Additional Health Concerns for Veterans

by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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    00:00 So I briefly mentioned that there are several different health concerns, veteran centric health concerns, but specifically when we think about mental health disorders, so PTSD is one of those, anxiety, insomnia.

    00:21 What are some other things? Sometimes bipolar disorder, schizophrenia, borderline personality disorder, and thinking about all of these are kind of related to the posttraumatic stress, sometimes it's traumatic brain injury that also alters mental health status.

    00:39 And then behavioral adjustment disorders.

    00:41 You heard me talk about deployment and then reintegration, and thinking about where some of those adjustment disorders could happen.

    00:49 One of them is the veteran may have left their entire family behind. Right? And so then I'm adjusting to being away from my family if they're not with me.

    01:00 Thinking about sometimes while a veteran or military service personnel are deployed, there's a death in the family and you weren't there.

    01:09 So just thinking about the mental or psychological impact of that and adjusting to that.

    01:14 So, I saw my family living before I left and I was away for all this time and then all of a sudden they're dead and so I didn't have closure.

    01:24 Thinking about the psychological impact of that and then reintegration into society, that's an adjustment as well.

    01:31 So you've gone from being in this completely structured environment, now you're back into the world trying to integrate.

    01:38 For some people, that happens easily.

    01:40 For some, they don't, but we need to take that into consideration.

    01:44 Those military-related diseases that we need to think about.

    01:48 Again, all this ties back into that military culture.

    01:52 And so it is important that the structural competency could fit in here because I'm thinking about how I need to be focused on all the different unique things that impact a veteran and so I do need to be aware this is where cultural intelligence comes in.

    02:10 I need to be motivated to learn so I need to ask that veteran "Which branch they served in? How long they served? What was their job while they were there?" Anything that they want to share with you, but that won't happen again unless you build a rapport and a trusting relationship and simply asking those questions and being interested, motivated, that enthusiastic about it which is that first piece of that cultural intelligence framework.

    02:36 And then when I have that conversation with that veteran and I will acknowledge this will be a lot of work, but after I have the conversation well I go look some of that stuff up that I'm not so familiar with, so some of the exposures that may have happened depending on the exposures and the war that people served in they are unique diseases and exposures that happen.

    02:58 And it helps me to improve my individualized care of the veteran because I can think about "Okay, they were here in this area then I need to be doing some screenings on longs because of the environmental exposures." If a person shows up with a certain type of rash, is that a result of service in that particular area? So lots of different things that it takes that extra time and effort and just being committed to that cultural intelligence.

    03:26 So the next time that person comes I'm going to employ the third cultural intelligence piece and that would be the strategy.

    03:34 So I know Mr. or Ms. X is coming in on a certain day, now I've learned more.

    03:40 So now I want to talk about, I want to ask some more specific questions that I may not have asked the last time.

    03:47 And then in that moment the A, the action piece which is behavior.

    03:51 So while I'm engaged in that conversation but let's just say I asked something and I didn't realize it might be triggering.

    03:58 Well, I need to be able to be flexible, apologize, have a conversation ask that veteran or the military service personnel, actively serving person.

    04:10 I need to ask "Oohh I'm sorry I triggered you." Like, "What is a better way I could ask you that? Would you like to talk more about it today? Can we talk about it another time?" And it's so important to explain why you're asking.

    04:23 So if I ask you that because I want to see if I need to do certain diagnostic screenings or test on this person, I need to say that so people don't think that people, meaning the veteran or the military person, doesn't think that I'm just prying or something like that and you don't know it's going to trigger them but you need to acknowledge that.

    04:43 So next time you need to be careful and just ask them.

    04:46 How can we engage in that conversation? If they said don't even want to talk about it, you have to respect it.

    04:52 The next thing is Substance Abuse Disorders.

    04:56 So, when we think about mental health and mental illness, people do try to find ways to fix or cope with something and sometimes that happens in the form of a substance use disorder, not substance abuse because abuse implies something negative, but substance use disorders.

    05:13 So not using that to label in stereotype, "How can I help a person? How can I offer some alternatives to that? How can I help rehabilitate the person so that I can provide those safe alternatives? You also want to acknowledge that suicide rate so high in a lot of veterans so you have to be real careful in your approach and sometimes there is a psychosis that happens, you have to be prepared that certain things will trigger and irritate certain veterans.

    05:48 Just lots of different things so it's so important to do your homework and apply that CQ framework, and I mentioned the homelessness thinking about why oftentimes it circles back to that mental health diagnosis that the person may have.

    06:05 And so if you know someone's home is there or resources and services, what your job as the advocate we talked about, what your job is is to try to find housing for that veteran.

    06:17 Some will refuse and I know this, I've seen it firsthand.

    06:21 So if they refuse how can I still continue to engage in and make sure that they're getting the medicines that they need, get in to those healthcare appointments, and accept that I can't judge if people just haphazardly show up to these appointments.

    06:36 When they show up, I need to be willing and able to help them along the way serving as an advocate in a healthcare provider focusing on what is optimal health for this person and it's not going to be the same for everybody because we want to assign what that should look like.

    06:53 What does wellness mean to that person? Not to me, but where does this person want to get to in terms of what they see as wellness? We have to also understand that a lot of veterans experience lots of different pain.

    07:08 And that pain is significant and oftentimes people get hooked on opioids, pain medicines, whatever it is. So, why is that? Because that pain is real, so how can I help with that instead of seeing them as a drug seeker or looking at it from a negative perspective? What can I do to help this person achieve a level of pain that's tolerable? For me as a fixer, I would want it to be a zero or a one.

    07:36 But to that person, not just veterans but any person, but to that person if they want to get down to a 5 I need to accept that and not try to force things on people.

    07:47 One point I do want to make in terms of going back to the suicide, depressed veterans are more likely to commit suicide than those with PTSD so sometimes we may misconstrue that but it's important that even though that little tidbit when we think about culturally responsible healthcare, not just for veterans but for everybody but in particular in this case I need to make sure that I'm able to identify when a person or a veteran is depressed and how can I intervene to try to prevent the suicide and also providing those resources for suicide prevention.

    08:25 And I know that the VA in particular is very committed to that offering those resources and those numbers for those high lines.

    About the Lecture

    The lecture Additional Health Concerns for Veterans by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE is from the course Veterans Health and Cultural Awareness.

    Author of lecture Additional Health Concerns for Veterans

     Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

    Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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