Innovation in Health Policy Education: Examples From Jonas Policy Scholars.

In the decade since the Institute of Medicine published the Future of Nursing report, the development of a pipeline of doctorally prepared nursing leaders proficient in research, leadership, teaching, and practice has been one of great successes. The investment of Jonas Philanthropies, in collaboration with donors and foundation partners, has supported scholarships to more than 1,000 scholars nationwide. Scholars are prepared to lead health care reform in education, practice, and leadership. This article shares four examples of creative approaches to teaching health policy with students and professionals who may inspire similarly creative approaches to prepare future health policy leaders.

Military Serving at What Cost? The Effects of Parental Service on the Well-Being Our Youngest Military Members.

Since the onset of war in Iraq and Afghanistan in April 2002, much attention has been given to the effect of war on servicemen and servicewomen who have now been serving in combat for over thirteen years, the longest sustained war in American history. Many service members have served multiple tours in Iraq and Afghanistan and suffered from the visible and invisible wounds of war. Much work has been done in the Veterans Administration, the Department of Defense, and the civilian sector after observing the effects of multiple deployments and overall military service on the service member. A survey of the literature revealed that the ethics of conducting research on programs to assist these brave men and women is fraught with ethical concerns based on a military culture that often precludes autonomy and privacy. While strides have been made in developing strategies to assist service members deal with their military service issues, a serious lack of information exists on the impact of a parent's service on the health and well-being of military children. A discussion of current research on services for children is presented with an analysis of the ethical problems that have precluded adequate study of those who need society's help the most.

"I Serve 2": Meeting the needs of military children in civilian practice.

The American Academy of Nursing launched the "Have You Ever Served in the Military?" campaign in 2013 in conjunction with the Joining Forces campaign spearheaded by First Lady Michelle Obama and Dr. Jill Biden. The "Have You Ever Served in the Military?" campaign provides guidance and resources for nurses outside the Military Health System and Veterans Health Administration where upwards of 80% of veterans receive care. However, most military personnel do not serve alone. More than half of the 2.2 million active duty, National Guard, and Reserve service members currently serving in the armed forces have families and many military children experience stress and anxiety secondary to parental military service. Although strides have been made to improve identification and treatment of the visible and invisible wounds of war for service members, little to no information exists regarding the impact parental service has on the physical, psychological, and behavioral health of military children. In addition, there is no mechanism in place to identify military children in civilian practice nor resources providing evidence-based best practices when caring for these children.

Building resilience in US military families: why it matters.

Service members and their families have endured significant stressors over the past 19 years in support of the nation's engagement in the wars in Iraq and Afghanistan. 'Resilience' is the term most commonly used to describe the military spouse and military-connected child. However, due to a paucity of research on military families, little is known about the impact of spousal/parental military service on the military family. The ability of the healthcare provider is critical to ensuring the success of the military spouse and military-connected child. Providers can support the physical and psychological health needs of military families through (1) identification of military family members in clinical practice and (2) providing culturally competent care that correlates the unique lifestyle and physical and psychological health exposures associated with spousal/parental military service. Historically, in the United States, there has been a proud legacy of generational military service in families-upwards of 80% of new recruits have a family member who has served in the military. The leading factor associated with retention of the service member on Active Duty or in the Reserve or National Guard is the satisfaction of the at-home spouse. Disenfranchising the military spouse and lack of services and support for military-connected children could create a gap in meeting recruitment goals creating a threat to national security in the United States.

I Serve 2: Identifying and caring for military-connected children in civilian primary care settings.

Military children make tremendous sacrifices in support of a parent(s) military service. More than two million children have a parent who is serving or has served in the Armed Forces. Research shows that military-connected children are at higher risk of physical, psychological, and behavioral health issues. While "resilient" is the word used to describe most military children, it is important to recognize the stresses/stressors of military life- that military children serve too-to support and care for them.

Opioid Overdose and Naloxone Kit Distribution: A Quality Assurance Educational Program in the Primary Care Setting.

PROBLEM: In 2014, there were approximately 200,000 incidents of an unintentional opioid overdose nationwide. The 2016 Centers for Disease Control and Prevention opioid prescription guidelines identified a knowledge deficit regarding opioid prescribing among primary care providers as a contributing factor to this epidemic. PURPOSE: The purpose of this quality assurance project was to provide education on opioid overdose and distribution of naloxone kits through a presentation to primary care providers at Veterans Administration facilities in the southeast region of the United States. METHODS: A convenience sampling strategy was utilized for this project. Primary care providers who prescribe opioids or care for patients at risk of an opioid-related event or death were invited to participate. A Likert scale survey was used to determine the effectiveness of the presentation. RESULTS: The results of the survey showed a potential for improving medical providers' perceptions and comfort with prescribing naloxone kits. The mean score at pretest was 32 of 50 (64%) in contrast to 42 of 50 (84%) after attending the presentation. Attending this quality assurance presentation was related to an increased awareness of naloxone kit availability and Centers for Disease Control and Prevention recommendations regarding the safe administration of opioids. CONCLUSION: This educational presentation can assist providers in identifying patients who are prescribed opioids and at risk for accidental overdose and death.

