Recommendations After an Objective Structured Clinical Examination Program Evaluation.

BACKGROUND: The use of objective structured clinical examinations (OSCEs) is a well-established method of clinical assessment in the medical profession, and these are currently being integrated into advanced practice nursing curricula. METHOD: A program assessment was conducted at a current family nurse practitioner track within a southwestern U.S. university using the OSCE evaluative strategy. The logic model from the Centers for Disease Control and Prevention framework was incorporated. Both focus group and the de-identified faculty-scored student rubrics during the fall, spring, and summer semesters of one cohort of students (N = 73) were examined. RESULTS: Strengths and challenges were found in the areas of student preparation, scoring/grading with variations of inter-rater reliability, and debriefing. CONCLUSION: Establishing a specific OSCE center with a dedicated director could support adequate attainment of formative and summative competencies for nurse practitioners and provide faculty education and standardized student preparation, while adhering to the multiple guidelines and standards related to nurse practitioner competency evaluation with simulation. [J Contin Educ Nurs. 2023;54(4):169-175.].

Military Veterans' End of Life: Supporting Them in Their Last Deployment.

More than 600,000 U.S. Veterans die from illness each year. Clinicians in civilian settings are increasingly providing care to Veterans at end of life. Veteran care should be distinctive and individualized to meet their unique needs. There is limited information to guide civilian clinicians in providing care to Veterans at end of life. This article provides bio-psycho-social information to holistically guide Veteran healthcare and assist them with solace, respect, and serenity at end of life. Various options for end-of-life care are discussed, as well as specific concerns of women, lesbian, gay, bisexual, and transgender Veterans. Some end-of-life entitlements for all Veterans and sometimes their spouses/children are included.

The Influence of Tattoos on Health Care Experiences.

Background Tattoos are an artistic, visible reflection of an individual's personality and life. According to Goffman and subcultural identity theory, the population with tattoos wants to be different from mainstream society. Method A qualitative descriptive phenomenological research process was used. Results Twelve participants described deep personal identity connections to their large, visible tattoos. They experienced positive reactions (n = 2, 16%), no reaction/acknowledgment (n = 7, 58%), or negative reactions (n = 3, 25%) from health care providers. Conclusion Comments made by health care providers tend to be remembered regardless of the context and can contribute to health and care disparities. Participants who received negative reactions to their tattoos switched providers. Those who received no reactions could have felt insignificant. Ongoing culturally sensitive education is important. Tattoos can start meaningful conversations that allow health care providers to gain valuable insight. [J Contin Educ Nurs. 2022;53(4):178-184.].

The Risks, Invisibility, and Health Issues Facing Women Veterans Who Are Homeless.

Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain "invisible." Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.

Predictors of student veterans progression and graduation in Veteran to Bachelor of Science in Nursing (VBSN) Programs: A multisite study.

BACKGROUND: Capitalizing on the veteran's extensive service experience, values, and norms, Health Resources Services Administration (HRSA) proposed Nurse Education, Practice, Quality and Retention - Veterans' Bachelor of Science (VBSN) Program grants (2016-2019). PURPOSE: The purpose was to identify predictors of student veterans' (SV) progression and graduation rates in VBSN programs. METHODS: A descriptive correlational retrospective design was used. Two hundred and eighty-two (282) SV records were examined. RESULTS: One hundred and forty (140) SVs graduated (49.6%) and 107 (37.9%) were still enrolled. Only program delivery mode (hybrid) was significantly associated with completion and confirmed by logistic regression modeling. An increased representation of SVs' gender, race/ethnicity was present; however, gender, age, race, ethnicity, and veteran status did not significantly predict progression nor graduation. CONCLUSIONS: Hybrid program delivery became the single predictor influencing VBSN progression and graduation. As non-traditional students in higher education with a history of social isolation and help-seeking stigma, this delivery mode may have assisted SV retention and persistence. With a registered nurse shortage and workforce calls for increased gender, race, and ethnic diversity, the findings suggest nursing education programs designed for veterans are a viable solution.

Nursing Care of Women Veterans of the Iraq and Afghanistan Wars.

The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.

Older Military Veteran Care: Many Still Believe They Are Forgotten.

