Facing Losses in Combat-Related Limb- Loss: A Classic Grounded Theory Study

Background: Combat-related limb-loss has been brought to the attention of the public and the political agenda due to the increased survival rates of injured veterans afforded by advances in body armour, better emergency treatment on the battlefield and improved evacuation methods. In the United Kingdom and United States, approximately 1900 veterans sustained an amputation as a result of the Iraq and Afghanistan conflicts. A dearth of qualitative studies currently exists in relation to combat-related limb-loss from the post-2001 conflicts, specifically in relation to the physical and mental wellbeing of veterans after amputation. In the UK, these veterans require long-term care from the National Health Service (NHS), therefore this research seeks to contribute empirical knowledge that health professionals can use to increase their awareness of the unique health care needs of veteran amputees. Method: A classic grounded theory approach (Glaser, 1978; 1998) was adopted in this study which employs the use of coding, constant comparison, theoretical sampling and memoing. In line with the classic grounded theory methodology, multiple data sources were utilised such as face to face and online interviews, autobiographies, documentaries, YouTube videos, online blogs, newspaper/online articles, symposia and armed forces’ charity websites and theatrical plays. Findings: The substantive grounded theory of ‘facing losses’ details how veterans deal with their physical, mental and professional losses when they become injured and lose their limbs. In order to work to resolve these losses and move forward in their 4 rehabilitation, veterans go through a process of ‘dealing with uncertainty’, ‘acceptance’ and ‘finding meaning’. The theory details the behaviours of veterans, from the frontline through to their rehabilitation and medical discharge. The theory of ‘facing losses’ contributes a unique conceptual understanding of the physical and psychosocial factors that impact on veterans’ experience of limb-loss, which has not been noted in the wider literature. Conclusion: The theory has generated insight into the complexities involved in sustaining combat-related limb-loss from the veterans’ perspective. Specifically, a theoretical explanation as to how they face uncertainty, acceptance and finding meaning has been discovered. The theory of ‘facing losses’ has implications for health professionals who may be in involved in the care of a veteran with limb-loss. By having an awareness of a veteran’s experiences from becoming injured through to their rehabilitation and ultimate medical discharge will enable practitioners to better understand their history, experiences and behaviours towards dealing with adversity, and be able to provide appropriate care for this group of people