Heidi Lynn Plach, Carol Haertlein Sells; Occupational Performance Needs of Young Veterans. Am J Occup Ther 2013;67(1):73–81. https://doi.org/10.5014/ajot.2013.003871
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© 2020 American Occupational Therapy Association
OBJECTIVE. We examined the occupational performance issues facing young U.S. veterans (aged 20–29 yr) who served in Iraq and Afghanistan. Perceived challenges in occupational performance, the most common mental health and brain injuries of war, and motivations for participation in daily occupations upon return to civilian life were identified.
METHOD. Thirty young veterans from Operation Iraqi Freedom and Operation Enduring Freedom were interviewed using the Canadian Occupational Performance Measure (Law et al., 2005). They were also screened for posttraumatic stress disorder, traumatic brain injury, major depression, and alcohol abuse or dependency.
RESULTS. The top five occupational performance challenges were engagement in relationships, school, physical health, sleeping, and driving. The health conditions screened positive for 23%–77% of respondents.
CONCLUSION. This study identified challenges faced by today’s young veterans when reintegrating into the community and daily life. Strategies for occupational therapy practitioners to aid veterans in community reintegration are discussed.
I think that there are some issues with society in general. They didn’t understand, and you just can’t describe what you’ve been through and what you’re feeling when people ask those questions. The worst question that is just appalling to me is, Did you kill anybody? That’s asking probably one of the most offensive questions that you can ask because there is just so much to that question. It’s very disturbing. Being with the veterans or the people you served with and being in that network, all of those questions are eliminated and they’re more geared on towards what are you doing now and what did you do yesterday? It’s more living again and starting over and starting new because you don’t have to talk about what you’ve done, where you’ve been. When you do and you resurface on old times, they’re usually on good memories.
I think it would be really helpful if they [faculty] would look at the experience and training that veterans get, especially those who have been deployed to a combat zone because you get so much more advanced training. . . . The basic entry medical stuff, how to take a blood pressure on people, how to hang an IV bag, how to give an injection or how to read a monitor, vital signs over 2 days or how to administer medications. That’s all stuff that I’ve been doing for a long time. I taught IVs in the military to people who have never done it before, and here I am practicing on a rubber arm. . . . Try doing this with stuff blowing up around you instead of being in a lab.
The first 3 months back I probably put on 35 pounds. . . . I just came back and ate as much as I could and drank as much as I could. It was access. Eating all of the things that you missed. Also, I had the time. I wasn’t working. I wasn’t in school yet. You’re like, Why wouldn’t I go out again or have a big dinner 4 days in a row where you wouldn’t do that normally? You’re not in a routine.
It seemed like I had to drink alcohol to get a decent night’s sleep. For one, having been on a completely different time schedule, it’s hard enough to adjust to because for over a year, you’re used to certain sleep schedules . . . transitioned between first, second, and third shift. On top of that, then there’s the emotional problems from being overseas, anything from posttraumatic stress disorder to readjustment disorders. . . . I have nightmares, waking up, thinking about things to death. Not being able to sleep for several hours, just lying there and thinking about it.
There would be roadside bombs, so you drove straight down the middle of the highway. Just different behaviors that were suited towards that environment, and obviously driving in conditions that were always tense at a higher level of alertness because you had in the back of your mind that you could be entering a scenario that was going to be violent or potentially lethal. So there is a transition period of going back to civilian domestic driving. I sped a lot. There was one instance in particular when I was driving home . . . and I had kind of a panic attack. I was in my truck and I had a quick moment of panic because I honestly thought that I lost my weapon. I said, “Oh my god. Where’s my weapon, where’s my rifle!”
Just finding a reason to carry out your day is the biggest challenge. When I came back and when I got out, I was in complete disarray, mentally, psychologically, and my entire life was just absolute chaos. . . . The capstone of challenges is finding a logical reason to continue to exist despite your experiences. . . . It’s just panic attack after panic attack.
I was drinking and making decisions in ways I never did before. One time I woke up on the sidewalk. . . . I just lived through a war and had an inflated sense of self-privilege that was above moral standards.
Supporting veterans’ health and well-being is imperative for clinical practice and research in all occupational therapy settings (e.g., mental health, physical rehabilitation, pediatrics, older adults, ergonomics).
The therapeutic relationship provides an avenue for recognizing the signature wounds of war, as presented in this study. Occupational therapy practitioners should address these wounds as appropriate, get trained in areas in which they are less familiar, and refer clients to specialists when the concerns extend beyond their scope of practice.
The traumas of war have implications for all members of a veteran’s family. For parents of young children, for example, the occupational therapist in pediatric or school-based settings can play a vital role in recognizing how transitions and loss contribute to behavioral or learning challenges.
The inception of occupational therapy practice began with veterans. Occupational therapy practitioners can continue to uphold this history by researching interventions, disseminating the results, continuing their education, and applying their skills to aid in successful, healthy transitions for veterans and their families.
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