2015-02-24

Introduction

The United States military dependants’ that are stationed in rural South Korea ability to understand medical care, may face unique challenges regarding the ability to access timely emergency care compared to urban individuals. Whitney et al. (2010) describes the challenges to be geographical and focuses on access to certain established medical care. Furthermore, individuals must have an established medical knowledge base concerning when he or she must access medical care. In addition, military beneficiaries give up a level of comfort when they choose to live outside of the United States. The ranking of world health systems describes that the United States ranks 37th in health care compared to South Korea at 58th (World Health Organization [WHO], 2011). Furthermore, the communities within South Korea that house military dependants are located 30-60 minutes from established American Military and South Korean emergency rooms or after hour health clinics located on the military bases. Subsequently, unique to Korea is that all military bases have an operating after-hour clinic that serves all military beneficiaries. Furthermore, the after hour-care clinics are operated with medical staff that can stabilize, treat, and transport patients to the nearest military American medical treatment facility or South Korean Hospital.

Background of the Problem

The individuals’ ability to decide when he or she will access medical care is based on symptoms, seriousness of the condition, and deciding that the emergency room is the most appropriate place to seek care (Padget & Brodsky, 1992). Furthermore, medical access for rural healthcare individuals may be challenging depending on the geographical locations. Subsequently, rural military families must have a predetermined knowledge base to aid in his or her ability to access the correct medical facility, while stationed in a rural military South Korean community.

Moreover, factors exist on military bases overseas that include types of medical services military facilities can provide, medical provider’s expertise, and access to specialty medical care. More specifically, the factors previously discussed may include medical knowledge decisions based the types of medical providers available

in South Korea, types of services available, and cost of these medical services. As discussed by Callahan and Zimring (2011), the military has provided military hospital facilities in countries like South Korea since 1959. The number of family members allowed to accompany his or her spouse is based on the number of command sponsored slots available. There is about 1000 authorized command sponsored slots according to the Command Sponsorship Program (CSP) allocation matrix for military Army military in Camp Humphreys that is the base near Pyeongtaek, South Korea (United States Forces Korea [USFK] Regulation, 614-1, 2010). Furthermore, individuals may have preconceived expectations regarding the standard of care he or she will receive compared to other duty stations where health care facilities are more established compared to South Korea.

As noted by Choi, Hong, Lee, Jung, and Kim (2007), the inception of the Korean Emergency Medical Society establishment in 1989 that allowed the ability to establish standards and regulations regarding emergency medical services (EMS) in South Korea. The relevance of this South Korean medical EMS system is the need to access this service when individuals are faced with a perceived medical emergency; in addition, the emergency medical technician is only responsible for basic life support. (Choi et al, 2007). Conversely, the EMS system in the United States was established in the 1970’s and the military and non-military dependants arriving from the United States are accustomed to a higher level of care when accessing emergency medical services (Wingrove & Reinert, 2009). Furthermore, the study and research being conducted will better understand perceptions and lived experiences as it relates to emergency medical knowledge of military dependents stationed in rural areas of South Korea.

The ability for individuals’ to have access to healthcare is a topic that must be sought with perseverance as it relates to the individuals understanding of the decision making process regarding where to seek medical care. Consequently, if the access is not provided to certain individuals with certain non-emergent or emergent medical conditions in a timely manner, he or she may suffer serious life threatening medical conditions. As noted by Fournier, Dumont, Tourigny, Dunkley, and Dramé (2009), in regard to the topic of obstetric emergencies, the overall rate of mortality and serious complications were reduced due to patients receiving early referral to more definitive care. The ability for the health care community continually to ensure where patients are supposed to go in case of certain emergencies is paramount in ensuring the patient gets the earliest and highest quality of care. For example, urban communities may have an advantage solely based on ease of transportation and facility access. Consequently, it is crucial that the communities and individuals located in rural environments understand all of their options in regard to the best quality of medical care access available to them. As discussed by Lucke et al. (2008), “many older carriers in both rural and urban areas do not access health and community services even when appropriate services are available” (p.1) The ability to study the topic of access to healthcare for individuals in the rural communities, will possibly discover the reasons why certain individuals are not using the services that are available.

Statement of the Problem

The problem is that military dependants residing in and around Camp Humphreys, South Korea use the closest medical resources available to take care of their acute and urgent medical conditions while living on and or off base in South Korea. As a result, this contributes to unqualified staff to treat serious medical patients that results in a delay in medical treatment. In addition, medical providers working at medical facilities on military bases in South Korea are subjected to malpractice risk when serious medical patients present to these medical facilities with possess limited resources to care patients with serious medical ailments. Furthermore, a delay in medical treatment may result in increased pain and suffering for the military dependants presenting to a medical facility that is unequipped to care for their needs.

As noted by Shen and Hsia (2012), a worse geographical access to emergency care is a contributing factor in delaying care for acute medical conditions and must result in a realignment of health care resources. “Among patients in communities with >30-minute increases in driving time, we find a substantial increase in long-term mortality rates, a shift to younger ages (suggesting that older patients die en route), and a higher probability of immediate percutaneous transluminal coronary angioplasty (PTCA) “ (p. 1). Consequently, the decision to choose to access a health care facility for mere convenience with limited resources may impact and delay the treatment needed for serious medical ailments. As discussed by Hjelmblink, Holmström and Kjeldmand (2010), patients that suffer from a stroke must not delay treatment and must access emergency care with a stroke treatment center within 3 hours to receive the fibrinoloyis treatment. The delay in medical treatment for stroke patients leads to a threatened loss of control bodily functions and autonomy (Hjelmblink, Holmström & Kjeldmand, 2010). In addition, unexpected complications due to pregnancy can result in immediate emergency care conducted by experienced medical personnel (Kadri, 2010). The military dependant while living on or off a military base in South Korea should have an understanding of what constitutes a medical emergency and the medical resources available that will best care for his or her emergent medical needs.

