Joining Forces: The Status of Military and Veteran Health Care in Nursing Curricula

Knowledge, Attitudes, Confidence, and comfort of Nurses and Nursing Students Caring for Military Veterans and Their Families

BACKGROUND

National initiatives such as 'Joining Forces' and the 'Have you ever served in the military?' campaign increased awareness of the needs of the military and veteran population. Yet, empirical evidence suggests that nurses and other healthcare providers continue to report insufficient cultural competency, as well as knowledge and awareness of unique healthcare needs to provide optimal care to this population.

PURPOSES

The study purposes were to explore nurses' and nursing students' knowledge, attitudes, confidence, and comfort levels to care for veterans and their family, identify potential factors associated with these outcome measures, and examine the relationships between knowledge, attitudes, confidence, and comfort.

METHOD

A quantitative, cross-sectional study design guided an online survey of 153 respondents. The military and veteran family cultural competency model provided a theoretical foundation.

FINDINGS

Overall, the confidence in skills and abilities, and comfort levels on addressing military culture, providing care, and discussing health issues increases as participants' gain knowledge and awareness of the military. Having an immediate family member(s) who served in the military was a significant factor related to confidence.

IMPLICATIONS

Nursing students and nurses in practice need education aimed at addressing the veteran care competencies, specifically military/veteran culture.

Above and Beyond the Call of Duty: Rural Home Care and Hospice Nurses' Experiences Caring for Veterans

Approximately 4.7 million Veterans live in rural areas and face challenges receiving support and care for complex service-connected healthcare needs. The purpose of this qualitative descriptive study was to explore nurses' experiences caring for Veterans in rural home care/hospice settings. Semistructured interviews (N = 14) were conducted between August 2020 and March 2021. Content and thematic analysis resulted in three central themes: Mission readiness: Ensuring safe home environments, Partnering with Veterans: Knowing when to lead and when to follow, and It's my duty: Caring with purpose and honor. Study findings highlight the need for cultural competence in both rural and Veteran cultures. Implications for practice reinforce currently emerging national priorities, including personal safety considerations and need for further professional development associated with screening for firearms and gun safety. Other implications for home care/hospice agencies, as well as nursing education, are discussed.

Veteran Competencies in Nursing Textbooks: Implications for Educators

AIM

The aim of this study was to examine the adequacy of military/veteran-related content in nursing textbooks used in prelicensure programs.

BACKGROUND

With increased numbers of veterans receiving care in civilian settings, nurses may lack essential knowledge, skills, and attitudes outlined in competencies required to provide culturally sensitive veteran-centered care. One explanation for this may be inadequate preparation during prelicensure nursing education.

METHOD

A quantitative, descriptive study guided the analysis and rating of 32 key words in 24 textbooks across eight content areas.

RESULTS

Key words were included in most textbooks but frequently not connected to military service or veterans. The key word with the highest mean rating was posttraumatic stress disorder; the highest rated content area was psychiatric/mental health.

CONCLUSION

With limited textbook resources, nurse faculty must engage in deliberate efforts to include veteran content in nursing curricula. As competency-based education trends evolve, these findings are relevant and should be considered in curricular design and revision.

Analysis of Content Gaps in Prelicensure Nursing Textbooks to Meet Veteran Care Competencies

BACKGROUND

Despite the Joining Forces initiative and recently published veteran care competencies, nursing students and graduates are often unprepared to care for veterans who have unique service-connected illnesses and injuries.

PURPOSE

The purpose was to evaluate identified content gaps in prelicensure nursing textbooks with the veteran care competencies knowledge, skills, and attitude (KSA) domains.

METHODS

A secondary qualitative analysis was conducted of veteran content in prelicensure nursing textbooks.

RESULTS

The skills and attitude domains of veteran care competencies were poorly addressed in nursing textbooks. Overall, the knowledge domain was adequately covered; however, most had limited connection with veterans and veteran care. Competency-focused recommendations for expanding and enhancing veteran content, KSAs, and teaching strategies are offered.