BACKGROUND: Almost 44% of our nation's 23 million men and women veterans are 65 years of age or older. Most are proud of their service, yet many believe their services for our country were forgotten, especially those in combat between 1950 and 1975. PURPOSE: Further information to ultimately assist their holistic well-being will be important for nursing practice as countless older veterans are beginning to obtain more care within civilian facilities. Using the Korean War (1950-1953) as a backdrop to illustrate the interconnectiveness of older veteran physical, emotional, and spiritual concerns that can occur from a military deployment, the major purposes of this article are to provide a brief historical snapshot of that war and discuss prior-era military environmental situations that now are producing the lingering effects from their combat exposure. DESIGN: Relevant literature about the Korean War and Veterans was compiled. FINDINGS: Some of these health risks for both the Korean men and women veterans are cold exposure, neurologic, and posttraumatic stress disorder concerns, as well as the need for hepatitis C and suicide assessments. CONCLUSIONS: To ultimately improve their bio-psycho-socio-spiritual well-being, prompt identification of the older military veteran, their lingering combat effects, and reminiscing will be important.

Deployed Women Veterans: Important Culturally Sensitive Care.

PROBLEM: Today, with almost 23 million veterans in the nation, and currently only about 10 million, or less, of them seeking active services associated with the Veterans Administration (VA) health facilities, these men and women veterans will be seeking some, more, or even all of their health care over their life time in civilian-based facilities. METHODS: Pertinent literary sources were reviewed to gather applicable data about the problem. FINDINGS: Every patient that enters your health facility should be asked an essential assessment question: "Have you served in the military?" Importantly, to gain effective rapport when they present, civilian nurses will need to anticipate their health needs and provide culturally sensitive care. Specific issues of deployed women veterans are provided in a series of two articles. CONCLUSION: This article provides a snapshot of the uniquely entrenched military culture, as well as women service member experiences in wartime, including the Global War on Terror (Iraq and Afghanistan). The next article discusses the various healthcare differences (e.g., post-traumatic stress disorder and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, employment, homelessness issues), and gender disparities (varied treatment patterns) so the civilian nurse can better advocate for women veterans.

Capitalizing on Military Nurse Skills for Second-Career Leadership and Staff Development Roles.

Nursing continues to face professional workforce and diversity shortage problems. This article advocates for examining an untapped resource-the consideration of applicants for nursing leadership and educational positions in civilian health care organizations. This untapped resource is highly qualified, already retired (or going to be separated) military nurse officers (MNOs) who possess extensive health care knowledge, as well as distinctive ethnicity and gender composition. Clinical educators, as part of the organizational leadership, can play an important role in assisting the MNO civilian position assimilation because they come from a structured and unique cultural environment. Several innovative preparatory strategies are proposed to highlight the organization's support and commitment regarding preselection, recruiting, hiring, and mentoring, including the use of a specific navigational mentor to achieve the necessary acquired cultural assimilation for the MNO's success, satisfaction, and retention. J Contin Educ Nurs. 2016;47(11):503-510.

Person-centered older military veteran care when there are consequences.

The consequences of each war present themselves in many ways and differently within a veteran's lifetime. For civilian nurses to give applicable, vital care to the older veteran, they need to deeply appreciate the military culture, the strength of the ethos, as well as the various health concerns connected with the individual war/conflict. Attentiveness to the evolving health issues of older veterans are a priority at a time when many personal developmental changes are also creating life stressors for the Vietnam veterans and they are often presenting to civilian health facilities for their care. This article explores the controversial war within Vietnam (1955-1973), and the use of the universal question of "Have you ever served in the military?" An incremental veteran health assessment is discussed in order to care for the specific, prior-era physical/behavioral issues of post-traumatic stress disorder, Agent Orange, military sexual trauma, hepatitis C, and homelessness that are discussed for these men and women veterans, along with a rationale for their long-term presence, which is still evident today. Other relevant nursing interventions for veterans are suggested such as reminiscing, and art/animal-assisted therapy to supplement their medical care.

Advocating for Deployed Women Veterans' Health Differences, Difficulties, and Disparities.

PROBLEM: The preceding article presented a glimpse of deployed women veterans, their military culture, and their experiences in the Global War on Terror (Iraq and Afghanistan) to assist civilian nurses to gain significant rapport and provide important culturally sensitive care. METHODS: Pertinent literary sources were reviewed to gather applicable data about the problem. FINDINGS: A confirmatory answer from the assessment question of "Have you served in the military?" and the use of the Military Health History Pocket Card for Clinicians (available at http://www.va.gov.oaa/pocketcard) will assist with revealing possible health risks from the increased amounts of military men and women veterans seeking (and/or returning to) a variety of community-based health services. This article about deployed women veterans examines their specific health differences (e.g., research literature, post-traumatic stress disorder, and military sexual trauma), difficulties (e.g., reproductive, gynecologic, urinary, suicide), and gender disparities (varied treatment patterns). CONCLUSION: Understanding these gender situations, civilian nurses can better advocate with increasing evidence-based decisions that their physical and behavioral responses were different from their male counterparts. Continual assessment, knowledgeable care, ongoing literature review, interdisciplinary health team development, and the presence of resourceful community agencies should be a significant part of their holistic care. Conard Armstrong.

