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How Military Service Affects Our Nurse Colleagues: A Personal Account
How Military Service Affects Our Nurse Colleagues: A Personal Account Kyung Jun, RN, MSN, CNOR
S
eptember 11, 2001, is a day that changed many lives forever. After the terrorist attack on the United States, our country and others deployed over 100,000 military personnel to Iraq and Afghanistan beginning in 2003.1 Since that time, additional military personnel have been deployed, and the fortunate ones have returned home. Over the next 5 years, it is estimated that more than 1 million service workers will return to the United States. Many of the deployed personnel were female reserves who served as registered nurses.2 Understanding the emotional and physical impact caused by 1 or multiple tours of duty on military personnel will enable us to provide compassionate care to these service workers as they return home as patients, family, and colleagues. I am fortunate to work with Captain Brigitte Brown and had the www.nurseleader.com
privilege to sit down with her for a personal interview. The following article is Captain Brown's story.
HISTORICAL BACKGROUND Captain Brown is employed as a nurse at a cardiovascular unit in a prominent medical center located in Los Angeles. Our discussions occurred just prior to her fourth tour of duty and deployment to Kuwait. Captain Brown enlisted in the Navy after high school. She went to “boot camp,” where she was trained as an operating room technician and, shortly afterward, proceeded to nursing school. Once Captain Brown became a nurse, she was promoted to second lieutenant. After her most recent tour of duty in Afghanistan, she was promoted to captain.
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In 2003, Captain Brown received her first call to duty at 3 o’clock in the morning. At first, she thought it was a hoax and ignored the telephone call. A short time later, she received another phone call that again stated she was being called to duty. She was given just 2 hours to travel to San Diego where she spent the next 6 months at the Naval Medical Center. Captain Brown still recalls her apprehension and thinking, “How am I going to pay my bills?” At the Naval Medical Center, Captain Brown worked in the operating room and was listed as a “backfill.” A “backfill” is the name used by the Navy to describe a soldier who is waiting to be deployed. Sadly, the “backfill” soldier is deployed and “fills” the place of another soldier who has been killed in battle, or otherwise needs to be replaced. Captain Brown served two tours of duty as a “backfill.”
CAPTAIN BROWN’S DEPLOYMENT TO AFGHANISTAN—2008 Captain Brown’s third deployment was in 2008 when she was ordered to report to Afghanistan. She was stationed at Bagram Airfield for an entire year. Captain Brown found this year to be 1 of the most rewarding experiences of her life. During this deployment, Captain Brown made a major impact on people’s lives, whether they were friend or foe. She treated all patients with respect, gave them food, shared her care packages, and even gave them her shoes. She realized that some of these individuals, although treated by her, posed a potential danger to her and her colleagues. However, Captain Brown decided it was her job to treat all patients in a fair, equitable, and humane manner. Patients who arrived in shackles and blindfolds were obvious Taliban fighters, but Captain Brown viewed and treated them as if they were like any other patient to be cared for, not to be judged. To get through the grueling days, Captain Brown silently recited her motto “to serve the defender.” While the soldiers fight to keep Americans safe and to maintain and promote our freedom, she serves to keep the soldiers alive. Captain Brown’s deployment to Afghanistan stirred some strong emotions. She saw the brutality of war and the complications of its aftermath. In one difficult situation, she gazed into a little girl’s eyes while the girl was yelling, “You killed my mother and my brother.” Another time, she stared blankly at a young woman who begged the Captain to just let her die. The young woman had lost her baby after being shot in the abdomen and the woman knew she would never be able to bear children again. At times, Captain Brown was discouraged by the fact that some of her work was in vain. Although the physicians and nurses in the army worked feverishly to treat the local Afghanis, many of their female patients would ultimately return to their village, only to be killed by their relatives because they had been disfigured and could never marry. One particularly difficult situation involved a little girl named Avizeh who was horribly burned when white phosphorous acid was dropped on her house. Captain Brown recalled that Avizeh was so badly burned that her face was
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still smoking when she came into the OR. Her face was disfigured, and her little fingers and toes had already been burned off. Countless surgeries later, the little girl eventually recovered some function. During her extended period of treatment, Avizeh lived with Captain Brown’s troop. The troop had parties for her and even bought her a wig. After a long period of rehabilitation, Avizeh returned to her village. Captain Brown later discovered that Avizeh had been shot by her father because he would never be able to marry her off. Captain Brown and her colleagues were angry and frustrated, and wondered, “Who do you hold accountable for this tragedy?” Even today, Captain Brown remains saddened and mortified with Avizeh's death. Returning Home Captain Brown had mixed feelings when she returned home in 2009 after her third deployment. What once had been her home no longer felt like home. She had difficulty understanding non-military Americans. They seemed more concerned with “things” than with “people.” It troubled her that Americans knew more about the affairs of Paris Hilton than of the events occurring in Afghanistan. She recognized that many of her fellow citizens were simply apathetic to war and related world events.
