Caring for Veterans and Active Duty Military

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

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    00:05 Why is it important to talk about veterans and active duty military personnel, because in addition to all of the things that we all face as human beings, people who serve in the military come from unique backgrounds, and they face some of the same stereotypes and biases that we all do, but then there are some additional ones that we should be aware of.

    00:26 Diversity has to be considered as part of the healthcare model, because it helps us provide effective military care.

    00:33 And that meaning, again, I'm gonna reiterate, when we talk about military care, we're talking about active duty.

    00:39 And we're also talking about veterans.

    00:41 And we're also talking about families.

    00:43 And I'll talk about that a little bit more.

    00:46 But one of the keys is that unique health risks exist for people who serve in the military and those require personalized treatment.

    00:54 We can't make assumptions that there's a one size fits all, not only because of them being in the same branch, but just thinking of each person as a unique individual and prioritizing or keeping at the forefront that these people have faced some additional issues and conditions based on their military service.

    01:16 And some of those include field trauma and toxins that people may have been exposed to.

    01:21 And oftentimes, those require rehab, and also pain management.

    01:25 And even when people haven't been in the field, just by way of the being in the military, and all of the physical things that, the physical trainings that they go through, people experience pain, carrying heavy backpacks, that puts stress and trauma on backs and knees and joints.

    01:43 So thinking about that.

    01:44 And then in addition, people who are military personnel have high rates of mental health issues.

    01:50 In addition to the things as I said, I keep reiterating that because I want you to know, there's a additional layer, and it's heavy in terms of the mental health.

    01:59 So those require unique approaches.

    02:02 It definitely requires building rapport with the person before you can start asking certain questions because there is lack of transparency.

    02:12 And oftentimes, that's because they've been conditioned to hide those things.

    02:16 Why is that? Because people are seen as weak or maybe harmful to the team if they reveal some of the physical and especially mental issues, and there's a lot of shame and stigma attached with mental health in general.

    02:31 And people who are in the military don't want that shame and stigma and they don't want that to be a part of their identity, so it's up to us as healthcare professionals, to make sure we normalize and prioritize attention to mental health.

    02:46 Specifically, these people may be resistant to seeking mental health services directly from a military facility due to fear of discrimination, or something being marked on their choice that may prevent them from promotions or participating in certain activities.

    03:02 So attention is needed to reintegrating veterans into the civilian world, specifically with employment, and helping to deal with some of those mental issues can also help with that.

    03:14 And building rapport and support again, is going to be extremely important for people to even divulge some of those things to you.

    03:23 Suicide risk is much higher for people in the military population.

    03:27 And for this reason, the VA has gone out of its way to provide additional resources in terms of suicide risks, hotlines, having people always available.

    03:38 So not only do we need to educate the patients about this, or the veterans about this, and active military personnel, but also significant others and any family members that may be assisting, or friends, assisting veterans and military personnel.

    03:54 So like every other human, there's a complex existence that goes beyond just those biological factors.

    04:02 We have to be aware of the military culture, as well as all the sub cultures within the military and not forget, again, those things that plague us all as humans.

    04:12 So it also differs in terms of the branches people served in, the regions they served in, whether it was during wartime or not, the job status or job duties, all those things have an impact.

    04:24 And just don't forget, even if you see someone as they sat behind a desk as a clerk, the culture of the military is a disciplined one.

    04:33 So all those things impact how people interact in the civilian world.

    04:38 Being aware that in addition to some of those other characteristics, again, such as age, gender, sexual orientation, and all the demographics are factors.

    04:48 There's also those compounding influences, some of which I've mentioned, and the type and the length of military service and also the disconnect from families, all those things impact people.

    05:01 Being familiar with those health care resources is so important, especially in terms of what each individual may need and being ready to advocate for.

    05:11 So we don't want to just give people a sheet of paper or a website, we want to actually sit and talk through some of those resources.

    05:18 And you can't do that if you're not familiar with what's available.

    05:22 And building relationships with the VA because a lot of veterans do receive care in the community.

    05:29 I think the VA has gone out of its way to make sure that veterans and active duty military personnel have options.

