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Postdeployment: A military nurse’s journey By Brenda Elliott, PhD, RN
Abstract Background: Although being deployed gives military nurses opportunities for personal and professional growth, their psychological equilibrium is often strained more than they thought imaginable. Limited research has focused on how soldiers and families cope with the disappointment of the postdeployment phase, which can result from unrealistic expectations. Research questions: Military nurses were asked these questions about the postdeployment phase. 1. How do you describe your experience? 2. What’s the meaning of the experience? 3. What strategies influenced your return to personal and professional roles? Method: The researcher conducted a qualitative study by interviewing 10 military nurses, then re-presented a narrative of what many nurses experience after returning home from deployment. Results: Seven themes emerged describing these nurses’ experience and its meaning. Application to nursing practice: Several strategies were developed for future nurses to manage postdeployment periods. Conclusions: Conducting narrative inquiry contributes to the use of the qualitative method in nursing research. Healthcare professionals’ increased knowledge and sensitivity can help them recognize the issues and challenges military nurses may face after returning home.
Background Recent wars, from Vietnam to the present day, have created more documented psychological concerns for U.S. veterans and their families than any previous wars.1-3 Military nurses account for a small but significant percentage of these veterans. According to the Air Force Office of the Surgeon General, healthcare personnel are among the three military groups reporting the highest frequency of posttraumatic stress disorder (PTSD) on postdeployment health assessments.3 (The other two are members of bomb disposal units and counterintelligence services.) Although nurses may not be directly in harm’s way while caring for the injured, they may be exposed to real or perceived threats to their safety that place them at a higher risk for developing PTSD than nurses in wartime 18 l Nursing2014 l January
conflicts prior to the Vietnam War.4 Experiencing the physical and emotional wounds of war when caring for others could place them at increased risk as well. The challenges military nurses face upon returning home are unique. Many return to nursing positions where they care for those injured in the war or where they can’t practice with the same level of autonomy.5,6 These two factors, coupled with other challenges, could have a negative impact on their mental and physical health. Their experiences can be complicated by the realities of personal and professional responsibilities. Studies that address military nurses’ distinct challenges are needed to help other nurses and healthcare providers gain understanding of their experiences as they return home.
Today’s military nurses and other veterans need healthcare providers, and in some instances, peers and family, to become more sensitive to them and demonstrate competence with the military subculture. The adverse psychological reactions of experiencing war could take several months to manifest after nurses return home.6 For this reason, this study focused on the postdeployment experience. Research questions The researcher developed these three questions: 1. How do military nurses describe their experiences in the postdeployment phase? 2. What’s the meaning of the postdeployment experience to the military nurse? 3. What strategies do military nurses identify as influencing the return to personal and professional roles in the postdeployment phase? Methods A qualitative study was conducted to investigate military nurses’ experiences returning home from war. A narrative inquiry was selected for this research study. (See Understanding narrative inquiries.) The researcher sent an e-mail letter to peers and colleagues, and 10 interested participants volunteered to be a part of the study. The participants (seven women and three men) were asked to describe their postdeployment experience and its meaning as well as strategies that may have influenced the return to personal and professional roles. They www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
were each asked the three specific questions, then were asked probing follow-up questions. Data were collected by listening to military nurses’ stories about returning home after deployment and the meaning the experience had for them. Insights into military nurses’ perceptions of reality could potentially provide a more holistic picture of their experiences and improve approaches to caring for them postdeployment. Results Five themes emerged from the first research question about their postdeployment experience: • learning to manage changes in the environment • facing the reality of multiple losses • feeling like everything is so trivial now • figuring out where I “fit” in all the chaos • working through the guilt to move forward. From the second research question, which asked about meaning in the postdeployment phase, two major themes emerged: • serving a greater purpose in life • looking at life through a new lens. The third research question explored strategies that influenced the return to personal and professional roles. Communicating, passing of time, taking time, using social supports, maintaining contact with military comrades, staying busy, establishing new routines, and exercising patience were the strategies that influenced the participants’ return to personal and professional roles. Although the retold story is based on the time and context of the study participants, it powerfully provides insight into what many military nurses may experience after deployment. Because no two individuals’ experiences will be the same, the www.Nursing2014.com
