Military Veterans' End of Life: Supporting Them in Their Last Deployment

More than 600,000 U.S. Veterans die from illness each year. Clinicians in civilian settings are increasingly providing care to Veterans at end of life. Veteran care should be distinctive and individualized to meet their unique needs. There is limited information to guide civilian clinicians in providing care to Veterans at end of life. This article provides bio-psycho-social information to holistically guide Veteran healthcare and assist them with solace, respect, and serenity at end of life. Various options for end-of-life care are discussed, as well as specific concerns of women, lesbian, gay, bisexual, and transgender Veterans. Some end-of-life entitlements for all Veterans and sometimes their spouses/children are included.

The Risks, Invisibility, and Health Issues Facing Women Veterans Who Are Homeless

Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain "invisible." Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.

Nursing Care of Women Veterans of the Iraq and Afghanistan Wars

The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.

Deployed Women Veterans: Important Culturally Sensitive Care

PROBLEM

Today, with almost 23 million veterans in the nation, and currently only about 10 million, or less, of them seeking active services associated with the Veterans Administration (VA) health facilities, these men and women veterans will be seeking some, more, or even all of their health care over their life time in civilian-based facilities.

METHODS

Pertinent literary sources were reviewed to gather applicable data about the problem.

FINDINGS

Every patient that enters your health facility should be asked an essential assessment question: "Have you served in the military?" Importantly, to gain effective rapport when they present, civilian nurses will need to anticipate their health needs and provide culturally sensitive care. Specific issues of deployed women veterans are provided in a series of two articles.

CONCLUSION

This article provides a snapshot of the uniquely entrenched military culture, as well as women service member experiences in wartime, including the Global War on Terror (Iraq and Afghanistan). The next article discusses the various healthcare differences (e.g., post-traumatic stress disorder and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, employment, homelessness issues), and gender disparities (varied treatment patterns) so the civilian nurse can better advocate for women veterans.

Older Military Veteran Care: Many Still Believe They Are Forgotten

BACKGROUND

Almost 44% of our nation's 23 million men and women veterans are 65 years of age or older. Most are proud of their service, yet many believe their services for our country were forgotten, especially those in combat between 1950 and 1975.

PURPOSE

Further information to ultimately assist their holistic well-being will be important for nursing practice as countless older veterans are beginning to obtain more care within civilian facilities. Using the Korean War (1950-1953) as a backdrop to illustrate the interconnectiveness of older veteran physical, emotional, and spiritual concerns that can occur from a military deployment, the major purposes of this article are to provide a brief historical snapshot of that war and discuss prior-era military environmental situations that now are producing the lingering effects from their combat exposure.

DESIGN

Relevant literature about the Korean War and Veterans was compiled.

FINDINGS

Some of these health risks for both the Korean men and women veterans are cold exposure, neurologic, and posttraumatic stress disorder concerns, as well as the need for hepatitis C and suicide assessments.

CONCLUSIONS

To ultimately improve their bio-psycho-socio-spiritual well-being, prompt identification of the older military veteran, their lingering combat effects, and reminiscing will be important.

Content Validity of a Screening Instrument for Breast Cancer Early Detection Among Asian American Women: The Cultural Health and Screening Mammography Belief Scale

BACKGROUND AND PURPOSE

Asian American women have the lowest mammography screening rate in the United States. There is no standardized instrument available to measure their cultural beliefs regarding screening mammography. The purpose of this study is to evaluate the content validity of the Cultural Health and Screening Mammography Belief Scale (CHSMBS) developed for this population. Procedures for Instrument Development: The content validity was examined using content validity index (CVI). Both item-level (I-CVI) and scale-level CVIs (S-CVI) were evaluated.

RESULTS

The instrument's I-CVIs ranged from 0.75 to 1.00, and the S-CVI was 1.00, reflecting excellent inter-rater agreement.

CONCLUSIONS

The study has established the scale's content validity to evaluate Asian American women's use of screening mammography. Further examination of the reliability and construct validity will add further support of the scale's utility in health research and practice.