The quality of emergency medical care given at an emergency room is much higher than urgent care clinics, after-hour clincs, or primary care clinics. As discussed by Green and McIntyre (2011) critically ill patients are common to the emergency room and require expertise to maximize outcomes. The military installation at Camp

Humphreys does have medical facilities available to treat military dependants for life threatening injuries and does not have an accredited emergency room. However, the South Korean medical system does have established emergency rooms that were recognized by the Korean Emergency Medical Society in 1989 and currently have emergency medicine as an established specialty for physicians since 1996 (Sung-Hyuk, Yun-Sik, Sung-Woo, In-Chul & Chul-Su, 2007). The ability to access high quality care in an established emergency may impact the pain and suffering a military dependant may endure.

The overuse of emergency room care, results in an increased cost associated with emergency department medical care and continues to increase at an alarming rate. Individuals continue to access emergency room care for non-emergent medical conditions that results in rising medical costs associated with healthcare (McGuigan

& Watson 2010). As noted by (McGuigan and Watson (2010), describes the reasons for obtaining care at to include: 1) the perceptions that they had a serious medical condition 2) located near an ER 3) advised by family members to go to the ER and 4) no primary care managers or regular healthcare provider. Individuals seeking medical care for perceived emergent medical conditions will continue to remain problematic as it relates to the depletion of medical resources to care for patients that have real emergent medical conditions. As discussed by Claver (2011), patients with nonemergent issues remain in the emergency rooms over four hours for chronic medical conditions that results in a mismatch with need and services provided to individuals.

A phenomenological qualitative study will be used to study the military dependents perceptions and experiences involved in the decision making process and the quality of care received, as it relates to seeking emergent medical care while living on or off a military base in South Korea. The population will include military dependents deployed with his or her spouse in South Korea that seek emergent

medical care at Army military health facilities and local established Korean hospitals. The military dependants experiences and perceptions will be analyzed to determine if like themes exist to establish a comprehensive description if the experience.

Purpose of the Study

The purpose of the this qualitative phenomenological study is to identify the perceptions and experiences of military dependants understanding related to what constitutes a medical emergency to better understand how they determine when to seek emergent medical care while living on or off a military base in South Korea. The study will identify the experiences and perceptions of military dependants in regard to their ability to access emergency medical care and the quality of medical care they receive. Furthermore, the study will explain military dependants’ perceptions and experiences of the medical support provided of military dependants and the medical resources available to take care of emergencies while living on or off a military base in South Korea. This phenomenological study is an appropriate method to analyze, describe, and understand the experiences and perceptions of military dependants. The sample will consist of 12 or more military dependents until data saturation occurs.

Significance of the Study

The ability to gather data as it relates to access of medical care for rural military dependants living in South Korea will potentially affect the overall ability for the research to identify methofactors and concepts related deficiencies in the rural access process. Furthermore, the ability to conduct research in this current geographical location within South Korea will give the research community a comprehensive few of the similarities and differences that exist. Subsequently, the research will allow the research to interface with the community and build a caring relationship with the customer and identify issues and recommendations that exist in certain areas. The research available about this topic has been studied and certain communities and individuals have been studied regarding access to medical care. However, healthcare access continues to be a major issue in regard to making sure all patients are aware of certain medical conditions and these medical conditions are identified as early as possible. In addition, healthcare providers can provide the necessary education and resources in a timely manner to improve survivability, which will increase overall mortality in regard to the number serious and chronic illnesses, which can be identified and referred early on in the progression of the disease process.

The research for this paper will provide further insight and identify what can be done to improve medical care access to military dependants living in South Korea and other similar military communities, whom may not have the resources available to them as their urban counterparts. The ability to conduct a study about military dependants perception of what constitutes a medical emergency while stationed in South Korea will provide a global picture of issues and concerns with access to medical care. The information gathered from this data will provide insight for all healthcare professionals, to ensure they are doing their part in their geographical area of operation. The number one goal in patient care is to ensure our patient’s are educated and understand on where he or she need to go in case individuals have questions in regard to his or her healthcare. As result, knowledge is power, which results in them going to a healthcare facility earlier than later to receive the definitive treatment and medical care.

Significance of the study to leadership

Leaders and medical providers must ensure he or she provides medical expertise and insight and to continue to development initiatives that will provide improvement of access to medical care. As discussed by Yukl (2010), change is guided by the top management team and any member of an organization can initiate change that may contribute to success. In addition, these initiatives will further benefit the customer and build on the goal of providing the highest quality of care to the customer. In addition, medical providers need to continue to be the leaders and educators within his or her communities. As discussed by Choi et al. (2007) South Korea has experienced multiple disasters in the 1990s that spurred the development of the Korean emergency medical response improvements. The ability to conduct this research will build on communication and the development of relationships between medical providers located in different global locations and customers. Finally, the research will provide certain healthcare organizations and key leadership another valid research tool to incorporate the necessary guidelines and recommendations necessary to provide the highest quality of care to the customer. As noted by Longest, Darer &Rakich (2000), transformational leaders focus on the development of new strategies or implement updated strategies from preexisting ones. The health care community leadership must have the ability to adapt and advocate new information and data as it supports the need to provide a service the customer desires. As discussed by Yukl (2010) describes a leaders success as it relates to ensuring stakeholders are involved in certain key areas of the organization.