CONCLUSIONS

Prelicensure textbooks met the knowledge domain for each veteran competency. Overcoming content gaps needed to achieve requisite skills and attitudes requires interaction with veterans through clinical immersion experiences in various care settings.

Is deployment status the critical determinant of psychosocial problems among reserve/guard soldiers?

A general assumption that deployment is the primary catalyst for psychological and social difficulties may contribute to underrecognition and undertreatment of problems among never-deployed service members (i.e., having no history of ever being deployed). We aimed to determine if ever-deployed (i.e., having a history of at least one deployment) and never-deployed United States Army Reserve and National Guard (USAR/NG) soldiers differed in mental health, substance use, and resiliency factors, and to determine the relative influence of deployment status and each of these factors on poor psychosocial outcomes. We analyzed a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years) (N = 404), an ongoing study examining the health and well-being of USAR/NG soldiers. Bivariate analyses demonstrated that soldiers did not significantly differ across a range of measures on the basis of deployment status (ps > 0.05). In fact, Factor Analyses and Discriminant Function Analysis revealed that deployment status was the least salient factor to psychosocial problems among the measured variables and that the observed variables could not accurately discriminate between ever-deployed and never-deployed soldiers, F(8, 374) = 1.34, p > .05. Measures of mental health and substance use were more salient to psychosocial problems (ps < .05). Measures of resiliency loaded negatively onto psychosocial problems (ps < .05), indicating that they contribute to better well-being. Targeting screening and intervention efforts only on soldiers who have been deployed will miss opportunities to intervene on an equally affected group. Resiliency factors should be considered as intervention targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Veteran-Centric Content Integration Into a Baccalaureate Nursing Curriculum

BACKGROUND

Nurse educators frequently search for innovative ways to address specific population needs such as those presented by veterans.

METHOD

To integrate veteran-centric content into undergraduate nursing curriculum, Veterans Affairs Nursing Academic Partnership (VANAP) faculty conducted a literature review, collaborated with stakeholders, developed veteran-centric competencies, identified natural areas in existing curriculum for content integration, developed learning activities, and created a content integration map.

RESULTS

Eight VANAP competencies were developed to guide content integration. A map of veteran-centric content integration into the baccalaureate curriculum was created, and content was integrated into theory and clinical courses, and simulation experiences in the undergraduate program.

CONCLUSION

The strategies for incorporating veteran-centric care into a curriculum can be used by all nurse educators to integrate and maintain various population-specific content. [J Nurs Educ. 2020;59(7):400-404.].

Medical Surgical Nurse Self-perceived Competency in Posttraumatic Stress Disorder/Substance Use Disorder Veteran Care in a Non-Veterans Health Administration Setting

OBJECTIVE

This study evaluated the self-perceived readiness of medical-surgical nurses in a non-Veterans Health Administration (VHA) facility to care for veterans with posttraumatic stress disorder (PTSD) and substance use disorder (SUD).

BACKGROUND

Nurses caring for veterans with PTSD and SUD at facilities other than the VHA should be equipped with the knowledge, skills, and attitudes to provide care for this population.

METHODS

Nurses evaluated their self-perceived knowledge, skills, attitudes, experiences, and perspectives related to caring for veterans.

RESULTS

Nurses overwhelmingly indicated that they had no knowledge of the "Have you served?" campaign, and fewer than half inquired about military status when assessing patients CONCLUSION: Nurses caring for veterans in non-VHA facilities do not consistently identify veterans or assess for service-related conditions, including PTSD and SUD. Nurses report low skill levels related to identifying, addressing, and referring patients with service-related conditions.

Examining the Capacity of Registered Nurses to Deliver Culturally Competent Health Care to Veterans and Their Families

BACKGROUND

Although more than 75% of veterans and their families are accessing care in non-Veterans Affairs (VA) settings, there is little information about health care workers, specifically registered nurses (RNs)' ability to provide culturally competent and appropriate care to military veterans and their families.

PURPOSE

The purpose was to examine the capacity of RNs working in non-VA hospitals to deliver culturally competent health care to military veterans and their families.