AFTER DEPLOYMENT General Assistance Assisting our health care colleagues after deployment is crucial in the areas of mental health, financial assistance, and related social programs. Many veterans face challenges with posttraumatic stress disorder (PTSD) and sexual abuse, which may have been at the hands of a military superior or colleague. After deployment, it is estimated that 9% of health care veterans meet the criteria for PTSD and 5% percent meet the criteria for depression.3 Consistent with Captain Brown’s story of the little girl who was burned, each nurse has a distinct memory of an unforgettable patient.3 Lack of empathy and decreased tolerance for the mundane are common feelings expressed by many veterans. Anger, sleep deprivation, and flashbacks are also reported. 3 Assistance for Returning Female Personnel—Potential Treatment Although women are still prohibited from serving in combat, this does not prevent them from experiencing PTSD and trauma after deployment.4 US female veterans account for 15%, or 15,000, of active military personnel in Afghanistan.5 Women also are sometimes subjected to sexual trauma, which can include sexual harassment, sexual coercion, and rape.4 It is intolerable to think about being raped by men who are supposed to work with and protect their female colleagues. All these factors can impact the veteran’s social and cognitive adjustment after they return home. The veterans who have suffered mental and physical assaults many times attempt to self-medicate. They turn to drinking, drug abuse, spousal and child abuse, and suicide.
October 2013
It is important for returning veterans to have a mental assessment and confidential counseling with assurances that their disclosures will not affect their current or future employment. Providing a venue for support groups allows these women the opportunity to come together, share their experiences, and support each another through the adjustment period. It is crucial to teach all veterans good coping strategies to assist them in their activities of daily living. Some of these mechanisms may also help promote quality rest time, relaxation, and sleep without recurrent nightmares. Assistance for Returning Female Personnel—What Their Workplace Supervisors and Employers Can Do A workplace policy to assist the veterans financially can help alleviate this additional stressor and potential financial burden. Many of our healthcare colleagues were called to duty as a reservist. There is some evidence that a reservist may have more difficulty adjusting to civilian life after she returns home from service.6 For the last decade, reserve military service in the United States has been a part-time endeavor.7 Service as a reserve requires only a small time commitment until the reservist is activated for duty. Thus, deployment for reservists is an enormous change in their lives and can result in a far more stressful experience compared to those on active duty.7 Additionally, multiple deployments and longer lengths of deployment have been associated with higher depression and mental health issues.7 Deployment can cause feelings of guilt from leaving their family behind, stress from loss of income, fear of losing their job and job seniority, and loss of promotional opportunities.6 In order to alleviate additional burden and stress for our colleagues, implementing an institutional workplace policy to assist our departing reservists is optimal and patriotic. The policy could include measures to keep the reservist financially whole while deployed, provide for timely raises, and allow continued accrual of vacation and sick time, and maintained seniority. Helping Our Returning Veterans Adjust to Everyday Life Social support and assistance would aid in transitioning these veterans to civilian life. It is vital to understand why the veterans chose to serve, what they saw and did while deployed, and how they felt during and after their deployment. Acknowledging that these individuals have been in life-and-death situations for