Posts Tagged ‘homelessness’

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How Military Service Affects Veterans’ Health: What All Nurses Need to Know

July 3, 2013

By Sylvia Foley, AJN senior editor

Photo (c) Associated Press

Photo (c) Associated Press

“The war tried to kill us in the spring,” says John Bartle, the narrator of The Yellow Birds, Kevin Powers’s acclaimed novel about two U.S. soldiers serving in Iraq. “I know now that everything that will ever matter in my life began then.” The same might be said by many war veterans. The effects of military service, especially on veterans’ health, vary greatly and can be lasting. And with most veterans seeking care through non-VA channels, it’s imperative that civilian nurses have some knowledge of the health issues veterans face.

In this month’s CE, “Enhancing Veteran-Centered Care: A Guide for Nurses in Non-VA Settings,” authors Barbara Johnson and colleagues describe a wide range of veterans’ health concerns and provide guidance for civilian nurses caring for these patients.

Overview: There are currently 22.5 million living U.S. military veterans, and this number is expected to increase dramatically as military personnel return from Iraq and Afghanistan. Although honorably discharged veterans may qualify for health care through the U.S. Department of Veterans Affairs (VA), only about 25% of all veterans take advantage of this benefit; a majority seek services in non-VA settings. It’s imperative for nurses in all civilian care settings to understand the impact that military service has on veterans’ health. This article provides an overview of veterans’ unique health care issues, focusing particularly on traumatic brain injury, polytrauma, hazardous exposures, chronic pain, posttraumatic stress disorder, military sexual trauma, substance use disorders, suicide, and homelessness. Evidence-based assessment tools and treatment guidelines for these health issues are discussed. A resource table provides telephone numbers and Web sites offering tools, educational materials, and veteran services. A second table provides detailed veteran-centered health assessment and screening questions.

Johnson and colleagues also discuss the roles of military culture and “veteran identity,” which continue to affect veterans even after they have transitioned back to civilian life. The authors conclude with three general suggestions:

  • Ask every adult patient whether she or he has served in the military.
  • If the answer is yes, take time to listen to the patient’s story.
  • Incorporate the patient’s military experiences and health concerns into the medical record.

To learn more, read the article, which is free online, and listen to our podcast with the lead author. If you’ve cared for veterans, please consider sharing your experiences with us in the comments.

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Walkers

February 15, 2013

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

800px-Billiards_balls

By Andrzej Barabasz (Chepry)/via Wikimedia Commons

I see, crossing my path as I ride my bike along the beach, a man in his mid-20s with sandy, sun-streaked blond hair and a long sharp nose that’s a dark, angry red. His gait is deliberate, arms and legs moving in sharp angles. Occasionally I’ve seen him sitting along the path, eyes staring out across the sea, chin on fist, always alone. As my bike glides by, I glance over at his face, which lacks all expression.

It occurs to me that the reason, perhaps, that I take notice of this man is because he reminds me of a patient I once had—Charles (not his real name)—who shared that expressionless gaze and deliberate gait, one that took him nowhere in particular as he covered miles every day.

I was working as an inpatient psych nurse and attending school to finish my BSN degree. Charles was intermittently admitted to our unit. He lived on the street, for the most part, and since I lived downtown, I’d occasionally notice him walking. It’s been too long for me to remember what brought him into the hospital. I’m sure it was a variety of things. A person had to be a danger to themselves or others to stay very long in the unit, so he rarely spent more than a few days with us.

Charles was quite handsome—tall, with thick dark hair and eyes the color of a calm sea. He was in his mid-20s, but unlike the blond man, he lived in a cold climate. It was winter when we first met and he was wearing five coats and multiple other layers. During the admission interview, he told me that he spent so much time of his time walking that he didn’t really get cold. Still, he didn’t want to lose his coats. If he put them down, someone would steal them. Nor did he want to remove any of his clothes, which I had hoped to help him launder. I finally persuaded him to take off a few layers and get comfortable, since when he was with us he had a nice closet available to him.

Charles never wanted to talk about any family or friends; he always insisted he really just needed to get back outside and walk. It seemed we were caging a bird until he got back on his meds and became calmer. He was never aggressive, just restless.

Working with psychiatric patients on an inpatient unit involves just being part of the environment, an active participant in milieu therapy. One day, Charles and I were playing a game of pool. As he held the pool cue and aimed at the ball, concentrating very closely, his head began to twist around on his neck, back and to the side. In a very short period of time, it looked as if his head was going to keep going until he was looking out from his back. I asked him, “Charles, why is your head turning so far. Are you okay?” It had started out with him just looking down the cue and aiming, but the twisting progressed until at last his eyes were barely able to remain on the ball. He answered, “I don’t know, but it kinda hurts.”

We quickly administered a medication to counteract his torticollis and he was soon right back to the game. He probably beat me. Those were some of the few smiles we would see, when he whipped us in a game of pool.

The opportunity to observe a textbook and quite dramatic example of a medication’s adverse effect has remained a clear, if a bit unsettling, memory over the years. Charles became one of my favorite ‘frequent flyers.’ He would come in, get cleaned up and back on his meds, and leave back to the streets. He was a handsome, sweet, young man apparently without a home, by situation or choice. We were never really sure which.

The story behind the blond guy at the beach is a mystery to me. Maybe I am too quick to compare him to Charles, but some apparent similarities in his affect make me hopeful that he has someone that cares about him and a safe place to sleep at night.

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