Easing Pain on the Western Front: American Nurses of the Great War and the Birth of Modern Nursing Practice by Paul E. Stepansky (review)

In this accessible and stimulating book, Paul Stepansky attempts to do for American nursing what Christine Hallett achieved with her accounts of British nurses in World War I. Drawing on primary sources—letters and journals of American nurses and their colleagues—his endeavor is partly to try to locate the roots of modern advancements in nursing practice. This he achieves by focusing on the main aspects of nursing in WWI. Easing Pain on the Western Front dives into the fundamental tenets of nursing practice, topics that are still debated and discussed a century later—the nature of caring, the importance of touch, the therapeutic role, the relationship with the medical profession, the provision of "total" care, and a "safe" pair of hands. Stepansky achieves this through an impressively broad exploration of different aspects of wartime nursing which have been organized into thematic chapters enabling identification of these practices in a developmental context.

For example, in the chapter on wound management, he explores the development and use of the Carrel-Dakin method of wound cleansing. This method had already appeared in the medical literature but was largely rejected by surgeons because of its complexity. Yet in the management of traumatic, often life-threatening wounds, the method was repeatedly documented and described by nurses—initially as witnesses to the positive effect on preventing catastrophic infections. Later, as physicians were required elsewhere (for example, to perform surgeries), it was nurses who took the lead in instigating the complex procedure, maintaining the infusion, and documenting its effects. As in all the other innovations identified and described in this book, the sense of real pride from the nurses' journal excerpts as they are able to expand and extend their roles is palpable.

The topic of psychiatric nursing is explored in the context of the lasting psychological impact of "shell shock." In Chapter Five, Stepansky explains how nurses came to view shell shock as yet another injury sustained in the battlefield that could be healed, just like the torn muscles and viscera of those injured by incendiaries. The dominant medical approach at that time appeared to be to repeatedly deliver the message that these symptoms would resolve with time. In contrast, the nurses who were positioned close to patients were able to obtain a unique view of psychological sequalae of trauma and came to adopt a somewhat different position, as part of a community of fellow sufferers, both mental and physical. Stepansky's account of this aspect of care reveals the roots of mental health nursing and the evolution of nonjudgmental acceptance of how patients present. Particularly resonant in this chapter are the examples of nursing creativity in the therapeutic role: the nurse who gave a soldier her violin to play, knowing that in his civilian role he was a professional violinist; the impact of seeing a small mouse scuttle across a tabletop and the resultant unlocking effect of the (small) shock. This normalization of mental suffering appears to have been a core part of the wartime nursing role and the reflections in these journals are a testament to the learning that these experiences enabled. Throughout the book, Stepansky refers to the impact on the nurses themselves on the provision of care and the emotional toll taken.

Surprisingly, the huge range of expanded roles described in the journals were not automatically implemented in nursing practice following the war. Nurses returning to civilian practice encountered levels of bureaucracy and professional hierarchy that had, during the wartime years, been at least partially suspended as the providers of clinical care were forced to work together in new and creative ways. This is a key message of the book: it is vital that we learn from extreme experiences and adversity, and that this learning is integrated into the ongoing evolution of professional...