Understanding narrative inquiries Narratives (or stories) evolve each time they’re told, whether the narrator or the researcher retells the story.10-12 Rather than merely telling a simple story, narrators can provide an historic account of experiences. They reflect on, clarify, and construct meaning about the past and justify their own behavior while linking the past to present thinking and actions. Narrative research is different from other qualitative approaches in that the data collection results in coherent stories rather than fragmented parts of information.8 Participants have more power in the research process because they control how the story is told. According to Holloway and Freshwater, narratives can help a healthcare provider understand the suffering or confusion of another person without experiencing it firsthand and then use that understanding to improve practice.10 Narratives, which are bound by context and time, can uncover where healthcare professionals have gone, reveal opportunities to improve practice, and give voice to marginalized groups that may not otherwise be heard.10-12
following story can’t be generalized as being entirely relevant to all military nurses. The presence and intensity of some of the feelings and experiences portrayed will vary for each individual. Narratives can engage the reader in the experiences of the storyteller.7 The stories of 10 military nurses have been constructed into one story that collectively re-presents the group interviewed for this research. (Detailed results of this qualitative study have been published elsewhere.8) This story is written from the first person point of view, as if he or she is speaking to the reader. The story retold Few words can express the feelings that you experience when you return home from a deployment. The anticipation grows weeks before the reality of it hits you. One day you’re in the comfort of your day-to-day routines in a deployed area, going to work every day, eating in the same mess hall every day, and doing your own thing on your time off, and soon after, you’re back in the “real world.” It’s amazing how you go from existing in one highly structured
environment to another in matter of 48 hours or so. It’s as if time stood still around me. I went from a fairly predictable routine and way of living back into the “real world,” back into chaos. At first, I had a mixture of emotions. While I was happy to see everyone, it was all very overwhelming. The physical environment was quite an adjustment. I remember being oversensitive to colors because over there everything was just different shades of brown and now things were bright again. Noises were an issue for a while. Loud motorcycles or cars would make me jump. The sound of helicopters signaled that injured soldiers or civilians were coming in. Even the sound of someone’s beeper going off made me reach for my waist and think that it was time to drop everything to report to the ED. Then I had to stop and remind myself that I’m not there anymore. People talk about how hard it is to reintegrate back home, but I didn’t think it was really going to be that hard. I was wrong! It was more of a challenge than I expected. I mean, the first few days you’re back, it’s like being on a honeymoon. Everyone is January l Nursing2014 l 19
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happy to see you, and for the most part, you’re happy to see them. But you’re thinking to yourself, “Please send me back.” The change in environment and day-to-day routines coupled with the reality of life hit me like a ton of bricks. Have you ever seen the movie “Groundhog Day”? The main character keeps reliving the same day over and over, and that’s what it was like over there. Coming back here was just chaotic. The frustration, stress, and uncomfortable feeling of not fitting in started to build, and all I wanted to do was go back to the routine of where I’d just came from. The tough part was knowing that I shouldn’t be feeling that way, that I should be grateful I’m home. Deep down, I am grateful. It’s just hard to switch gears so fast again. So, you fight with the guilt and stress of having to go through a painful process. It’s much like dealing with death. The reality of your old way of life and everyone else around you no longer exists. You changed, they changed, the whole world changed—all while you were off in another part of the world doing something that your country asked you to do. It’s like moving through the grieving process. At first, I was in denial that things were different, and then I got angry. People frustrated me, and situations around me frustrated me. I’m not sure when I finally started to accept a new way of being, but it probably took me 2 to 3 months. It was like I’d been in a coma for a year and then woke up. I had to catch up on everything that had happened so I could start to make sense of the world around me again. I struggled to regain control of all that I’d lost or, rather, all I’d had to give up when I left. This took assertion on my part because I could’ve 20 l Nursing2014 l January