METHODS

A prospective survey design was carried out with nurses from a large academic health system. The RAND Corporation's Ready to Serve web-based survey was adapted with permission for use with RNs employed in civilian urban and community hospitals. In addition to reporting descriptive statistics on demographics and each individual item, a score was calculated to define high cultural competency.

RESULTS

Twenty-five (4%) RNs demonstrated the capacity to deliver culturally competent health care.

CONCLUSIONS

This study revealed significant gaps in the capacity of nurses to deliver culturally competent care to military veterans and their families.

Increasing nurse practitioner students' comfort levels in caring for veterans with post-traumatic stress disorder

ABSTRACT

Few nurse practitioner programs integrate education on care of veterans into their curriculum. Because more veterans are seeking health care outside of the Veteran Affairs system, all advanced practice nurses need to be prepared to meet the unique needs of veterans with post-traumatic stress disorder (PTSD). The authors developed an education session on military-to-civilian transition and screening and treatment of veterans with PTSD. The session was provided to a convenience sample of students. Case studies were included to allow student participation and active learning. Students completed pre-education and post-education surveys to measure their comfort level in caring for this specific population and their understanding of PTSD. The participant scores on comfort level with identifying and managing PTSD after the education session were significantly increased. Placing veteran-specific education into nurse practitioner programs enhances the comfort level with identifying and managing PTSD. Adding this veteran-specific education could enhance the overall care for veterans in the civilian sector.

Developing a Measure to Assess Emotions Associated with Never Being Deployed

BACKGROUND

Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers' well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions.

METHODS

We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174). Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing survey-based study examining the health of USAR/NG soldiers and their partners. The protocol was approved by the Institutional Review Board at the State University of New York at Buffalo. The relationship between each of the items was examined by calculating correlation and alpha coefficients. Latent class analyses tested for the existence of distinct levels of negative emotions related to non-deployment. Negative binomial regression models examined the cross-sectional associations between NDE summary score and each of the following outcomes, separately: anger, anxiety, depression, and post-traumatic stress.

FINDINGS

More than half of never-deployed USAR/NG soldiers expressed negative emotions for having not been deployed. "Guilt," "value," "camaraderie," and "connectedness" were each positively correlated with each other (p < 0.001) and the internal consistency reliability was high (male soldier α = 0.90, female soldier α = 0.93). Latent class analyses revealed a superior three-class model with well-delineated class membership (entropy = 0.93): "Class 1" (low NDE; 47.6%), "Class 2" (moderate NDE; 33.8%), and "Class 3" (high NDE; 18.6%). Regression models demonstrated that greater non-deployment emotions were independently associated with more severe anger (RR = 1.02, 95% CI: 1.01, 1.03, p < 0.001), anxiety (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), depression (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), and PTSD (RR = 1.10, 95% CI: 1.04, 1.16, p < 0.01).

DISCUSSION

Findings demonstrate that negative emotions regarding non-deployment are prevalent among never-deployed USAR/NG soldiers and that these emotions are related to a mental health. The NDE provides a measure of "guilt," "value," "camaraderie," and "connectedness" specific to non-deployed soldiers and is able to well discriminate between soldiers that have low, moderately, and highly negative non-deployment emotions. These findings suggest that all military personnel, regardless of deployment status, could be at risk for negative outcomes. As with any survey-based study, there is a potential for response bias; however, given the range of responses collected with the NDE, social desirability is unlikely. Further work is needed to confirm our findings in other components of the military and to examine soldiers in the rear detachment.

Improving the awareness and care of veterans in healthcare services

This article aims to raise awareness of veterans (people who have served in the UK military) who are receiving nursing care. Nurses will often provide care and treatment for veterans, so they should be aware of the potential health needs of this patient group to provide optimum care. Veterans should receive priority treatment where it relates to a condition that results from their service in the armed forces. Therefore, it is important for healthcare professionals to recognise if patients may be veterans and if their conditions are attributable to military service. Increased awareness of veterans is required in primary care services, as well as in healthcare professionals' education and training, to ensure that they gain access to appropriate care and support.