an extended period and more than once their life and the lives of their military colleagues depended on split-second decisions goes a very long way in appreciating the service extended to our nation. Most of the politeness and civility we engage in during our day-to-day lives does not exist under their pressure-packed situations. Being patient with a returning veteran can be quite helpful, especially to an officer who is used to ordering his or her troops, sometimes with salty language. Similarly, Captain Brown recognized that she could no longer behave like a captain when she returned to her employer’s medical center. She required an adjustment period, and her colleagues handled it well by simply being patient. Veterans also adjust to life as a citizen when they www.nurseleader.com
Assisting our health care colleagues after deployment is crucial in the areas of mental health, financial assistance, and related social programs. know they are appreciated and that their sacrifice is not forgotten. Captain Brigitte Brown said, “Freedom is not free.” For example, simply saying “Thank you for serving our county” and shaking hands can truly make a veteran’s day. Also, sending them care packages while deployed goes a long way to making them feel valued and remembered. A warm welcome home when they return is a great memory for many veterans. Many cities have groups that meet soldiers at airports to say “good-bye” or “welcome home,” depending on whether they are deploying or returning. There are also a number of organizations that prepare care packages for the troops.
FINAL THOUGHT Captain Brown was deployed for the fourth time in June 2012. Marine Sergeant William Stacey’s final letter said it all.8 He detailed why our military personnel do what they do, why it is imperative that we understand the sacrifice they make, why we need to understand these individuals, and why we need to care for them so that they can return 1 day to care for us. “My death did not change the world; it may be tough for you to justify its meaning at all. But there is a greater meaning; perhaps there is still injustice in the world. But there will be a child who will live because men left the security they enjoyed in their home country to come to his. And this child will learn in the new schools that have been built…. He will grow into a fine man who will pursue every opportunity his heart could desire. He will have the gift of freedom, which I have enjoyed for so long. If my life buys the safety of a child who will one day change the world, then I know that it was all worth it.”8 Sgt William Stacey was age 23 when he was killed in combat in Afghanistan.8 NL References 1. Scannell-Desch E, Doherty M. Experiences of U.S. military nurses in the Iraq and Afghanistan wars, 2003-2009. J Nurs Scholarsh. 2010;421:3-12. 2. McFee R. Gulf war servicemen and servicewomen: the long road home and the role of health care professionals to enhance the troops’ health and healing. Dis Mon. 2008;54:365-333. 3. Hopkins-Chadwick. Strategies to support nurse work reintegration after deployment. US Army Med Dep J. 2012;October-December:59-63. 4. Mattocks KM, Haskell SG, Krebs EE, Justice AC, Yano EM, Brandt C. Women at war: understanding how women veterans cope with combat and military sexual trauma. Soc Sci Med. 2012;74:537-545.
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5. Maguen S, Luxton DD, Skopp NA, Madden E. Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. J Psychiatr Res. 2011;46:311-316. 6. Harvey S, Hatch S, Jones M, et al. Coming home: social functioning and the mental health of UK reservists on return from deployment to Iraq or Afghanistan. Ann Epidemiol. 2011;21:666-672. 7. Griffith J. Citizens coping as soldiers: a review of deployment stress symptoms among reservists. Mil Psychol. 2010;22:176-206. 8. Winton R. A Letter From Killed Marine Continues to Inspire Others. Los Angeles Times. http://latimesblogs.latimes.com/lanow/2012/07/letter-frommarine-inspires-others.html. Accessed February 15, 2013.
