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  1. When it comes to healthcare, veterans of the armed services sometimes have unique behavior issues which may require specialized care. Abraham Lincoln established the Veterans Health Administration (VHA) in 1865 “….to care for him who shall have borne the battle and for his widow and his orphan.” Not all military service members qualify for care at a VHA facility, however. On average, 600 veterans retire or resign from military service per day. Factors that determine a veteran’s qualification for VA care include discharge status (honorable, medical, general), service time and type of military experience. Behavioral Issues of Military Veterans without War Stories - ProQuest Forty percent of all Iraq and Afghanistan Veterans, plus an additional 10 million military service members who were not deployed seek care at civilian health care facilities. Behavioral Issues of Military Veterans without War Stories - ProQuest It is not always obvious if a patient has had military experience, so it is important to ask patients if they have ever been a member of the military. It is also important to know what branch of the service they were in and in which era (WWII, Vietnam, Iraq/Afghanistan) they served. Behavioral issues can and often do go hand in hand with physical complaints. In addition, behavioral diagnoses may accompany substance abuse or suicidal ideation. Veterans may have special behavioral issues which all nurses should be sensitive to and include in a thorough assessment. Post-traumatic Stress Disorder Post-traumatic stress disorder (PTSD) is triggered when a person experiences a terrifying event or series of events over time. After the event has ended patients with PTSD experience hypervigilance, anxiety or anger. Soldiers have experienced PTSD for generations and the disorder has gone by different names. PTSD was formally recognized in the 1980s. When approaching a Veteran who is anxious consider their trauma history. Ask the Veteran if they have been constantly on guard or are easily startled. It is common for vets with PTSD to feel guilt or blame themselves for past events. PTSD is linked to suicide and alcohol dependence. Suicide According to the National Veteran Suicide Prevention Annual Report, members of the armed services are 1.5 times greater risk for suicide than the civilian population. That makes assessing for suicide particularly important in the Veteran population. Suicide prevention strategies that work include universal screening, safety planning and cognitive behavior therapy. The VA has programs in place to help all service members, even those that don’t qualify for other VA medical care. Military Sexual Trauma As with suicide, the VA has programs in place for Veterans with military sexual trauma (MST) even if the Veteran doesn’t qualify for other services. MST is defined as any unwanted sexual conduct, including comments, unwanted attention and inappropriate verbal or physical conduct, up to and including assault. Between 13.9 and 31.2% of military service members have experienced MST. Assessment questions for MST include: Did you have unwanted or threatening sexual advances? Have you ever received frequent comments about sex? MST does not have to be documented in the Veteran’s service record for them to receive care at VHA. Depression Depression is another common ailment among military service members. Patients may have symptoms of depression without a diagnosis of clinical depression. Severe depression may lead to suicidal ideation and substance abuse. Patients with depression may be lethargic or withdrawn. Others may be angry or agitated. Many people may not show signs of depression. Depression is treatable, even in severe cases. Physical Health Concerns Common for Veterans Military service members have certain physical ailments at a higher rate than the general public. Those complaints include: Tinnitus - Veterans tend to have hearing issues such as tinnitus, or ringing in the ear. This is due to work environments which involve exposure to loud noise, including gunfire and aircraft and generators. Tinnitus may affect a former service member’s concentration and work performance and may lead to anxiety and depression. Musculoskeletal Injuries - Service members often carry heavy loads over difficult terrain, perform repetitive tasks, or wear protective body armor. These are just some of the activities that can lead to musculoskeletal injuries including rotator cuff damage, cervical and lumbar strain and knee damage. Conclusion Members of the military perform a service to the country, and that service sometimes leaves them with both physical and behavioral health problems. It is important to identify Veterans who may have these behavioral and physical issues as a result of their service. The VHA has special programs to help them recover from trauma even if they do not qualify for other outpatient services. Prompt identification and treatment of Veterans ‘physical and behavioral ailments can save lives. Views expressed here are solely those of the author. Ms. Cole does not write for VHA References Conard, P. P., Keller, M. P., & Armstrong, M. L. (2021, March/April). Behavioral issues of military Veterans without war stories. Medsurg Nursing, 30(2), 138-142. Contractor, A. A., Forkus, S. R., Monteith, L. L., Roselini, A. J., & Weiss, N. H. (2020, October). Military sexual trauma and alcohol misuse among military veterans: The role of negative and positive emotion dysregulation. Psychological Trauma: Theory, Research, Practice and Policy, 716-724. Elsevier -. (2021, May). Depression. Post Traumatic Stress Disorder, Suicide. Retrieved from Elsevier Clinical Skills: elsevierperformancemanager.com United Health Foundation. (2021). Public Health Impact: Suicide. Retrieved from America"s Health Rankings: https://www.americashealthrankings.org/explore/annual/measure/Suicide/state/ALL US Department of Veterans Affairs. (2021, April). celebrate VA motto. Retrieved from VA.gov: https://www.VA.gov/opa/publications/celebrate/vamotto.pdf Military sexual trauma and alcohol misuse among military veterans: The roles of negative and positive emotion dysregulation
  2. The American Legion Auxiliary sponsors the Children of Warriors National Presidents' Scholarship to support the children of our warriors. These scholarships are for undergraduate study only at a four-year accredited college or university, and may be used for tuition, books, fees, room, and board. Criteria Candidates for this award shall be daughters, sons, grandsons, granddaughters, great-granddaughters, great-grandsons of veterans who served in the Armed Forces during eligibility dates for membership in The American Legion, listed below. April 6, 1917, to November 11, 1918 Any time after December 7, 1941 Applicants must be in their senior year of high school. Applicant must complete 50 hours of volunteer service within the community during his/her high school years. Scholarship Deadline March 1 of each calendar year
