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Recommendations

Existing knowledge of reintegration experiences is largely dependent on using clinical samples focusing on those who have documented post-traumatic stress disorder (PTSD) and its impact on family life. However, to study reintegration broadly and deeply, further research is needed with nonclinical samples because the majority of returning veterans do not have PTSD. The research study that culminated in this book was an attempt to capture the reintegration experience with such a sample. A qualitative, phenomenological approach allowed the 35 nurses participating in this study to tell their stories. This method yielded personal, anecdotal, and meaningful information about their reintegration journey, which is far different from checking boxes on a survey. In addition, there needs to be a balance between strength-based and resiliency approaches and those emphasizing psychopathology (Marek et al., 2012).

Family-focused, longitudinal studies would add greatly to knowledge development about the reintegration process and could lead to the formulation, implementation, and evaluation of effective support programs, resources, and services. Collaboration between military and civilian communities would be needed to put forth a research agenda of this nature. Yet, the mission of helping military families to build resiliency during reintegration is of immense importance (Marek et al., 2012).

Family and friends of active duty and reserve nurses could benefit from family-readiness training to help the reintegration process. This training is usually military-service-branch specific, base specific, and unit specific for active duty families. It frequently consists of biweekly meetings for families of deployed personnel. Attendance is voluntary. The meeting agenda is usually developed by the base family support center in concert with mental health services, financial services, and family advocacy and readiness services. Attendees normally have input for the following meetings so their concerns can be addressed. Sometimes reserve component units try to hold similar meetings, but geographical distance from the base can impair attendance.

All returning veterans need a comprehensive assessment to check their level of functioning and to formulate a treatment plan if necessary. Areas to evaluate include: work functioning, interpersonal functioning, recreation and self-care, physical functioning, psychological signs and symptoms, past stress-reduction activities and coping mechanisms, a history of previous traumatic events, and deployment-related experiences.

The assessment process should commence by focusing on current psychosocial functioning and the immediate needs of the veteran. Trauma exposure should take place later in the assessment process, if possible. It is of utmost importance that reintegrating veterans feel safe, secure, comfortable, and accepted. Reintegration has no specific time frame or map. It is a very individual process for each returning veteran.

Vet Centers provide counseling services for various problems affecting reintegration. All veterans can utilize the resources and services at a Vet Center. A Vet Center is a place where veterans can come for professional help with combat-related trauma, harassment, employment, bereavement, benefits, and educational services. Families of deceased service members are welcome as well. Currently, there are 232 community-based Vet Centers located in all 50 states, as well as Washington, DC, Guam, Puerto Rico, and the U.S. Virgin Islands.

Although Vet Centers were originally set up to help returning Vietnam veterans, they are now available to counsel all combat veterans from all military conflicts, including World War II, Korea, Lebanon, Grenada, Panama, the Persian Gulf, Somalia, and Kosovo/Bosnia. Most veterans being seen at Vet Centers today are veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and subsequent operations within the Global War on Terrorism (GWOT).

There is also a national center for PTSD. This center provides written materials for families of returning military personnel. The mission is to help the service member and his or her family understand what to expect when returning from a war zone and how to help the returning veteran adapt to life back home.

CONCLUSION

In writing this book, we followed an enlightening and insightful path to get at the heart of the reintegration experience by capturing the words, phrases, and narratives of nurses who had served the United States in the Iraq and Afghanistan wars. Our travels took us from Maine to North Carolina. Our telephone interviews spanned to Hawaii, Alaska, and Guam. We interviewed nurses who served as early as 2003 and as late as 2014. Numerous books have been published describing the experiences of reintegration for returning soldiers, sailors, marines, and airmen serving in these wars. Yet, very little has been written about the reintegration experiences of military nurses. Therefore, the mission of this book is to do just that—to identify, describe, explore, and document the reintegration experiences of nurses who served in Iraq (OIF) and Afghanistan (OEF). A rather lengthy and in-depth research study was conducted by the authors in an effort to tell the nurses’ stories, which has culminated in this book.

As nurses ourselves, we feel a kinship to the nurses in this study. Their words resonated with us, staying in our minds and hearts. Occasionally after an interview, we had difficulty sleeping because of what they told us. Sometimes, they made us laugh with their anecdotes. Other times, their stories caused our eyes to well up with tears and get a sinking feeling in our stomachs. Their narratives were never boring and we often got the feeling that the nurses experienced a kind of catharsis as a result of telling their stories. We listened intently and were never judgmental. We marveled at their sense of duty, patriotism, selflessness, kindness, and compassion. Repeatedly, they told us how much they loved America and how much they appreciate the freedoms and way of life they enjoy at home. No matter how much they struggle with reintegration issues, a sense of home was important to them. They saw up close and personal the devastation and carnage resulting from the wars. They saw maimed, burned, and slaughtered children. They witnessed firsthand the lack of regard for women in both countries, in terms of education and social status. They learned how precious and fragile human life could be and how easily it could be gone in an instant. Many stated that they never felt truly safe while deployed and that they are having issues with fear, safety, and uncertainty here at home as well.

Most nurses doubt that any human experience will exceed their wartime deployment in terms of stress, horror, and vulnerability while at the same time they feel that they benefitted with the growth of their professional nursing expertise, decision making, and leadership. Yet, the majority of the nurses feel like they took the war home with them. They think about their patients and colleagues, the elderly villagers, and the women and children. They wonder how the amputees are getting along or if the traumatic brain injury (TBI) patients are making progress. By the nature of their work, nurses tend to live with trauma almost every day when deployed. They learn to anticipate and prepare for mass casualty events. However, many of the nurses were not prepared for what they would be dealing with on U.S. soil when they came home.

The voices of reintegrating nurses were heard loud and clear in this book. They tried to make sense of their experiences within the framework of reintegration. The ones who had positive experiences had less difficulty adjusting, such as the nurse who met her future husband in a prison hospital when he was serving as an interpreter or some of the air force nurses who had shorter deployments. Long deployments seemed to be the most difficult, and reintegration for reservists who did not live near a military installation could be problematic. It could also be quite troublesome when reservists had to return to their civilian nursing positions before they felt ready but needed to do so for economic reasons. A plethora of variables could impact the reintegration process.

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