    05:37 So they're not confined to the VA, because trust is another big issue.

    05:42 In terms of service personnel and veterans, oftentimes, they think that some of the things that they share in the care in the community providers will be used against them.

    05:52 If it's divulged to the VA, we all know we follow the HIPAA guidelines.

    05:57 But explaining to a veteran that it helps to keep that integrated.

    06:02 Integrated Care helps to keep them more comprehensively cared for, I guess, and meet their needs better if we're able to communicate between the two sites.

    06:13 So it's important to help them understand that we would only devote information from care in the community to the VA in terms of helping to improve care and reduce some of the disparities.

    06:25 And then we also focus so much oftentimes on the veteran who's the patient, but we don't think about asking the significant others, the children, the parents, including parents of adults who may have also been impacted rather by their person serving in the military.

    06:43 So we need to be intentional about making sure not only asking patients, if they've served in the military, but also have someone in their family or close to them in their immediate family has served in the military, and how that may have impacted them.

    06:59 Promoting inclusivity and belonging is very important.

    07:03 We want to welcome all patients.

    07:04 But when we think about someone who may have served in the military, think about some things that may have impacted their service in the military.

    07:13 And we want to think about all the things that we take for granted and may not consider if we haven't experienced some of the things that our veterans or active duty personnel or their families and significant others have experienced.

    07:28 So understanding also that this population may receive health care from multiple sources.

    07:35 And we need to know that again, we need to have a complete picture of what's going on.

    07:40 So that we can provide the best care and reduce some of the disparities and also see where we can consolidate some of the care.

    07:49 Because I mentioned already, they will be receiving care in the community, from civilian providers as well as military organizations.

    07:56 And it's often structured differently.

    07:58 So it's important to know that again, and build relationships and make sure there's communication, and knowing that there's added complexity in terms of having all these different sources of care, but the whole point of that was to improve access to care, decrease wait times, because sometimes there's a whole long wait period, not only in the civilian world, but also in the VA world.

    08:22 So integrating the two helps to get people into care more quickly, and also provide more comprehensive and holistic care.

    08:32 Trauma informed care is a big, big deal when we talk about any patient or any person, but especially when we talk about military personnel.

    08:41 So one of the things to think about to in terms of that is when you're building those relationships with the patient and building that rapport and the trust, to ask specific questions and explain to the person while you're asking those questions, because you want to make sure that you are as inclusive as you can be.

    09:01 And to make sure that we're as considerate as we can be in terms of how we set people up.

    09:07 An example is if we put someone in the waiting room, and they may have experienced some type of PTSD for whatever reason, my father in law went to war twice and doesn't like people behind him.

    09:18 So those are things again, that we may not consider or think about because we might not necessarily have to, but asking people before you touch them explaining what you're going to do to people and asking permission.

    09:31 One of the other things when we talk about trauma and the mental health piece, a lot of times veterans like to tell you stories, you have to make the time and space for people to be able to share those stories because that is oftentimes where you get a lot of the information from that may not have been divulged to you in some of the questions you ask in your interview.

    09:51 So supporting the military community definitely begins with respect for their unique needs and making sure that you provide care from a veteran centric standpoint because veteran centric needs or specific to veterans and military personnel.

    10:08 So you have to consider how to advocate and assist them in a navigating the healthcare system.

    10:14 And again, ask permission.

    10:15 Don't make assumptions with any one patient.

    10:18 Don't put everybody in one box, treat every person as a unique individual with all those veteran centric things in mind.

    10:26 So it's a primary step for alleviating those health disparities if we do it that way.

    10:32 And at the end of the day, the beginning and the end of all this work starts with respect, respect for human beings, respect for the work they've done, and then also showing veterans that you respect and appreciate that they have sacrificed because one of the things the VA has ban on their freedom isn't free, and we need to know that and we also need to acknowledge and respect that people who serve or have served do that for all of us so that we can do the things that we do and they do appreciate us showing respect for that.

    About the Lecture

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

    Author of lecture Caring for Veterans and Active Duty Military

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

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

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