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One Out of Ten Veterans Is Seriously Injured While In The Military  - Pew Research Center (Rich Morin)

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One Out of Ten Veterans Is Seriously Injured While In The Military  - Pew Research Center (Rich Morin)

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Analysis of injured and uninjured veterans view their lives, military service, and country.

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3 Tips on Caring For Veterans (For Nurses) - Crosby Steen

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3 Tips on Caring For Veterans (For Nurses) - Crosby Steen

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Check out this video, this guy shares his tips about when providing care for veterans.
I found this really connects with the things I learned in this course.

His 3 tips:
1. Understand the culture
2. Ask questions
3. Honor and respect their service

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MST: Military Sexual Trauma - Make the Connection

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MST: Military Sexual Trauma - Make the Connection

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Hear stories from Veterans about their own experiences with the effects of MST.

Learn how MST can affect Veterans, What are the concerns related to MST, and how to treat them.

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What is military sexual trauma (MST)?

During their service, both female and male Service members sometimes have upsetting, unwanted sexual experiences, including sexual assault or sexual harassment. "Military sexual trauma" or MST is the term used by the U.S. Department of Veterans Affairs to refer to these experiences. The official definition of MST used by VA is given by federal law (U.S. Code 1720D of Title 38). It is:

Psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty for training.

Sexual harassment is defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character."

In more concrete terms, MST includes any sexual activity where you were involved against your will. You may have been physically forced into sexual activities. Or, no physical force may have been used but you were coerced or pressured into sexual activities. For example, you may have been threatened with negative consequences for refusing to cooperate. Or it may have been suggested that you would get faster promotions or better treatment in exchange for sex. These are all signs of MST.

Military sexual trauma also includes sexual experiences that happened while you were not able to consent to sexual activities, such as if you were intoxicated. Other MST experiences include unwanted sexual touching or grabbing, threatening, offensive remarks about your body or your sexual activities, and threatening and unwelcome sexual advances. If these experiences occurred while you were on active duty or active duty for training, they are considered to be MST.

"I remember the faces, the words, the smells, the negative, the unwarranted, unsolicited touches. I remember all of that. And I have friends who also are Veterans and went through worse than I did."

It's important to know that MST can occur on or off base, during war or peacetime, and while a Service member is on or off duty. Perpetrators can be men or women, military personnel or civilians, superiors or subordinates in the chain of command. They may have been a stranger to you, or even a friend or intimate partner. Veterans from all eras of service have reported experiencing MST.

If you experienced military sexual assault or harassment, you may blame yourself or feel ashamed. It is important to remember that MST is not your fault. Nothing ever justifies someone harassing or assaulting you.

How can MST affect Veterans?

Military sexual trauma is an experience, not a diagnosis or a condition in and of itself. Because of this, Veterans may react in a wide variety of ways to experiencing MST. Problems may not surface until months or years after the MST, and sometimes not until after a Veteran has left military service. For some Veterans, experiences of MST may continue to affect their mental and physical health, work, relationships, and everyday life even many years later.

Your reaction may depend on factors such as:

Whether you have a prior history of trauma

The types of responses you received from others at the time of the experience

Whether the experience happened once or was repeated over time

Some of the difficulties both female and male survivors of MST may have include:

Strong emotions: feeling depressed; having intense, sudden emotional responses to things; feeling angry or irritable all the time

Feelings of numbness: feeling emotionally "flat"; trouble feeling love or happiness

Trouble sleeping: trouble falling or staying asleep; bad dreams or nightmares

Trouble with attention, concentration, and memory: trouble staying focused; often finding your mind wandering; having a hard time remembering things

Problems with alcohol or other drugs: drinking to excess or using drugs daily; getting drunk or "high" to cope with memories or unpleasant feelings; drinking to fall asleep

Trouble with reminders of the sexual trauma: feeling on edge or "jumpy" all the time; not feeling safe; going out of your way to avoid reminders of the trauma; trouble trusting others

Problems in relationships: feeling alone or not connected to others; abusive relationships; trouble with employers or authority figures

Physical health problems: sexual issues; chronic pain; weight or eating problems; stomach or bowel problems

Fortunately, people can recover from experiences of trauma, and VA has services to help Veterans move their lives forward.

Why can MST be so harmful?

Sexual assault is more likely to result in symptoms of posttraumatic stress disorder (PTSD) than are most other types of trauma, including combat. Also, the experience of MST can differ from the experience of other traumas, and even from the experience of sexual trauma in the civilian world. Why is this?