Nature of the Study

This phenomenological qualitative study will interview 12 individuals or more that are military dependants living in South Korea stationed with his or her spouse. This phenomenological qualitative study is an appropriate method to analyze and determine if themes and codes to substantiate further the research in the ability to access medical care for this particular group of individuals. In addition, the interview process will develop themes directly related to deficiencies and strengths in the current health care facilities, leaders, and communities as it relates to these individuals making an accurate and assessment to seek timely emergency care.

Overview of the research method

The ability to use a qualitative research method in this study allows the researcher to ask a series of broad and general questions to the participants to establish a subjective and biased view of the data (Creswell, 2009). As discussed by Creswell (2009), an essential component to qualitative research is the ability to explore and understand the participant’s experiences. Furthermore, qualitative research will allow the researcher to describe, observe, and interpret the interaction of the participant in a natural setting that relates directly to the diverse social settings that

exist in the military and nonmilitary individuals living in South Korea. The Phenomenological method allows the researcher to collect data using induction and descriptive techniques. As noted by Flood (2010), “the researcher’s task is to analyze the intentional experiences of the consciousness to perceive how the meaning of a phenomenon is given meaning and to arrive at its essence” (p.5). As noted by Moustakes (1994), the ability for the researcher to provide a topic of discussion that is of both personal interest and has social relevance.

Overview of the design appropriateness

The phenomenological research design will allow the researcher to gain insight and understanding regarding the lived experiences of military and non-military dependants living in South Korean military communities. As noted by Moustakes (1994), the ability to formulate and expand on the concept of induction and it relates to personal experience that may provide insight and relevance to a topic of interest. Furthermore, the interview of 12 participants or more will allow the data to be analyzed to determine the identification to like perceptions in regard to the medical knowledge. In addition, the ability to interview participants in a social setting in South Korea will allow the research to observe, describe, and interpret the data to capture common minor and major themes to further substantiate the research.

Research Questions

The current study attempted to ask questions that will provide insight to the perceptions of medical knowledge when military dependants are faced with the decision process when he or she is faced with emergency situations while stationed in South Korea. In addition, the ability to discuss perceptions gives a non-bias approach. The questions address the potential answers related to what the respondents have learned prior to arrival and after adapting to life in South Korea after six months. The research questions will attempt to gain insight in regard to perceptions and shared experiences for military dependants as it relates to the decision process when they seek emergency care while living on or off post in South Korea. The ability to understand the diversity in regard to medical knowledge that exists in the South Korean military community may provide insight in regard to the decision making process for individuals faced with this scenario. The research questions address the ability for the leadership to identify possible gaps in information given to military dependents living in military communities in South Korea.

Research Question 1: What are the perceptions and experiences of military dependants’ regarding their ability to access emergency care while living on or off a military base in South Korea?

Research Question 2: What are the perceptions and experiences of military dependants’ regarding the quality of medical care received during an emergency or serious medical condition while living on or off a military base in South Korea?

Research Question 3: What are the perceptions and experiences of military dependants’ regarding the support received when seeking emergency medical care while living on or off a military base in South Korea?

Research Question 4: What are the perceptions and experiences of military dependants’ regarding their knowledge of the medical resources available to take care of emergencies while living on or off a military base in South Korea?

The analysis of the perceptions and experiences and concerns directly related to the seeking emergency care may provide commonalities. Furthermore, data can be collected to identify gaps in informational knowledge from individuals in regard to its relationship to the identification of emergent medical conditions requiring immediate referral and access. The research questions address the current systems in place and may provide insight and understanding that can be put in place to ensure each individual is aware or transport times and the need for immediate referrals in certain situations. In addition, a correlation and benefit may be achieved by the explaining the perceptions and experiences military dependants may have living in South Korea when seeking emergency care.

Theoretical Framework

The ability to explore the perceptions and lived experience of individuals is the cornerstone of Phenomenological research. It is one of the oldest research methods tracing its origin back to Edmund Husserl, who was a philosopher

(Moustakas, 1994). His perspectives have been adapted and adjusted into what is now referred to as phenomenology. As discussed by Moustakas (1994), the ability to return to the experience that can provide a comprehensive description and reflect on the experience of the individual. Furthermore, the ability to engage the individuals

and ask questions related to the experience may provide insight into the topic. As noted by Finley (2009), the ability of the researcher to look at the experience through reduction and to look afresh ensuring he or she suspends judgments and theories. In addition, the ability to understand the situation for the research may take a fluid and

creative approach to engage the researcher into the process (Finely). Moreover, the ability for the researcher to engage his or her passion about the subject provides motivation for the researcher. As noted by Mortari (2008) describes the ability to acquire a detailed consciousness description of the phenomenon. Mortari (2008) stated “starting from this ontological assumption, phenomenology is claimed to be the science of phenomena that is of “what appears as such” (p.2). As discussed by Chenaill (2011) qualitative research allows the researcher to discover new information and learn from the experiences of others. Furthermore, one of the main goals of phenomenology is the ability to reduce individual experiences with the situation or phenomenon (Creswell, 2009).

The ability to understand the lived experiences and perceptions of individuals is an essential way to understand the potential different experiences during a lifetime each person has encountered. As a result, it can provide a collaborative picture of experiences and behaviors of individuals that experience these phenomena. As discussed by Dickerson (2010), the ability to understand Epistemology as it relates that persons, problems, and changes that may occur that are unique that that individual. Furthermore, the ability to take those individuals perceptions and place that information into context may provide insight.

Hermeneutics also entails the ability to focus of the consciousness and the experiences of the participants (Moustakas, 1994). As noted by Moustakas (1994), the correct interpretation of the text unravels the real meaning behind the moral phenomena. Furthermore, the experience of that interview and experience must ensure the text and experience is fully understood.

