Educating nurses to care for military veterans in civilian hospitals: An integrated literature review

Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System

BACKGROUND

Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health.

PURPOSE

The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period.

METHODS

The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts.

DISCUSSION

Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed.

CONCLUSION

This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Understanding how Canadian healthcare providers have learned to identify co-occurring PTSD symptoms and dementia in Veterans

WHAT IS KNOWN ON THE SUBJECT?: Little is known about how PTSD and dementia in Veterans is identified by health care providers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Healthcare providers identify those behavioural symptoms experienced by older people living with dementia that represent an unmet need associated with PTSD secondary to military service. Once healthcare providers recognize the presence of symptoms relevant to PTSD, they modify their care approach to include focused/tailored non-pharmacological care interventions that address environmental and situational variables that reflect military action. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Specialized education and training is needed to improve the identification of PTSD when existent with other co-occurring neurocognitive conditions such as delirium, dementia and depression. ABSTRACT: Introduction Co-occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia-related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/Question The purpose of this study was to understand how Canadian healthcare providers have learned to identify the co-occurrence of PTSD symptoms in Veterans with dementia. Methods Eight semi-structured interviews employing the Critical Incident Technique were conducted with key informant healthcare providers who treat Veterans from across Canada. Framework analysis was used to code, sort and develop themes. Results Observed differences in Veterans with PTSD and dementia cued healthcare providers to seek our more information, leading to a new understanding of past trauma underlying the symptoms they observed. Healthcare providers then altered their usual care approaches to utilize trust-based and validation-oriented strategies resulting in more effective care management. Discussion Improvement in the identification of co-occurring PTSD and dementia in Veterans requires specialized education and training for healthcare providers. Implications for Practice Recognizing the complex needs of older Veterans with co-occurring PTSD and dementia is necessary for healthcare providers to implement more effective care for this population. Relevance Statement This paper provides mental health nurses with new understanding of co-occurring PTSD and dementia in Veterans. With an ageing Veteran population in Canada, mental health nurses need to be knowledgeable about the care for Veteran specific mental health needs.

To select suitable supplier for complex equipment military-civilian collaborative design based on fuzzy preference information that from matching perspective

Combine complex equipment collaborative development in military-civilian integration context not only fulfils actual development requirement, but also beneficial to the national economy. Design procedure as first stage of complex equipment military-civilian collaborative development process, select suitable design supplier is significant to whole development process of complex equipment. In order to select suitable design supplier for complex equipment, two aspects done in this paper. One is comprehensive analysis of evaluated influencing factors that affect complex equipment military-civilian collaborative design process, corresponding evaluation indicator constructed and a combination of grey correlation, entropy, DEMATEL (Decision-making Trial and Evaluation Laboratory) and VIKOR analysis theory to obtain grey entropy-DEMATEL-VIKOR, then the combined method is utilized to acquire matching attributes for followed research content. Meanwhile, satisfaction degree for matching side obtained with the help of information aggregation based on power generalized Heronian mean which on the basis of fuzzy preference information. Then, through constructed matching model, suitable design supplier obtained. Finally, a corresponding illustrative example given.

PTSD Symptoms and Dementia in Older Veterans Who are Living in Long-Term Care

Co-occurring posttraumatic stress disorder symptoms and dementia can result in increased symptoms, such as suspicion, aggression, and nightmares in Veterans that can be difficult to manage in long-term care environments. The objective of the study was to explore how the co-occurrence of posttraumatic stress disorder symptoms and dementia are understood in Canadian Veterans who are living in long-term care. A descriptive multiple case study was conducted in two Veteran long-term care facilities in Canada. Data collection consisted of semi-structured interviews with Veterans, their family caregivers, and health care providers, non-participant observation, and a chart audit. Three major themes emerged relating to symptom expression and care approach: a) symptoms are the same but different; b) differences in the complexity of care; and c) added dimensions involved in care. The results of this study contribute foundational information about co-occurring posttraumatic and dementia symptoms that can inform policy, care approaches, and potential interventions.

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.].

Examining the Capacity of Registered Nurses to Deliver Culturally Competent Health Care to Veterans and Their Families

BACKGROUND

Although more than 75% of veterans and their families are accessing care in non-Veterans Affairs (VA) settings, there is little information about health care workers, specifically registered nurses (RNs)' ability to provide culturally competent and appropriate care to military veterans and their families.

PURPOSE

The purpose was to examine the capacity of RNs working in non-VA hospitals to deliver culturally competent health care to military veterans and their families.

METHODS

A prospective survey design was carried out with nurses from a large academic health system. The RAND Corporation's Ready to Serve web-based survey was adapted with permission for use with RNs employed in civilian urban and community hospitals. In addition to reporting descriptive statistics on demographics and each individual item, a score was calculated to define high cultural competency.

RESULTS

Twenty-five (4%) RNs demonstrated the capacity to deliver culturally competent health care.

CONCLUSIONS

This study revealed significant gaps in the capacity of nurses to deliver culturally competent care to military veterans and their families.

