Ethical decision-making of military nurses during war and humanitarian crises

Background The unfamiliar situations and complex environments encountered in evolving combat and humanitarian operations, combined with advances in practice, means that deployed military nurses are increasingly likely to become more involved in, or lead, ethical decision-making in military treatment facilities. Aim How do United Kingdom military nurses experience ethical decision-making on combat and humanitarian deployments? Question: What are the experiences of military nurses regarding ethical decision-making during war or humanitarian crisis? Design A qualitative, interpretive, ‘Big Q’ design analysed through reflexive thematic analysis was used. Participants Thirty United Kingdom military nurses with operational experience in combat or humanitarian missions, serving or retired, were purposively recruited. Ethics Ethical approval was obtained from both the Ministry of Defence Research Ethics Committee (1009/MODREC/19) and the University of Birmingham Research Ethics Committee (ERN_17-1414). All participants gave informed consent and interviews were anonymised. Results Two themes were developed: ‘Doing the Right Thing’, with one sub theme ‘Professional Codes and Guidelines as Ethical Handrails’, and ‘The Deployed Context’. Conclusion The findings show how military nurses try and do the ethically right thing, but situational constraints are, perhaps, significantly different to non-military nursing making ethical decision-making especially complex. Relatedly, military nurses’ attempts to manage the prioritisation of their sometimes-conflicting identities of being both a healthcare professional and military professional compound this complexity.