The objective of this study is to understand and identify the gaps in knowledge in regard to individual’s ability to understand the complexity of healthcare access in rural communities and when and how to use certain referral bases healthcare. The ability to look at this specific geographical location will ensure that this group experiences and perceptions identify ideas that may provide research and information gained through perspectives and knowledge base in regard access to medical care. The research conducted in this study will add to the concepts and research already identified and researched in other communities. For example, the ability for authors to study a specific topic as it relates to obstetric emergencies and how it relates to referral and access to care (Fournier et al., 2008).

Definition of terms

The following operational terms listed below are relevant to the development of theoretical content of the current study.
Rural: A geographical area that has a population that is directly related to the land mass. The National Health Service in the United Kingdom defines rural as greater than 5km from any physician service. As described by Whitney et al. (2010) rural can encompass factors to include: population density, distance from specific services, available transportation, and seasonal changes that may affect availability to care.

After Hour Clinic: A health care facility that provides urgent and routine care through the use of medical personnel on shift and on-call healthcare provider. As noted by Gould (2009) describes an After Hour Clinic that provide a service related to primary care and medical treatment of various medical ailments.
Basic Life Support: The ability for a medical person to perform skills necessary to recognize and assist individuals that are suffering from cardiopulmonary complications (Page & Cash, 2011).
Command Sponsorship: The ability for the active duty military family member to reside in an overseas assignment and receive the appropriate benefits that include medical, housing, and other mandated benefits (AR 614-1, 2010).
Non-Command Sponsorship: The active duty military family member’s ability to reside in an overseas assignment and not receive the appropriate benefits that include limited off-base medical care and space-available educational benefits (AR 614-1, 2010).

Assumption

Multiple assumptions will contribute to the potential outcome of the qualitative phenomenological study. The participants when asked during the interview process will answer the questions honestly and straightforward based on his or her experiences. In addition, the sample population incorporates a diverse group of participants that will be interviewed. Furthermore, the interviewer will not recruit participants in a way to bias the qualitative study. In addition, the study group will incorporate a set of inclusion criteria to further allow the development of like individuals to allow for the development of minor and major themes to further substantiate the phenomenological study.

Scope and Limitations

As discussed by Creswell (2009) limitations are potential weaknesses that may be identified in the study by the researcher. The limitations of this phenomenological study are discussed in the following information. The ability to only capture a small number of participants in the study directed affiliated with the military dependants living in South Korea during the time of the current study. As a result, this only represents a narrow view of the information within this participants’ geographical location that may not be accurate in other areas in South Korea. Solicitation of

participants will conducted on a military and off military establishments. In addition, the time needed to conduct the interview is limited due to the transition of these members to different duty locations.

Delimitations

Twelve participants that consisted of military dependants living in South Korea were directly interviewed and the interview was audio taped. The interview questions were limited to medical knowledge associated with factors affecting participants concerns regarding lived experiences in South Korea. The ability to interview a wider range of participants would have been too problematic and potentially resulted in a bias and conflict of interest. In addition, the geographical diverse locations resulted in difficulties with personal interview follow-up.

Summary

Military dependants living in South Korea represent a growing population in regard the ability for active duty soldier’s to complete tour normalization with his or her family members. As a result, the ability to conduct research to study these participants medical knowledge, may lead to the development of medical information and resources available at military and non-military installations. Furthermore, information is lacking regarding the obstacles and gaps identified for military dependants faced with uncertain medical decisions when he or she chooses to live abroad in South Korea. The researcher will conduct 12 interviews using open-ended questions to explore the lived experiences of the participants. The research information will be synthesized to determine the themes and relevance. A complex and in depth review of the literature in Chapter 2 will allow the researcher to substantiate the findings and the need to build this phenomenological study. The literature builds on topics to include: military overseas healthcare, availability of emergency services in South Korea, military dependant’s role in the military, and obstacles facing military families. The review will offer insight into the ability to identify the complex nature of decision processes faced by the participants regarding his or her experiences when seeking emergency care while living on or off a military base while stationed in South Korea.

Method

The description of lived experiences and perceptions of military dependents as it relates to the perception of a medical emergency while living in South Korea is the foundation of this current study. The purpose of the this phenomenological study is to identify in military dependants, the lived experiences and knowledge that exists in what constitutes a medical emergency, key areas of delinquencies, gaps in information knowledge to better understand how he or she determine when to seek emergent medical care. This phenomenological qualitative study is an appropriate method to analyze and describe and understand the lived experiences the above individuals. The sample will consist of 12 military dependents. Furthermore, the phenomenological qualitative study will develop themes directly related to deficiencies and strengths in the current health care facilities, leaders, and communication as it relates to these individuals.

The examination of the perceptions and lived experiences of the military dependents living in South Korea may provide useful to data from expectations provided during the interview of the participant. In addition, the data may provide an enhanced planning strategy as it relates to measures that can be incorporated for military dependents to better understand medical emergencies in his or her current environment. The research utilized an interview methodology to provide a phenomenological study that described the lived experiences and perceptions of medical emergencies of the military dependents living in South Korea.

This Chapter 3 contains a description of the design and the appropriateness of the design in the current study. The research question and the population in current study are described and explained. In addition, the informed consent process as it relates to confidentiality of the participant is explained. In addition, the sampling frame, instrumentation and geographical data collection and analysis will be described.

Design

Qualitative Phenomenological design “In phenomenology, perception is regarded as the primary source of knowledge, the source that cannot be doubted” (Moustakas, 1994, pg.52). As discussed by Moustakas (1994), the relationships between perceptions and horizontalization as it relates to the importance of the experience. The ability to understand that individual beneficiaries seeking care medical care and living in South Korea have certain established perceptions about his or her experience. As a result, the ability to capture these perceptions and experiences may be instrumental in the development of the current research. Furthermore, the ability to understand the subjects view will allow the research the possibility for a new view and understanding (Haggman-Laitila, 1999).