Civilian Nurses' Experiences Caring for Military Veterans: Qualitative Data From a Mixed-Methods Study

Over nine million people living in the United States are military Veterans over the age of 65. Many utilize civilian care providers, creating a need for civilian providers to have an understanding of the unique healthcare issues of this population. This article describes the qualitative results of a mixed-methods study of nine home care nurses' experiences caring for Veterans. Three themes emerged from the data: Challenges Coordinating Care, Building a Rapport Takes More Time, and Recognizing Impact of Military Service on Patient's Worldview. As demonstrated in this study, home care nurses care for Veterans every day. Although similarities exist, nurses readily described differences in caring for Veterans compared with non-Veterans that can impact patient outcomes. It is imperative for the nursing workforce to not only assess for military/Veteran status but to also have some knowledge of military culture and Veteran-specific healthcare issues.

Care of veterans in a non-veteran health administration hospital: What is the status of nursing practice after continuing education?

AIMS AND OBJECTIVES

To identify how civilian nurses are caring for military veterans following mandatory continuing education on veterans' mental health needs and to describe challenges nurses are facing in provision of that care.

BACKGROUND

Veterans and military personnel experience mental health conditions at a high rate and are increasingly receiving care in civilian healthcare facilities. Nonmilitary providers may not be prepared to address this population's challenging needs. Military culture may influence the presentation of mental health conditions; thus, critical assessment points by nonmilitary medical personnel may be missed. Education is touted internationally as a means to address deficits, but research is lacking to support that statement.

METHODS

Adhering to research reporting guidelines, 115 of a proposed 322 civilian nurses in a tertiary hospital volunteered to complete a one-time online survey that contained quantitative and demographic questions. Forty of 115 nurses went on to complete the qualitative query. Descriptive statistics summarised quantitative results, and constant comparative analysis was applied to qualitative responses for theme identification.

RESULTS

The study was stopped early due to reports of violence from veterans upon nurses. Results showed continuing education did not change documentation of military status. Following mandatory continuing education, civilian nurses continued to describe uncertainty in how to adapt care, on how to interact with veterans and in how to deal with violence.

CONCLUSION

The status of care to veterans remains insufficient, but nurses are asking critical questions on how to update practice. Additional support and research in the clinical setting is needed to promote a safe caring environment.

RELEVANCE TO CLINICAL PRACTICE

Continuing education alone may not advance care of the veteran. A multipronged approach to include mandatory documentation of military status and coaching of providers by those experienced with the military way of life may be used to augment staff preparedness.

Teaching Patient-Centered Care Through the Veterans History Project

Determining the best ways to teach military culture and the veteran experience to nursing students and new nurses is an essential component in developing a culturally sensitive nursing workforce. The purpose of this article is to describe a theory-driven, experiential learning approach to integrating the Veterans History Project into the curricula for a postbaccalaureate nurse residency program. Participants acknowledged that this educational project better prepared them to care for the veteran population.

Civilian Nurses' Knowledge, Confidence, and Comfort Caring for Military Veterans: Survey Results of a Mixed-Methods Study

More than 20 million Veterans currently live in the United States, representing World War II, Korea, Vietnam, Iraq, and Afghanistan war eras, as well as many who served during peacetime. Little is known regarding what home care nurses know about the unique healthcare needs of this population. Using Purnell's Model for Cultural Competence, a mixed-methods study was designed to examine home care nurse's knowledge, comfort, and confidence in caring for active military, Veterans and their families. This article provides the data from a national survey of 102 home care nurses. Findings suggest that civilian home care nurses have limited experience working with active military but work with Veterans at least monthly, if not weekly. Nurses were most confident in managing pain and least confident in managing issues related to military sexual trauma. Knowledge of resources available to Veterans, war-specific exposures, and Veteran-specific health issues were the top areas nurses felt less confident in. Continued efforts need to be put in place so that 100% of all patients seeking healthcare are screened for military/Veteran status. In addition, continuing education for nurses needs to include Veteran-specific topics so evidence-based, culturally sensitive care can be provided.