To Care for Him Who Has Borne the Battle: Veteran Care in Community Hospitals

Ellen720, BSN, MSN

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

JBMmom, MSN, NP · Sep 9, 2021

We have had a few veterans, some of them very young, in our intensive care unit. Most recently we have had young men in their 20s and 30s battling substance abuse issues, especially alcoholism. They are generally reserved and respectful, although the challenges of detox periods can impact anyone's behavior. It's really heart breaking to see how these men and women, who were willing to put their lives on the line for complete strangers in defense of our nation, are cast off when they return from duty and faces challenges. It's so unfortunate that a larger part of the defense budget isn't put towards the care of these true heroes.

Emergent, RN · Sep 10, 2021

This terrible human fallout is because of the fact that the US is a militaristic nation, not defending freedom, but advancing the interests of multinational corporations. Meanwhile, individual freedoms of ordinary Americans get chiseled away more with each passing year.

**Lunah, MSN, RN** · Sep 10, 2021

Women's services are lacking in some locations. Where I live, we only have a VA clinic, and it was too full for me to receive care there when I moved to my city in 2020. I was sent out to a civilian doctor as part of the community care program. Meanwhile, I was assured to "just wait, we are building a new VA clinic that will have a women's health team!" So after that, it was just crickets from the VA. I found out in August that I could have been using the women's health services for MONTHS, as the clinic opened sometime in February. When I called the women's health coordinator (who is in a completely different region, totally assinine), she assured me I could just call for an appointment! (Not true. You have to be reviewed for eligibility again by the facility before scheduling, even if you already receive VA healthcare.) This coordinator also asked for suggestions as to what they could do to improve care for women. I said, "Uh, how about some OUTREACH?" And .... no response. I was like, "No, I'm serious." Ugh. She said, "Feel free to let other women veterans know they have access to services!" Okay, so I should do THEIR job for them? AWFUL.

chevyv, BSN, RN · Sep 10, 2021

I love working at the VA! There are a lot of programs for our Veterans and I agree that word of mouth is what helps other Vets get connected into some of these lesser known programs. That can make getting services difficult, but please don't give up! Getting reviewed for eligibility should not be difficult especially if you've already have been to any VA. They may have to look in remote data but that goes pretty smoothly once you know how to maneuver around. Many of my patients hear about programs from other Vets who they trust more than any system. Word of mouth is important just like any other healthcare facility. We, at the VA, should always be working on Outreach. I'm sorry Lunah that the person you spoke with didn't seem to take your suggestion seriously. It's a valid point and should be addressed.

Daisy4RN · Sep 10, 2021

I have taken care of at least 2 gentlemen with leukemia that were exposed to Agent Orange in Vietnam and were sure the illness was from the exposure. They were told by the government at the time it was safe. It was not. I am not sure why they were at the hospital I worked for as there was a VA close by but I guess it was because we either had an Oncology unit and/or they were there for "higher level of care". The stories they told were horrific although they remained proud to have served their country, and countrymen, and said they would do it all again bc we have a great Country worth fighting for. I am glad that the VA has better services/programs now than in the 70s but it is still lacking IMO. I hope that all caregivers (and people in general) would give these Vets the care and respect they deserve. Many have been through he** and back and do not deserve a medical system that doesn't have their back, whether VA or community.

OUxPhys, BSN, RN · Sep 11, 2021

The VA needs to update alot of their hospitals. They need to fill the thousands of vacant physician openings as well as nurse openings. They also need to become more efficient. All of these factors contribute to caring for vets. If you don't have the staff and if you aren't efficient the veteran will not get the care they need.

The VA has come a long way based on stories from other vets but they also still have a long way to go.

ComeTogether, LPN · Sep 13, 2021

Such an important topic. My Husband lost his dad to suicide in the 80s because he wasn't helped after Vietnam. So sad.

To Care for Him Who Has Borne the Battle: Veteran Care in Community Hospitals

Post-traumatic Stress Disorder

Suicide

Military Sexual Trauma

Depression

Physical Health Concerns Common for Veterans

Conclusion

About Ellen720, BSN, MSN

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