The qualitative design approach facilitates the researches ability to understand the perceptions and lived experiences of military dependants living in South Korea as it relates to his or her understanding of a medical emergency. As explained by Mapp (2008) a goal of phenomenology is to understand the experience through individuals that have gone through the experience. The ability to use qualitative research allows the research to be conducted in a natural setting that allows the participant to have face-to-face interaction with the researcher. As noted by Creswell (2009), qualitative research as the ability of the inquirer to use open-ended questions and interviews to examine an issue. As noted by Moustakas (1994), Phenomenological Reduction as it relates the ability for the individual to have self-awareness and self-reflection through his or her own experiences. The ability to engage military dependants through qualitative research may provide insight into his or her unique experience as it relates to perceptions of a medical emergency.

Appropriateness of design.

The Phenomenological research design will allow the researcher to gain insight and understanding regarding the lived experiences of military and non-military dependants living in South Korean military communities as the encounter decisions related to medical emergencies.. As noted by Creswell (2009) “phenomenological research is a strategy of inquiry the researcher identifies the essence of human experiences about a phenomenon as described by the participants (p. 610). As noted by Moustakas (1994) explains Phenomenological Reduction as it relates the ability for the individual to have self-awareness and selfreflection through his or her own experiences.

Quantitative research needs to ensure preciseness and completeness. The use of the quantitative research goal is twofold: to describe things according to preestablished measurement criteria and test predictions based on theory (Shank, 2006). Quantitative research must also be accurate and reliable through validity and reliability. As discussed by Black (2009), “carefully defining concepts and consequential constructs helps eliminate ambiguity and establishes construct validity and reliable operational definitions of the variables” (p.57).

Qualitative research will be conducted giving a subjective approach through use of interviews, observations of participants in a study. To ensure success will be the ability for the researcher to select a participant and site that will be conducive. As noted by Shank (2006), three basic sampling strategies will identify qualitative research to include: 1) personal characteristic 2) theoretical and 3) logistical. In addition, the ability to ensure the researcher understands the importance of convenience, opportunistic, and snow-ball sampling (Shank, 2006).

The ability for the individual collecting the qualitative data to fully understand the analytical techniques and concepts related to content analysis is paramount. As noted by Shank (2006), the author describes the four phases to include: 1) “defining the type of analysis to use, 2) classifying the data, 3) making connections among different classes of data, and 4) presenting the results of the analysis” (pg.146). In addition, the raw data must be dissected by the researcher to identify and report the main themes and outliers of the data.

The interview of 12 participants will allow the data to be analyzed to determine the identification of similar experiences and perceptions as it relates seeking emergency care while living on or off post in South Korea. In addition, the ability to interview participants in a social setting in South Korea will allow the research to observe, describe, and interpret the data to capture common minor and major themes to further substantiate the research. Moustakas (1994) claims the importance to understand the experience of the participant and determine the meaning

through a comprehensive description of the experience.

Research Questions

As noted by Cone and Foster (2006), research questions need to encompass an interest to the scientific community. In addition, the research question must have a place in literature review conceptually and methodologically (Cone & Foster, 2006).The current study attempted to ask questions that will provide insight to the perceptions of medical knowledge when military dependants are faced with emergency situations while stationed in South Korea. As discussed by Moustakas (1994) the ability to discuss perceptions gives a non-bias approach. Furthermore, the answers will attempt to gain insight in regard to the perceptions and lived experiences of military dependents seeking medical care on or off post while living in South Korea. The research questions facilitated the development of the qualitative study.

Research Question 1: What are the perceptions and experiences of military dependants’ regarding their ability to access emergency care while living on or off a military base in South Korea?

Research Question 2: What are the perceptions and experiences of military dependants’ regarding the quality of medical care received during an emergency or serious medical condition while living on or off a military base in South Korea?

Research Question 3: What are the perceptions and experiences of military dependants’ regarding the support received when seeking emergency medical care while living on or off a military base in South Korea?

Research Question 4: What are the perceptions and experiences of military dependants’ regarding their knowledge of the medical resources available to take care of emergencies while living on or off a military base in South Korea?

Population

The participants are military dependants 18-80 years of age that live in South Korea, located by the U.S. Army military base at Camp Humphreys. The geographical area includes military dependants living in a 30km radius from the cities of Osan and Pyoungtaek. In addition, included in the study are English and Korean speaking individuals with a random mix of education and life experiences. The participants have agreed to be interviewed and this interview will take approximately one-two hours.

Informed Consent

Informed consent importance is crucial. A written consent was obtained on all participants (see Appendix C). The participants will be notified and verbalized understanding regarding the interview process being recorded. The military leadership at Camp Humphreys will provide written and verbal consent to use the facility where the interview will be conducted.

Sampling Frame

Convenience sampling and snowball sampling were used for the current study. Convenience sampling allowed the participants to volunteer once he or she understood the basis of the current study. The sampling strategy allowed the participants to come from a large group that allows the researcher to gather a diverse about of information. Snowball sampling allowed referral of military dependants by other participants in the current study and provided the ability for the researcher to gather enough data to achieve data saturation. The limitation for convenience and snowball sampling include participant bias and the inability of the researcher to relate to the target group.

