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Ensuring the privacy of patient health information

Once it's established that a veteran has a history of MST, care by a mental health provider is warranted, and a referral to the VA is recommended. As is common in cases of PTSD, veterans with MST may try to avoid thoughts, feelings, and activities that remind them of the trauma or precipitate flashbacks. In the long run, such avoidance can be more harmful than remembering and actively dealing with the issue. Furthermore, men and women with a history of MST are at much higher risk for suicide or self-harm.

These disorders might involve illicit drugs, prescribed medications, tobacco, or alcohol or a combination of these. If local VA services are available, veterans experiencing SUDs should be referred for treatment and follow-up care. The VA Chemical Dependency Program, designed to provide comprehensive and individualized treatment, can include inpatient and outpatient detoxification, methadone maintenance, an outpatient recovery program, and relapse prevention. Both the outpatient recovery program and relapse prevention can be self-accessed or accessed by referral from a VA provider. A VA referral is required for the intensive evidence-based outpatient addiction treatment program.

Cigarette smoking is a significant public health issue for veterans. From World War I until the mids, the practices of distributing free cigarettes in troops' rations, using cigarettes and cigarette breaks as rewards during basic training, and featuring military personnel in advertising all contributed to an increased likelihood that soldiers would smoke. Although these practices have since ceased and despite military policies aimed at lowering smoking rates, tobacco use remains much higher among veterans and active-duty soldiers than among civilians.

The VA lists smoking cessation treatment as a high priority among veterans seeking health care. Public Health Service's clinical practice guideline on treating tobacco use, 91 and recommends that nurses and other primary care providers use "the 5 As" to guide treatment: a sk about tobacco use at every visit, a dvise quitting, a ssess readiness to quit, a ssist users with appropriate treatment, and a rrange follow-up. Studies have found that recent alcohol consumption is significantly higher among veterans than nonveterans. It's estimated that, every day, about 18 to 22 U.

In conducting a risk assessment, the involvement of family members may be warranted, both in gathering data and to obtain their commitment to help the veteran. Nurses can also encourage the use of the VA's confidential crisis line. Designated suicide prevention coordinators at each VA medical center receive referrals from the crisis line to ensure that veterans receive needed counseling and services. Contributing factors for homelessness among veterans and nonveterans are largely similar: substance abuse, mental and physical illnesses, shortage of affordable housing, lack of employment, and insufficient support networks.

Women veterans are two to four times more likely to become homeless than nonveteran women. And like male veterans, female veterans assimilate to the military culture, in which seeking help may be considered a sign of weakness. Being homeless is associated with numerous health concerns, including thermal injuries, substance abuse, mental health illnesses, bronchitis, pneumonia, skin infections, and communicable diseases.


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In , the VA committed to ending veteran homelessness by When caring for veterans who are homeless, it's important for nurses to understand their physical environment and risk factors that may compromise their safety and health. Discharge instructions must be tailored accordingly.


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  • Collaboration with social workers and other interdisciplinary team members is essential to minimize the possibility of readmission and ensure continuity of care. Once any needed medical care has been provided, nurses should encourage the veteran to contact the VA's National Call Center for Homeless Veterans or help the veteran do so. Every VA medical center is staffed with both a homeless veteran coordinator and a women veterans program manager.

    More than 16 million veterans seek health care outside of the VA. Veteran identity, developed in basic training and honed during deployment and combat experiences, presents challenges during the transition back to civilian life. In one study, veterans described three important challenges to that transition: feeling a lack of respect from civilians, holding themselves to a higher standard than civilians, and not fitting into the civilian world. But for those whose injuries and disabilities adversely affect their health, relationships, and quality of life, making the transition may be much more difficult.

    Physical wounds and battle scars are often recognizable; but nurses might not associate a patient's emotional issues or mental health conditions with military service. The mechanism of injury must be considered to ensure a comprehensive assessment and appropriate treatment plan. And it's essential that nurses understand and acknowledge the influence of veteran identity on health and health-seeking behaviors. Eligibility for VA health care is based on a number of variables.

    Many of the conditions discussed here are high-priority VA issues, for which the veteran may be best served in a VA setting. Yet many health concerns go unreported for various reasons, including embarrassment, concern about confidentiality, fear of stigmatization, and lack of awareness of available treatments and resources. The VA has improved veterans' health outcomes by introducing specific health care initiatives, implementing multiple screenings and evidence-based treatment programs, and using technology to improve access to care.

    Advance Care Planning Australia

    VA providers and staff also receive education about the symptomatology of many health conditions, in order to ensure proper assessment and treatment. Many veterans may feel safer in a VA setting, where other comrades are experiencing similar issues. VA facilities are located throughout the United States and its territories; anyone can contact a local VA facility for information regarding a veteran's access to care. Researchers have linked many health care issues to military service, and veteran health care continues to evolve as research unfolds.

    But more research into the long-term effects of military service on veterans' health and their nursing implications is needed. And in both academic and practice settings, nursing education about veterans' health care needs must be expanded. Spelman and colleagues have proposed several clinical "pearls" for primary care providers who treat veterans, beginning with acknowledgment of military service, obtaining a military history, and keeping this information easily accessible in the medical record.

    The Opioid Mortality Surveillance Report

    In assessing every adult patient, nurses should ask whether the patient has served in the military. If the answer is affirmative, time should be taken to learn the patient's story. Listen and ask questions in an open and unbiased manner, and incorporate the patient's military experiences and health-related concerns into the medical history. The VA Office of Academic Affiliations offers a Military Health History Pocket Card for clinicians, which includes a series of questions that should be asked of military service members and veterans.