easily kept myself isolated from the pain of going through this process. But I knew I had to establish new routines to move forward. I had to work through the stress, frustration, and guilt for myself, my family, and my friends. A lot of power struggles took place, and communication was difficult at times. I couldn’t always make my needs known to others, and I didn’t want to rock the boat too much either. I knew things were just as hard back home while I was away all that time. I spent many months—and even now catch myself at times—surveying my surroundings for people, cars, or things that look out of place. You look for dangers all around you after you’ve lived in fear of dying, thinking that the next approaching vehicle could have a bomb inside. The hypervigilance to personal safety was a challenge to get past until I’d been home long enough to know that I was in a safe environment again. That’s just a part of being near the danger. Going to the grocery store may seem like an easy task, but I found it stressful because I’d gotten used to having very few choices. Here I was, faced with deciding which cereal to buy. Someone else had been deciding what breakfast would be, and now I was faced with having to choose among 40 different kinds of cereal. I just hadn’t had to think about all those things for so long. Even the people and crowds in the store really got to me. I couldn’t stand listening to people complain about waiting 5 minutes to check out when I knew that the cashiers were moving as fast as they could. It was hard to be in crowded places because I didn’t trust that someone bad wasn’t out there. Not only that, but I was used to my
group of people. We worked, ate, and slept together. Being around other people was like having outsiders around. I was glad to have some downtime when I came back to put together all the pieces of my life. It was helpful to talk with family and friends about my experiences, and I hate to say it, but some just can’t see and accept the changed person you’ve become. That part is really hard. You think that your friends will be there no matter what, but some people just don’t get it. If you know returning soldiers, I’d advise you to give them time, patience, and tolerance. They’ll be grateful to you in the end for sticking it out. Returning to my professional roles wasn’t as challenging as returning to my personal roles. I was lucky to start a new job when I returned, which was good. It was like getting a fresh start. I didn’t have to go back to an old way of doing things like some of my peers. I did feel as if I had a diminished capacity for caring. It was stressful and frustrating to deal with other nurses or patients who complained about issues that were trivial or not really an emergency. After all, I’d just come back from where real emergencies, or the aftermath of them, were quite a reality. My scope of practice was so much more autonomous during deployment compared with the hospital care I provided before I left. I gained confidence and skills that I’ll never be able to use here in the United States. Being deployed was the pinnacle of my professional career. I was glad when I came home that I could start something new because going back to the same old thing would’ve felt like even more of a disappointment. Soldiers I cared for made me feel so appreciated and thanked me for www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
every little thing I did for them. Nothing is more rewarding than that. No words can describe how I feel when I think about what I’ve done, but sometimes it’s hard to be empathetic now. I just have to remind myself that each individual patient experience is his or her own, not mine. Now, looking back and talking to you, I can see how much this deployment experience has changed me. I see things from a different perspective now. It’s like I’ve changed the lenses in my glasses. The frames are the same, but what I see out of the lenses is different. I’m a better person now. I appreciate the small things in life, and I’m grateful for all I have and all of our freedoms. Time and patience let me share these feelings with you. It’s hard to express to others what it was like for me over there, just as you can’t compare any two people who deployed, because their experiences will be different. Despite that, we share many common feelings and reactions after coming home. It’s a similar process regardless of where you were located or what year you deployed. The whole experience changed me forever. The personal toll a deployment takes on you is much greater than the professional toll. As nurses, we’re equipped with some coping mechanisms to help us deal with issues like trauma, pain, death, and dying. I may never again serve a greater purpose in my professional career, and I’m thankful for the opportunity I had. I’d do it all over again, even knowing the emotional toll it would take on my life and the lives of those closest to me. Reflecting now, I can see that I’ve grown as a human being in many aspects of my life, and I feel fulfilled. I’m grateful for the support system I www.Nursing2014.com