"Going through a sexual assault is bad enough. Then to have this happen to me in my job as a soldier; it was really difficult because what happened to the unit support? Your fellow soldiers are supposed to have your back."

Factors that may be unique to MST include:

You may have had to continue to live and work with your perpetrator, and even rely on him or her for essential things like food, health care, or watching your back on patrol

You may have been worried about damaging the team spirit of your unit if your perpetrator was in the same unit

You may have been worried about appearing weak or vulnerable, and thoughts that others would not respect you

You may have thought that if others found out, it would end your career or your chances for promotion

For these and other reasons, the experience of MST can put Service members in some no-win situations and be emotionally difficult for them to resolve as Veterans.

What should I know about treatment and VA services?

Although MST can be a very difficult experience, there are treatments available that can significantly improve your quality of life. Treatment often involves addressing any immediate health and safety concerns, followed by counseling to help you learn new ways of thinking, practice positive behaviors, and take active steps to cope with the effects of MST. Treatment may focus on strategies for coping with difficult emotions and memories or, for Veterans who are ready, treatment may involve actually talking about the MST experiences in depth.

At VA, Veterans can receive free, confidential treatment for mental and physical health conditions related to MST. You may be able to receive this MST-related care even if you are not eligible for other VA services. To receive these services, you do not need a VA service-connected disability rating, and you don't need to have reported the incident when it happened nor to have other documentation that it occurred.

Knowing that MST survivors may have special concerns, every VA health care facility has an MST Coordinator who can answer any questions you might have about VA's MST services. VA has a range of services available to meet Veterans where they are in their recovery process:

Every VA health care facility has providers knowledgeable about treatment for problems related to MST. Many have specialized outpatient mental health services focusing on sexual trauma. Vet Centers also have specially trained sexual trauma counselors.

VA has over 20 programs nationwide that offer specialized MST treatment in a residential or inpatient setting. These programs are for Veterans who need more intense treatment and support.

Because some Veterans do not feel comfortable in mixed-gender treatment settings, some facilities have separate programs for men and women. All residential and inpatient MST programs have separate sleeping areas for men and women.

What can I do to help manage my reactions to my experiences of MST?

If you're having problems related to your experiences of MST, you should consider seeking support from a doctor or counselor. In addition, there are many things you can do on your own to heal and recover after MST. Some basic lifestyle changes can have a positive impact on your overall well-being. Try to:

Get a good night's sleep

Maintain a healthy diet by eating right

Seek medical advice for any health concerns

Avoid excessive use of alcohol

Take over-the-counter and prescription drugs only as directed by your doctor

Avoid illegal drug use

Avoid risky behavior, like unsafe sex, gambling, and reckless driving

Recognize triggers-keep a record to help identify situations that are more likely to worsen your symptoms

Take up a new hobby or a recreational activity that can be a healthy way to fill your time

Talk to others-this can help you from feeling isolated and give friends and loved ones a chance to help you

Exercise regularly

Practice relaxation techniques such as breathing exercises, meditation, or prayer

Your close family and friends may notice that you're having a tough time. If you feel comfortable, you may want to talk to them about what you're experiencing. They may be able to provide support and help you find treatment that is right for you.

"You can find the plan and techniques that work for you. What worked for me may not work for you but I can tell you I found the steps that led to my recovery: going to VA, asking about their options, talking to somebody about my MST and PTSD, going to their classes, attending their groups."

You can also take a confidential and anonymous self-assessment about your reactions. This short list of questions may help you decide how important it is to see a professional for further evaluation.

Take the next step to connect with care.

Every day, Veterans from all military service branches and eras connect with proven resources and effective treatments for MST-related issues. Here's how to take the next step: the one that's right for you.
New to VA? Apply for health care benefits. Already enrolled in VA and interested in mental health support? Schedule a mental health appointment.

If you're already enrolled and using VA health care, the fastest way to schedule VA appointments is to call the VA facility where you want to receive care.

With VA Appointments tools , you can schedule some VA health care appointments online, view details about upcoming appointments, and organize your health care calendar.

If you're not using VA medical services, contact your nearest VA medical center or Vet Center to talk about your needs.

What about other options at VA? VA offers a variety of tools and resources.

The Veteran Training online self-help portal for overcoming everyday challenges includes modules on managing anger, developing parenting and problem-solving skills, and more.