Confidentiality

The ability to achieve confidentiality was to assign a number to each participant. The number will be used when listening to the audio recordings and during the transcribing process. In addition, the audio recordings will not be used in any public forum. The information placed on computer files will not be released to any other user besides the researcher. The audio recordings, raw data on computer files and research notes of the participants will be kept in a locked and secure location for up to three years. After the three years have been completed the written information will be shredded and the audio recordings destroyed. The participant is aware of the above process (see Appendix C).

Geographical Location

The geographical area includes military dependants living in a 30-100km radius from the cities of Osan and Pyoungtaek in South Korea. The location is geographically located near the U.S. Army base of Camp Humphreys, South Korea that is located in the upper northwest of South Korea. The U.S. Military has only five Health clinics and two U.S military hospitals located in South Korea.

Data Collection

The ability to collect multiple forms of data through different processes is based on triangulation and further substantiates the qualitative data collection process. As noted by Creswell (2009) triangulation allows the data collection to occur through interviews, observations document analysis. The current study provides the researcher the ability to collect data through personal interviews asking open-ended questions and observing the participant of the study. Furthermore, during the data collection process using audio recording during the interview process will allow the researcher to ensure accuracy and validity of the information.

Thirteen participants will be interviewed in the data collection process. The inclusion criteria included: 1) experienced an emergency while living in South Korea 2) lived or worked in South Korea for at least three- six months, and 3) have children living or have lived in South Korea. The decision to further interview more than twelve participants is determined upon whether data saturation is achieved.

The interview process includes the ability to ask open-ended questions to facilitate the discussion of the lived experiences of the military dependant. As noted by Moustakas (1994) describes the ability for the researcher to create a climate of trust for the participant to allow he or she to answer questions honestly. The interview process will be audio recorded and transcribed verbatim into a written format to begin the process of data analysis.

The audio recording process is a technique to observe and capture all verbal communication during the interview process. As noted by Creswell (2009) describes the ability to use audiotaping as means to facilitate the interview process to ensure accuracy and the researcher should also take notes during this process due to possible failure of equipment. The ability to audiotape allows the researcher to validate and cross reference the notes taken during the interview process.

Instrumentation

The main instrument used in this qualitative phenomenological study was personal interview. As discussed by Shank (2006) describes a semi-structured interview to allow the researcher to ask the same basic questions to give a somewhat structure to the interview process (see Appendix A). Furthermore, the interview process was conducted using open-ended questions to facilitate the emerging themes of the military dependants lived experiences in relation to seeking emergency care while living in South Korea. As noted by Creswell (2009) described the use a personal interview to facilitate an up-close observation that is an essential element to qualitative research. In addition, the interview process may gain the greatest affect on the individual being interviewed.

A pilot study was used to ensure the interview questions that were asked to the participant where understandable and accurate. As noted by Creswell (2005) describes the ability for the researcher to administer the questions to a small group of people and make changes based on feedback. The current interview questions (see Appendix A) were given to multiple peers and the peers provided feedback on the clarity and accuracy of the questions being asked. The feedback from the pilot test of the interview questions was used to strengthen the content and accuracy of the questions.

Validity and Reliability

The ability for the individual collecting the qualitative data to fully understand the analytical techniques and concepts related to content analysis is paramount. As noted by Shank (2006), the author describes the four phases to include: 1) “defining the type of analysis to use, 2) classifying the data, 3) making connections among different classes of data, and 4) presenting the results of the analysis” (pg.146). In addition, the raw data must be dissected by the researcher to identify and report the main themes and outliers of the data. Quantitative research must also be accurate and reliable through validity and reliability. As discussed by Black (2009), “carefully defining concepts and consequential constructs helps eliminate ambiguity and establishes construct validity and reliable operational definitions of the variables” (p.57).

Internal validity

The ability to provide data that is trustworthy and accurate must ensure validity is established at all times during the current study. As noted by Cooper and Schindler (2003) describes internal validity is to ensure the research instrument is measuring what it is supposed to measure. As noted by Creswell (2009) describes the need to ensure the researcher can identify the common threats to internal validity in qualitative research. The potential threats to internal validity in this current study are bias and instrumentation. As a result, the researcher must ensure the data has validity through spending time with the data and continued verification for accuracy of the instruments used in data collection.

External validity

The external validity is the ability for the data to be generalized across certain people, settings, and times (Cooper &Schindler, 2003). The current study provides external validity through allowing the data to meet

requirements of being generalized across military communities. The threats to external validity that can occur correlate to incorrect inferences drawn from the sample data and other persons (Creswell, 2009).

Reliability

Reliability of the data is established through an accurate trail of documentation of the data. As noted by Creswell (2009), qualitative reliability is related to comparing other research studies and ensuring these studies are consistent. In addition, ensuring the data can be interpreted accurately and correlated to the accurate transcription of the interviews. As noted by Shank (2006), the ability for the researcher to verify reliability through measuring the same thing and getting the same results. The current study will provide a thorough analysis of the data that will provide an accurate interpretation of the data.

Data Analysis

The data collected from qualitative research needs include a comprehensive, expansive, and holistic approach to the data. “A major skill in qualitative research is this ongoing conceptualization and re-conceptualization of some holistic focus of attention” (Shank, 2006, p.9). In addition, the data collected must be reliable and accurate through the use of verification. Quantitative research needs to ensure preciseness and completeness. The use of the quantitative research goal is twofold: to describe things according to pre-established measurement criteria and test predictions based on theory (Shank).

The ability for qualitative research to use the concept of reduction to establish categorization and coding with the data that is collected is paramount. The types of data analysis in qualitative used will include: 1) debriefing 2) subjective 3) content analysis and 4) interpretive (Hair, Bush, Ortinau, 2009, p.153).The above data needs to be integrated and grounded in theory. The trustworthiness of the data will be established by the credibility, dependability, and confirm ability of the data, through peer examination, and triangulation. In quantitative research the data analysis will identify data through statistical, descriptive, and causal predictions (Hair et al., 2009).

