- Email: [email protected]
Integration of military and veteran health in a psychiatric mental health BSN curriculum: A mindful analysis
Integration of Military and Veteran Health in a Psychiatric Mental Health BSN Curriculum: A Mindful Analysis Edna Ruiz Magpantay-Monroe Ed.D., A.P.R.N PII: DOI: Reference:
S0260-6917(16)30225-8 doi:10.1016/j.nedt.2016.09.020 YNEDT 3399
To appear in:
Nurse Education Today
Received date: Revised date: Accepted date:
19 November 2015 13 September 2016 26 September 2016
Please cite this article as: Magpantay-Monroe, Edna Ruiz, Integration of Military and Veteran Health in a Psychiatric Mental Health BSN Curriculum: A Mindful Analysis, Nurse Education Today (2016), doi:10.1016/j.nedt.2016.09.020
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT INTEGRATION OF MILITARY AND VETERAN HEALTH IN A PSYCHIATRIC MENTAL HEALTH BSN CURRICULUM: A MINDFUL ANALYSIS Edna Ruiz Magpantay-Monroe, Ed.D., A.P.R.N.
PT
Associate Professor
RI
Chaminade University of Honolulu School of Nursing
NU
SC
[email protected] Office Phone: 739-8380 3140 Waialae Avenue Honolulu, HI, 96816
MA
Word Count: 2155 including keywords, table and figure
AC CE P
TE
D
Acknowledgment: Sarah Jarvis. MSN RN, Simulation Lab Coordinator of St. Joseph’s College of Maine Department of Nursing.
ACCEPTED MANUSCRIPT Integration of Military and Veteran Health in a Psychiatric Mental Health BSN curriculum: A Mindful Analysis Abstract:
AC CE P
TE
D
MA
NU
SC
RI
PT
The military and veteran populations in the U. S. state of Hawaii have a strong presence in the local communities. It was this substantial presence that provided the impetus to integrate military and veteran health into a Bachelor’s of Science in Nursing (BSN) curriculum. This exploratory study investigated the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students’ understanding of the many facets of military veterans’ health. The concepts related to military and veterans’ health was infused in didactic, seminar, simulation and clinical instruction. Examples of approaches to teaching include guest speakers from military clinical partners, inclusion of military/military families in simulation, the reading of evidence-based articles focusing on the military and veteran population, use of identification of problem based learning and clinical placements in hospital(s) and community agencies specific to servicing military and veterans and their families. Students were encouraged to record their reflections which provided some insight on the value of integration of this important segment into the curriculum. Classroom discussions and reflections were analyzed using an exploratory method of inquiry by categorizing themes which revealed some biases about the military and veteran population and how working with this population helped students to understand their health needs. Although the data is limited, it an important foundation for further exploration into the significance of the integration of military and veterans’ health in a psychiatric mental health BSN nursing curriculum. The recommendation is to further include military and veterans’ health across the curriculum in order to help future nursing graduates understand and evaluate their role in working with this distinctive population, recognize challenges and opportunities in working with this population and identify available evidence-based resources to inform their practice. Key words: military, veterans health, nursing curriculum, psychiatric mental health Highlights:
Content integration about military and veteran health in a BSN curriculum prepares nursing students to care for active duty, veterans and their families. Developing military cultural awareness begins with self-reflection and self-assessment regarding one's own experiences, beliefs and biases. Future nurses need to understand military culture to provide optimal physical and mental health outcomes for our military and veterans
Introduction The United States of America Joining Forces initiative provides a platform for organizations, professional associations and educational institutions to better serve our veterans and military
ACCEPTED MANUSCRIPT
RI
PT
families (Biggins, et al, 2013; Keavney, 2014 & Kuehler, 2012). According to Kuehler (2012), to effectively join forces, we must appreciate the serious threats to the physical and mental health of our uniformed personnel and their families by investing in the required time and resources to provide compassionate care. Nurses with military cultural competence and knowledge are more likely to deliver suitable patient-centered care to patients with military culture experiences (Westphal, 2015). The ability to understand the experiences of the military and veterans directly relates to the development of a trusting relationship (“To Know Them”, 2011; Campbell, 2008).
SC
Objective
NU
The objective of this study was to explore the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students’ understanding of the many facets of military veterans’ health (Figure 1).