Suicide assessment and action for women veterans.

Many deployed women Veterans, as described in a previous article, have experienced similar combat exposure as their male counterparts in wars since 1990. Upon reintegration, many Veterans visit civilian health facilities with behavioral health issues, sometimes voicing and/or attempting suicide. Effective nursing assessment and actions are needed to specifically care for this unique population. Any suicide variables (e.g., ideation, attempts, completed) are concerning; therefore, all women Veterans from the Vietnam, Gulf I, Iraq, and Afghanistan wars should be assessed. The first priority is always patient safety. Timely and frequent screening for a variety of risk factors, documented for both men and women Veterans, and women specifically, are important. Symptomology may not become evident for 3 to 15 months into reintegration. Applicable dialogue can recognize changing thoughts, judgment, and behavior patterns. Health promotion efforts, interventions, and resourceful referrals are provided.

Nursing advocacy for women veterans and suicide.

Little is known about suicide variables in women Veterans. The authors reviewed numerous applicable health care and military literary sources regarding suicide in this population. The current article describes the surrounding circumstances, military war/conflict culture, and potential effects on women Veterans, including major collection problems with current Veteran data. Women Veterans are increasingly reporting more behavioral health issues (e.g., posttraumatic stress disorder) and attempting suicide upon civilian reintegration. Outcomes from this literature review suggest the importance of nursing advocacy to create better rapport and communication with women Veterans from Vietnam, Gulf I, Iraq, and Afghanistan wars seeking care at civilian health facilities, as some may present with suicidal ideologies.

Preparing staff to care for veterans in a way they need and deserve.

More than 2.5 million military veterans have been deployed for service in Iraq and/or Afghanistan, whereas another 20 million veterans currently reside in the United States. For various reasons, increasing numbers of military and associated personnel from various wars could go to civilian population-based care facilities for their rest-of-life health care. Therefore, educational activities are important to prepare nursing staff for the culturally sensitive care that veterans, their dependents, and civilian contractor personnel need. This article (a) provides rationale for veterans' admissions, (b) summarizes some common health situations that veterans are likely to encounter, (c) stresses major educational goals, and (d) emphasizes the use of the universal assessment question: Have you ever served in the military? Several educational implications and challenges are discussed, including war zone physiology, reintegration, military culture and pride, ethical challenges, educational speakers, simulation, veteran individuality, and compassion fatigue. Available resources to accompany this content are provided.

Opportunities, hurdles, solutions, and approaches to transition military veterans into professional nursing programs.

Capitalizing on the almost 2.2 million service members returning from Operation Iraqi Freedom and New Dawn (OIF) in Iraq, and Operation Enduring Freedom (OEF) in Afghanistan, baccalaureate educators are encouraged to create realistic, applicable nursing transitional programs for the health and health-related oriented military veterans. Opportunities, hurdles, and solutions related to the veteran's unique socio-economic circumstances of education, finances, and advisement are provided so the potential veteran student is successful within the university's milieu. Transitional nursing educational interventions related to assessment, didactic, and clinical used by two baccalaureate nursing curriculums, including the eLineMilitary* (ELM) Program, provide approaches of how to propel the veteran's journey toward graduation in a professional nursing program. These interventions include modular didactic, competency based education, as well as the concentrated, collegial time within the Faculty/Clinical Coach triad for essential role modeling, care, and skills.

Encountering women veterans with military sexual trauma.

PURPOSE: As women veterans (WVs) are returning from Operation Iraqi Freedom and Operation Enduring Freedom with military sexual trauma (MST), the purpose of this article is twofold. First, important exploratory questions that can assist with a thorough assessment and history are presented as well as the applicable treatment for any new, recurrent, or unresolved symptoms that involve MST. DESIGN AND METHODS: Review of multiple literary materials, as well as a clinical situation. FINDINGS: WVs will be encountered in a variety of military or civilian primary and community care healthcare settings. Every woman (and man) in the civilian sector should be asked, "Have you ever served in the military?" PRACTICE IMPLICATIONS: Recognition, acknowledgment, and applicable interventions for MST and associated comorbidities, especially post-traumatic stress disorder, are presented as currently 80-90% of MST experiences have gone unreported. Immediate treatment and follow-up are critical for the well-being of the WVs.