    We also recommend that every health care facility designate a veteran liaison to assist veterans in receiving care from the VA or other agencies. Veterans have made many sacrifices while serving this country. The ranks of veterans continue to grow as thousands of soldiers return from Iraq and Afghanistan. It's imperative that nurses be familiar with the various health care issues veterans face, risk factors and comorbidities, and the complexity of care.

    They should also be able to provide patients and their families with appropriate education and help in accessing available resources. The warrior ethos includes a promise never to leave a fallen comrade. In that spirit, every clinician can ensure that no veteran is "left behind" without adequate health care. Table Veterans living by period of service, age, and sex: p. Washington, DC Veterans by selected period of service and state: page Washington, DC Profile of veterans: Data from the American community survey.

    Damron-Rodriguez J, et al. Accessibility and acceptability of the Department of Veteran Affairs health care: diverse veterans' perspectives Mil Med. Harada ND, et al. Demers A. When veterans return: the role of community in reintegration Loss Trauma. Adkins RE Medical care of veterans. Department of Veterans Affairs. Geriatrics and extended care: community living centers VA nursing homes. Richardson C, Waldrop J. Census brief - veterans: Washington, DC: U. Census Bureau; May. Veteran population projections: FY to FY Department of the Army. Army leadership. Washington, DC; Sep ADRP , C1.

    Department of Veterans Affairs and U. Department of Defense. Clinical practice guideline for post-deployment health evaluation and management. Washington, DC; Sep. Riggs DS, Sermanian D. Military health history pocket card for clinicians. United States Government Accountability Office.

    Report to Congressional requesters. Washington, DC; Feb. Prins A, et al. Kimerling R, et al. Bradley KA, et al. Bush K, et al. Clinical practice guideline for management of substance use disorders SUD. Washington, DC; Aug. Suicide risk assessment guide. Washington, DC; Okie S. Traumatic brain injury in the war zone N Engl J Med. Owens BD, et al. Washington, DC; Apr. Sucher L. Concussions most common brain injuries sustained by U. Defense and Veterans Brain Injury Center.

    Department of Defense numbers for traumatic brain injury worldwide-totals Silver Spring, MD Silver Spring, MD; n. Traumatic brain injury and PTSD. Elder GA, et al. Blast-induced mild traumatic brain injury Psychiatr Clin North Am. Watts DD, et al. Mild traumatic brain injury: a survey of perceived knowledge and learning preferences of military and civilian nurses J Neurosci Nurs.

    Geiling J, et al. Medical costs of war in long-term care challenges for veterans of Iraq and Afghanistan Mil Med. Gawande A. VHA handbook Physical medicine and rehabilitation: individualized rehabilitation and community reintegration care plan. VHA handbook. Belanger HG, et al. Post-acute polytrauma rehabilitation and integrated care of returning veterans: toward a holistic approach Rehabil Psychol. Siddharthan K, et al. Maestas KL, et al. Probst C, et al. Clinical re-examination 10 or more years after polytrauma: is there a gender related difference?

    J Trauma. Cobb AM, Pridgen N. Polytrauma care: a delicate balance for the military nurse case manager J Trauma Nurs. Public health. Military exposures. Military exposures: Agent Orange. Facts about herbicides Benefits: Agent Orange registry health exam for veterans. Research on health effects of herbicide exposure.

    Veterans and Agent Orange: update eighth biennial update. Burn pits. World Health Organization. Rabies: a neglected zoonotic disease. Clark JD. Chronic pain prevalence and analgesic prescribing in a general medical population J Pain Symptom Manage. Haskell SG, et al. Lew HL, et al. Gironda RJ, et al. Traumatic brain injury, polytrauma, and pain: challenges and treatment strategies for the polytrauma rehabilitation Rehabil Psychol.

    Chronic pain and PTSD: a guide for patients. Hovanitz CA, et al. Muscle tension and physiologic hyperarousal, performance, and state affectivity: assessing the independence of effects in frequent headache and depression Appl Psychophysiol Biofeedback. Magruder KM, et al. The role of pain, functioning, and mental health in suicidality among Veterans Affairs primary care patients Am J Public Health. Clark ME, et al.

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    Skidmore WC, Roy M. Practical considerations for addressing substance use disorders in veterans and service members Soc Work Health Care. Clinical practice guideline for management of opioid therapy for chronic pain. Washington, DC; May. Galloway KT, et al. Pain management across the military continuum American Nurse Today. Otis JD, et al. The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder Pain Med.

    Chan BL, et al. Mirror therapy for phantom limb pain N Engl J Med. Denneson LM, et al. Complementary and alternative medicine use among veterans with chronic noncancer pain J Rehabil Res Dev. American Psychiatric Association. Diagnostic and statistical manual of mental disorders.

    At-a-Glance

    Understanding PTSD. Kulka RA. Clinical practice guideline for management of post-traumatic stress. Seal KH, et al. Aging veterans and posttraumatic stress. Solomon Z, et al. Complex trauma of war captivity: a prospective study of attachment and post-traumatic stress disorder Psychol Med. PTSD screening instruments: assessment.

    Wisco BE, et al. Screening, diagnosis, and treatment of post-traumatic stress disorder Mil Med. Neason K. News Staff Development. Shelton Award. Column Financial Leadership. How HFMA is bringing together healthcare finance. By Joseph J. News Leadership Skills Development. By Jennifer Novoseletsky. News Financial Leadership.

    Reflections on a year of imagining a better tomorrow. How To Financial Leadership. By Michael Raddatz. Trend Financial Leadership. By John McFarland.