Mental health apps for Veterans cover a variety of topics, ranging from PTSD to anger management to quitting smoking.

VA TeleMental Health connects you with a VA mental health provider through a computer or mobile device in your home or at your nearest VA health facility. You can learn more about this option from your local VA medical center.

Vet Centers provide support, counseling, and readjustment services for Veterans and active duty service members (including members of the National Guard and Reserve) who have served on active military duty in any combat theater or area of hostility or have experienced a military sexual trauma. Find a Vet Center near you or call 1-877-WAR-VETS (1-877-927-8387) to talk with a fellow combat Veteran about your experiences, 24 hours a day, 7 days a week, 365 days a year.

What about support beyond VA?
There's a whole community of support ready to help with whatever you're going through. Use this tool to find resources near you.

Explore these resources for more information about MST and its effects in Veterans.

Learn more about what you can do if you are experiencing specific concerns related to military sexual trauma, such as relationship problems, alcohol or drug problems, depression, and posttraumatic stress.

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Military Sexual Trauma | Real Stories From Military Veterans | Make the Connection

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During their service, both female and male Service members sometimes have upsetting, unwanted sexual experiences, including sexual assault or sexual harassment. "Military sexual trauma" or MST is the term used by the U.S. Department of Veterans Affairs to refer to these experiences. The official definition of MST used by VA is given by federal law (U.S.

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Learn how to apply for VA disability pay(eligibility) and manage the Veterans disability benefits.

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Learn about VA disability pay (compensation) for Veterans, including ratings, which conditions qualify, and how to file a claim. Find out if you can get VA disability pay for a service-connected disability (an illness or injury caused or made worse by your service).

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Previously, veterans facing a wait of 30 days or more for an appointment at their closest V.A. health care center could seek private care.

Did you know that veterans have to wait 30 days or more to see a doctor? Will privatizing the VA solve the problem? What do you think?

I think private for profit healthcare systems work on the basis of profits. VA needs more doctors, staff, and facility upgrades.

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A Department of Veterans Affairs outpatient clinic in Austin, Tex. Under the new policy, veterans facing a wait of 20 days or more for an appointment at their closest V.A. facility will be able to seek private care. Credit Credit Tamir Kalifa for The New York Times

WASHINGTON - The Department of Veterans Affairs on Thursday will begin allowing a broad section of its nine million enrollees to seek medical care outside of traditional V.A. hospitals, the biggest shift in the American health care system since the passage of the Affordable Care Act nearly a decade ago.

While department officials say they are ready, veterans groups and lawmakers on Capitol Hill have expressed concerns about the V.A., which has been dogged for years by problems with its computer systems. They worry that the department is not fully prepared to begin its new policy, which Congress adopted last year to streamline and expand the way veterans get care.

Previously, veterans facing a wait of 30 days or more for an appointment at their closest V.A. health care center could seek private care. Under the new policy, that waiting time would be reduced to 20 days, with the goal of 14 days by 2020.

The new measurement is expected to greatly open private-sector medical care to veterans in both rural communities and high-traffic urban areas, a goal conservatives have long pushed, especially after a 2015 scandal over hidden waiting lists for care. Veterans will also be allowed to use a bevy of walk-in clinics.

In the 2018 fiscal year, 1.7 million veterans used some form of private care. That number, based on the department's eligibility projections, could increase as much as 30 percent under the new Mission Act, adding just over a half-million veterans to the pool seeking private care - although both critics and supporters of the change believe that number is low.

"I think it's safe to assume that over the next several years you will see more veterans getting their health care in the community," said Dan Caldwell, a senior adviser to Concerned Veterans for America - an advocacy group with ties to the billionaire industrialist Charles G. Koch - which has pursued expanding the use of private health care for veterans. Democrats on Capitol Hill agree.

Even so, it will take some time to see whether the expanded access to private care results in a gentle migration of veterans who are not being well served by nearby V.A. centers, or in a shift of a significant share of veteran care to an increasingly expensive private health care marketplace, starving the V.A., as critics have warned. The quality of care in the private system, as well as wait times within it, will be closely monitored by both opponents and supporters of private care.

"I don't expect a flood of veterans coming in tomorrow or next week saying I want to go into the private sector," Robert Wilkie, the secretary of veterans affairs, said Tuesday in an interview. "I'm confident that we will have a good rollout. I'm looking forward to it." Mr. Wilkie said he will visit the V.A. in Salem, Va., on Thursday to observe the start there.

