Educating Nurses about

Veteran Family Care

Needs

Sharon Denham, PhD, RN, CNE

Professor, Houston J. & Florence A. Doswell Endowed Chair in Nursing for Teaching
Excellence
Texas Woman's University, College of Nursing

Objectives
Identify the importance and value of
including veteran family in nursing
education and practice.
Describe at least three critical concerns
linked with veterans and their families.
Discuss three approaches educators can
use in teaching students about the care of
Veteran families in clinical practice.

VANAP Academic
Partnership
(Office of Academic Affiliations)
Veterans Administration North Texas Health Care
System and Texas Womans University (Dallas
Campus)
Nursing faculty hired
Student cohorts each semester (n = 10)
Dedicated Education Network (DEN)
Post Baccalaureate Nurse Residency Program
(PBNR)

What do you teach nursing students about care needs

linked with military personnel, veterans, and veteran
families?

Institute of Medicine (IOM): Crossing the Quality Chasm

Patient-centered care: Providing care that is respectful and responsive
to individual patient preferences, needs, and values ...Ensuring that patient
values guide all clinical decisions.
(IOM, 2001, p. 6).

Nursing plays a pivotal role in advancing health & leading

change associated with the patient experience.

VA Nursing

Improve quality, safety, & access

Reduce numbers of unnecessary inpatient
admissions
Reduce length of inpatient stays
Expand & retool robust set of ambulatory care
services
http://www.va.gov/nursing/docs/2012onsAnnualRptweb.pdf

Who are the Veterans?

(American Community Survey, 2014)

Over 22.7 million U.S. Veterans

Male median age was 64 years
Female median age is 49 years
Largest cohort of male Vets served during Vietnam
Largest number of female Vets served during Gulf
War II
Higher % of female Vets have a service-connected
disability

Just the Facts

Veterans number.
About 9% of Vets are women
2.7 million Vets of Iraq & Afghanistan wars (2.6 million
Vietnam Vets)
Women Vets have lower median household income than
men
Higher % of women Vets have higher education
attainment & are enrolled in higher education moped to
males
About 11% of homeless are Vets (HUD estimates 39,471
homeless on any given night) - 68% reside in cities, 51%
have disabilities, 50%serious mental illness, 70% have
substance abuse problems

Military Culture & Values

Support your team
Uniformity

Loyalty

Attention to detail

Duty

Rank makes a difference

Respect

Fitness

Courage

Discipline

Honor

Follow commands/No
questions

Integrity

Pride

Selfless service

Individual mistakes cost

everyone

Works with others

Reintegration Issues

Military Life
Move every 2 to 3 years
Do not have family support systems in most military
locations
New careers, new schools, new life every time you
move
Guarantee check, medical and dental insurance
Cant quit-4 years to 30 depending on rank and time in
service
The military has its own legal system
Can be kicked out at a moments notice

Why Educate Nursing Students about

Vets?
About 61% of Vets post 9/11 have used VA
health care services - Others use
community health services
Military & Veteran families may be seen in
community settings
Veterans are students in your classes

Multiple Deployments

Common Vet Problems

Almost 2 million Vets have become eligible for VA care
since 2002 (61% have obtained services)
Musculoskeletal ailments (61.8%)
Ill defined symptoms (58.1%)
Mental health disorders (57.6%)

Military Sexual Trauma

What do Homeless Vets

Need?
Secure housing
Nutritional meals
Basic physical health care
Substance abuse care and aftercare
Mental health counseling
Job assessment, training & placement assistance
Personal development & empowerment

PTS
PTS prevalence = 14% (50% seek treatment)
19% of Vets may have traumatic brain injury (TBI)
7% have PTS & TBI
Veteran suicide = 22 a day

Agent Orange

Some 12 million gallons of this supercharged

weed killer, enough to douse 18,000 square miles,
were sprayed on the 66,000 square miles of
South Vietnam during the War.

Agent Orange

AL Amyloidosis
A rare disease caused when an abnormal protein, amyloid, enters tissues or organs

Chronic B-cell Leukemias

A type of cancer which affects white blood cells

Chloracne (or similar acneform disease)

A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. Under VA's rating regulations, it must be
at least 10 percent disabling within one year of exposure to herbicides.

Diabetes Mellitus Type 2

A disease characterized by high blood sugar levels resulting from the bodys inability to respond properly to the hormone insulin

Hodgkin's Disease
A malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes, liver, and spleen, and by progressive anemia

Ischemic Heart Disease

A disease characterized by a reduced supply of blood to the heart, that leads to chest pain

Multiple Myeloma
A cancer of plasma cells, a type of white blood cell in bone marrow

Non-Hodgkin's Lymphoma
A group of cancers that affect the lymph glands and other lymphatic tissue

Parkinson's Disease
A progressive disorder of the nervous system that affects muscle movement

Peripheral Neuropathy, Early-Onset

A nervous system condition that causes numbness, tingling, and motor weakness. Under VA's rating regulations, it must be at least 10 percent disabling within
one year of herbicide exposure.

Porphyria Cutanea Tarda

A disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. Under VA's rating regulations, it must be at least 10
percent disabling within one year of exposure to herbicides.

Prostate Cancer
Cancer of the prostate; one of the most common cancers among men

Respiratory Cancers (includes lung cancer)

Cancers of the lung, larynx, trachea, and bronchus

Soft Tissue Sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma)

Support Caregivers
Holistic care - Mind, body, spirit
22% say personal health has gotten worse as a result of
caregiving
Post 9/11 family caregivers report poorer levels of health
than non-caregivers - depression, low-quality relationships
(RAND, 2014)
Building Better Caregivers - 6 week online interactive
workshop for those caring for Vets with serious injury or
illness
VA Caregiver Support: Support line (1-855-260-3274),
Caregiver Support Coordinator, Peer Support, Adult Day
Health Care, Home Care Services, Telehealth, Respite Care

Two Question
Assessment
Are you a Veteran?
Do you belong to a military
family?