Readiness of Non-Veteran Health Administration Advanced Practice Registered Nurses to Care for Those Who Have Served: A Multimethod Descriptive Study.

Federal, state, and educational policy, as well as public and professional initiatives, should influence how care is delivered to veterans from non-Veteran Health Administration (VHA) advanced practice registered nurses (APRNs) located in civilian health care facilities. Due to the MISSION Act, more veterans are receiving care outside the VHA, but little is known about the readiness of APRNs to address the needs of this population. This mixed-methods study describes the perceptions of 340 non-VHA APRNs concerning practice, clinical needs, and challenges they face while delivering care to veterans. Survey results show only 8% of APRNs consistently asked about military service; less than 1% asked if the patient has a family member with military history; and only 25% applied research by inquiring into military history when patients presented with conditions like chronic pain, interpersonal violence, or insomnia. Technology use via mobile application was minimally reported (<1%). "Missing in Action," the overarching theme from qualitative data, included three subthemes: (a) absence facilitated collaboration with VHA, (b) concerns regarding personal competency in the care of the military person, and (c) lack of recognition of the significance of the need to know about military status. Practice implications proffered include implementation of mandatory inquiry into military service and enactment of APRN veteran-centric nursing competencies. Education actions involve updating graduate nursing programs to include veteran health content and increased policy awareness. Future research should encompass replication of this study in specific APRN roles and consist of ongoing evaluation of veteran care by the civilian sector as the MISSION Act is implemented.

Care of veterans in a non-veteran health administration hospital: What is the status of nursing practice after continuing education?

AIMS AND OBJECTIVES: To identify how civilian nurses are caring for military veterans following mandatory continuing education on veterans' mental health needs and to describe challenges nurses are facing in provision of that care. BACKGROUND: Veterans and military personnel experience mental health conditions at a high rate and are increasingly receiving care in civilian healthcare facilities. Nonmilitary providers may not be prepared to address this population's challenging needs. Military culture may influence the presentation of mental health conditions; thus, critical assessment points by nonmilitary medical personnel may be missed. Education is touted internationally as a means to address deficits, but research is lacking to support that statement. METHODS: Adhering to research reporting guidelines, 115 of a proposed 322 civilian nurses in a tertiary hospital volunteered to complete a one-time online survey that contained quantitative and demographic questions. Forty of 115 nurses went on to complete the qualitative query. Descriptive statistics summarised quantitative results, and constant comparative analysis was applied to qualitative responses for theme identification. RESULTS: The study was stopped early due to reports of violence from veterans upon nurses. Results showed continuing education did not change documentation of military status. Following mandatory continuing education, civilian nurses continued to describe uncertainty in how to adapt care, on how to interact with veterans and in how to deal with violence. CONCLUSION: The status of care to veterans remains insufficient, but nurses are asking critical questions on how to update practice. Additional support and research in the clinical setting is needed to promote a safe caring environment. RELEVANCE TO CLINICAL PRACTICE: Continuing education alone may not advance care of the veteran. A multipronged approach to include mandatory documentation of military status and coaching of providers by those experienced with the military way of life may be used to augment staff preparedness.

The Experience of Women Veterans Coming Back from War.

Issues surrounding mental health are common for women veterans who have served in Iraq and Afghanistan wars. The goal of this phenomenological study was to document themes in the stories gathered from eight women veterans who had come back from war. Themes in the stories were: arriving with mixed sentiments; evolving to a changed view of self; permeating aggravation; confounding broken relationships, frequent deployments, and change in military status; remembering war experiences; and seeking opportunity for what is possible. Mental health issues can be observed in the themes. Including story as part of the mental health visit with veterans may be beneficial to veterans as they deal with the transition of coming back.

Use of ultrasound guidance for peripheral intravenous placement in difficult-to-access patients: advancing practice with evidence.

Placement of peripheral intravenous (PIV) lines in difficult-to-access patients can be daunting. Multiple unsuccessful peripheral sticks, numerous PIV restarts, and potentially excess use of peripherally inserted central catheters can result. The goals of this project were to decrease the number of peripherally inserted central catheter referrals and lower the number of PIV restarts by having clinical nurses employ ultrasound guidance when initiating deep PIVs. After 10 months of nurses using the ultrasound as needed to insert a PIV line, the number of total peripherally inserted central catheter referrals decreased by 20%.

Veteran-to-Veteran Program.

More Veterans are receiving health care outside of the Veterans Health Administration. Over concern for the Veteran's safety and the provider's competency, three progressive steps have been taken within the state of West Virginia. J Contin Educ Nurs. 2018;49(11):493-495.

Perspectives of caregivers of stroke survivors: implications for nursing.

The majority of stroke survivors receive home care. To offer better support, home caregivers and nurses must understand the caregiving experience. This knowledge will enable nurses to help home care givers provide more effective care and conserve their own resources.