do have—my family, friends, and military comrades. Many times, I reached out to them to just help talk things through, to make sense of everything that was happening when I first came back. It was validating to know they too had struggles like me. Time does heal the pain, just like grieving the loss of a loved one, the loss of your old self. Application to nursing practice Military nurses returning from war go through a transitional process as they begin to establish new routines again. During the first 12 months after returning home, they experience many emotional highs and lows. The passage of time and the distance away from friends, family, and work create a time warp for them upon their return. These nurses can’t just pick up where they left off because they’ve changed and the world around them also changed while they were serving their country. This transition can be compared with other life transitions, such as changing jobs or having a child. Based on this research study, the first few months after returning are very chaotic. After 3 to 4 months, things begin to feel a bit more under control and between 9 and 12 months, all’s usually in balance again. After this point, most military nurses have a sense of fitting back into their personal and professional roles. They’ve had time to process their experiences and establish a new “normal.” Nurses and other healthcare providers can play an integral role in supporting military nurses when they return from war, just by listening to and validating their feelings during this difficult transition. Nurses and healthcare providers need to be understanding and
sensitive to the fact that the transition is a normal process and that the psychological injury most military nurses experience takes time to heal. These nurses and healthcare providers will also be better able to recognize when military nurses may be in trouble or in need of intervention. Providing a safe, supportive, and empathetic environment for military nurses will help them work through establishing new routines. Healthcare providers and nurses should establish cultural competency with the military subculture, especially if they live in an area where interaction with veteran military nurses is expected.9 Interventions should focus on personal growth rather than psychological pathology to decrease the stigma of not being able to cope.2 Limitations Several limitations to the study were noted. No personnel from the Navy or Coast Guard participated. The results of the study must be interpreted based on the time and context of the 10 nurse participants. Because about 80% of the participants had more than 10 years of nursing experience, they might have had more life and professional experiences to help them transition successfully in the postdeployment phase than less-experienced nurses. Conclusions Narratives are a mode of human expression through which an individual makes meaning of a personal experience through a process of reflection.10 Information gained from the stories helped this researcher grasp transitions from event to event or between turning points in a process. This was useful in linking relevant information told by the narrator about the phenomenon under study. January l Nursing2014 l 21
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Deployment, separation from everyday living, and experiencing nursing in a war zone can singularly impact a person’s emotional and physical well-being. All military nurses who’ve been deployed have been affected in some way by their individual experiences. What differs is the manner and the extent to which it has affected their lives. Understanding what occurs in the postdeployment phase can empower others to be more supportive of returning military nurses, as well as other veterans. Homecoming, while intoxicating with happy emotions, has subsequent real-life challenges that these nurses and their friends and families must work through. In the end, meaning and personal growth from the experience can ideally create a positive, oncein-a-lifetime experience. ■
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REFERENCES 1. American Psychological Association. The psychological needs of U.S. military service members and their families: a preliminary report. 2007. http:// www.ptsd.ne.gov/publications/military-deployment-task-force-report.pdf. 2. Black WG Jr. Military-induced family separation: a stress reduction intervention. Soc Work. 1993;38(3):273-280. 3. Boivin J. War on the mind. Nursing Spectrum. 2010;19(16):16-18. 4. Kolkow TT, Spira JL, Morse JS, Grieger TA. Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Mil Med. 2007;172(5):451-455. 5. Baker RR, Menard SW, Johns LA. The military nurse experiment in Vietnam: stress and impact. J Clin Psychol. 1989;45(5):736-744. 6. Wands LM. Caring for veterans returning home from Middle Eastern wars. Nurs Sci Q. 2011;24(2):180-186. 7. Riessman CK. Narrative Methods for the Human Sciences. Thousand Oaks: CA, Sage Publications; 2008.
…Look no further than NursingCenter.com.
8. Elliott B. Military nurses’ experiences returning home from war. Doctoral dissertation. Chester, PA: Widener University; 2012.
Here, you’ll find
9. Coll JE, Weiss EL, Yarvis JS. No one leaves unchanged: insights for civilian mental health care professionals into the military experience and culture. Soc Work Health Care. 2011;50(7):487-500.
continuing education (CE)
10. Holloway I, Freshwater D. Narrative Research in Nursing. Malden, MA: Blackwell Publishing; 2007.
articles on the specialties
11. Koch T. Story telling: is it really research? J Adv Nurs. 1998;28(6):1182-1190.
that most interest you,
12. Moen T. Reflections on the approach of narrative inquiry. Int J Qual Methods. 2006;5(4):1-11. http://www.ualberta.ca/~iiqm/backissues/5_4/pdf/ moen.pdf.
