Marissa Cence, age 26, presents to the ED with chest pain and pressure. (This patient is a composite of several cases we've encountered in our practice.) She was driven to the ED by a neighbor who's now in the waiting room with the patient's two young children. Ms. Cence is tachycardic and diaphoretic. She expresses concern that, if she's admitted, she knows of no one who can care for her children. She begins to cry. The intake nurse schedules Ms. Cence for a thorough cardiac workup, starting with an electrocardiogram within 10 minutes, two 81-mg aspirin tablets by mouth, supine patient positioning, sublingual nitroglycerin 0.4 mg (1/150 grain) for vasodilation and pain relief, oxygen at 4 to 6 L per minute by nasal cannula, pulse oximetry, immediate portable chest X-ray, IV access with a saline lock, and cardiac panel laboratory studies. The intake interview reveals that Ms. Cence's husband Greg, a 10-year member of the National Guard, was recently deployed to Afghanistan, having returned from a tour in Iraq only two years ago. The family has dealt with deployment previously, and the military has provided them with information on family separation issues, but Ms. Cence still finds herself struggling with everyday activities and has become increasingly obsessed with TV coverage of the Afghanistan conflict. Her current chest pain started shortly after she heard a TV report that fighting had intensified near the area in which her husband is stationed. Ms. Cence's situation isn't unusual. In a study of 798 spouses of active duty military personnel, deployment was found to have a markedly negative effect on health and well-being, with spouses reporting loneliness, anxiety, and depression in 78.2%, 51.6%, and 42.6% of all cases, respectively.1 Families of National Guard and reserve members face additional challenges. Unlike active duty military families, who live on or near a military base, families of guardsmen and reservists tend to live within the civilian community and are often unaware of supportive and preventive services available to them through the military.2 When problems arise, they may delay seeking care, presenting initially to an ED. Would you be able to provide a military spouse like Ms. Cence with the information she needs to access available resources that could help her address the issues creating stress in her life and, possibly, contributing to her current health concerns? How would you proceed if her evaluation showed her to be facing a true medical emergency? Given the number of guardsmen and reservists currently deployed in Afghanistan and Iraq, it's vital for civilian nurses to know how to address the needs of military families residing within the community. This article underscores the most important aspects of nursing assessment and care of the families stressed by military deployment.
U02/2016