In addition, the ability to use multiple coders can increase the inter-reliability of the

data through triangulation.

The ability to provide proper data analysis in phenomenological research requires the research to understand the concept of bracketing as an essential element to ensure the researcher provides information that is nonbiased and truthful directly from the experience of the participant. Fischer (2009) claims that bracketing in qualitative research continues throughout the research process and requires the researcher to remain engaged with the data to develop the emerging findings. As discussed by Hamill and Sinclair (2010), the qualities essential to the researcher as it

relates to bracketing that include: 1) openness 2) remaining quizzical 3) reflective 4) honesty and 5) articulate clear understanding. Furthermore, the ability to provide information that is precise and the meaning is fully understood by both the researcher and the participant remains paramount (Hamill & Sinclair, 2010).

Summary

The purpose of the this phenomenological study is to identify in military dependants the lived experiences and knowledge that exists in what constitutes a medical emergency, key areas of delinquencies, and gaps in information knowledge; to better understand how he or she determine when to seek emergent medical care. The ability to conduct in depth individual interviews of military dependants living in South Korea near or on a military base is utilized to collect the data. The findings of the data that include a complete analysis of the interviews through reduction and interpretation will be presented in Chapter 4.

Results

The purpose of the this qualitative phenomenological study is to identify the perceptions and experiences of military dependants understanding related to what constitutes a medical emergency to better understand how they determine when to seek emergent medical care while living on or off a military base in South Korea. The following research questions guided the study: What are the perception and experiences of military dependants’ regarding their ability to access emergency care while living on or off a military base in South Korea? What are the perceptions and experiences of military dependants’ regarding the quality of medical care received during an emergency or serious medical condition while living on or off a military base in South Korea? What are the perceptions and experiences of military dependants’ regarding the support received when seeking emergency medical care while living on or off a military base in South Korea? What are your perceptions and experiences regarding the administrative and medical screening programs given to you prior to arriving in South Korea? The importance of this study may allow the leadership and management within the U.S. Army or Korean healthcare system to develop or reexamine policies and procedures to improve the medical services they provide military dependants’ while living in South Korea. The data may also assist in the implementation of more standardized training programs related to medical cultural differences that exist for military dependants’ prior and during arrival to South Korea.

The results of the study are described in Chapter 4. The data collection consisted of face-to-face interviews with 13 female military dependants’ that currently live on or off a military base in South Korea. The participants had the opportunity to access either urgent of emergency medical care at three on-post healthcare facilities treated by the United States military healthcare team and local national healthcare providers and staff. In addition, the participants had the opportunity to seek urgent or emergency medical care at five off-post Korean healthcare facilities treated only by the Korean healthcare medical providers and staff. The Korean healthcare facilities that treat the military members and their dependants are approved to be a Tricare (ISOS) approved facility. The procedure to become and approved Tricare and ISOS approved facility is accomplished through a written memorandum of agreement with the United States medical military leadership and the host-nation healthcare facility.

Chapter 4 encompasses an analysis of the transcribed interviews to gain further understanding of the perceptions and experiences involved when seeking urgent or emergency medical care. In addition the research questions addressed the concepts of participant’s perceptions and experiences during the access of medical care, the quality and support received during the process, and administrative and medical screening programs. Chapter 4 is divided into sections that include: 1) data collection process 2) research questions and corresponding interviews questions

objectives 3) Data analysis and findings 4) summary.

Review of Data Collection Procedures

The data collection process followed a systematic approach that included: 1) all participants meeting the inclusion criteria required 2) in person interviews digitally recorded in December 2013 from Korea 3) interviews transcribed by the researcher and 4) each interview validated by the each participant. The data analysis phase of the study maintained reliability and validity through triangulation. As explained by Creswell (2007) the ability to triangulate the data provides the researcher to collect from multiple sources such as interviews, observations, and analysis of the data. Subsequently, each interview was analyzed by the researcher to identify meaning units within the context of each transcribed interview and placed on research report. As noted by Creswell (2007) identifies that phenomenological research uses the analysis of the meanings from the significant statements in the data analysis. The research report contained all the meaning units that analyzed in detail by the researcher to identify idiographic and nomothetic themes.

The emergent themes with frequency answered as it relates to the research question are described below.

Emergent Themes

Research Question 1 Themes

What are the perceptions and experiences of military dependants’ regarding their ability to access emergency care while living on or off a military base in South Korea?

1) Emergency medical care easily accessible on and off base (11-13)

2) Emergency medical care capabilities understood on and off base (7-13)

3) Prompt service received with Tricare (7-13)

4) Tricare support adequate when facilitating off-post emergency medical care (6-13)

Research Question 2 Themes

What are the perceptions and experiences of military dependants’ regarding the quality of medical care received during an emergency or serious medical condition while living on or off a military base in South Korea?

1) Sanitary issues and concerns with cleanliness of healthcare facilities offpost (5/13)

2) Timely emergency medical care on and off-base (6-13)

3) Communication between medical providers and patient adequate (7/13)

4) Satisfied with quality of emergency medical care on military health care facilities on-post (7-13)

5) Lack of trust in medical treatment given at off-post for emergency medical care. (2/13)

Research Question 3 Themes

What are the perceptions and experiences of military dependants’ regarding the support (i.e. ambulance transport, admission personnel and discharge summary) received when seeking emergency medical care while living on or off a military base in South Korea?

