By Debra Wood, RN, contributor
September 20, 2012 - With more than 22 million military veterans living in the United States, nurses in any setting must be prepared to assesses their unique needs and properly refer or care for them. Yet even experienced mental health professionals often feel unprepared to help veterans with reintegration issues, according to the Jonas Center for Nursing Excellence, which has launched an initiative to better prepare nurses.
Darlene Curley said nursing is the key to getting veterans back on their feet.
“The need for health care for veterans, especially those returning from Iraq and Afghanistan, is a crisis, because no one is prepared for the kinds of injuries the veterans have,” said Darlene Curley, executive director of the Jonas Center for Nursing Excellence in New York. “It’s a new kind of veteran returning home, and nursing is the key to getting the veterans back on their feet.”
Ninety percent of troops deployed to serve in Iraq and Afghanistan who were injured have survived, the highest percentage in history, in part because they are transported so quickly from the battlefield to definitive care, she said. However, they return with many injuries, such as amputations. More than 320,000 veterans of these two wars sustained traumatic brain injuries (TBI), and 20 percent of them suffer from post-traumatic stress disorder (PTSD), anxiety or depression.
“Physical [problems] are much more visible and in some ways easier to treat than the invisible wounds that don’t often show themselves as soon as the veteran leaves duty,” Curley said. “They often show later, and that’s where the nurse needs to be alert.”
In addition, veterans are seeking care in a variety of settings, not only at government facilities, because a significant number are reservists, Curley said.
“They are going back to their home towns, many in rural areas,” Curley said. “They are being seen by health care providers in clinics, emergency departments, physician offices, and they may not be that up to date on the health care needs of the veterans. Nurses are on the front lines of all health care organizations.”
Speaking at the UCLA forum were Darlene Curley, executive director, Jonas Center for Nursing Excellence; Keynan Hobbs, MSN, PMHCNS-BC, VA Mission Valley Outpatient Clinic PTSD Clinical Team; Pamela Wall, Lieutenant Commander, US Navy, Psychiatric Nurse Practitioner, Jonas Veterans Healthcare Scholar; Brigadier General (Ret.) William Bester, US Army RN, MSN, NEA-BC; and Courtney H. Lyder, ND, ScD (Hon.), FAAN, dean and professor of UCLA School of Nursing.
The Jonas Center and the UCLA School of Nursing in Los Angeles, recognizing the incredible commitment veterans have made serving the country, recently held a panel discussion to talk about the status of veterans’ health care and raise awareness and support for nurses who are on the front lines, providing that care.
“The UCLA School of Nursing is proud to partner with the Jonas Center in this mission,” said Courtney H. Lyder, ND, ScD(hon), FAAN, Dean, UCLA School of Nursing, which has three doctoral Jonas Scholars focused on veterans’ health. “We are confident this collaboration will positively impact this underserved population.”
How nurses can help
“Our goal is to increase the knowledge of nurses in every setting,” Curley said. “So when a veteran seeks services, there is a nurse knowledgeable to get them to the right kind of service.”
Nursing care begins with an assessment. Curley recommends asking the person if he or she is a veteran, since many people do not automatically share that information. Nurses can screen for depression or PTSD and assess the veteran’s support system, which is critical to reintegration. Service members will be screened six months after returning from a deployment.
LCDR Pamela Herbig Wall, NC, USN, PMHNP-BC, recommends nurses assess veterans for any difficulties re-entering civilian life.
“Nurses are always assessing for problems,” said LCDR Pamela Herbig Wall, NC, USN, PMHNP-BC, and a Jonas Veterans Healthcare Scholar. “And we are in step with everyone else trying to get the best care for the patient.”
Veterans may be reluctant to seek mental health care due to stigmas associated with such conditions.
Complaints of sleeplessness, difficulty concentrating, short-term memory losses--symptoms of TBI or PTSD--should alert the nurse to ask a few more questions and perhaps refer to outside resources or a U.S. Department of Veterans Affairs (VA) health facility. Differentiating which condition the veteran suffers from often requires an interview with a skilled clinician, according to the VA.
The VA has developed guidelines of best practices when caring for patients with these conditions. It also offers an online educational program about military cultural competence, something helpful when communicating and interacting with veterans and their families.
Preparing for the future
The Jonas Center has established the Jonas Nursing Scholars Program for Veterans Health and is supporting 54 doctoral nursing students committed to veterans’ health. Those nurses can help educate other nurses and nursing students. A pilot cohort with five military nursing doctoral students at the University of San Diego Hahn School of Nursing began the program in 2011.
“Another reason we are focused on the doctoral level is there is so much we don’t know about traumatic brain injury and post-traumatic stress, and this is where nursing care has every opportunity to develop new practices,” Curley said.
The center is working on securing other funding to increase resources.
“Our goal is to do much more,” said Curley, who encourages nursing organizations to work together to help the nation’s veterans.
“There are so many great things going on right now in communities across the country to help veterans,” Curley said. “At the Jonas Center, we felt our mission was to work on the health needs and get them back on their feet to make the transition from wartime to peace time.”
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