Mr. Wilkie has repeatedly said that most veterans would continue to seek care at department health care centers because they largely like the care and the understanding of veterans' issues. Several studies underscore the V.A.'s popularity.

Some veterans groups and members of Congress have listed their concerns. Will there be enough doctors to take in the potentially large number of new veteran patients around the nation? Will the department's information systems, particularly a software tool meant to integrate patient data from six information systems, be ready? Will providers and schedulers have adequate training in the new system? Will the V.A., which often has trouble making timely payments to providers, keep up with the expected influx - especially after computer glitches resulted in major problems with G.I. bill payments last year?

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"I'm confident that our team is ready across the country," said Robert Wilkie, the secretary of veterans affairs, last month. Credit Sarah Silbiger/The New York Times

A smooth transition to the policy is a major test for Mr. Wilkie, who was brought in to restore both political and policy equilibrium after years of conflict and scandals at the department. The policy went from passage to rollout in just one year, an aggressive time frame for any large-scale change to an enormous health care system.

But even before it went into effect, critics were speaking out.

"After touring both the Atlanta and Boston V.A. facilities this past month, I'm concerned that V.A. has not done its due diligence to adequately prepare veterans, community providers, and V.A. staff for the June 6 implementation of the Mission Act's new community care guidelines," said Representative Mark Takano, Democrat of California and the chairman of the House Committee on Veterans' Affairs. "I'm apprehensive about the transition this week."

Members of the committee were even asked by the department not to visit, or to send their staff aides to visit, veterans health care centers this week.

Despite that, officials from the House panel plan to visit V.A. facilities around the country that have lower rankings to assess their progress on Thursday. The officials do not know if they will be allowed entry.

President Trump views veterans - a group he has taken pains to court, even though at times he has slighted them - as part of a key component of his political base, and he has long sought to put more veterans in private health care.

"All during the campaign, I'd go out and say, 'Why can't they just go see a doctor instead of standing in line for weeks and weeks and weeks?'" Mr. Trump said last year as he signed the Mission Act. "Now they can go see a doctor. It's going to be great."

"The V.A. certainly does not have the best track record implementing new I.T. systems," said Representative Phil Roe of Tennessee, the top Republican on the House veterans committee. "It's important to remember that while June 6 is a major milestone, many of the other shifts the law requires have either already been implemented or are still to come, and we will continue to provide oversight of all of these changes."

Officials at the V.A. say they are confident things will go smoothly.

The agency has "conducted extensive user testing and training at sites across the nation," said Curt Cashour, a department spokesman. He noted that all veterans enrolled in V.A. health care received mailings about the changes, which also are detailed online. He said that Mr. Wilkie and other department officials have done extensive outreach to veterans.

The V.A. is expected to have over 8,000 new urgent care clinics participating in that part of the program, he said. As of last month, the department had over 548,000 health care providers participating in its private care network, up from 474,765 in January 2018.

"We continue to work with our contracting partners to grow that number," Mr. Cashour said.

Some veterans' service organizations have complained that the V.A. has left them in the dark. "They can't give straight answers about who is eligible," said Rick Weidman, the executive director for policy and government affairs at Vietnam Veterans of America, which is threatening to file a lawsuit to slow the process down. "We should be delaying this until the V.A. gets its act together."

There is no other analogous public health care system in the United States to the V.A. or this transition with services.

Medicare under Mr. Trump has increasingly shifted consumers into private plans, but that is a public payer system, not a health care system. "The V.A. has a number of characteristics worth studying for valuable lessons on health care in the private sector," said David Blumenthal, the president of the Commonwealth Fund.

A version of this article appears in print on , on Page A17 of the New York edition with the headline: As V.A. Prepares to Allow Private Care for Millions, Many Worry About Details. Order Reprints | Today's Paper | Subscribe

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V.A. Prepares for Major Shift in Veterans' Health Care

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WASHINGTON - The Department of Veterans Affairs on Thursday will begin allowing a broad section of its nine million enrollees to seek medical care outside of traditional V.A. hospitals, the biggest shift in the American health care system since the passage of the Affordable Care Act nearly a decade ago.

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A new policy restricting smoking  at VA health care facilities by October 2019.