MA
Background
TE
D
Military veteran care happens from inpatient settings to community health settings. According to Allen, et al (2013), preparation to care for the military and veteran population is especially important in the United States community health care systems because that is where most veterans are seeking services. Nurses in the US are in a unique position to address the healthcare needs of our military and veteran populations, therefore inclusion of these topics should be a vital part of nursing education.
AC CE P
It is necessary for nursing education in the US to help students understand the culture of the men and women who faithfully served their country. Understanding selfless service, post service transition, health transition, and reintegration of service personnel into civilian society are just some key concepts that need to be addressed (Campbell, 2008; Haynes- Smith, 2010; Kuehler, 2012). The rationale for content integration and realistic educational recommendations for faculty to prepare future nurses to care for the military and veteran population is imperative. [Insert Figure 1 here]
Curriculum Development and Content In Fall semester (August-December) of 2013, the psychiatric mental health course was offered for the first time to senior nursing students at a new four year nursing program in Hawaii. This course is on a 7 week track which repeats three times during the academic year prior to the students taking their clinical immersion course. The course is built on a hybrid concept-based curriculum, but special populations such as the military population are intentionally incorporated into the course schedule. On week 5 of the course, the major concept is stress and coping and the sub-topic of military and veterans’ health is formally infused. The exemplars used to discuss the concept of stress and coping includes anxiety disorders, obsessive compulsive, phobias and posttraumatic stress disorder.
ACCEPTED MANUSCRIPT
RI
PT
The use of evidence-based practice readings and informational materials about military and veterans’ health are key to the synthesis of their care. Selected readings are related to enhancing veterans-centered care and transforming nursing practice for veterans into personalized, proactive and patient driven healthcare (Biggins, et al 2013 & Johnson et al 2013). When one understands the impact of military service, one can understand veterans’ health without judgement (Halvorson, 2010; Johnson et al., 2013). Keeping our veterans safe at all times and using best practices to inform care is critical to improving outcomes (Campbell, 2008; Kelly, U. et al, 2014).
MA
NU
SC
Military and veteran health is also incorporated through other avenues, such as guest speakers. Military clinical partners readily agree to have experts in their area share their expertise both in the classroom and clinical settings. Some valuable experiences include an active duty behavioral health nurse manager talking to the students about the military culture and the issues that trigger inpatient hospitalization; a program manager from a veteran center talking to the students about reintegration; and a civilian physician working with the veteran population speaking about different ways to engage veterans regarding their treatment.
AC CE P
TE
D
The use of best-practice simulation in nursing education allows learning objectives to be taught in a realistic clinical environment (Wilford & Doyle, 2006). Most schools use simulation as part of clinical teaching. Simulation for the senior level course of psychiatric mental health is used as an adjunct to didactic teaching. One simulation is an unfolding case (Table 1), a patient with both medical-surgical and psychiatric mental health needs who has family affiliation with the military. This simulation addresses the holistic approach to caring for mental health patients. [Insert Table 1 here]
The school is fortunate to have a memorandum of understanding with the only military hospital and veterans’ facility in the state. A group of students are clinically placed and rotate between the active duty and veteran inpatient behavioral health unit at Tripler Army Medical Center. Students also rotate to community care based agencies specific to servicing military and veterans and their families (e.g. US Vets Barbers Point). The rotation provides a realistic perspective on military health care needs and provides a body of knowledge to civilian future nurses that they may otherwise not fully understand. An average American soldier and his or her family have difficulties and personal challenges, ethical and moral dilemmas that may be difficult to comprehend (Kuehler, 2012; Noel et al, 2011; Haynes-Smith 2010). Another part of the curriculum is the use of problem based learning. Students initiated a comprehensive needs assessment of their agency/focused population (e.g. unit serving veterans and/or military and their families). One example of an identified key issue is trauma informed care. Students used peer-reviewed literature reviews to support their assessment and interventions. Students created a 5-6 minute video representing their needs assessment and showcasing the key issue they chose to address. The students’ clinical groups compare their needs assessments with each other providing an opportunity to reflect on the differences between civilian and military type facilities.