Kyung Jun, RN, MSN, CNOR, is a service line manager at Cedars Sinai Health Systems in Los Angeles, California, and can be reached at [email protected]. 1541-4612/2013/ $ See front matter Copyright 2013 by Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2013.05.014
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October 2013
S
eptember 11, 2001, is a day that changed many lives forever. After the terrorist attack on the United States, our country and others deployed over 100,000 military personnel to Iraq and Afghanistan beginning in 2003.1 Since that time, additional military personnel have been deployed, and the fortunate ones have returned home. Over the next 5 years, it is estimated that more than 1 million service workers will return to the United States. Many of the deployed personnel were female reserves who served as registered nurses.2 Understanding the emotional and physical impact caused by 1 or multiple tours of duty on military personnel will enable us to provide compassionate care to these service workers as they return home as patients, family, and colleagues. I am fortunate to work with Captain Brigitte Brown and had the www.nurseleader.com
privilege to sit down with her for a personal interview. The following article is Captain Brown's story.
HISTORICAL BACKGROUND Captain Brown is employed as a nurse at a cardiovascular unit in a prominent medical center located in Los Angeles. Our discussions occurred just prior to her fourth tour of duty and deployment to Kuwait. Captain Brown enlisted in the Navy after high school. She went to “boot camp,” where she was trained as an operating room technician and, shortly afterward, proceeded to nursing school. Once Captain Brown became a nurse, she was promoted to second lieutenant. After her most recent tour of duty in Afghanistan, she was promoted to captain.
Nurse Leader
41
In 2003, Captain Brown received her first call to duty at 3 o’clock in the morning. At first, she thought it was a hoax and ignored the telephone call. A short time later, she received another phone call that again stated she was being called to duty. She was given just 2 hours to travel to San Diego where she spent the next 6 months at the Naval Medical Center. Captain Brown still recalls her apprehension and thinking, “How am I going to pay my bills?” At the Naval Medical Center, Captain Brown worked in the operating room and was listed as a “backfill.” A “backfill” is the name used by the Navy to describe a soldier who is waiting to be deployed. Sadly, the “backfill” soldier is deployed and “fills” the place of another soldier who has been killed in battle, or otherwise needs to be replaced. Captain Brown served two tours of duty as a “backfill.”
CAPTAIN BROWN’S DEPLOYMENT TO AFGHANISTAN—2008 Captain Brown’s third deployment was in 2008 when she was ordered to report to Afghanistan. She was stationed at Bagram Airfield for an entire year. Captain Brown found this year to be 1 of the most rewarding experiences of her life. During this deployment, Captain Brown made a major impact on people’s lives, whether they were friend or foe. She treated all patients with respect, gave them food, shared her care packages, and even gave them her shoes. She realized that some of these individuals, although treated by her, posed a potential danger to her and her colleagues. However, Captain Brown decided it was her job to treat all patients in a fair, equitable, and humane manner. Patients who arrived in shackles and blindfolds were obvious Taliban fighters, but Captain Brown viewed and treated them as if they were like any other patient to be cared for, not to be judged. To get through the grueling days, Captain Brown silently recited her motto “to serve the defender.” While the soldiers fight to keep Americans safe and to maintain and promote our freedom, she serves to keep the soldiers alive. Captain Brown’s deployment to Afghanistan stirred some strong emotions. She saw the brutality of war and the complications of its aftermath. In one difficult situation, she gazed into a little girl’s eyes while the girl was yelling, “You killed my mother and my brother.” Another time, she stared blankly at a young woman who begged the Captain to just let her die. The young woman had lost her baby after being shot in the abdomen and the woman knew she would never be able to bear children again. At times, Captain Brown was discouraged by the fact that some of her work was in vain. Although the physicians and nurses in the army worked feverishly to treat the local Afghanis, many of their female patients would ultimately return to their village, only to be killed by their relatives because they had been disfigured and could never marry. One particularly difficult situation involved a little girl named Avizeh who was horribly burned when white phosphorous acid was dropped on her house. Captain Brown recalled that Avizeh was so badly burned that her face was
42
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still smoking when she came into the OR. Her face was disfigured, and her little fingers and toes had already been burned off. Countless surgeries later, the little girl eventually recovered some function. During her extended period of treatment, Avizeh lived with Captain Brown’s troop. The troop had parties for her and even bought her a wig. After a long period of rehabilitation, Avizeh returned to her village. Captain Brown later discovered that Avizeh had been shot by her father because he would never be able to marry her off. Captain Brown and her colleagues were angry and frustrated, and wondered, “Who do you hold accountable for this tragedy?” Even today, Captain Brown remains saddened and mortified with Avizeh's death. Returning Home Captain Brown had mixed feelings when she returned home in 2009 after her third deployment. What once had been her home no longer felt like home. She had difficulty understanding non-military Americans. They seemed more concerned with “things” than with “people.” It troubled her that Americans knew more about the affairs of Paris Hilton than of the events occurring in Afghanistan. She recognized that many of her fellow citizens were simply apathetic to war and related world events.
