Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN, Chairperson; Denise M. Boren, PhD, RN; Linda D. Urden, DNSc, RN, CNA-BC, FAAN


Grounded theory, Humanitarian aid, nursing, Operation Unified Assistance, tsunami, USNS Mercy, United States Navy, women


On December 26, 2004, the most powerful earthquake in 40 years erupted under the Indian Ocean triggering a deadly tsunami that devastated 11 Asian and African countries and killed more than 280,000. The US Navy responded through Operation Unified Assistance (OUA). In a historic first on the hospital ship USNS MERCY, the U.S. Navy deployed one team with members from the Navy, the U.S Public Health Service, a non-government organization (NGO), and a civilian mariner crew to provide humanitarian aid. Despite these efforts, there is a dearth of scholarly research work published on nurses' experiences during the disaster. The purpose of this original study was to explain Navy nurses' preparation, practice, and collaboration aboard the USNS MERCY during OUA. The study's purpose was carried out through a grounded theory methodology. IRB approval was granted by the Naval Medical Center San Diego and the University of San Diego. A purposive convenience sample of Navy nurses was recruited through advertisements and word of mouth. Participants were Navy nurses who took part in OUA on the USNS MERCY. Sample size currently was 11. Interviews took place from July 2006 to October 2006. Data were collected from interviews, observations, field notes, memos, and a demographic tool. Data were categorized, coded, and compared to incoming data as is fundamental to grounded theory's constant comparative method. Data were analyzed using Strauss & Corbin's open coding, axial coding, and selective coding methods. Demographic data were analyzed through descriptive statistics. A theoretical model was developed to illustrate how Navy nurses experienced the readiness of Operation Unified Assistance through the roles they served and the relationships they encountered. Readiness was the overarching theme and was instrumental for the participants during their journey from packing their seabags, to steaming west, to engaging in humanitarian nursing. The participants' mindsets, knowledge, skill sets, and coping mechanisms contributed to their readiness. This readiness was significant in helping the participants overcome challenges and difficulties they faced during the phases of the mission. The participants recounted how they responded and reacted to roles as a Navy sailor, Navy nurse, Naval Officer, and Ambassador of the U.S. The participants also shed light on their relationships with others, highlighting how they communicated with patients and their families, translators, NGO nurses from Project Hope, and hospital corpsmen. Overall, the participants fondly recounted their readiness to meet the mission and accomplish tasks. To be prepared for future like missions, the participants recommended: current proficiency in transcultural medical-surgical nursing for patients and families of all ages; public health education skills; and primary care skills. Ultimately, a program of research in this area will involve an integration of both qualitative and quantitative studies, addressing the intersection of the needs of registered nurses and indigenous peoples alike. Future studies on moral distress, deployment coping mechanisms, and use of pediatric and mental health advance practice nurses to address nursing stressors unique to humanitarian missions.

Document Type

Dissertation: Open Access



Included in

Nursing Commons