The Ignored History of Nurse PTSD


This text appeared within the September/October 2021 difficulty of Uncover journal as “Frontline Fatigue.” Change into a subscriber for limitless entry to our archive.

In February 1945, U.S. Navy nurse Dorothy Nonetheless was a prisoner of struggle within the Japanese-occupied Philippines. Together with 11 different Navy nurses, Nurse Nonetheless offered take care of civilian inmates in a jail camp the place meals was scarce and guards have been brutal. Few inmates weighed greater than 100 kilos, and most have been dying from malnutrition. 

On the night time of Feb. 22, Nurse Nonetheless and the opposite inmates watched as their captors arrange weapons across the perimeter of the camp and turned the barrels inward. Different guards dug shallow graves. The inmates had lengthy suspected the camp commander deliberate to bloodbath all of them, and it appeared the rumors have been coming true. But Nurse Nonetheless and one other Navy nurse reported to the infirmary for the night time shift. They’d little medication or meals to supply their sufferers; consolation and kindness have been all that they had left to offer. 

Nurse Nonetheless heard gunfire the subsequent morning at daybreak and assumed the bloodbath had begun. She steeled herself to look out the infirmary window and noticed parachutes gliding to the bottom. Liberation had come simply in time! U.S. and Filipino forces swiftly evacuated the two,400 inmates to security. 

However that wasn’t the top of Nurse Nonetheless’s journey. She was haunted by the horrors she witnessed within the jail camp, and the trauma caught along with her for the remainder of her life. Now nursing leaders and advocates are saying the issue of not addressing nurses’ psychological well being wants has once more reached a essential level. Nurses have been on the entrance strains of the COVID-19 disaster, however most aren’t receiving complete psychological well being screening or remedy. Nursing advocacy teams and students who examine PTSD in nursing warn that leaving nurses’ psychological well being wants untreated may result in a nursing scarcity, a lot because it did after World Warfare II.

Taken as prisoners of struggle in 1942, Dorothy Nonetheless and 11 different Navy nurses offered medical care within the midst of brutal struggling at Los Baños Internment Camp. (Credit score: Courtesy of Bureau of Medication and Surgical procedure)

Struggling in Silence 

Again within the States, Nurse Nonetheless was tasked with talking at struggle bond drives in regards to the three years she was a prisoner of struggle. She discovered the expertise troubling and requested a switch to Panama, however her reminiscences adopted her to her new put up. At occasions, she was depressed. Different occasions, she couldn’t cease desirous about all she had endured. She typically cried with out provocation and struggled to cease crying as soon as she had began. On recommendation of her fiancé, she booked an appointment with a naval doctor. 

Throughout her appointment, Nurse Nonetheless informed the doctor she had been a prisoner of struggle for greater than three years, and requested for a medical discharge based mostly on the trauma she was experiencing. The physician requested when Nurse Nonetheless was liberated; the date was the identical because the elevating of the flag at Iwo Jima. The doctor mentioned these males have been heroes, however Nurse Nonetheless was a girl and a nurse, and subsequently, didn’t undergo. Denied remedy, Nurse Nonetheless left the appointment shaking. She vowed she would maintain her ache to herself. 

The Navy nurses weren’t the one medical care suppliers taken prisoner throughout WWII. Sixty-six U.S. Military nurses in addition to lots of of physicians, pharmacists, and medical assistants have been additionally held captive within the South Pacific. However on the finish of the struggle, because the U.S. ready to welcome dwelling tens of millions of women and men who served their nation, psychological well being remedy was restricted — and reserved for males. Nurses, it was assumed, didn’t undergo. 

On the time, the U.S. navy was the most important employer of nurses, and it had established an anticipated code of silence relating to how nurses responded to their very own trauma. In 1947, an article within the American Journal of Psychiatry claimed a navy hospital was a managed surroundings that insulated nurses from the brutality of struggle. The examine’s creator claimed that nurses’ psychological well being wants have been “much less complicated,” and that nursing fulfilled ladies by catering to their pure intuition to take care of males: “They have been supplying a service which gratified the passive wants of males. And which recognized these ladies with the mom, the spouse, or the lover again dwelling.”

Many nurses, together with Nurse Nonetheless, responded to the dearth of psychological well being remedy by leaving each the navy and nursing. The late 1940s noticed a scarcity in nurses at time when hospital admissions rose by 26 %. The scarcity persevered till the late 1960s when wages started to extend.