AFTER DEPLOYMENT General Assistance Assisting our health care colleagues after deployment is crucial in the areas of mental health, financial assistance, and related social programs. Many veterans face challenges with posttraumatic stress disorder (PTSD) and sexual abuse, which may have been at the hands of a military superior or colleague. After deployment, it is estimated that 9% of health care veterans meet the criteria for PTSD and 5% percent meet the criteria for depression.3 Consistent with Captain Brown’s story of the little girl who was burned, each nurse has a distinct memory of an unforgettable patient.3 Lack of empathy and decreased tolerance for the mundane are common feelings expressed by many veterans. Anger, sleep deprivation, and flashbacks are also reported. 3 Assistance for Returning Female Personnel—Potential Treatment Although women are still prohibited from serving in combat, this does not prevent them from experiencing PTSD and trauma after deployment.4 US female veterans account for 15%, or 15,000, of active military personnel in Afghanistan.5 Women also are sometimes subjected to sexual trauma, which can include sexual harassment, sexual coercion, and rape.4 It is intolerable to think about being raped by men who are supposed to work with and protect their female colleagues. All these factors can impact the veteran’s social and cognitive adjustment after they return home. The veterans who have suffered mental and physical assaults many times attempt to self-medicate. They turn to drinking, drug abuse, spousal and child abuse, and suicide.
October 2013
It is important for returning veterans to have a mental assessment and confidential counseling with assurances that their disclosures will not affect their current or future employment. Providing a venue for support groups allows these women the opportunity to come together, share their experiences, and support each another through the adjustment period. It is crucial to teach all veterans good coping strategies to assist them in their activities of daily living. Some of these mechanisms may also help promote quality rest time, relaxation, and sleep without recurrent nightmares. Assistance for Returning Female Personnel—What Their Workplace Supervisors and Employers Can Do A workplace policy to assist the veterans financially can help alleviate this additional stressor and potential financial burden. Many of our healthcare colleagues were called to duty as a reservist. There is some evidence that a reservist may have more difficulty adjusting to civilian life after she returns home from service.6 For the last decade, reserve military service in the United States has been a part-time endeavor.7 Service as a reserve requires only a small time commitment until the reservist is activated for duty. Thus, deployment for reservists is an enormous change in their lives and can result in a far more stressful experience compared to those on active duty.7 Additionally, multiple deployments and longer lengths of deployment have been associated with higher depression and mental health issues.7 Deployment can cause feelings of guilt from leaving their family behind, stress from loss of income, fear of losing their job and job seniority, and loss of promotional opportunities.6 In order to alleviate additional burden and stress for our colleagues, implementing an institutional workplace policy to assist our departing reservists is optimal and patriotic. The policy could include measures to keep the reservist financially whole while deployed, provide for timely raises, and allow continued accrual of vacation and sick time, and maintained seniority. Helping Our Returning Veterans Adjust to Everyday Life Social support and assistance would aid in transitioning these veterans to civilian life. It is vital to understand why the veterans chose to serve, what they saw and did while deployed, and how they felt during and after their deployment. Acknowledging that these individuals have been in life-and-death situations for an extended period and more than once their life and the lives of their military colleagues depended on split-second decisions goes a very long way in appreciating the service extended to our nation. Most of the politeness and civility we engage in during our day-to-day lives does not exist under their pressure-packed situations. Being patient with a returning veteran can be quite helpful, especially to an officer who is used to ordering his or her troops, sometimes with salty language. Similarly, Captain Brown recognized that she could no longer behave like a captain when she returned to her employer’s medical center. She required an adjustment period, and her colleagues handled it well by simply being patient. Veterans also adjust to life as a citizen when they www.nurseleader.com