Brenda Elliott, who currently lives in Wahiawa, Hawaii, is online adjunct faculty for Bloomsburg University in Bloomsburg, Pa., and Drexel University in Philadelphia, Pa. Research Corner is coordinated by Cheryl Dumont, PhD, RN, CRNI, director of nursing research and the vascular access team at Winchester Medical Center in Winchester, Va. Dr. Dumont is also a member of the Nursing2014 editorial board. The content in this article has received appropriate institutional review board and/or administrative approval for publication. The author has disclosed that she has no financial relationships related to this article.
such as critical care, med-surg, emergency, surgical, and management.
Just visit www.nursingcenter.com and select “CE Connection.”
DOI-10.1097/01.NURSE.0000438723.58463.3b
22 l Nursing2014 l January
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Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Postdeployment: A military nurse’s journey By Brenda Elliott, PhD, RN
Abstract Background: Although being deployed gives military nurses opportunities for personal and professional growth, their psychological equilibrium is often strained more than they thought imaginable. Limited research has focused on how soldiers and families cope with the disappointment of the postdeployment phase, which can result from unrealistic expectations. Research questions: Military nurses were asked these questions about the postdeployment phase. 1. How do you describe your experience? 2. What’s the meaning of the experience? 3. What strategies influenced your return to personal and professional roles? Method: The researcher conducted a qualitative study by interviewing 10 military nurses, then re-presented a narrative of what many nurses experience after returning home from deployment. Results: Seven themes emerged describing these nurses’ experience and its meaning. Application to nursing practice: Several strategies were developed for future nurses to manage postdeployment periods. Conclusions: Conducting narrative inquiry contributes to the use of the qualitative method in nursing research. Healthcare professionals’ increased knowledge and sensitivity can help them recognize the issues and challenges military nurses may face after returning home.
Background Recent wars, from Vietnam to the present day, have created more documented psychological concerns for U.S. veterans and their families than any previous wars.1-3 Military nurses account for a small but significant percentage of these veterans. According to the Air Force Office of the Surgeon General, healthcare personnel are among the three military groups reporting the highest frequency of posttraumatic stress disorder (PTSD) on postdeployment health assessments.3 (The other two are members of bomb disposal units and counterintelligence services.) Although nurses may not be directly in harm’s way while caring for the injured, they may be exposed to real or perceived threats to their safety that place them at a higher risk for developing PTSD than nurses in wartime 18 l Nursing2014 l January
conflicts prior to the Vietnam War.4 Experiencing the physical and emotional wounds of war when caring for others could place them at increased risk as well. The challenges military nurses face upon returning home are unique. Many return to nursing positions where they care for those injured in the war or where they can’t practice with the same level of autonomy.5,6 These two factors, coupled with other challenges, could have a negative impact on their mental and physical health. Their experiences can be complicated by the realities of personal and professional responsibilities. Studies that address military nurses’ distinct challenges are needed to help other nurses and healthcare providers gain understanding of their experiences as they return home.
Today’s military nurses and other veterans need healthcare providers, and in some instances, peers and family, to become more sensitive to them and demonstrate competence with the military subculture. The adverse psychological reactions of experiencing war could take several months to manifest after nurses return home.6 For this reason, this study focused on the postdeployment experience. Research questions The researcher developed these three questions: 1. How do military nurses describe their experiences in the postdeployment phase? 2. What’s the meaning of the postdeployment experience to the military nurse? 3. What strategies do military nurses identify as influencing the return to personal and professional roles in the postdeployment phase? Methods A qualitative study was conducted to investigate military nurses’ experiences returning home from war. A narrative inquiry was selected for this research study. (See Understanding narrative inquiries.) The researcher sent an e-mail letter to peers and colleagues, and 10 interested participants volunteered to be a part of the study. The participants (seven women and three men) were asked to describe their postdeployment experience and its meaning as well as strategies that may have influenced the return to personal and professional roles. They www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
