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

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.

Supporting nursing faculty to teach veteran's care: a mixed method, multi-intervention study

OBJECTIVES

This study aimed to (a) describe nurse educators' attitudes towards veterans after workshop participation, (b) evaluate the effectiveness of the workshop and timed digital interventions (TDI) on nurse educators' integration of veteran-centered content into their courses and curricula, and (c) describe nurse educators' experiences with transferring learning from the workshop to teaching practice.

METHODS

A longitudinal multi-intervention, multi-method pilot study was conducted using pre- and post-workshop surveys and interviews.

RESULTS

Twenty-six nurse faculty reported a neutral attitude toward working with veterans during the pre-workshop survey period. TDIs kept veteran-centered content fresh on faculty minds, yielding evidence of integration into nursing courses.

CONCLUSIONS

Nursing faculty preparation and development is crucial to effectively integrate specific veteran care content into nursing education to ensure a competent and culturally sensitive workforce. Integrating TDIs using widely accessible technologies is a cost-effective way of increasing engagement with new information and bridge implementation gaps associated with traditional professional development activities.

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.

An Exploration of Civilian Nurses' Knowledge of the Military Culture

BACKGROUND

In fiscal year 2019, approximately $78 million was spent on veteran medical care alone apart from other civilian costs. Some veterans state their health care providers do not understand the military culture, which makes them uncomfortable seeking care in the private sector.

METHOD

A nonexperimental cross-sectional study was conducted using a convenience sample of 127 RNs who completed an electronic survey of the Military Culture Certificate Program.

RESULTS

The total overall mean on the Knowledge and Awareness subscale was 4.38 of 6, representing a modest level of military knowledge. The Confidence in Skills and Abilities subscale also scored at a modest level, with an overall mean of 81.3 of 100. Although the nurses demonstrated modest knowledge levels of military culture and confidence skills, there were low scores in veteran referral to the appropriate resources.

CONCLUSION

It is essential to educate nurses regarding how and where to refer veterans to the appropriate resources. Further studies should expand on this work. [J Contin Educ Nurs. 2021;52(4):176-183.].

Medication Discrepancies in Older Veterans Receiving Home Healthcare

In a prospective cohort study of Veterans and community health nurses, we enrolled hospitalized older Veterans referred to home care for skilled nursing and/or physical or occupational therapy for posthospitalization care. We assessed preadmission activities of daily living and instrumental activities of daily living, health literacy, numeracy, and cognition. Postdischarge phone calls identified medication errors and medication reconciliation efforts by home healthcare clinicians. Veterans Administration-based community health nurses completed surveys about content and timing of postdischarge interactions with home healthcare clinicians. We determined the types and frequency of medication errors among older Veterans receiving home healthcare, patient-provider communication patterns in this setting, and patient characteristics affecting medication error rates. Most Veterans (24/30, 80%) had at least one discordant medication, and only one noted that errors were identified and resolved. Veterans were asked about medications in the home healthcare setting, but far fewer were questioned about medication-taking details, adherence, and as-needed or nonoral medications. Higher numeracy was associated with fewer errors. Veterans Administration community health nurses reported contact by home healthcare clinicians in 41% of cases (7/17). Given the high rate of medication errors discovered, future work should focus on implementing best practices for medication review in this setting, as well as documenting barriers/facilitators of patient-provider communication.

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.