ACCEPTED MANUSCRIPT Methods
NU
SC
RI
PT
Data was collected formally through course evaluations and assigned reflections and informally through classroom discussions. The evaluation of the integration of military and veteran health in a psychiatric mental health BSN curriculum was accomplished to provide a mindful analysis of its effectiveness. The formal course evaluation provided limited written feedback into the inclusion of military and veteran health into the curriculum. There was no specific question on the course evaluation that address the incorporation of the military and veteran health. Some students commented on their course evaluation and simulation experience evaluation regarding the experience without being prompted by specific questions. The semi-structured evaluation data was gathered through in class discussions which includes simulation debriefing and post conference with students, unsolicited feedback from clinical adjuncts facilitating the clinical experiences and the course coordinator’s self-reflections. Results
D
MA
The formal course evaluations provided limited written feedback into the inclusion of military and veteran health into the curriculum. The available data were categorized into themes which provided an impetus for a more in-depth empirical data to be gathered. The intent is not to generalize the findings but to provide some scaffolding on which to build better BSN curriculum.
TE
Discussions
AC CE P
Initial classroom discussions with students revealed some biases students held about the military and veteran population. The perception was that care rendered to civilians would be sufficient for all, but that military and veteran populations did not need unique care. Students most often lack the understanding about the different military services ethos and core values. The lack of information about resources available to the military community is very apparent. During class discussions, students sometimes expressed their comfort level, or lack thereof, in a clinical agency with military and veteran patients. Through more in depth discussions, students began to appreciate the value of being exposed to the information provided to them through this course. Some student comments provided beginning insights on the value of the integration of military and veteran health in the psychiatric mental health curriculum: A student commented on the value of the simulation experience where she was able to “gain insight and understanding on how this population functions on [sic] a daily basis.” Students’ understanding of the military culture enabled them to provide more veteran centered patient care. Students found the problem based learning project working with the military and veteran population to be an exceptional project. The active duty or veteran is the center of this initiative. The learning activities above appear to provide the students the ability to understand the holistic care necessary for such a complex and diverse population. The use of reflective practice along with a well-thought out integration of information about military culture, health issues, and coping skills grant future nurses the ability
ACCEPTED MANUSCRIPT to make compassionate care a reality. The analysis of the semi structured evaluation data provided a beginning for more robust evaluation in the future and its empirical relevance to understanding the care for this special population in the United States and globally.
PT
Conclusion
SC
RI
The recommendation is to include information about military and veterans’ health across the school’s curriculum. When students in the United States and globally are exposed to this information consistently and can apply it in any setting, it will help future nursing graduates understand and evaluate their role in working with this distinctive population. The recognition of military and veteran challenges allows better transition to the opportunities of working with this population and identifying available evidence-based resources to inform their practice.
NU
References
MA
Allen, P.E, Armstrong, M.L., Conard, P.J., Saladiner, J.E., Hamilton, M.J. 2013, Nov. Veteran’s health care considerations for today’s nursing curricula. 52(11), 634-640
D
Biggins, M.S., Engstrom, C., Jackson, P.D., Sommers, E.T., & Thorne-Odem, S. 2013, Oct. Transforming nursing practice for veterans personalized, proactive and patient - driven healthcare. Nurse Leader. 28-33.
AC CE P
TE
