Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Joseph F. Burkard, DNSc, CRNA, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN, CDR; Dennis L. Spence, PhD, CRNA, NC, USN


Anesthesia, Combat exposure, mental health, nursing, Preoperative Stress, United States Military


Since September 11, 2001, the United States has been engaged in large-scale combat operations exposing numerous military service members to stressful, traumatic, and threatening environments. As a result, many of these individuals have experienced significant psychological problems, such as anxiety, depression, and posttraumatic stress disorder (PTSD), as well as physiological alterations, such as cardiovascular changes and neuroendocrine disturbances. The preoperative experience may be perceived as stressful, often increasing in magnitude as the patient progresses through the preoperative period. Military anesthesia providers frequently provide anesthetic care to military members with a history of combat exposure. Anecdotally, it is not uncommon for this patient population to require a more "heavy-handed" anesthetic regimen, potentially resulting in increased side effects or prolonged recovery. An enormous gap exists in knowledge related to the preoperative stress response, especially in military members with a history of combat exposure. Therefore, the purpose of this study was to determine predictive relationships between the number of combat experiences and the preoperative stress response in U.S. military personnel on the day of surgery. This prospective, descriptive study was conducted at Naval Hospital Camp Pendleton, enrolling active duty men and women undergoing elective surgery. One to 14 days prior to surgery, anxiety, depression, and PTSD symptoms were assessed. In addition, participants reporting a prior military deployment having received combat-related pay completed a U.S. Army-developed combat exposure scale. On the day of surgery, the preoperative psychological and physiological stress response was measured using the Visual Analogue Scale for Stress, Multiple Affect Adjective Checklist-Revised, and salivary alpha-amylase. This may be the first investigation to determine predictive relationships between varying degrees of combat exposure and the preoperative stress response in military personnel on the day of surgery.

Document Type

Dissertation: Open Access



Included in

Nursing Commons