The Lived Experience of Iraqi Nurses in Communities Impacted by War or Terrorist Threat

Sunday, 8 November 2015: 11:40 AM

Elizabeth J. Diener, PhD, MSN, BSN, RN, CNE
Kramer School of Nursing, Oklahoma City University, Oklahoma City University, OK, USA

Background: Over the last two decades Iraq has endured three international wars, 13 years of economic sanctions, dictatorship, foreign occupation, and acts of terrorism.  For professional nurses practicing in Iraq, expectations have been that professional life continues “as usual;” caregivers are to function as if the stress of political unrest and personal insecurity does not have personal impact. Results of an extensive review of the literature review emphasize the lack of published research exploring the lived experiences of nurses living and practicing in communities that experience war and terrorist threat.  These gaps make development of supportive structures, policy, and educational interventions impossible. 

Methodology:  Guided by Jean Watson’s Human Caring Science, the purpose of this phenomenological investigation is to describe the lived experiences of Iraqi nurses who have experienced the realities of war as both citizens and practitioners in Iraq.  Hour-long phenomenologic interviews were conducted with 10 male Iraqi nurses who met the inclusion criteria of: Possessing a degree in nursing, lived and practiced nursing in Iraq during a time of war or terrorist threat, and are able to communicate in English or Arabic.  Data analysis was ongoing utilizing Giorgi’s approach.

Findings: Two main themes and seven subthemes emerged from data analysis. Main Themes-Living under the Shadow of War and Violence: A Daily Routine and, second, the Shield of Adaptation and Resilience.  The first theme, Living under the Shadow of War and Violence, had five subthemes, Impact on Personal Life, Effects on Physical Well-Being, Influence on Mental Health and Emotional Well-being, Impact on the Delivery of Nursing Care, and Lost Sense of Personal Safety.  The second theme, The Shield of Adaptation and Resilience, yielded two subthemes, Faith- Based Hope and Commitment to a Profession of Care

This research highlights a number of outcomes from traumatic experiences faced by Iraqi nurses on a daily basis and their multidimensional effects.  The first theme confirms the heavy responsibility of caring and advocating for citizens of a distressed community while also experiencing this same trauma. Continuous trauma not only affected their physical well-being, but also social integration, nursing practice quality, and psycho-mental health.  Major symptoms of PTSD such as flashbacks, unexplained anxiety, nightmares, and insomnia were evident. 

As portrayed by the second theme, even without a secure practice setting Iraqi nurses adapted to their environment using faith-based resilience and professional commitment.  Nonetheless, nurses also needed professional and formal support to continue performance of their professional role while holding the responsibility of caring and advocating for traumatized members of a community to which they were members.

Recommendations: Results from this phenomenological study are expected to inform and guide “caregivers of caregivers” in healing the trauma of war and terror.  This study confirms that nurses living and practicing in communities continually impacted by violence lose their sense of security and suffer the consequences of prolonged and constant stress.  Establishing work environments that assure physical safety and provide treatment for stress related disorders are imperative to assure quality, care-centered nursing practice.