07:33pm Wednesday 26 February 2020

Military nurses and combat-wounded patients struggle to cope with stress

“It was the first time in 16 years that I’ve felt I’ve really done something,” one of the military nurses told researchers. “I have nothing in my life that has been more rewarding,” another nurse reported.

At the same time, nurses said the military failed to provide specialized training to help them care for themselves as they struggled with the emotional work of dealing with severely injured service members.

“There is nothing to prepare you for what you are going to see, how you’re going to feel,” said one nurse.

Twenty military nurses and eight combat-wounded patients were interviewed by U-M researchers and their colleagues for a study published in the current edition of Perspectives in Psychiatric Care. The U-M authors are Bonnie Hagerty, an associate professor in the School of Nursing, and Reg Williams, a professor in the School of Nursing and at the Medical School’s Department of Psychiatry.

The study involved focus-group interviews lasting 90 minutes. Nurses were asked to describe their experiences of caring for Iraq and Afghanistan combat casualties and how it affected them. Wounded service members were asked to share the emotional experiences they faced in dealing with their combat injuries and to describe how military nurses helped them manage their emotional responses and difficulties.

All the patients viewed their nurses as important in their survival and recovery and said they preferred care by military, rather than civilian, nurses. Civilian nurses “just don’t understand the military life in general,” one patient said.

All of the patients were airmen, marines, sailors or soldiers who had been deployed to active combat zones and who were injured and required hospitalization. Their injuries included amputations, gunshot and shrapnel wounds, and burns.

Wounded service members reported they were often confused about how to cope with their post-injury lives and were seeking strategies that would enable them to move forward and reintegrate into family and society. They said that being around other combat-wounded patients provided a helpful sense of shared experience.

“People in your unit, they’re your family. You’ve been through hell with them, protected them, and they were doing the same,” one wounded service member said. Another described “a sense of camaraderie, brotherhood. It’s very powerful. Your survival is built on it.”

Many service members said they were reluctant to acknowledge that they needed help in dealing with psychological issues associated with their injuries. In fact, several said that seeking such assistance is often viewed as a sign of weakness or a barrier to future military careers.

“Any change in policy or procedures that promotes more immediate attention to the psychological needs of wounded service members will have to be accomplished through a changed culture in which stigma is minimized and seeking psychological assistance is rewarded,” the authors wrote.

Funding for the study was provided by the Department of Defense’s TriService Nursing Research Program at the Uniformed Services University of the Health Sciences. The interviews were conducted at National Naval Medical Center in Bethesda, Md.; Brooke Army Medical Center in San Antonio, Texas; and Wilford Hall Air Force Medical Center in San Antonio, Texas.

In a separate research paper, U-M’s Williams and Hagerty, along with several colleagues, examined the feasibility of using an Internet-based stress-management intervention for military personnel.

Known as Stress Gym, the web-based program is designed to help active-duty military personnel deal with stress. The modules in Stress Gym focus on managing stress by developing an awareness of stress in interpersonal relationships, stress associated with specific health issues, and maladaptive responses to stress, such as altered sleep patterns, depression and alcohol abuse.

One hundred forty-two U.S. Navy officers and enlisted sailors participated in the study, which found that the self-help Stress Gym program is feasible to deploy, is accepted by the intended users with a highly positive evaluation, and appears to help reduce stress.

The study was published in the July edition of Military Medicine.


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Contact: Jim Erickson
Phone: (734) 647-1842

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