Campbell, J. (July, 2008) Veterans speak out about stigma. National Council Magazine. Retrieved Oct 24, 2015 from http://www.thenationalcouncil.org/wp-cntent/uploads/2013/02/NCMag-Veterans-Final.pdf Haynes-Smith, G. 2010. Nursing in a Sandbox: A lived experience. Creative Nursing. 16(1), 2932. Halvorson, A. 2010. Understanding the military: The institution, culture and the people. Retrieved from http://www.samhsa.gov/sites/default/files/military_white_paper_final.pdf Johnson , B.S., Boudiab, L.D., Freundle, M., Anthony, M., Gmerek, G.B. & Carter, J. 2013, July. Enhancing Veteran- centered care: A guide for nurses in non-VA settings. American Journal of Nursing 113(7). 24-39 Keavney, E.K. 2014. A core course on veteran’s health in an online RN to BSN program: Preparing nurses to work with veterans. Online Learning. Retrieved Oct 24, 2015 from olj.onlinelearningconsortium.org Kelly, U., Boyd, M.A., Valente, S.M., & Czekanski, E. 2014. Trauma informed care: Keeping mental health settings safe for veterans. Issues In Mental Health Nursing 35(6), 413-419 Kuehner, C.A. 2013. My military: A Navy nurse practitioner’s perspective on military culture and joining forces for veteran health. Journal of the American Association of Nurse Practitioners, 25, 77–83. doi: 10.1111/j.1745-7599.2012.00810.x
ACCEPTED MANUSCRIPT
PT
Noel, P., Zeber, J., Pugh, M., Finley E., Parchman, M. 2011. A pilot survey of postdeployment health care needs in small community- based primary care clinics. BMC Family Practice. 12(79), 1-6. Retrieved from http://www.biomed central.com/1471-2296/12/79
RI
To know them is to serve them better. 2011, May/ June. Vanguard LVII( 3). Retrieved Oct 24, 2015 from http://www.va.gov/opa/publications/vanguard/vanguard_11_mayjun.pdf
SC
Westphal, R. J., and Convoy, S. P. 2015, Jan. Military Culture Implications for Mental Health and Nursing Care. Online Journal of Issues in Nursing 20(1), 1-1
AC CE P
TE
D
MA
NU
Wilford, A. & Doyle, T.J. 2006. Integrating simulation training into the nursing curriculum. British Journal of Nursing 15 (11), 604-607
ACCEPTED MANUSCRIPT Figure:
AC CE P
TE
D
MA
NU
SC
RI
PT
Figure 1 Facets of Military Health
ACCEPTED MANUSCRIPT Table:
Table 1 Simulation Sample Unfolding Case – inclusion of military families in simulation
PT
General Objectives:
SC
RI
Apply a holistic approach to caring for patients and families with both medical –surgical and psychiatric mental health needs. Synthesize the use of self through listening responses in the care of a patient and family. Evaluate one’s own biases and perceptions when rendering care to a patient and family.
MA
NU
Students meet a woman whose husband, a US Army veteran, recently committed suicide. She also has an 18 year old son with schizophrenia. As the case unfolds the woman receives a diagnosis of endometrial cancer. She undergoes surgery and chemotherapy, but ultimately she develops lung metastases and progresses to death. The case unfolds through 9-11 vignettes.
D
Pairs of students interact with the patient and her family (played by a live actors). Pairs are drawn at random before each vignette.
AC CE P
TE
Students care for the patient and her family in a variety of settings: 1. Doctor’s office/clinic 2. Hospital: pre-op and post-op 3. Therapy/support group 4. Home hospice Students who are not participating in the vignette observe the students who are, so that each student has the full story Use of reflective writing during the Unfolding Case assists students to formulate critical thinking and use of evidence-based practice, such as Quality Safety and Education for Nurses (QSEN), to care for the patient. Simulation run time: 45 minutes Debriefing time: 45 minutes
S0260-6917(16)30225-8 doi:10.1016/j.nedt.2016.09.020 YNEDT 3399
To appear in:
Nurse Education Today
Received date: Revised date: Accepted date:
19 November 2015 13 September 2016 26 September 2016
Please cite this article as: Magpantay-Monroe, Edna Ruiz, Integration of Military and Veteran Health in a Psychiatric Mental Health BSN Curriculum: A Mindful Analysis, Nurse Education Today (2016), doi:10.1016/j.nedt.2016.09.020
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT INTEGRATION OF MILITARY AND VETERAN HEALTH IN A PSYCHIATRIC MENTAL HEALTH BSN CURRICULUM: A MINDFUL ANALYSIS Edna Ruiz Magpantay-Monroe, Ed.D., A.P.R.N.
PT
Associate Professor
RI
Chaminade University of Honolulu School of Nursing
NU
SC
[email protected] Office Phone: 739-8380 3140 Waialae Avenue Honolulu, HI, 96816
MA
Word Count: 2155 including keywords, table and figure
AC CE P
TE
D
Acknowledgment: Sarah Jarvis. MSN RN, Simulation Lab Coordinator of St. Joseph’s College of Maine Department of Nursing.
