"No one gets through it OK": the health challenge of coming home from war

Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings

The experiences of military personnel moving into civilian life can be varied for the individual, families and communities. This paper aims to shed light on the various meanings of the multiple and "nested" transitions of military personnel to civilian life in the context of attending a mental health service in the UK. This was achieved through secondary analysis of semi-structured interviews with veterans who were engaging with a mental health service in the UK and a further interview with the mental health service lead. A thematic analysis was employed based on a descriptive phenomenological approach. Results indicate that an appropriate support infrastructure needs to be put in place for veterans prior to, during and after the transition to civilian life. The support appropriateness includes themes specific to connectedness to others, support service accessibility, mental health professionals' military culture awareness and mental health stigma. Although the findings suggest that community services need an awareness of veterans' specific needs, many of the themes are similar to those of the general population. Therefore, the need for an integrated healthcare system is essential in the transition of military service personnel to civilian life. Drawing on international evidence as well as the current findings, implications for policy and practice are highlighted throughout.

Claiming the Narrative Wave With Story Theory

Over the past few decades, there has been a narrative wave that has advanced and subsided but consistently moved toward acceptance in health care circles. Despite the importance of narrative to nursing practice and research, the discipline has been slow to claim the narrative wave as its own. The purpose of this article is to claim the narrative wave for the discipline of nursing with story theory-guided research and practice and to describe dimensions of the narrative movement in health-related literature. Practical application of story theory is described for both nursing practice and nursing research.

A qualitative analysis of meaning-making and mental health among OIF/OEF veterans

OBJECTIVE

After combat, veterans may experience mental health symptomology and attempt to make meaning from their experiences. The present study qualitatively examined the mental health effects of deployment and meaning-making among Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) veterans.

METHOD

OIF/OEF veterans who were exposed to combat (N = 14) participated in semi-structured interviews to assess how their perspectives had changed post-deployment. Most participants (86%) were male, with a mean age of 30.

RESULTS

Veterans described issues post-combat that caused psychological distress or promoted distancing from others. Veterans also discussed factors that could promote or hinder meaning-making, including perceptions of growth, changed global beliefs, and disillusionment. Finally, veterans described psychological reactions to death, which could be related to moral injury.

CONCLUSION

Mental health concerns, meaning-making, and consideration of mortality appear to characterize veterans' experiences post-deployment. These constructs may be important for clinicians to consider when working with OIF/OEF veterans.

Student Veterans' Coping with Posttraumatic Stress Symptoms: A Glaserian Grounded Theory Study

The present study investigated the ways in which student military veterans cope with their posttraumatic stress symptoms. The participants were a total of 21 military veterans attending a U.S. university. The results of the grounded theory data analysis reveal the core category of modulating intrusions, a process indicating how student veterans cope with recurrent and unwanted posttraumatic stress experiences. Our findings also demonstrate that veterans cope by either avoiding or allowing themselves to experience the pain associated from their traumatic experiences. The proposed framework can be meaningfully used to facilitate the development of adaptive coping among veterans with posttraumatic stress.

Military nurse deployments: Similarities, differences, and resulting issues

BACKGROUND

Military nurses have a long history of deploying to combat and disaster. Much can be gleaned from their experiences.

PURPOSE

The purpose of this secondary analysis was to explore military nurses' perceptions of similarities, differences, and resulting issues of military deployments from narratives of three previous studies.

METHODS

Secondary analysis of interviews from 65 U.S. military nurses (Air Force, Army, Navy) was conducted. Line-by-line readings and Nvivo8 qualitative software were used.

DISCUSSION

Seven themes emerged. Similarities: We Have Suffered, Support Really Matters, The Chaos Is Real, and I'm a Different Person Now; Differences: We Didn't Know, The Structure Is Missing, and Disasters and War Are Not Equal.

CONCLUSION

Findings indicated potential areas for improvement in behavioral health, support, and preparedness. Nurses noted they had changed; that they were a different person, and were having difficulty fitting into postdeployment roles. Positive experiences included personal growth and pride.

Understanding deployment from the perspective of those who have served

BACKGROUND

The term deployment is used by the military to describe sending troops to carry out a combat, peacekeeping, or humanitarian mission.

PURPOSE

The purpose of this analysis was to illustrate the variations around combat deployment experiences.

METHODS

Qualitative descriptive methodology was used to examine data from 17 members of the U.S. military who deployed at least once to a combat zone after the September 11, 2001 attacks.

FINDINGS

No two deployments were the same between individuals or within individuals if they deployed more than once. Variations were discovered in deployment experiences related to deployment demands, deployment resources, and coming back changed as individuals.

CONCLUSIONS

Regarding deployment as a singular concept does not take into account the variations in the deployment experience. Individuals caring for those who have served in war would benefit from understanding that each deployment is unique and a life-altering experience.

Understanding contextual influences of community reintegration among injured servicemembers

As part of a larger mixed-methods research project investigating the influence of contextual factors on community reintegration (CR), this qualitative study sought to understand the subjective experiences of injured servicemembers and their perception of how contextual factors influenced their CR. More specifically, this article addresses how the influences of contextual factors differ between injured servicemembers with different levels of CR. Using a phenomenological framework, semistructured interviews were conducted with nine injured, community-dwelling servicemembers with low, moderate, and high levels of CR (three per category). Participants provided in-depth descriptions of the contextual barriers and facilitators of CR. Thematic analysis indicated the importance of social support and personal factors (e.g., self-efficacy, personal motivation) as the primary means for being reintegrated into their homes and communities. Other themes indicated factors that had an indirect but important influence on CR, including adapted sports, recreation, and other social programs; rehabilitation programs and therapists; school, work, and volunteering; and organizations and policies in developing social supports and personal factors. Comparisons between servicemembers indicated participants with low CR described many more contextual barriers and far fewer contextual facilitators to reintegration than those with high CR. Those with moderate CR were unique in that they described many facilitators and barriers to reintegration.

The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection

Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans’ transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a “family” that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents—those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems—were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed.