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A Guide to Caring for Our Veterans:
A Focus on War Exposure Concerns

“Patient advocacy is the heart and soul of nursing practice.”

A Learning Tool for Nursing Students
1. Understanding the Patient Population
o The Veterans Health Administration (VA) is America’s largest integrated health care system.  8.6 million of Veterans seen each year o This patient population poses specific challenges to the healthcare system.  Demanding and complex need to care for both older, aging veterans AND younger veterans facing significant disabilities related to service

2. Understanding the Importance of a Military Health History
o Patients may have been exposed to a range of chemical, physical, and environmental hazards during military service.  Possible associations between illnesses and deployment o Military veterans can be considered a “cultural group” of their own.  Common issues and stressors  Understanding this can help establish rapport and therapeutic partnership

3. Asking Open-ended General Questions
o o o o Tell me about your military experience. When and where do you / did you serve? What do you / did you do while in the service? How has military service affected you?

4. Assessing Exposure Related Health Concern
o Veterans may have been exposed to a wide variety of hazards and potentially harmful substances during military services that may cause health problems. o Chemical Exposure (ex: Agent Orange, contaminated water, pollution, etc.) o Biological (ex: infectious disease) o Physical (ex: radiation such as nuclear weapons or x-rays, occupational hazards, etc.) o Ask patients … o What they were exposed to o Where/when they were exposed o About any precautions taken o About duration of exposure o Any concerns regarding the exposure

A Learning Tool for Nursing Students (Continued)
5. Learning about Specific Exposure/War Concerns
o Certain diseases related to military service are called “presumptive diseases.” o Important for nurses to be aware and knowledgeable of these veteran health issues A. Agent Orange (Herbicide) Exposure Issues  From Vietnam War  Certain associated health problems and cancers  Neurological Problems o Episodes of anger, depression, memory loss and lack of concentration, severe personality changes, suicidal behavior, tingling, numbness, headache, loss of sensation  Intestinal Distress o Gastrointestinal distress, jaundice, hepatitis, liver inflammation, gastric hyperplasia, ulcers  Skin Problems o Rashes, acne, hair loss, brittle nails, changes in skin color and increased sensitivity to sunlight The spraying of herbicide  Cancer o Most troubling side effect of Agent Orange o Onset of different types of cancers and sarcomas with symptoms of weight loss, chills, fever, tumors, and extreme fatigue B. Chronic Multi-Symptom Illnesses  From Gulf War/military service in Southwest Asia (see map on left)  Prominent condition of a cluster of medically unexplained chronic symptoms  Fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorder, and memory problems  Not referred to as “Gulf War Syndrome” since symptoms vary widely C. Radiation Exposure Issues  From radiation-risk activities such as weapon testing during military service  Associated with different cancers  Cancers of the bile ducts, bone, brain, breast, colon, esophagus, gall bladder, liver, lung, pancreases, pharynx, ovary, salivary gland, small intestine, stomach, thyroid, urinary tract  Leukemia, lymphomas, and multiple myeloma
Radioactive substances

6. Enhancing Veteran-Centered Care
o Critical that nurses ask about military experience  To understand and acknowledge the influence of veteran identity on health  To be familiar with various health care issues veterans face, different risk factors and co-morbidities, and the complexity of their care o Exposure concerns may be the underlying factor to understanding patients’ medical problem.  Nurses can then help veterans maintain and regain health  By ensuring a proper assessment and treatment with the knowledge of symptomatology of many health conditions related to military service  By documenting in their nursing diagnoses how certain concerns are related to military service exposures and may be exacerbated by current factors  By referring patients to any needed specialized medical resources earlier
Further Information on the promotion of Veteran Health can be found on the VA website http://www.publichealth.va.gov