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PTSD Assessment and Intervention (For Nurses) 

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PTSD Assessment and Intervention (For Nurses) 

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Listen to their stories. Nurse can provide the care that veterans and their families with PTSD need. Determine risk for PTSD or other psychological conditions associated with military life and the transition to civilian life.

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Horrors of War, It Impacts  Veterans' Mental Health        - Psychology and Aging (Lee, et al.)

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Horrors of War, It Impacts  Veterans' Mental Health        - Psychology and Aging (Lee, et al.)

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Combat veterans are more likely to experience mental health issues in later life. Each war is different, and so it affects veterans differently.

* This journal article is available on TWU Libraries Online Resources, please login with TWU to view article *

APA citation:
Lee, H., Aldwin, C., Choun, S., & Spiro, A. (2019). Impact of Combat Exposure on Mental Health Trajectories in Later Life: Longitudinal Findings From the VA Normative Aging Study. Psychology and Aging, ₃₄(4), 467-474.

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Veterans with traumatic brain injuries, PTSD can increase suicidal thoughts and behavior, depression, sleep disorders, and so much more symptoms. I would encourage veterans and their families to seek care for mental health issues, just like you would treat for physical wounds.
https://www.psychiatrictimes.com/ptsd/veterans-day-and-military-mental-health-startling-facts

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Learn About VA Suicide Prevention Program 

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Learn About VA Suicide Prevention Program 

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Don't hesitate to call Veterans Crisis Line. Get help. They got your back.
1-800-273-8255

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Facts: 10% of U.S. Veterans are Women - VA

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Facts: 10% of U.S. Veterans are Women - VA

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Women are now the fastest growing cohort within the Veteran community.

"The overall Veteran population is DECREASING at a rate of about 1.5% per year, and the women Veteran population is INCREASING at a rate of 1% per year."

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Find VA Urgent Care And Retail Location (For Eligible Veterans)

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Find VA Urgent Care And Retail Location (For Eligible Veterans)

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Urgent Care Benefit started in June 2019. This benefit is considered open access, allowing Veterans to access urgent care within VA’s community care network and receive care without prior authorization from VA. The benefit started in June 2019.This benefit is considered open access, allowing Veterans to access urgent care within VA’s community care network and receive care without prior authorization from VA.

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"PTSD Family Coach" app contains information about PTSD, tips and tools to manage PTSD in veterans and family members.

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PTSD Family Coach - PTSD: National Center for PTSD

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PTSD Family Coach is an app to support family members of those living with posttraumatic stress disorder (PTSD).

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Importance of Promotion and Implementation of Veteran-Specific Health Issues

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Importance of Promotion and Implementation of Veteran-Specific Health Issues

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Programs targeted at enhancing veteran-specific knowledge for faculty and students will serve to improve care for diverse veteran populations.

APA Citation:
Olenick, M., Flowers, M., & Diaz, V. J. (2015). US veterans and their unique issues: enhancing health care professional awareness. Advances in medical education and practice, ₆, 635–639. doi:10.2147/AMEP.S89479

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Abstract

United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18-44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.

Keywords: veterans, veteran health care, veteran health issues, veteran content

Introduction

United States veterans are multifaceted and may be considered a population, a culture, and a subculture. Military culture includes, but is not limited to, the values, customs, traditions, philosophical principles, ethos, standards of behavior, standards of discipline, teamwork, loyalty, selfless duty, rank, identity, hierarchy, ceremony and etiquette, cohesion, order and procedure, codes of conduct, implicit patterns of communication, and obedience to command (LD Purnell, University of Delaware and Florida International University, personal communication, January, 2015). 1

The American veteran population is a unique population. Varying military service branches and varying military experiences among the veteran population is unique. Varying wartime eras and health-specific issues associated with those eras are unique among the veteran population. From a comparison of veterans from the Vietnam, Persian Gulf, and Iraq/Afghanistan (Operation Iraqi Freedom [OIF]/Operation Enduring Freedom [OEF]) war eras, Fontana and Rosenheck 2 noted distinct differences. OIF/OEF veterans include fewer African-Americans, more Latinos, and more females than other eras. In addition, this group is younger, less likely to be married, less likely to have been incarcerated, and more likely to be gainfully employed. 2 It was also observed that OIF/OEF veterans appear to be more socially integrated, less often diagnosed with substance abuse disorders, and required less Veterans Affairs (VA) disability compensation for post-traumatic stress disorders (PTSDs) when compared to their Persian Gulf and Vietnam veteran counterparts. 2

