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The holistic healthcare needs of veterans

Section Editor(s): Davis, Charlotte BSN, RN, CCRN

doi: 10.1097/01.NME.0000546256.61537.5d
Department: Editorial

Clinical Editor • Nursing made Incredibly Easy!

Surgical-Trauma ICU Nurse Educator • Ocala Regional Medical Center • Ocala, Fla.

Clinical Adjunct Faculty Member • Clayton State University • Morrow, Ga.

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Throughout our nursing career, we provide care for diverse patient populations. Although our patients will have common healthcare needs, some also have unique requirements. For example, the National Institutes of Health identifies neonatal, geriatric, and past or current military patients as being at increased risk for poor clinical outcomes. We must take a holistic approach to preventive and acute care management, including assessing the specific physiologic and psychosocial needs of each patient, family, and community.

Past or current military personnel may have unique healthcare needs because of environmental exposure during combat and humanitarian missions. Occupational exposure to toxic substances, such as lead and asbestos; radiation; air pollutants; and warfare agents (chemical and biologic weapons), can leave veterans with debilitating chronic health issues.

Military personnel are often exposed to geographic areas with extensive outbreaks of infectious diseases that have long-term health complications, such as tuberculosis, West Nile virus, malaria, and chronic Q fever. Areas to which soldiers are deployed often lack sanitary or functioning waste disposal facilities, which may result in cross-contamination of water supplies. Some environments may have standing water or lack clean water sources, forcing soldiers to consume potentially infectious water. Although military healthcare team members work vigilantly to administer preventive vaccinations and provide education on minimizing environmental risks, they face barriers such as short preparation times, prolonged deployment duration, and imminent threats to personal and unit safety, as well as instances that may require soldiers to enter known environmental threat areas. Some vaccinations, such as those to prevent malaria and the effects of nerve and biologic agents (anthrax), are still being studied to assess for potential links to unexplained chronic symptoms experienced by veterans.

According to the US Department of Veterans Affairs (VA), during the Vietnam War, many soldiers were exposed to the toxic herbicide Agent Orange, which is linked to numerous types of cancer, such as B cell leukemia, multiple myeloma, and non-Hodgkin lymphoma. During the Gulf War, many veterans returned with a collage of debilitating symptoms, such as fatigue, chronic headaches, and skin and respiratory disorders, often referred to as “Gulf War syndrome.” Infectious agent exposures during the Iraq War included brucellosis, which can result in extensive edema and pain in veterans' joints. In addition to infectious agent exposure, Operation Enduring Freedom veterans also experienced cold and heat injuries, inhalation injuries from open pit waste disposal sites, and depleted uranium ammunition injuries. Penetrating gunshot wounds from depleted uranium ammunition, bullet fragments, or shrapnel can result in long-term health issues.

Many current and past military personnel have been exposed to extensive noise during active combat missions, in which death is a realistic potential outcome. Many veterans have lost limbs and experienced devastating injuries from gunshot wounds or direct or indirect encounters with hidden roadside bombs. Exposure to noise; personal and witnessed injuries; and imminent, recurrent threats to safety have resulted in many veterans being diagnosed with sleep disturbances, depression, anxiety, and posttraumatic stress disorder.

These types of exposures make providing care for current and past military personnel a complicated task. Many veterans are eligible for healthcare services through the VA, such as primary and specialty medical services, in-home care, long-term hospice and respite services, and inpatient and outpatient mental health services. Accessing these services can be a daunting process for veterans. The VA Health Administration has patient representatives who act as liaisons to help navigate the benefits application process. Veterans may reach out to local Veterans of Foreign Wars chapters in their community, and social workers at your facility can also assist. For a list of healthcare benefits available to veterans, visit www.benefits.va.gov/benefits/applying.asp.

The price of freedom isn't free; it's forever etched on the faces of our veterans and the pained faces of the families of our fallen soldiers. As we celebrate Veterans Day, please take a moment to thank a veteran for his or her service to our country. It's truly an honor to be able to provide care for these brave men and women—thank you to all of the nurses doing so every day.

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