Person-centered older military veteran care when there are consequences

The consequences of each war present themselves in many ways and differently within a veteran's lifetime. For civilian nurses to give applicable, vital care to the older veteran, they need to deeply appreciate the military culture, the strength of the ethos, as well as the various health concerns connected with the individual war/conflict. Attentiveness to the evolving health issues of older veterans are a priority at a time when many personal developmental changes are also creating life stressors for the Vietnam veterans and they are often presenting to civilian health facilities for their care. This article explores the controversial war within Vietnam (1955-1973), and the use of the universal question of "Have you ever served in the military?" An incremental veteran health assessment is discussed in order to care for the specific, prior-era physical/behavioral issues of post-traumatic stress disorder, Agent Orange, military sexual trauma, hepatitis C, and homelessness that are discussed for these men and women veterans, along with a rationale for their long-term presence, which is still evident today. Other relevant nursing interventions for veterans are suggested such as reminiscing, and art/animal-assisted therapy to supplement their medical care.

Advocating for Deployed Women Veterans' Health Differences, Difficulties, and Disparities

PROBLEM

The preceding article presented a glimpse of deployed women veterans, their military culture, and their experiences in the Global War on Terror (Iraq and Afghanistan) to assist civilian nurses to gain significant rapport and provide important culturally sensitive care.

METHODS

Pertinent literary sources were reviewed to gather applicable data about the problem.

FINDINGS

A confirmatory answer from the assessment question of "Have you served in the military?" and the use of the Military Health History Pocket Card for Clinicians (available at http://www.va.gov.oaa/pocketcard) will assist with revealing possible health risks from the increased amounts of military men and women veterans seeking (and/or returning to) a variety of community-based health services. This article about deployed women veterans examines their specific health differences (e.g., research literature, post-traumatic stress disorder, and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, suicide), and gender disparities (varied treatment patterns).

CONCLUSION

Understanding these gender situations, civilian nurses can better advocate with increasing evidence-based decisions that their physical and behavioral responses were different from their male counterparts. Continual assessment, knowledgeable care, ongoing literature review, interdisciplinary health team development, and the presence of resourceful community agencies should be a significant part of their holistic care. Conard Armstrong.

Opportunities, hurdles, solutions, and approaches to transition military veterans into professional nursing programs

Capitalizing on the almost 2.2 million service members returning from Operation Iraqi Freedom and New Dawn (OIF) in Iraq, and Operation Enduring Freedom (OEF) in Afghanistan, baccalaureate educators are encouraged to create realistic, applicable nursing transitional programs for the health and health-related oriented military veterans. Opportunities, hurdles, and solutions related to the veteran's unique socio-economic circumstances of education, finances, and advisement are provided so the potential veteran student is successful within the university's milieu. Transitional nursing educational interventions related to assessment, didactic, and clinical used by two baccalaureate nursing curriculums, including the eLineMilitary* (ELM) Program, provide approaches of how to propel the veteran's journey toward graduation in a professional nursing program. These interventions include modular didactic, competency based education, as well as the concentrated, collegial time within the Faculty/Clinical Coach triad for essential role modeling, care, and skills.

Encountering women veterans with military sexual trauma

PURPOSE

As women veterans (WVs) are returning from Operation Iraqi Freedom and Operation Enduring Freedom with military sexual trauma (MST), the purpose of this article is twofold. First, important exploratory questions that can assist with a thorough assessment and history are presented as well as the applicable treatment for any new, recurrent, or unresolved symptoms that involve MST.

DESIGN AND METHODS

Review of multiple literary materials, as well as a clinical situation.

FINDINGS

WVs will be encountered in a variety of military or civilian primary and community care healthcare settings. Every woman (and man) in the civilian sector should be asked, "Have you ever served in the military?"

PRACTICE IMPLICATIONS

Recognition, acknowledgment, and applicable interventions for MST and associated comorbidities, especially post-traumatic stress disorder, are presented as currently 80-90% of MST experiences have gone unreported. Immediate treatment and follow-up are critical for the well-being of the WVs.