were each asked the three specific questions, then were asked probing follow-up questions. Data were collected by listening to military nurses’ stories about returning home after deployment and the meaning the experience had for them. Insights into military nurses’ perceptions of reality could potentially provide a more holistic picture of their experiences and improve approaches to caring for them postdeployment. Results Five themes emerged from the first research question about their postdeployment experience: • learning to manage changes in the environment • facing the reality of multiple losses • feeling like everything is so trivial now • figuring out where I “fit” in all the chaos • working through the guilt to move forward. From the second research question, which asked about meaning in the postdeployment phase, two major themes emerged: • serving a greater purpose in life • looking at life through a new lens. The third research question explored strategies that influenced the return to personal and professional roles. Communicating, passing of time, taking time, using social supports, maintaining contact with military comrades, staying busy, establishing new routines, and exercising patience were the strategies that influenced the participants’ return to personal and professional roles. Although the retold story is based on the time and context of the study participants, it powerfully provides insight into what many military nurses may experience after deployment. Because no two individuals’ experiences will be the same, the www.Nursing2014.com
Understanding narrative inquiries Narratives (or stories) evolve each time they’re told, whether the narrator or the researcher retells the story.10-12 Rather than merely telling a simple story, narrators can provide an historic account of experiences. They reflect on, clarify, and construct meaning about the past and justify their own behavior while linking the past to present thinking and actions. Narrative research is different from other qualitative approaches in that the data collection results in coherent stories rather than fragmented parts of information.8 Participants have more power in the research process because they control how the story is told. According to Holloway and Freshwater, narratives can help a healthcare provider understand the suffering or confusion of another person without experiencing it firsthand and then use that understanding to improve practice.10 Narratives, which are bound by context and time, can uncover where healthcare professionals have gone, reveal opportunities to improve practice, and give voice to marginalized groups that may not otherwise be heard.10-12
following story can’t be generalized as being entirely relevant to all military nurses. The presence and intensity of some of the feelings and experiences portrayed will vary for each individual. Narratives can engage the reader in the experiences of the storyteller.7 The stories of 10 military nurses have been constructed into one story that collectively re-presents the group interviewed for this research. (Detailed results of this qualitative study have been published elsewhere.8) This story is written from the first person point of view, as if he or she is speaking to the reader. The story retold Few words can express the feelings that you experience when you return home from a deployment. The anticipation grows weeks before the reality of it hits you. One day you’re in the comfort of your day-to-day routines in a deployed area, going to work every day, eating in the same mess hall every day, and doing your own thing on your time off, and soon after, you’re back in the “real world.” It’s amazing how you go from existing in one highly structured
environment to another in matter of 48 hours or so. It’s as if time stood still around me. I went from a fairly predictable routine and way of living back into the “real world,” back into chaos. At first, I had a mixture of emotions. While I was happy to see everyone, it was all very overwhelming. The physical environment was quite an adjustment. I remember being oversensitive to colors because over there everything was just different shades of brown and now things were bright again. Noises were an issue for a while. Loud motorcycles or cars would make me jump. The sound of helicopters signaled that injured soldiers or civilians were coming in. Even the sound of someone’s beeper going off made me reach for my waist and think that it was time to drop everything to report to the ED. Then I had to stop and remind myself that I’m not there anymore. People talk about how hard it is to reintegrate back home, but I didn’t think it was really going to be that hard. I was wrong! It was more of a challenge than I expected. I mean, the first few days you’re back, it’s like being on a honeymoon. Everyone is January l Nursing2014 l 19
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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happy to see you, and for the most part, you’re happy to see them. But you’re thinking to yourself, “Please send me back.” The change in environment and day-to-day routines coupled with the reality of life hit me like a ton of bricks. Have you ever seen the movie “Groundhog Day”? The main character keeps reliving the same day over and over, and that’s what it was like over there. Coming back here was just chaotic. The frustration, stress, and uncomfortable feeling of not fitting in started to build, and all I wanted to do was go back to the routine of where I’d just came from. The tough part was knowing that I shouldn’t be feeling that way, that I should be grateful I’m home. Deep down, I am grateful. It’s just hard to switch gears so fast again. So, you fight with the guilt and stress of having to go through a painful process. It’s much like dealing with death. The reality of your old way of life and everyone else around you no longer exists. You changed, they changed, the whole world changed—all while you were off in another part of the world doing something that your country asked you to do. It’s like moving through the grieving process. At first, I was in denial that things were different, and then I got angry. People frustrated me, and situations around me frustrated me. I’m not sure when I finally started to accept a new way of being, but it probably took me 2 to 3 months. It was like I’d been in a coma for a year and then woke up. I had to catch up on everything that had happened so I could start to make sense of the world around me again. I struggled to regain control of all that I’d lost or, rather, all I’d had to give up when I left. This took assertion on my part because I could’ve 20 l Nursing2014 l January
