The American Revolution. World War II. The War on Terror. While millions of soldiers have been killed over the years, most casualties happen off the battlefield years later, quietly, without recognition or ceremony. Injuries, sickness, suicides, and homicides kill military members at a higher rate than combat – taking four out of five lives, according to the Defense Manpower Data Center. This is one of the silent costs of war, and one that University of Colorado Anschutz College of Nursing PhD student Amy Crisp, MSN, RN, CEN, TCRN, wants to change.

Advances in battlefield medicine have improved survivability, while concurrently increasing the number of veterans with service-related illnesses and injuries as well as the number of current and future caregivers.

“Veterans with Traumatic Brain Injuries (TBI) and Post Traumatic Stress Disorder (PTSD) may appear uninjured to others, but they can have difficulty with Instrumental Activities of Daily Living (IADLs). This may make things like concentrating on tasks, planning/prioritization, flexibility, and stress tolerance challenging for them. While this manifests differently for each veteran, some require assistance making and keeping appointments, managing finances and medications, performing housekeeping tasks, and handling transportation. These limitations can affect their ability to reintegrate into civilian life,” says Crisp.

The responsibility for caring for veterans with these invisible injuries often falls to family members, most commonly spouses, but also parents and siblings. That’s why Crisp will focus her PhD dissertation on developing new protocols that offer veterans and their families better ways to cope with stress and improve their quality of life.

She has been awarded a grant by Jonas Philanthropies, a leading national philanthropic funder of graduate nursing education. The scholarship will help the Michigan student earn a PhD with a research focus on Caring Science through an online hybrid program at the College of Nursing.

“It’s exciting and humbling,” Crisp said. “The scholarship will enhance my doctoral education, and support my leadership development while providing additional access to veterans health experts and networking opportunities.”

Crisp’s lived experience as an Army wife for 25+ years has shaped her research interests. Her coursework helped refine her topic. She wants to work with traumatically injured Reserve Component Veterans and their caregiving spouses from the post 9/11 era.

Combat operations tempo following the terrorist attacks of 9/11 quickly outpaced the capacity of the Active-Duty Component, leading to unprecedented reliance on the Reserve Component. Reserve Component service members found themselves thrust into the position of being activated and deployed, many times without the level of support and resources provided to those on Active Duty. While this gap has narrowed since the initiation of the Global War on Terrorism (GWOT) in 2001, Reserve Component service members and their families still carry a heavy burden in comparison to previous conflicts.

According to Krull et al., from 2002 to 2017, almost 300,000 service members were diagnosed with TBI and more than 200,000 were diagnosed with PTSD, making them the signature injuries of the Post 9/11 era.

The interventions Crisp will develop will be grounded in Caring Sciences, a human science perspective to caring experiences, phenomena, and processes. The ultimate goal is for spouses to be a caring and healing environment for their veteran. Her research will be qualitative, focusing using on the lived experience of traumatically injured Reserve Component Veterans and their caregiving spouses.

Qualitative research requires asking questions and carefully listening to the answers. It’s a skill Crisp has mastered as an instructor at Michigan State University’s College of Nursing. During her classes for Nursing Care of Acute and Chronically Ill Patients and Leadership in Clinical Practice, she teaches students how to use therapeutic communication techniques when interviewing patients.

“The goal is to collect accurate information while conveying caring. Many times, patients are afraid of being judged and are reluctant to share sensitive information. This is where explaining to patients and families why we are asking these questions can reassure them that we will use this information to help them.”

“All of our patients have stories to tell and are anxious about something. It could be something as simple as ‘Who will feed my cat’ to ‘How much will this cost because I don’t have health insurance,’” she says. “If that is all the patients are thinking about, then they can’t focus on healing.”

Crisp earned a Bachelor of Science in Nursing at Lake Superior State University. That’s where she met Professor Carole Connaughton, PhD, “Who helped me see nursing as more than a set of tasks to be accomplished. Dr. Connaughton was able to challenge me to succeed while nurturing my growth as a student nurse. Her knowledge and passion for nursing inspired me to pursue graduate education while I was still an undergraduate student and is one of the reasons I wanted to teach nursing.” After working for a decade as an Emergency Department nurse, Crisp earned a Master of Science in Nursing Education at Michigan State University.

- Submitted by Amy Crisp, MSN, RN, CEN, TCRN