Roles and responsibilities of the nursing scholar

Scholarship is an important facet of the nursing profession. There are many components, virtues, and roles and responsibilities of a nursing scholar practicing in today's ever-changing health care environment. Scholarship was redefined by Boyer to include scholarly activities in addition to research. Boyer's Model of Scholarship includes four interrelated and overlapping domains of discovery, integration, application, and teaching. Each domain is explained with examples for the pediatric nurse scholar, which includes roles in academia as well as in the practice setting. Pediatric nurses are key to scholarship in nursing because they work to improve the care of children.

Deployment and PTSD in the female combat veteran: a systematic review

BACKGROUND

The number of females serving in the Gulf War has risen and continues to be a rapidly growing group. Females occupy a wide range of roles and face a myriad of challenges as they serve alongside their male counterparts in almost every role. Females are also facing redeployment, multiple deployments, and/or extended deployments. The stressors of war and deployments may be putting them at risk for posttraumatic stress disorder (PTSD). If left untreated, PTSD can have devastating and debilitating consequences for veteran's functioning and relationships, their families, and society.

OBJECTIVE

To examine the literature over the past 10 years to determine if there is a relationship between deployments and the incidence of PTSD in female combat veterans as compared with male veterans.

METHOD

Systematic review.

RESULTS

The numbers of veterans screening for PTSD are increasing. Those who have experienced extended or multiple tours have higher screening rates. Females report slightly less combat exposure than males but higher exposures to other stressors of war such as military sexual trauma. Females were at higher risk for depression while males were at higher risk of substance abuse. Females and lower rank were associated with greater utilization of Veterans Administration services.

The use of oral transmucosal fentanyl citrate for painful procedures in children

OBJECTIVE

To investigate the efficacy and safety of oral transmucosal fentanyl (OTFC) in providing analgesia and sedation for painful diagnostic procedures in children.

DESIGN

Randomized, placebo-controlled clinical trial.

METHOD

Forty-eight children referred to the University Connecticut Division of Pediatric Hematology/Oncology for bone marrow aspiration or lumbar puncture were randomized to receive either OTFC (15 to 20 micrograms/kg) or a placebo lollipop. Thirty minutes after administration, the procedure was begun. An anesthesiologist monitored the child's heart rate, blood pressure, and oxygen saturation every 10 minutes. At the conclusion of the procedure, the nurse, the child's parent, and all children over 8 years of age were asked to rate the pain associated with the procedure using a 1 to 10 visual analogue scale. Young children (less than 8) used a modified scale, the Oucher, yielding a 0 to 5 score.

RESULTS

Significant differences in pain ratings between the OTFC and placebo groups were noted on the pain scores of the parents (P = .005), nurses (P = .001), younger children (P = .006), and older children (P = .013), and median pain scores in the OTFC group were reduced to tolerable levels. Vomiting (P = .003) and itching (P = .001) were more common in the OTFC group, but no clinically significant vital sign deviations occurred.

CONCLUSION

OTFC is safe and effective for use in relieving the pain of pediatric procedures, but frequency of vomiting may restrict its clinical usefulness.

Ibuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery

The authors compared the analgesic efficacy of one dose of oral ibuprofen with that of intravenously administered fentanyl for relief of pain after outpatient laparoscopic surgery. Thirty healthy female patients received either 800 mg of oral ibuprofen preoperatively or 75 micrograms of intravenous fentanyl intraoperatively plus respective intravenous or oral placebos in a randomized, double-blind manner. Patients recorded their degree of pain and nausea in the recovery room, in the same-day surgery stepdown unit, during the ride home, and upon arrival at home. The postanesthesia care nurse recorded the amount of fentanyl and droperidol needed to treat pain and nausea in the recovery room. Patients who received ibuprofen were more comfortable in the stepdown unit (P less than 0.05) and after arrival home (P less than 0.05) than those in the fentanyl group. Additionally, patients who received ibuprofen had lower nausea scores in the step-down unit (P less than 0.05); this may have been related to the lower total fentanyl dose in these patients. The authors conclude that ibuprofen may be a useful alternative to fentanyl for providing postoperative analgesia for outpatient surgery.