easily kept myself isolated from the pain of going through this process. But I knew I had to establish new routines to move forward. I had to work through the stress, frustration, and guilt for myself, my family, and my friends. A lot of power struggles took place, and communication was difficult at times. I couldn’t always make my needs known to others, and I didn’t want to rock the boat too much either. I knew things were just as hard back home while I was away all that time. I spent many months—and even now catch myself at times—surveying my surroundings for people, cars, or things that look out of place. You look for dangers all around you after you’ve lived in fear of dying, thinking that the next approaching vehicle could have a bomb inside. The hypervigilance to personal safety was a challenge to get past until I’d been home long enough to know that I was in a safe environment again. That’s just a part of being near the danger. Going to the grocery store may seem like an easy task, but I found it stressful because I’d gotten used to having very few choices. Here I was, faced with deciding which cereal to buy. Someone else had been deciding what breakfast would be, and now I was faced with having to choose among 40 different kinds of cereal. I just hadn’t had to think about all those things for so long. Even the people and crowds in the store really got to me. I couldn’t stand listening to people complain about waiting 5 minutes to check out when I knew that the cashiers were moving as fast as they could. It was hard to be in crowded places because I didn’t trust that someone bad wasn’t out there. Not only that, but I was used to my
group of people. We worked, ate, and slept together. Being around other people was like having outsiders around. I was glad to have some downtime when I came back to put together all the pieces of my life. It was helpful to talk with family and friends about my experiences, and I hate to say it, but some just can’t see and accept the changed person you’ve become. That part is really hard. You think that your friends will be there no matter what, but some people just don’t get it. If you know returning soldiers, I’d advise you to give them time, patience, and tolerance. They’ll be grateful to you in the end for sticking it out. Returning to my professional roles wasn’t as challenging as returning to my personal roles. I was lucky to start a new job when I returned, which was good. It was like getting a fresh start. I didn’t have to go back to an old way of doing things like some of my peers. I did feel as if I had a diminished capacity for caring. It was stressful and frustrating to deal with other nurses or patients who complained about issues that were trivial or not really an emergency. After all, I’d just come back from where real emergencies, or the aftermath of them, were quite a reality. My scope of practice was so much more autonomous during deployment compared with the hospital care I provided before I left. I gained confidence and skills that I’ll never be able to use here in the United States. Being deployed was the pinnacle of my professional career. I was glad when I came home that I could start something new because going back to the same old thing would’ve felt like even more of a disappointment. Soldiers I cared for made me feel so appreciated and thanked me for www.Nursing2014.com
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every little thing I did for them. Nothing is more rewarding than that. No words can describe how I feel when I think about what I’ve done, but sometimes it’s hard to be empathetic now. I just have to remind myself that each individual patient experience is his or her own, not mine. Now, looking back and talking to you, I can see how much this deployment experience has changed me. I see things from a different perspective now. It’s like I’ve changed the lenses in my glasses. The frames are the same, but what I see out of the lenses is different. I’m a better person now. I appreciate the small things in life, and I’m grateful for all I have and all of our freedoms. Time and patience let me share these feelings with you. It’s hard to express to others what it was like for me over there, just as you can’t compare any two people who deployed, because their experiences will be different. Despite that, we share many common feelings and reactions after coming home. It’s a similar process regardless of where you were located or what year you deployed. The whole experience changed me forever. The personal toll a deployment takes on you is much greater than the professional toll. As nurses, we’re equipped with some coping mechanisms to help us deal with issues like trauma, pain, death, and dying. I may never again serve a greater purpose in my professional career, and I’m thankful for the opportunity I had. I’d do it all over again, even knowing the emotional toll it would take on my life and the lives of those closest to me. Reflecting now, I can see that I’ve grown as a human being in many aspects of my life, and I feel fulfilled. I’m grateful for the support system I www.Nursing2014.com
