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Experiences of Australian Army theatre nurses - Statistical Data Included

AORN Journal, Feb, 2002 by Narelle Biedermann

Today, as nurses focus on the future to find new ways of nursing to meet the demands ahead, it is important to reflect on the past. This article describes the role of Australian Army theatre nurses (ie, perioperative nurses) in the Vietnam War. It is based on information collected during a study of the experiences of Australian Army nurses who served in the Australian military hospital in Vung Tau, Vietnam, between 1967 and 1971. (1) Forty-three Australian Army nurses served in Vietnam. This article incorporates the experiences of five of these women who spent up to 12 months working as theatre nurses during one of Australia's most controversial wars.

PRINCIPLES OF THEATRE NURSING IN VIETNAM

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The treatment of wounded soldiers in operating theatres in the Australian military hospital was, as in any hospital, one event in a chain of several. Before a wounded soldier arrived for surgical intervention, he already had been through evacuation, triage, and initial treatment--a process that often took as little as 30 minutes. In Vietnam, medical evacuation helicopters were used for their speed and agility to evacuate sick and wounded soldiers virtually from the site where they were wounded. Before the helicopter arrived, basic treatment had already begun and would continue in the air.

On arrival at the military hospital, a team of stretcher bearers met wounded soldiers on the helicopter pad. The soldiers then were taken to the triage area, where each was examined by medical or nursing staff members and categorized according to wound severity, the number of other casualties in the triage area at that time, and available resources. This meant that the extent of a soldier's wounds often was not known until he was in the operating theatre.

For many of the five years during which Australian Army nurses were in Vietnam, the Australian military hospital had two functioning operating theatres; the larger served as the main theatre for extensive procedures, and the smaller served as a backup or for procedures that required minimal space or resources. Generally, only one nurse was assigned to the theatre department. This nurse played an important role in the transition of casualties from triage to theatre. She normally would spend the first few minutes in triage with the triage officer to gauge which patients would be sent to the theatre first. After that was ascertained, she would enter the theatre and allocate medical assistants to the two theatres, informing them of the incoming surgical procedures. By the time the theatre was ready to receive the casualties, IV access had been established, and patients usually had been washed or, at the very least, some attempt had been made to irrigate their wounds.

DATA COLLECTION AND FINDINGS

Historical research methodology was used to guide this study. Knowledge of the roots of nursing has the capacity to put nursing theories and practices into an appropriate context, particularly at this time, when Australian nurses are working to define and extend their professional roles. Using oral history as the primary data collection tool, this study investigated the nature of nursing work in the Vietnam War by using the voices of 17 of the Australian Army nurses who served in either the 8th Field Ambulance or 1st Australian Field Hospital in Vung Tau. Additionally, written documents, such as reports and correspondence, were used to support or contradict data gained from the oral history interviews. Ethical clearance was sought and gained from the James Cook University Human Ethics Committee and the Australian Defence Medical Ethics Committee.

As previously mentioned, five of the nurses who participated in this study worked primarily in theatre. These women came from a variety of nursing backgrounds before joining the Australian Army and being sent to Vietnam, although most of the five had spent some time as theatre nurses before assuming the role of charge nurse in the Australian military hospital theatres in Vietnam. Their accounts collectively offer a picture of theatre nursing in the Australian military hospital in Vung Tau. Their stories, though unique in many ways, share common elements of sacrifice, humor, fear, professionalism, stress, and role conflict.

THEATRE EXPERIENCES-1967

When the first four Australian Army nurses arrived in Vietnam, the military hospital had been functioning for two years as a 60-bed hospital housed in tents and galvanized iron huts. The hospital was set up to treat two major injuries and eight minor injuries in triage and perform one major and as many as two minor surgical procedures in the operating theatre simultaneously. Often, casualties that required surgical intervention were sent to the 36th Evacuation Hospital located nearby, or they were flown back to Australia.

During 1967, a variety of surgical procedures from trauma procedures (eg, bowel resections and repairs, amputations, cranial surgery) to simple surgical procedures (eg, appendectomies) were performed in the theatres. Contrary to traditional theatre practices, surgeons in Vietnam discovered that most wounds, apart from cranial, facial, and hand wounds, responded better to delayed closure. This allowed necessary wound drainage to occur more readily, ultimately reducing infection rates.

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Experiences of Australian Army theatre nurses - Statistical Data Included

AORN Journal, Feb, 2002 by Narelle Biedermann

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