US veteran-specific health issues

Mental health or behavioral adjustment disorders

Medical records of veterans reveal "that one in three patients was diagnosed with at least one mental health disorder - 41% were diagnosed with either a mental health or a behavioral adjustment disorder". 3 In compensation or in combination with military-related diseases, many veterans develop substance use disorders (SUDs) and a large number ultimately commit suicide. LeardMann et al 4 found that male veterans diagnosed with "depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems" were significantly associated with an increased risk of suicide. Thus, identifying and treating mental health illness has the greatest potential to mitigate suicide risk. Unfortunately, reluctance to seek help or treatment makes diagnosing and treating mental illness difficult in this population.

SUDs

The stressors of military service increase the risk of veterans having problems with alcohol, tobacco, or drugs (or a combination). Johnson et al 5 found that cigarette smoking and alcohol consumption is higher among veterans than non-military personnel. For some veterans, treatment of a co-morbid condition (eg, PTSD, depression, pain, insomnia) may resolve the problem. For others, long-term care is required. Thus, multiple clinical practice guidelines have been developed "and evidence-based screening tools to help clinicians identify veterans with SUDs and improve outcomes". 5

PTSD

Also known as "shell shock" or "combat fatigue", PTSD results from witnessing or experiencing (directly or indirectly) a traumatic event. 6 The disease is not limited to veterans, however, military personnel experience PTSD almost four fold (8% of non-military men versus 36% of male veterans). 5 PTSD is an amalgam of symptoms, severity, and duration. According to the American Psychiatric Association, 6 diagnosis is based upon four symptom categories: intrusive symptoms (flashbacks), avoidance of reminders (isolation), negative thoughts and feelings ("no one can be trusted"), and arousal and reactivity symptoms (exaggerated startle response). PTSD is often associated with "traumatic brain injury (TBI), military sexual trauma (MST), sleep problems, substance use, pain, and other psychiatric disorders, and requires comprehensive assessment". 5 Treatment is aimed at therapy (psychotherapy, prolonged exposure therapy, family/group therapy, and others), social support, and/or medication such as antidepressants. Screening tools and evidence-based guidelines have been developed to accurately and expeditiously assess and treat veterans.

TBI

TBI is "a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force". 5 TBI can be classified as mild, moderate, or severe depending on the length of unconsciousness, memory loss/disorientation, and responsiveness of the individual following the event (ie, are they able to follow commands). While mild TBI (or concussion) is the most common, diagnosis is difficult since symptoms include "headaches, dizziness/problems walking, fatigue, irritability, memory problems and problems paying attention". 5, 7

Depression

Among the available data from the National Alliance on Mental Illness (NAMI), 2 depression ranks among the most common mental health disorders. The diagnosis rate for veteran depression is 14% (although NAMI believes depression is under diagnosed). Notably, NAMI 2 found that individuals with PTSD were less likely to commit suicide versus those with depression probably due to the increased awareness and acceptance of PTSD. Despite its devastating effects, major depression is a treatable illness with 80%-90% success rate using medication, psychotherapy, and/or electroconvulsive therapy. 2 Models of care, such as Translating Initiatives for Depression into Effective Solutions, show eight out of ten veterans are effectively treated. 8

Suicide

With 18 to 22 veterans committing suicide on a daily basis, risk assessment and intervention are paramount. 9 Private and public health care professionals must be aware of patients' military history (since not all veterans seek care in VA clinics) 5 and be able to recognize suicide-risk factors, regardless of age. Young veterans aged 18-44 years are most at risk of suicide; yet, Kemp and Bossarte 9 found that even older veterans, aged 50 years and older, were still almost twice as likely to commit suicide versus non-veterans (69% and 37%, respectively). Additionally, "11% of veterans who survive a first suicide attempt will reattempt within 9 months, and 6% of those will die". 5 Kemp and Bossarte 9 found evidence supporting the efficacy of VA health care systems in lowering veterans' non-fatal suicide attempt rate, thus referral to a VA facility is recommended for appropriate counseling and health services.

Chronic pain

With 82% of OEF and OIF veterans reporting chronic pain, diagnosis and treatment are essential. 5 A comprehensive assessment of pain is crucial, but also identifying associated physiological/biological and psychological factors since "chronic physical pain is often associated with co-morbid conditions, including TBI and PTSD, that may complicate treatment". 5, 7 Treatment should focus on concurrently addressing all conditions, with extreme cautionary use of opioids due to the heightened risk of veterans developing SUDs.