  3. I have a passion for history and a passion for patients. When the two come together, I am held transfixed, unable to tear myself away. Veteran's Day is an important holiday to honor those men and women who have served to protect our country. With the wars in Afghanistan and Iraq, nurses can expect to see more patients who have war stories of what they went through. However, most of the patients we see are those from the Greatest Generation, those who lived and suffered through World War II. As a nurse, it can be difficult to find time to talk at length about a patient's past. Sometimes, though, these patients need to get their story out. They need to have their pasts heard by someone who is caring and compassionate. Veteran's Day is a great day to take the time to ask about service, but honestly, you can ask on any day. Take the time, even if its just five minutes, to listen to a war story. Say thank you honestly, and give them your attention. Many veterans feel like others don't care, but as a nurse, this is a great opportunity to bond with your patient. Asking About Service History I walked into a patient's room one night and saw a book on the table. I recognized it because I had read it myself. It was Band of Brothers by Stephen Ambrose, the book that the popular HBO miniseries was based on. Thinking I found another military historian, I asked him if he liked the book, what he thought about it. He replied, "I lived it. I was in the 101st Airborne Division in World War II." What followed was a fascinating account about how he and his buddies parachuted into Normandy and led the spearhead that eventually ended up in Germany itself. I would have stayed longer, but unfortunately, med pass was calling. I remember this conversation because it was extraordinary. What was merely a history lesson to me was this man's life. If you find a patient who mentions their military service, it doesn't hurt to ask about it. Some are delighted to relate their stories. You may have pressing matters that you need to take care of, but ask your questions while providing care. It doesn't take too much time to listen, and your patient may feel grateful that you cared enough to ask. Instead of merely performing the actions of your job, take the time to make the human connection and care for more than just their body. Honoring Our Veterans I usually worked night shift, and the weather outside one night was blustery and cold. I entered a patient's room and noticed him sitting by the window, a frown on his face. Concerned that he was in pain, I asked him what was wrong. He pointed to the flag outside his window. "That flag shouldn't be flying in this weather, and it isn't lit properly. I suffered for the flag, and I hate to see it disrespected." I was taken aback, never having heard these rules before. I assured him I would do everything I could to take care of it. I sent a message to the comments department of my hospital, and a new light was installed shortly thereafter. Veterans want to be honored, and this man was rightfully upset that the flag was not being cared for properly. Of course, there wasn't much I could do as a simple floor nurse, but I did express my sympathy and empathy. He cared for that flag, and it hurt him to see it in the rain. No matter what your political persuasions, service men and women have given a great sacrifice for their country. Rather than focusing on what those wars meant, focus instead on what these people gave. Even if you couldn't care less about the flag or patriotic overtures, your patient may, and it is all about them. Do what you can to listen, fix what you can, and keep your opinions close to the vest. Dealing with Reluctant Soldiers I was working in a nursing home as an activities aid when I met a nice older woman who had suffered a broken hip. Her husband was always with her, helping her when he could. I noticed he had a long scar that extended from just under his right eye, crossed his mouth, and ended at his left jaw. I'm not sure what got us talking about history, but he admitted he was in World War II. However, he didn't want to talk about it. You could see in his eyes that something haunted him about his time in the war. In the end, he gave me a typed up copy of a short biography his son convinced him to write. He had killed. He had been left for dead when he got his wound. When I saw him again after reading it, he said, "I hope you don't think any less of me." Some patients will not want to talk about their service, and that's quite alright. War is, indeed, hell, and many veterans don't want to relive it. If you notice a tattoo or a scar that may indicate service, you can ask casually, but don't be surprised if the patient clams up. Some memories have never even been expressed to their families, and they aren't likely to express them to you. Instead, thank them for their service, offer to lend an ear if they ever feel like talking, and allow the conversation to drift to other topics. As with all sensitive issues, nurses need to be discreet and careful when probing for information, especially a history that likely doesn't impact their medical history. That said, Veteran's Day should not be ignored. It is November 11th, which happens to be the date the Germans surrendered in World War I. Take the time out from your schedule to talk to a veteran. At the very least, thank them for their service. They sacrificed in service, as nurses do to an extent, and the urge to give to others can give you a common ground for a deeper connection with your patient.
  4. This holiday usually marks the beginning of the summer season. For many it is a time to fire up the grill and cut open the watermelon. There may be parades and other special events. But let's not forget the real reason for this day........a time for us to remember and honor those men and women who died while serving their country. It is a day when many visit cemeteries to decorate the graves of fallen heroes. From the Presidential speech regarding Memorial Day. As we did last night, we try to watch the National Memorial Day Concert in Washington DC - a program which honors the valor and patriotism of Americans who have served our country. The show pays tributes to their sacrifices as well as those of their families. There is also a special tribute to courageous American heroes disabled for life as a result of injuries received in the line of duty. Here is a picture of The Nurse's Memorial in Arlington National Cemetery where many military nurses are buried. Now today we will fire up the grill and try not to burn the burgers. What do you do to remember this day?