ACCEPTED MANUSCRIPT Integration of Military and Veteran Health in a Psychiatric Mental Health BSN curriculum: A Mindful Analysis Abstract:
AC CE P
TE
D
MA
NU
SC
RI
PT
The military and veteran populations in the U. S. state of Hawaii have a strong presence in the local communities. It was this substantial presence that provided the impetus to integrate military and veteran health into a Bachelor’s of Science in Nursing (BSN) curriculum. This exploratory study investigated the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students’ understanding of the many facets of military veterans’ health. The concepts related to military and veterans’ health was infused in didactic, seminar, simulation and clinical instruction. Examples of approaches to teaching include guest speakers from military clinical partners, inclusion of military/military families in simulation, the reading of evidence-based articles focusing on the military and veteran population, use of identification of problem based learning and clinical placements in hospital(s) and community agencies specific to servicing military and veterans and their families. Students were encouraged to record their reflections which provided some insight on the value of integration of this important segment into the curriculum. Classroom discussions and reflections were analyzed using an exploratory method of inquiry by categorizing themes which revealed some biases about the military and veteran population and how working with this population helped students to understand their health needs. Although the data is limited, it an important foundation for further exploration into the significance of the integration of military and veterans’ health in a psychiatric mental health BSN nursing curriculum. The recommendation is to further include military and veterans’ health across the curriculum in order to help future nursing graduates understand and evaluate their role in working with this distinctive population, recognize challenges and opportunities in working with this population and identify available evidence-based resources to inform their practice. Key words: military, veterans health, nursing curriculum, psychiatric mental health Highlights:
Content integration about military and veteran health in a BSN curriculum prepares nursing students to care for active duty, veterans and their families. Developing military cultural awareness begins with self-reflection and self-assessment regarding one's own experiences, beliefs and biases. Future nurses need to understand military culture to provide optimal physical and mental health outcomes for our military and veterans
Introduction The United States of America Joining Forces initiative provides a platform for organizations, professional associations and educational institutions to better serve our veterans and military
ACCEPTED MANUSCRIPT
RI
PT
families (Biggins, et al, 2013; Keavney, 2014 & Kuehler, 2012). According to Kuehler (2012), to effectively join forces, we must appreciate the serious threats to the physical and mental health of our uniformed personnel and their families by investing in the required time and resources to provide compassionate care. Nurses with military cultural competence and knowledge are more likely to deliver suitable patient-centered care to patients with military culture experiences (Westphal, 2015). The ability to understand the experiences of the military and veterans directly relates to the development of a trusting relationship (“To Know Them”, 2011; Campbell, 2008).
SC
Objective
NU
The objective of this study was to explore the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students’ understanding of the many facets of military veterans’ health (Figure 1).
MA
Background
TE
D
Military veteran care happens from inpatient settings to community health settings. According to Allen, et al (2013), preparation to care for the military and veteran population is especially important in the United States community health care systems because that is where most veterans are seeking services. Nurses in the US are in a unique position to address the healthcare needs of our military and veteran populations, therefore inclusion of these topics should be a vital part of nursing education.
AC CE P
It is necessary for nursing education in the US to help students understand the culture of the men and women who faithfully served their country. Understanding selfless service, post service transition, health transition, and reintegration of service personnel into civilian society are just some key concepts that need to be addressed (Campbell, 2008; Haynes- Smith, 2010; Kuehler, 2012). The rationale for content integration and realistic educational recommendations for faculty to prepare future nurses to care for the military and veteran population is imperative. [Insert Figure 1 here]
Curriculum Development and Content In Fall semester (August-December) of 2013, the psychiatric mental health course was offered for the first time to senior nursing students at a new four year nursing program in Hawaii. This course is on a 7 week track which repeats three times during the academic year prior to the students taking their clinical immersion course. The course is built on a hybrid concept-based curriculum, but special populations such as the military population are intentionally incorporated into the course schedule. On week 5 of the course, the major concept is stress and coping and the sub-topic of military and veterans’ health is formally infused. The exemplars used to discuss the concept of stress and coping includes anxiety disorders, obsessive compulsive, phobias and posttraumatic stress disorder.
ACCEPTED MANUSCRIPT
RI
PT
The use of evidence-based practice readings and informational materials about military and veterans’ health are key to the synthesis of their care. Selected readings are related to enhancing veterans-centered care and transforming nursing practice for veterans into personalized, proactive and patient driven healthcare (Biggins, et al 2013 & Johnson et al 2013). When one understands the impact of military service, one can understand veterans’ health without judgement (Halvorson, 2010; Johnson et al., 2013). Keeping our veterans safe at all times and using best practices to inform care is critical to improving outcomes (Campbell, 2008; Kelly, U. et al, 2014).
MA
NU
SC
Military and veteran health is also incorporated through other avenues, such as guest speakers. Military clinical partners readily agree to have experts in their area share their expertise both in the classroom and clinical settings. Some valuable experiences include an active duty behavioral health nurse manager talking to the students about the military culture and the issues that trigger inpatient hospitalization; a program manager from a veteran center talking to the students about reintegration; and a civilian physician working with the veteran population speaking about different ways to engage veterans regarding their treatment.
