender, perceived health status, BMI ≥ 30 kg/m(2)); and clinical preventive services utilization (check-up in last 12 months; ever had colonoscopy/sigmoidoscopy) showed statistically significant (P < 0·05) improvement in model fit by adding interaction terms (access X moderator). CONCLUSION Exploring the impact of moderators on utilization may yield more insight into variations than could be explained by measurement of the direct affect of having near universal health coverage alone.

Health Literacy Rates in a Sample of Active Duty Military Personnel

The results reported in this article are from a larger descriptive study examining the health literacy rates in active duty military personnel receiving health care within a culture of universal access. The purpose of this article is to describe the health literacy skills among a sample of active duty military personnel with comparison to the national population. Data were collected using the shortened version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM) in a convenience sample of 155 active duty subjects at a major military hospital from January 2007 through May 2007. Results indicate that military personnel have adequate health literacy skills although variations were noted on the basis of health training and race/ethnicity. Although the S-TOFHLA was found to be a practical tool for assessing health literacy in a high-tempo health care setting, additional reliability and validity testing is needed.