Assisting our health care colleagues after deployment is crucial in the areas of mental health, financial assistance, and related social programs. know they are appreciated and that their sacrifice is not forgotten. Captain Brigitte Brown said, “Freedom is not free.” For example, simply saying “Thank you for serving our county” and shaking hands can truly make a veteran’s day. Also, sending them care packages while deployed goes a long way to making them feel valued and remembered. A warm welcome home when they return is a great memory for many veterans. Many cities have groups that meet soldiers at airports to say “good-bye” or “welcome home,” depending on whether they are deploying or returning. There are also a number of organizations that prepare care packages for the troops.
FINAL THOUGHT Captain Brown was deployed for the fourth time in June 2012. Marine Sergeant William Stacey’s final letter said it all.8 He detailed why our military personnel do what they do, why it is imperative that we understand the sacrifice they make, why we need to understand these individuals, and why we need to care for them so that they can return 1 day to care for us. “My death did not change the world; it may be tough for you to justify its meaning at all. But there is a greater meaning; perhaps there is still injustice in the world. But there will be a child who will live because men left the security they enjoyed in their home country to come to his. And this child will learn in the new schools that have been built…. He will grow into a fine man who will pursue every opportunity his heart could desire. He will have the gift of freedom, which I have enjoyed for so long. If my life buys the safety of a child who will one day change the world, then I know that it was all worth it.”8 Sgt William Stacey was age 23 when he was killed in combat in Afghanistan.8 NL References 1. Scannell-Desch E, Doherty M. Experiences of U.S. military nurses in the Iraq and Afghanistan wars, 2003-2009. J Nurs Scholarsh. 2010;421:3-12. 2. McFee R. Gulf war servicemen and servicewomen: the long road home and the role of health care professionals to enhance the troops’ health and healing. Dis Mon. 2008;54:365-333. 3. Hopkins-Chadwick. Strategies to support nurse work reintegration after deployment. US Army Med Dep J. 2012;October-December:59-63. 4. Mattocks KM, Haskell SG, Krebs EE, Justice AC, Yano EM, Brandt C. Women at war: understanding how women veterans cope with combat and military sexual trauma. Soc Sci Med. 2012;74:537-545.
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5. Maguen S, Luxton DD, Skopp NA, Madden E. Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. J Psychiatr Res. 2011;46:311-316. 6. Harvey S, Hatch S, Jones M, et al. Coming home: social functioning and the mental health of UK reservists on return from deployment to Iraq or Afghanistan. Ann Epidemiol. 2011;21:666-672. 7. Griffith J. Citizens coping as soldiers: a review of deployment stress symptoms among reservists. Mil Psychol. 2010;22:176-206. 8. Winton R. A Letter From Killed Marine Continues to Inspire Others. Los Angeles Times. http://latimesblogs.latimes.com/lanow/2012/07/letter-frommarine-inspires-others.html. Accessed February 15, 2013.
Kyung Jun, RN, MSN, CNOR, is a service line manager at Cedars Sinai Health Systems in Los Angeles, California, and can be reached at [email protected]. 1541-4612/2013/ $ See front matter Copyright 2013 by Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2013.05.014
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October 2013