After three years as POWs, the Navy nurses have been liberated in 1945. Right here, they converse with Admiral Thomas C. Kinkaid after their launch, and are proven subsequent to the plane that introduced them from the South Pacific to Hawaii. (Credit score: U.S. Navy Bureau of Medication and Surgical procedure)

A Looming Disaster 

The COVID-19 pandemic has meant that for the primary time since WWII, the overwhelming majority of U.S. nurses are embroiled in combating a typical enemy. It’s a demanding and emotional battle that advocates say provides a deeper stress to an already taxing job.

Throughout the nation, nurses have been caring for sufferers dying from COVID-19 who wouldn’t have the assist of household at their bedside because of customer restrictions. “The nurses are sometimes those who’re serving because the liked one and serving to the affected person navigate the end-of-life journey,” says Holly Carpenter, a senior coverage advisor with the American Nurses Affiliation. 

Along with caring for dying COVID-19 sufferers, Carpenter says, many nurses weren’t correctly geared up on the peak of the pandemic with the private safety tools wanted to keep away from an infection. These nurses lived in concern of being contaminated or transmitting the virus to family members at dwelling. 

And on prime of those stressors, nurses are additionally nonetheless dealing with the standard calls for of the job. “There are the issues which have all the time been there — lengthy shifts, typically obligatory time beyond regulation, a workload that’s heavier than you’re snug with, having to work by means of breaks or lunchtime, having to return in early and keep late,” Carpenter says. 

Previous to the pandemic, research estimated that as many as half of critical-care nurses skilled post-traumatic stress dysfunction (PTSD). Because the pandemic started, researchers have discovered the disaster has amplified signs of psychological well being issues. A 2020 examine in Basic Hospital Psychiatry discovered that 64 % of nurses in a New York Metropolis medical heart reported experiencing acute stress. 

“Acute stress included signs like nightmares, incapability to cease desirous about COVID-19, and feeling numb, indifferent, and on guard,” says examine chief Marwah Abdalla, a medical heart specialist and assistant professor of drugs at Columbia College Medical Heart. “That is regarding. We all know that if these signs persist for greater than a month, it could result in PTSD.” 

Some nurses skilled PTSD earlier than COVID-19, however the situations of the pandemic have amplified psychological well being issues. (Credit score: Eldar Nurkovic/Shutterstock)

An individual is recognized with PTSD in the event that they meet standards outlined by the DSM-5, the psychiatric career’s official handbook. Standards embody experiencing, witnessing or studying a couple of traumatic occasion (similar to dying, critical harm, or sexual violence); intrusive signs like goals and flashbacks; avoidance of reminders of the occasion; detrimental adjustments in ideas and moods; and behavioral adjustments. An individual also can develop PTSD if they’re repeatedly uncovered to particulars of a traumatic occasion. 

Affected by undiagnosed or untreated PTSD is a life-altering situation with numerous ramifications, and should lead a nurse to go away well being care. “We’re probably establishing an occupational well being care disaster,” Abdalla says. “This has long-term implications for the well being care business and our capability to ship sufficient well being take care of our sufferers.” 

Carpenter says well being care organizations have to be proactive with screening nurses for signs associated to anxiousness, melancholy, and PTSD. Such screenings have to be confidential and include the peace of mind {that a} nurse’s license or job won’t be compromised. Organizations additionally have to work to destigmatize psychological well being prognosis and remedy. 

“Traditionally, nurses are all the time regarded upon because the healers and the helpers,” Carpenter says. “They really feel they must be sturdy for different individuals. What do you do when the hero wants assist?”

For Nurse Nonetheless, assist by no means got here. She left the Navy and nursing, married, and had three youngsters. She returned to nursing within the late 1950s after her husband died instantly and she or he wanted to assist her household.

Solely within the 1990s did she start talking about her experiences in interviews with oral historians and documentary producers. She additionally wrote a memoir, however stored the story gentle and didn’t disclose her in depth struggling.

The career has superior since Nurse Nonetheless’s 1940s attraction for psychological well being assist was rejected. “We do acknowledge the complete PTSD, compassion fatigue, and burnout of nurses. It’s been chronicled now and we perceive it,” Carpenter says. 

Now the problem is encouraging every nurse to hunt and obtain assist. In any other case, advocates warn, their well being and wellbeing will proceed to say no, and historical past might repeat as confused nurses go away a strained career. 

Emilie Le Beau Lucchesi is a journalist within the Chicago space and the creator of That is Actually Warfare: The Unbelievable True Story of a Navy Nurse POW within the Occupied Philippines.


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