Amputations

Advancement in medical technology and bodily protection allow soldiers to survive injuries at a higher rate than in previous wars. Yet, the scars from a traumatic amputation are deep and many soldiers develop mental health injuries related to the event and "in cases involving multiple limb amputations or disfigurement, body image issues may create multiple social and employment barriers". 5 According to military casualty statistics, 1,573 veterans have suffered major loss of limb amputations from battle injuries since 2010. 10

Health care professionals must be able to address the physical safety concerns, as well as, the emotional health of the veteran. Sensory aids, prosthesis, and medical rehabilitation require an interdisciplinary-team approach in healing wounded soldiers.

Rehabilitation care

Many veterans have a hard time reacclimating into society after deployment due to military skills that are not transferrable to civilian life, bodily trauma that rendered that individual handicapped, and/or war-related mental disease. Rehabilitation care is aimed at a balance of vocational, physical, social, and mental therapies to prepare veterans for re-entry into civilian life. Vocational programs help job-seeking veterans develop skills and knowledge required for a particular job. Physical rehabilitation focuses on improving veterans' quality of life and independence. Social rehabilitation assists veterans to assimilate to non-military life and establish new ways of life post-deployment. Mental rehabilitation teaches veterans with mental health illness the living skills of community functioning and ability to deal with their new environment.

Hazardous exposures

Veterans' past exposure to chemicals (Agent Orange, contaminated water), radiation (nuclear weapons, X-rays), air pollutants (burn pit smoke, dust), occupational hazards (asbestos, lead), warfare agents (chemical and biological weapons), noise, and vibration increase their risk of health problems even years after the initial assault. 11 For example, long-term health problems have been implicated in association with Agent Orange exposure in Vietnam veterans. 12 For those who served in Iraq and Afghanistan, there is insufficient data to identify long-term health effects of hazardous exposure to pollutants, such as "burn pits" and infectious agents such as rabies, despite the immediate side-effects experienced by most veterans. 5 Obtaining an accurate medical and deployment history is essential in providing accurate diagnosis and appropriate treatment.

Homelessness

It is estimated that approximately 49,933 veterans are homeless (~12% of homeless adult population). 13 Homeless veterans face the same difficulties as non-veterans such as substance use, unemployment, and mental illness; yet plagued with the additional burdens of military-related factors, "such as PTSD, TBI, a history of multiple deployments, and military skills that might not be transferable to the civilian work environment". 5 National Coalition for Homeless Veterans 13 found that 51% of homeless veterans have disabilities, 50% suffer from a serious mental illness, and 70% have SUDs. National Coalition for Homeless Veterans 13 believes housing and employment opportunities are a top priority for homeless veterans.

Complex deployment and reintegration needs

Veteran issues related to separation from military service and other issues related to complex deployment needs are among specifically identified veteran issues. Veterans' successful reintegration into civilian life outcomes and interprofessional solutions stem from community involvement, access to resources, and support from peers. Reflection on best practices related particularly to employability and training builds on knowledge and skills gained in the military (ie, university accelerated programs for veterans where military medics and corpsmen transition through an accelerated program into nursing earning credit for military education and training [such as the Veterans Bachelor of Science in Nursing which is a Health Resources and Services Administration funded program]; Military Police to Criminal Justice, Navigational Experience and Knowledge to Geology and/or Geography, etc), employment post-military separation, reintegration into society, veteran demographics, homelessness prevention and other mental health and SUD programs that facilitate veterans' successful transition into urban civilian and family life. Successful reintegration after military separation is an essential focus for holistic and effective veteran care.

Rationale for integrating veteran-centric content into curricula

The veteran population is growing. In 2014, over 20 million veterans resided in the USA per the US Department of Veteran Affairs, 2015. 14 Veterans are seeking health care services in the Veteran Health Administration as well as civilian treatment facilities. In order to understand and address health care needs of this vast and growing population, incorporating veteran-specific content into curricula is of primary importance. Veteran content specifically illuminates the unique yet complex health issues, mental and behavioral adjustment disorders, veteran wartime era, and civilian reintegration obstacles that, in combination, magnify their physical condition. Transparent presentation of the veteran circumstance can facilitate an interdisciplinary approach to care incorporating nursing, occupational therapy, physical therapy, mental health, pain management, nutrition, psychosocial, and social support services to ensure positive health care outcomes for this population. Several innovative strategies address these unique issues.