AC CE P
TE
D
The use of best-practice simulation in nursing education allows learning objectives to be taught in a realistic clinical environment (Wilford & Doyle, 2006). Most schools use simulation as part of clinical teaching. Simulation for the senior level course of psychiatric mental health is used as an adjunct to didactic teaching. One simulation is an unfolding case (Table 1), a patient with both medical-surgical and psychiatric mental health needs who has family affiliation with the military. This simulation addresses the holistic approach to caring for mental health patients. [Insert Table 1 here]
The school is fortunate to have a memorandum of understanding with the only military hospital and veterans’ facility in the state. A group of students are clinically placed and rotate between the active duty and veteran inpatient behavioral health unit at Tripler Army Medical Center. Students also rotate to community care based agencies specific to servicing military and veterans and their families (e.g. US Vets Barbers Point). The rotation provides a realistic perspective on military health care needs and provides a body of knowledge to civilian future nurses that they may otherwise not fully understand. An average American soldier and his or her family have difficulties and personal challenges, ethical and moral dilemmas that may be difficult to comprehend (Kuehler, 2012; Noel et al, 2011; Haynes-Smith 2010). Another part of the curriculum is the use of problem based learning. Students initiated a comprehensive needs assessment of their agency/focused population (e.g. unit serving veterans and/or military and their families). One example of an identified key issue is trauma informed care. Students used peer-reviewed literature reviews to support their assessment and interventions. Students created a 5-6 minute video representing their needs assessment and showcasing the key issue they chose to address. The students’ clinical groups compare their needs assessments with each other providing an opportunity to reflect on the differences between civilian and military type facilities.
ACCEPTED MANUSCRIPT Methods
NU
SC
RI
PT
Data was collected formally through course evaluations and assigned reflections and informally through classroom discussions. The evaluation of the integration of military and veteran health in a psychiatric mental health BSN curriculum was accomplished to provide a mindful analysis of its effectiveness. The formal course evaluation provided limited written feedback into the inclusion of military and veteran health into the curriculum. There was no specific question on the course evaluation that address the incorporation of the military and veteran health. Some students commented on their course evaluation and simulation experience evaluation regarding the experience without being prompted by specific questions. The semi-structured evaluation data was gathered through in class discussions which includes simulation debriefing and post conference with students, unsolicited feedback from clinical adjuncts facilitating the clinical experiences and the course coordinator’s self-reflections. Results
D
MA
The formal course evaluations provided limited written feedback into the inclusion of military and veteran health into the curriculum. The available data were categorized into themes which provided an impetus for a more in-depth empirical data to be gathered. The intent is not to generalize the findings but to provide some scaffolding on which to build better BSN curriculum.
TE
Discussions
AC CE P
Initial classroom discussions with students revealed some biases students held about the military and veteran population. The perception was that care rendered to civilians would be sufficient for all, but that military and veteran populations did not need unique care. Students most often lack the understanding about the different military services ethos and core values. The lack of information about resources available to the military community is very apparent. During class discussions, students sometimes expressed their comfort level, or lack thereof, in a clinical agency with military and veteran patients. Through more in depth discussions, students began to appreciate the value of being exposed to the information provided to them through this course. Some student comments provided beginning insights on the value of the integration of military and veteran health in the psychiatric mental health curriculum: A student commented on the value of the simulation experience where she was able to “gain insight and understanding on how this population functions on [sic] a daily basis.” Students’ understanding of the military culture enabled them to provide more veteran centered patient care. Students found the problem based learning project working with the military and veteran population to be an exceptional project. The active duty or veteran is the center of this initiative. The learning activities above appear to provide the students the ability to understand the holistic care necessary for such a complex and diverse population. The use of reflective practice along with a well-thought out integration of information about military culture, health issues, and coping skills grant future nurses the ability
ACCEPTED MANUSCRIPT to make compassionate care a reality. The analysis of the semi structured evaluation data provided a beginning for more robust evaluation in the future and its empirical relevance to understanding the care for this special population in the United States and globally.
PT
Conclusion
SC
RI
The recommendation is to include information about military and veterans’ health across the school’s curriculum. When students in the United States and globally are exposed to this information consistently and can apply it in any setting, it will help future nursing graduates understand and evaluate their role in working with this distinctive population. The recognition of military and veteran challenges allows better transition to the opportunities of working with this population and identifying available evidence-based resources to inform their practice.