1) Medical team supportive during patient encounter (7-13)

2) Poor communication during patient encounter by the physician on and off-post (7-13)

3) Medical transport system adequate from on-post to off-post (6-13)

4) Distrust in current the emergency medical capabilities off base at Good Morning hospital (2/13)

5) Emergency medical transport experience involved poor communication (2/13)

6) Lack of informed consent for patient procedure at off-post facility (1/13)

Research Question 4 Themes

What are your perceptions and experiences regarding the administrative and medical screening programs given to you prior to arriving in South Korea?

1) The Exceptional Family Member Program(EFMP) not fully explained as it relates to medical capabilities for military family members moving to a military base in South Korea (8/13)

2) The EFMP program understood as it relates to its importance (7/13)

3) The EFMP screening process adequate (8-13)

4) Non-command sponsored families have to pay up-front for medical care (4-13)

5) Command sponsored do not have to pay up-front (4/13)

Results and Findings

The first section of data collected was related to the demographics information. The participants were asked seven basic questions and they included (a) gender, (b) race and ethnicity, (c) age, (d) education attainment, (e) household income, (f) location of home, and (g) sponsorship. Discussion of the demographic information appears in Appendix F.

Interview Question Objectives:

The participant was asked open-ended interview questions related to each research question. Research question one had two interview questions. Research question two and three had one interview question. Research question four had two interview questions. The interview question objectives for each research question will be described in this section.
IQ1: What are your perceptions and experiences regarding your ability to access emergency medical care while living on or off a military base in South Korea?
Objective: The objective of this question is for the participant to provide insight and to share their personnel experiences and perceptions in the ability to access emergency medical care while living off or on a military base. The term access for the participant may mean a lot of different things as it relates to the personal perception and experience during the emergency medical care process. The experiences and perceptions provided by the each participant during the access of emergency medical care may identify challenges or sustains within the access to care processes for the on and off-post health care facilities. As a result, these identified meaning units can be described as it relates to accessing emergency care in an affective and timely manner.
IQ2: What are your perceptions and experiences regarding the managed care organization (TRICARE), ability to facilitate emergency consults to outside South Korean healthcare facilities?
Objective: The objective of this question is for the participant to provide input and share their personnel experiences and perceptions as relates TRICARE’s ability to provide the necessary guidance and support. Subsequently, this input may allow the researcher to assess the processes TRICARE’s uses in the ability to facilitate a consult when the participant has an emergency medical condition. The information provided by the participant may provide valuable data to assess whether the current procedures provided by TRICARE are adequate when the participant is seeking emergency medical care on or off a military post.
IQ3: What are your perceptions and experiences regarding the quality of urgent and emergency medical care that you received while living on or off a military base in South Korea?
Objective: The objective of this question was to identify each participant’s perceptions and experiences as it relates to the quality of care received while seeking urgency or medical care on or off-post. Each participant has her own idea of whatconstitutes the standard of quality when seeking urgent or emergent medical through past and present experiences. The variety of experiences and perceptions by military dependants may provide some insight to identify deficiencies and sustains to describe the quality of care received during the medical encounter.

IQ4: What are your perceptions and experiences regarding the support you received when seeking emergency care while living on or off a military base in South Korea?
Objective: The objective of this question was to identify each participant’s perceptions and experiences as it relates to the support received while seeking urgency or medical care on or off-post. The ability to provide support to the military dependants when seeking urgent or emergency medical care may or may not be standardized from location to location. As a result, the ability to capture the experiences and perceptions from a wide range of past medical counters from the participants when seeking urgent or emergent medical care may provide insight to describe if the standard was met when it pertains to proper and adequate support during the process.
IQ5: What are your perceptions and experiences regarding the screening process of the Exceptional Family Member Program (EFMP)?
Objective: The objective of this question is to identify from the participants the variety of perceptions and experiences as it relates to the EFMP process. The ability to identify the variety of perceptions and experiences may allow the researcher to identify from the participants the themes and commonalities that exist from different military installations. In addition, it may allow the researcher to identify unique experiences from the participants in the data analysis process.
IQ6: What are your perceptions and experiences of the command sponsorship program as it relates to access emergency medical care?
Objective: The objective of this question is to allow the participants to explain their perceptions and experiences as it relates to the command sponsorship program. In addition, the command sponsorship program is mandated program when being stationed in overseas assignments on a variety of military installations. Subsequently, the ability for participants to understand the program may be identified in the data analysis and allow the researcher to describe unique or common experiences shared by the participants.

Emergent Themes

The purpose of the this phenomenological study was to identify in military dependants the lived experiences and knowledge that exists in what constitutes a medical emergency, key areas of delinquencies, and gaps in information knowledge; to better understand how he or she determines when to seek emergent medical care. The theme validation process was conducted by identifying idiographic and nomothetic themes during the data analysis. As a result, emergent themes were identified that correlates to each research question in order of frequency identified. Furthermore, if an isolated or significant emergent theme was identified as it relates to a research question, the theme will be described after explaining all nomothetic themes.

Research Question 1 Emergent Themes

What are the perceptions and experiences of military dependants’ regarding their ability to access emergency care while living on or off a military base in South Korea?

Emergency medical care easily accessible on and off base.

A major nomothetic emergent theme was identified as it relates to the ability to access emergency military care on or off a military base in South Korea. Interview question one (IQ1) was used related to research question one (RQ1). The ability to easily access emergent medical care was mentioned 11 out of 13 participants. It was determined that 85% of the participants identified that they were able to easily access urgent or emergent medical care while living on or off a military base. Sue identified that “emergency was available when needed.” Gene described that “access to emergent medical care at the after-hour clinic at Camp Humphreys is convenient and timely.” Judy described, “access to emergency medical care is convenient and available.” As a result, it was determined through t

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