Professional curricula

Ideas for strategies to begin integration of veteran content into health care professional curricula include but are not limited to the following:

1. Provide presentations and seminars on veteran content delivered by well-known and distinguished speakers and/or experts on particular veteran content.

2. Embed veteran content into courses (undergraduate and graduate) and identify specific courses to curriculum map where veteran content occurs.

3. Recruit and hire faculty that come from veteran and military backgrounds and experiences.

4. Provide faculty development opportunities to expand and improve their knowledge on veteran issues.

5. Identify veterans in clinical areas and provide clinical experiences for students with veteran patients of different war eras, branches of service, and military experience backgrounds.

6. Provide veteran simulations and case studies as part of undergraduate and graduate curriculum.

7. Provide students the opportunity to develop individualized patient plans and Subjective, Objective, Assessment, Plan (SOAP) notes that reflect needs of veteran patient.

The American Association of Colleges of Nursing 15 offers a "Joining Forces: Enhancing Veterans' Care Tool Kit" ( http://www.aacn.nche.edu/downloads/joining-forces-tool-kit/educational-resources) with a variety of educational resources on many veteran issues, references to articles on particular veteran issues, case studies, a veteran assessment tool, curricular examples including slides and syllabi for veteran-specific courses. This site is an excellent resource.

Discussion

Currently, there are approximately 22 million US veterans. 14 Preparing future health care providers to meet the needs of this extraordinary number of veterans is essential. Providing faculty development in the area of veteran-specific health issues and how to integrate veteran content into curricula will contribute to improving veteran outcomes and providing excellent care to those who served this country.

Total enrollees of veterans who utilize the VA health care system (8.9 million in 2013) 16 is less than half the current total veteran population. Furthermore, approximately 61% of all separated OEF/OIF veterans have used VA health care since October, 2001. 17 This means that veterans are largely using civilian medical care facilities further stressing the need for health care providers to be well versed in veteran-specific health issues, war eras, and reintegration issues veterans face; in order to provide excellent veteran care and outcomes.

Conclusion

Promotion and implementation of veteran health issues into curricula, and other veteran content relevant to enhancing veteran care and outcomes, is essential in health care provider education and vital to the holistic care of veterans across the lifespan and across the country. Programs targeted at enhancing veteran-specific knowledge for faculty and students will serve to improve care for diverse veteran populations.

Acknowledgments

This project was supported by funds from the Division of Nursing and Public Health, Bureau of Health Workforce, Health Resources and Services Administration, Department of Health and Human Services Grant UF1HP26980, Veterans' Bachelor of Science Degree in Nursing Program (VBSN).

Footnotes
Disclosure
The authors have disclosed no conflicts of interest, financial or otherwise in this work.

References

1. Lattanzi JB, Purnell LD. Developing Cultural Competence in Physical Therapy Practice. 1st ed. Philadelphia, PA: FA Davis; 2005. [ Google Scholar]

2. Fontana A, Rosenheck R. Treatment-seeking Veterans of Iraq and Afghanistan: Comparison with veterans of previous wars. J Nerv Ment Dis. 2008;196(7):513-521. [[ PubMed] Google Scholar]

4. LeardMann CA, Powell TM, Smith TC, et al. Risk factors associated with suicide in current and former US military personnel. [[ PubMed] Google Scholar]

5. Johnson BS, Boudiab LD, Freundl M, Anthony M, Gmerek GB, Carter J. Enhancing veteran-centered care: a guide for nurses in non-VA setting. Am J Nurs. 2013;113(7):24-39. [[ PubMed] Google Scholar]

12. Institute of Medicine . Veterans and Agent Orange: Update 2012. Washington, DC: National Academies Press; 2012. [ Google Scholar]

# data[].attributes.attachment_link.title
US veterans and their unique issues: enhancing health care professional awareness

# data[].attributes.attachment_link.description
United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts.

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Combat Veterans talking about hardships adjusting to civilian life from their military life.

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Health Services Are Here For You, Veterans - VA (Thomas Sells)

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Health Services Are Here For You, Veterans - VA (Thomas Sells)

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Through one veteran's story, learn how his care team gave him the training and support to succeed, and he achieved Health for Life.

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Introducing Health For Life: Through One Veteran's Story