Caring for Veterans

Caring for our nation’s veterans is a noble, yet challenging, task. The University of Alabama at Birmingham School of Nursing is working to make the next generation of nurses better equipped to treat members of the military.

The school developed a series of 10 nursing competencies around veterans’ care.

1. Military and veteran culture

2. Post-traumatic stress disorder

3. Amputation and assistive devices

4. Environmental and chemical exposures

5. Substance use disorder

6. Military sexual trauma

7. Traumatic brain injury

8. Suicide

9. Homelessness

10. Serious illness at end of life

“We wanted to open the door a bit and help people understand veterans’ culture,” explained Randy Moore, DNP, RN, CCRN, assistant professor. As a former navy nurse himself, Moore is especially interested in getting the word out about the healthcare needs of the population.nurse talks to patient

Incorporating Care into the Curriculum
Moore and UAB colleagues Jacqueline Moss, Ph.D., professor of nursing, and Cynthia Selleck, Ph.D., assistant dean for clinical and global partnerships developed the competencies, which were first published as “Veteran Competencies for Undergraduate Nursing Education” in the October/December 2015 issue of Advances in Nursing Science. Moore said, “These competencies need to be threaded throughout the curriculum so students are receiving education from day one through graduation.” The competencies are woven into the nursing curriculum where they are most relevant.

That through line was not always the case. The UAB School of Nursing has an academic partnership sponsored by the VA Office of Academic Affiliations. One of the objectives was to create an elective course on veterans’ health issues taught once each year. While that was beneficial, the concentrated knowledge did not reach as many students as necessary. “People are treating veterans within their civilian hospitals whether they know it or not,” remarked Moore.

Sixteen percent of the 23 million veterans in the U.S. have a service-connected disability. Only 38% of them receive care from the VA. The remainder receives treatment at their local hospitals, clinics and physician offices. Caring for veterans then is a task for all nurses. “We have provided the toolkit for nurse generalists,” Moore noted.

Battlefield Concerns
The physical and psychosocial conditions covered by the competencies are not unique to veterans but occur with increased frequency among that population. Moore said, “Dealing with veterans and knowing what they’re exposed to over their career and their mentality when they get out can be a tough nut to crack.”

He explained, “The signature wound for veterans of Iraq and Afghanistan is traumatic brain injury.” Major TBI is diagnosed at the point of impact, often an IED blast. Mild TBI is not as easily recognizable and needs further investigation from the medical team. A solder might suffer a series of smaller concussions for example.

Another sometimes related issue is post-traumatic stress disorder. It is sometimes triggered by re-entry into civilian life but it can take a while for it to be diagnosed and for the veteran to receive proper treatment. “The suicide rate among veterans is higher than the general population,” noted Moore. All nurses, not just those working in mental health, need to be aware of that statistic.

Female veterans, while a small fraction of the population, face additional healthcare issues. Exposure to chemical and biological agents could affect fertility, though little is known for sure. Military sexual trauma is a well-known physical and psychological

SEE ALSO: Improving Healthcare for Veterans

Opening Up
At the UAB School of Nursing, they teach the students to ask every patient: “Have your or any member of your family served in the military?” If the patient answers yes, the nursing student asks: “Have you served in combat?” It’s not always evident at first meeting who is a veteran. Sometimes those in the military can have hard time opening up and talking to those who didn’t have same experience. Backed by the knowledge of the competencies, though, nurses can show they understand and refer the patient to the proper resources for their situation.

Moss would like to see the competencies applied beyond nursing school. “We hope institutions that are hiring new graduates may also look and see where they might be able to incorporate them into their new-hire orientations.”

She continued, “Understanding their experiences and knowing what to look for, how to intervene and when to refer are extremely important skills for nurses, and we want to do our best to make sure they have these skills.”

Danielle Bullen is a staff writer. Contact:

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