So you want to be a Fellow in the American Association of Nurse Practitioners: Navigating the Fellowship process to ensure your success.

The professional designation as Fellow of the American Association of Nurse Practitioners (FAANP) is the highest professional designation for any nurse practitioner (NP). The Fellows of the American Association of Nurse Practitioners (AANP) operate the FAANP program and annually invite colleagues that have made a significant impact on the NP profession for consideration of this prestigious designation. Since its inception in 2000, nearly 700 NPs, or less than 1% of the membership, have been inducted as FAANPs. The number of candidates for consideration has continued to rise given that there are more than 75,000 members, many of whom have made significant contributions to health care. This article provides updates regarding the Fellows application process and provides guidance for both the candidate and the sponsors on how to prepare a competitive application.

Women Veterans, a Population at Risk for Fibromyalgia: The Associations Between Fibromyalgia, Symptoms, and Quality of Life.

BACKGROUND: The Institute of Federal Health Care recently published an executive summary from a round table discussion indicating that active duty and retired female military personnel are at high risk for adverse health outcomes unique to military service including complications related to post-traumatic stress disorder (PTSD), unreported sexual trauma, and musculoskeletal problems. In 2008, the Institute of Medicine began to review, evaluate, and summarize the literature on health outcomes in Gulf War-deployed and found sufficient evidence of a causal relationship with PTSD and suggestive evidence of an association with fibromyalgia (FM). This study examines the prevalence and impact of FM in women veterans and to explore the association between other comorbidities to improve risk differentiation for treatment and improve outcomes. METHODS: This study is designed as a nested, cross-sectional study within a larger project funded by the U.S. Army at the University of South Florida, College of Nursing entitled "Nursing Health Initiative for Empowering Women Veterans." A sample of 76 participants completed a battery of study instruments related to physical and psychological stressors. FINDINGS: Over half of the sample had a positive FM screening score (56.68%) although only 14.42% were deployed to the Middle East. More than 70% of participants reported harassment in life in the military and 32.9% reported sexual assault while in the military. Results of the 1-way analysis of variances find that there was a significant association of FM with the psychological symptoms of stress, depression, and PTSD. There was a significant association of FM with quality of life and sleep difficulty. DISCUSSION, IMPACT, AND RECOMMENDATIONS: The results from this pilot study suggest there is a significant relationship between FM and the psychological symptoms of depression and PTSD. Nearly two-thirds of these women screened positive for depressive symptoms and just over one-quarter of participants had symptoms indicative of PTSD. Only a small proportion of women veterans in this study were deployed (14.42%) and this suggests that a trigger or risk factor other than deployment or combat may contribute to the development of FM and mental health symptomology. To focus on the complex interrelationships between pain, fatigue, sleep, and depression, a follow-up study with a larger sample powered for more complex statistical analyses is warranted. Additional analyses in this study reveal that over half of women veterans who reported military sexual trauma (MST) while in the military, screened positive for FM. Although our analyses did not reveal there to be a significant effect between FM and MST, it should be considered as a potential risk factor for FM as MST can be a precursor for PTSD. Women veterans who present with FM should be screened for MST as sexual trauma may not be disclosed. Understanding how many women veterans are affected with FM and the relationship with PTSD, MST, stress, depression, and sleep can improve screening and treatment to improve quality of life. This will also inform decision-making about how best to design and implement interventions, programs, and policies.

The invisible wounds of war: caring for women veterans who have experienced military sexual trauma.

PURPOSE: The purpose of this case study is to raise awareness about military sexual trauma (MST) and posttraumatic stress disorder (PTSD), and the physical and psychological comorbidities associated with MST. DATA SOURCES: Health Science Data Sources-PubMed and authors' experiences. CONCLUSIONS: Women veterans are the fastest growing segment of the veteran population. Approximately 200,000 of the 2.6 million veterans who have deployed in support of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) are women. Many are seeking care in both the Veteran Administration and the civilian sector. It is estimated that upwards of 26,000 women have experienced some form of sexual assault in the military. MST can lead to multiple deleterious physical and psychological comorbidities. It is imperative that nurse practitioners (NPs) ask women about military service and utilize the Military Health History Pocket Card for Clinicians to ascertain service-connected health risks, primarily MST and PTSD. Prompt identification and intervention is key to reducing physical and psychological comorbidities. IMPLICATIONS FOR PRACTICE: This case study emphasizes the need for NPs to ask all women about military service and potential exposure to sexual trauma. It provides guidance on how to incorporate the Military Health History Pocket Card for Clinicians into practice.