do have—my family, friends, and military comrades. Many times, I reached out to them to just help talk things through, to make sense of everything that was happening when I first came back. It was validating to know they too had struggles like me. Time does heal the pain, just like grieving the loss of a loved one, the loss of your old self. Application to nursing practice Military nurses returning from war go through a transitional process as they begin to establish new routines again. During the first 12 months after returning home, they experience many emotional highs and lows. The passage of time and the distance away from friends, family, and work create a time warp for them upon their return. These nurses can’t just pick up where they left off because they’ve changed and the world around them also changed while they were serving their country. This transition can be compared with other life transitions, such as changing jobs or having a child. Based on this research study, the first few months after returning are very chaotic. After 3 to 4 months, things begin to feel a bit more under control and between 9 and 12 months, all’s usually in balance again. After this point, most military nurses have a sense of fitting back into their personal and professional roles. They’ve had time to process their experiences and establish a new “normal.” Nurses and other healthcare providers can play an integral role in supporting military nurses when they return from war, just by listening to and validating their feelings during this difficult transition. Nurses and healthcare providers need to be understanding and
sensitive to the fact that the transition is a normal process and that the psychological injury most military nurses experience takes time to heal. These nurses and healthcare providers will also be better able to recognize when military nurses may be in trouble or in need of intervention. Providing a safe, supportive, and empathetic environment for military nurses will help them work through establishing new routines. Healthcare providers and nurses should establish cultural competency with the military subculture, especially if they live in an area where interaction with veteran military nurses is expected.9 Interventions should focus on personal growth rather than psychological pathology to decrease the stigma of not being able to cope.2 Limitations Several limitations to the study were noted. No personnel from the Navy or Coast Guard participated. The results of the study must be interpreted based on the time and context of the 10 nurse participants. Because about 80% of the participants had more than 10 years of nursing experience, they might have had more life and professional experiences to help them transition successfully in the postdeployment phase than less-experienced nurses. Conclusions Narratives are a mode of human expression through which an individual makes meaning of a personal experience through a process of reflection.10 Information gained from the stories helped this researcher grasp transitions from event to event or between turning points in a process. This was useful in linking relevant information told by the narrator about the phenomenon under study. January l Nursing2014 l 21
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R ESEARCH COR N ER
Deployment, separation from everyday living, and experiencing nursing in a war zone can singularly impact a person’s emotional and physical well-being. All military nurses who’ve been deployed have been affected in some way by their individual experiences. What differs is the manner and the extent to which it has affected their lives. Understanding what occurs in the postdeployment phase can empower others to be more supportive of returning military nurses, as well as other veterans. Homecoming, while intoxicating with happy emotions, has subsequent real-life challenges that these nurses and their friends and families must work through. In the end, meaning and personal growth from the experience can ideally create a positive, oncein-a-lifetime experience. ■
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8. Elliott B. Military nurses’ experiences returning home from war. Doctoral dissertation. Chester, PA: Widener University; 2012.
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9. Coll JE, Weiss EL, Yarvis JS. No one leaves unchanged: insights for civilian mental health care professionals into the military experience and culture. Soc Work Health Care. 2011;50(7):487-500.
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articles on the specialties
11. Koch T. Story telling: is it really research? J Adv Nurs. 1998;28(6):1182-1190.
that most interest you,
12. Moen T. Reflections on the approach of narrative inquiry. Int J Qual Methods. 2006;5(4):1-11. http://www.ualberta.ca/~iiqm/backissues/5_4/pdf/ moen.pdf.
Brenda Elliott, who currently lives in Wahiawa, Hawaii, is online adjunct faculty for Bloomsburg University in Bloomsburg, Pa., and Drexel University in Philadelphia, Pa. Research Corner is coordinated by Cheryl Dumont, PhD, RN, CRNI, director of nursing research and the vascular access team at Winchester Medical Center in Winchester, Va. Dr. Dumont is also a member of the Nursing2014 editorial board. The content in this article has received appropriate institutional review board and/or administrative approval for publication. The author has disclosed that she has no financial relationships related to this article.
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DOI-10.1097/01.NURSE.0000438723.58463.3b
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