NU
References
MA
Allen, P.E, Armstrong, M.L., Conard, P.J., Saladiner, J.E., Hamilton, M.J. 2013, Nov. Veteran’s health care considerations for today’s nursing curricula. 52(11), 634-640
D
Biggins, M.S., Engstrom, C., Jackson, P.D., Sommers, E.T., & Thorne-Odem, S. 2013, Oct. Transforming nursing practice for veterans personalized, proactive and patient - driven healthcare. Nurse Leader. 28-33.
AC CE P
TE
Campbell, J. (July, 2008) Veterans speak out about stigma. National Council Magazine. Retrieved Oct 24, 2015 from http://www.thenationalcouncil.org/wp-cntent/uploads/2013/02/NCMag-Veterans-Final.pdf Haynes-Smith, G. 2010. Nursing in a Sandbox: A lived experience. Creative Nursing. 16(1), 2932. Halvorson, A. 2010. Understanding the military: The institution, culture and the people. Retrieved from http://www.samhsa.gov/sites/default/files/military_white_paper_final.pdf Johnson , B.S., Boudiab, L.D., Freundle, M., Anthony, M., Gmerek, G.B. & Carter, J. 2013, July. Enhancing Veteran- centered care: A guide for nurses in non-VA settings. American Journal of Nursing 113(7). 24-39 Keavney, E.K. 2014. A core course on veteran’s health in an online RN to BSN program: Preparing nurses to work with veterans. Online Learning. Retrieved Oct 24, 2015 from olj.onlinelearningconsortium.org Kelly, U., Boyd, M.A., Valente, S.M., & Czekanski, E. 2014. Trauma informed care: Keeping mental health settings safe for veterans. Issues In Mental Health Nursing 35(6), 413-419 Kuehner, C.A. 2013. My military: A Navy nurse practitioner’s perspective on military culture and joining forces for veteran health. Journal of the American Association of Nurse Practitioners, 25, 77–83. doi: 10.1111/j.1745-7599.2012.00810.x
ACCEPTED MANUSCRIPT
PT
Noel, P., Zeber, J., Pugh, M., Finley E., Parchman, M. 2011. A pilot survey of postdeployment health care needs in small community- based primary care clinics. BMC Family Practice. 12(79), 1-6. Retrieved from http://www.biomed central.com/1471-2296/12/79
RI
To know them is to serve them better. 2011, May/ June. Vanguard LVII( 3). Retrieved Oct 24, 2015 from http://www.va.gov/opa/publications/vanguard/vanguard_11_mayjun.pdf
SC
Westphal, R. J., and Convoy, S. P. 2015, Jan. Military Culture Implications for Mental Health and Nursing Care. Online Journal of Issues in Nursing 20(1), 1-1
AC CE P
TE
D
MA
NU
Wilford, A. & Doyle, T.J. 2006. Integrating simulation training into the nursing curriculum. British Journal of Nursing 15 (11), 604-607
ACCEPTED MANUSCRIPT Figure:
AC CE P
TE
D
MA
NU
SC
RI
PT
Figure 1 Facets of Military Health
ACCEPTED MANUSCRIPT Table:
Table 1 Simulation Sample Unfolding Case – inclusion of military families in simulation
PT
General Objectives:
SC
RI
Apply a holistic approach to caring for patients and families with both medical –surgical and psychiatric mental health needs. Synthesize the use of self through listening responses in the care of a patient and family. Evaluate one’s own biases and perceptions when rendering care to a patient and family.
MA
NU
Students meet a woman whose husband, a US Army veteran, recently committed suicide. She also has an 18 year old son with schizophrenia. As the case unfolds the woman receives a diagnosis of endometrial cancer. She undergoes surgery and chemotherapy, but ultimately she develops lung metastases and progresses to death. The case unfolds through 9-11 vignettes.
D
Pairs of students interact with the patient and her family (played by a live actors). Pairs are drawn at random before each vignette.
AC CE P
TE
Students care for the patient and her family in a variety of settings: 1. Doctor’s office/clinic 2. Hospital: pre-op and post-op 3. Therapy/support group 4. Home hospice Students who are not participating in the vignette observe the students who are, so that each student has the full story Use of reflective writing during the Unfolding Case assists students to formulate critical thinking and use of evidence-based practice, such as Quality Safety and Education for Nurses (QSEN), to care for the patient. Simulation run time: 45 minutes Debriefing time: 45 minutes