Post-traumatic stress disorder and dementia in veterans: A scoping literature review

Emerging research has found an association between post-traumatic stress disorder (PTSD) and dementia in veterans, yet little is known about the nature of this association and how it is conceptualized in the literature. The purpose of this scoping review is to understand how the relationship between PTSD and dementia in veterans is recognized and described in the peer-reviewed literature. A scoping review was conducted using Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 19, 2005) framework. Articles are included if participants were veterans with a focus on PTSD and dementia. A total of six databases (CINAHL, MEDLINE, EMBASE, PsycINFO, HealthSTAR, and PubMed) were searched along with the reference lists of eligible sources in September 2018. Thematic analysis was used to summarize the data. Thirty-six studies were included in this review. Three main themes emerged from the literature: (i) symptomatic expression of PTSD and dementia; (ii) aetiology underlying the relationship between PTSD and dementia; and (iii) implications of PTSD and dementia on healthcare providers, treatment, and resources. This study highlights the ongoing need to understand mechanisms underlying the association between PTSD and dementia, the need for definition of PTSD symptoms, and to sensitize healthcare providers to the presence of PTSD when caring for veterans with dementia.

Improving the awareness and care of veterans in healthcare services

This article aims to raise awareness of veterans (people who have served in the UK military) who are receiving nursing care. Nurses will often provide care and treatment for veterans, so they should be aware of the potential health needs of this patient group to provide optimum care. Veterans should receive priority treatment where it relates to a condition that results from their service in the armed forces. Therefore, it is important for healthcare professionals to recognise if patients may be veterans and if their conditions are attributable to military service. Increased awareness of veterans is required in primary care services, as well as in healthcare professionals' education and training, to ensure that they gain access to appropriate care and support.

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.

Care of veterans in a non-veteran health administration hospital: What is the status of nursing practice after continuing education?

AIMS AND OBJECTIVES

To identify how civilian nurses are caring for military veterans following mandatory continuing education on veterans' mental health needs and to describe challenges nurses are facing in provision of that care.

BACKGROUND

Veterans and military personnel experience mental health conditions at a high rate and are increasingly receiving care in civilian healthcare facilities. Nonmilitary providers may not be prepared to address this population's challenging needs. Military culture may influence the presentation of mental health conditions; thus, critical assessment points by nonmilitary medical personnel may be missed. Education is touted internationally as a means to address deficits, but research is lacking to support that statement.

METHODS

Adhering to research reporting guidelines, 115 of a proposed 322 civilian nurses in a tertiary hospital volunteered to complete a one-time online survey that contained quantitative and demographic questions. Forty of 115 nurses went on to complete the qualitative query. Descriptive statistics summarised quantitative results, and constant comparative analysis was applied to qualitative responses for theme identification.

RESULTS

The study was stopped early due to reports of violence from veterans upon nurses. Results showed continuing education did not change documentation of military status. Following mandatory continuing education, civilian nurses continued to describe uncertainty in how to adapt care, on how to interact with veterans and in how to deal with violence.

CONCLUSION

The status of care to veterans remains insufficient, but nurses are asking critical questions on how to update practice. Additional support and research in the clinical setting is needed to promote a safe caring environment.

RELEVANCE TO CLINICAL PRACTICE

Continuing education alone may not advance care of the veteran. A multipronged approach to include mandatory documentation of military status and coaching of providers by those experienced with the military way of life may be used to augment staff preparedness.

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

More than 20 million Veterans currently live in the United States, representing World War II, Korea, Vietnam, Iraq, and Afghanistan war eras, as well as many who served during peacetime. Little is known regarding what home care nurses know about the unique healthcare needs of this population. Using Purnell's Model for Cultural Competence, a mixed-methods study was designed to examine home care nurse's knowledge, comfort, and confidence in caring for active military, Veterans and their families. This article provides the data from a national survey of 102 home care nurses. Findings suggest that civilian home care nurses have limited experience working with active military but work with Veterans at least monthly, if not weekly. Nurses were most confident in managing pain and least confident in managing issues related to military sexual trauma. Knowledge of resources available to Veterans, war-specific exposures, and Veteran-specific health issues were the top areas nurses felt less confident in. Continued efforts need to be put in place so that 100% of all patients seeking healthcare are screened for military/Veteran status. In addition, continuing education for nurses needs to include Veteran-specific topics so evidence-based, culturally sensitive care can be provided.

Courage to care for our United States veterans: A constructivist way of teaching and learning for future nurses

The knowledge and skills in providing veteran centered care is essential. The purpose of this retrospective evaluation is to examine a faculty's reflections on a BSN psychiatric mental health curriculum initiative that provides knowledge and skills regarding veterans care through several avenues to senior nursing students. This qualitative study use self-reflections through a constructivist view of teaching and learning as the framework. Open discussions in didactic about the unique psychological health issues of veterans formed a foundational knowledge for the students. The seminar time was used to discuss real veteran case situations. Simulation provided opportunities to address veteran resources. Problem based projects use available evidence to solve veteran health issues. The educators show their commitment to the compassionate and caring ideals of our profession by fostering an educational environment where future nurses can truly learn about veteran centered care.