Informational Factsheet: Educating nursing students who may have to care for veterans Currently, I have my clinical rotation at a VA hospital, which offers care to veterans. During orientation, we had reviewed general questions we can ask our patients such as “when and where do/did you serve?” Asking this would be helpful to understanding a patient’s health since there are different exposure concerns for veterans of different wars. I had previously encountered a patient who was a corpsman and medical professional himself, who had served in the Vietnam War. While I was checking for pedal pulses, found on his feet, the patient pointed out that he had dried, chipped, brittle toe and finger nails. He told us that this was due to exposure to Agent Orange during the Vietnam War! This is where my motivation for this project stems from. I wanted to make an informational document for other student nurses to serve as a guide to keep in their pockets, to learn how to approach assessing a veteran, by asking certain open-ended questions, and to learn about their different exposures and health risks, since I was not very knowledgeable in the matter. This would also be a good learning opportunity for me as well to improve my performance and get the most out of my clinical experience. The purpose of the professional document is clear in its title: “A Guide to Caring for Our Veterans,” with a focus on war concerns. As its subheading suggests, this should be used as a learning tool for nursing students, with numbered and bolded steps to ultimately provide enhanced veterancentered nursing care. I purposely chose the color scheme blue, as on the VA website, the background is mainly blue. In this document, the titles and headings have a blue background and the yellow font color to show their importance. The picture on the top of the page indicates that this document should be helpful to nurses/student nurses serving in the VA. I included a quote “Patient advocacy is the heart and soul of nursing practice,” because this should be the motivation behind reading this document, to understand the patient population of veterans better and provide better care. There are six sections/steps in the document which provide an introduction to the patient population and challenges nurses face, reasoning for the importance of a military health history, examples to how nurses can help provide that history by asking open-ended general questions, and assessing their exposure risks and related health concerns. This information is all provided in a logical sequence. The second page focuses on specific exposures related to military service especially Agent Orange in the Vietnam War, chronic illness symptoms related to military service in the Gulf War/ other military service in Southwest Asia, and lastly, radiation. The facts offered are meant to be general and easy-to-read (utilizing numbers and bullet points), but the second page does contain more text and information which is why the spacing is altered in order to assure even alignment. Each exposure concern has one picture next to that section that either shows the source or location of the exposure such as air force involvement in spreading the herbicide Agent Orange, a map of the military operation in Southwest Asian, and lastly storage of radioactive substances. The document should be educational and the conclusion should further bring home the message that as nurses, it is important to know all this information and further information to promote veteran health can be found on the VA website. Reflection: This may be good fit for my professional portfolio as it shows my interest in learning about my patient population and the need for others to be educated as well. I had seen the need for a helpful tool to be created and used in my clinical at the VA hospital, and designed it to address the audience of fellow nursing student peers.

References Boehlke, J. (2013, August 16). Symptoms of Agent Orange in Vietnam Veterans. LIVESTRONG.COM. Retrieved from http://www.livestrong.com/article/23779-symptoms-agent-orange-vietnamveterans/n Brown, J. L. (2012). The Unasked Question. JAMA, 308(18), 1869. Caring for Veterans. (2013, November 11). on ADVANCE for Nurses. Retrieved from http://nursing.advanceweb.com/Features/Articles/Caring-for-Veterans-2.aspx Explore VA. (2013). - Benefits for Veterans and Their Families [Image] . Retrieved from http://www.va.gov/explore/index.asp Joining Forces: Enhancing Veterans' Care Tool Kit - General Resources. (n.d.). American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/downloads/joining-forces-toolkit/general-resources#clinician Office of Academic Affiliations. (2013). Military Health History Pocket Card for Clinicians. Retrieved from http://va.gov/oaa/pocketcard/ Office of Nursing Services. (2011). United States Department of Veteran Affairs [Image]. Retrieved from http://www.va.gov/NURSING/images/OfficeofNursingServices-ONS-Logo.jpg Public Health. (2014). Gulf War Service [Image]. Retrieved from http://www.publichealth.va.gov/exposures/gulfwar/military-service.asp Public Health. (2014). Military Exposures [Image]. Retrieved from http://www.publichealth.va.gov/exposures/index.asp Public Health. (2014). Radiation [Image]. Retrieved from http://www.publichealth.va.gov/exposures/radiation/index.asp Therapeutic Communications Skills. (2008). Therapeutic Communications Skills [Image]. Retrieved from http://www.slideshare.net/consgp/therapeutic-communications-skills Veterans Affairs (VA) Nurse. (2014). DiscoverNursing.com. Retrieved from

http://www.discovernursing.com/specialty/veterans-affairs-va-nurse#.UwAjB_ldVqV Veterans Benefits . (2013.). Veterans Benefits [Image]. Retrieved from http://www.loraincountyveterans.com/va_seal.jpg Veterans Health Administration. (2014). Home [Image]. Retrieved from http://www.va.gov/health/