Nursing Care of Rural Military Veterans: Building Partnerships Focused on Understanding the Veteran Experience Libba Reed McMillan, RN PhD CDR (ret) David Crumbley, RN MSN CWCN W. Blake Busbin, PhD IRNC 2016; Rapid City, South Dakota

Presentation Goals 1.Describe a baccalaureate nursing school’s integration of content related to caring for Veterans and military service members into student experiences. 2.Describe local and National level experiences formation and development of academic-practice partnerships with the purpose of increasing student interactions with Veterans 3.Describe the importance of understanding the Veteran perspective to providing competent nursing care

Statistics of Rural Veterans Of 8.9 million enrolled Veterans, 3.2 million enrolled Veterans live in rural/highly rural areas 22 million Veterans nationwide, 6.1 million Veterans living in rural areas 22 million Veterans nationwide, 6.1 million Veterans living in rural areas 36% of total enrolled Veteran population live in rural/highly rural areas 36% of total enrolled Veteran population live in rural/highly rural areas Approximately one-third (31 percent) of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) users of the VA Health Care System in FY12 reside in rural or highly rural areas. Approximately one-third (31 percent) of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) users of the VA Health Care System in FY12 reside in rural or highly rural areas.

Community Needs for Veteran Care Only 37% of military families live on military installations; 63% live in communities Only 37% of military families live on military installations; 63% live in communities Understanding of new policies on veteran’s choice/ access to care Understanding of new policies on veteran’s choice/ access to care Greater than 50% of veterans seek care outside of the VA and military treatment system -- they seek care at their local hospital staffed by nurses and doctors in the community Greater than 50% of veterans seek care outside of the VA and military treatment system -- they seek care at their local hospital staffed by nurses and doctors in the community “Finding” veteran’s to determine if healthcare needs are being met “Finding” veteran’s to determine if healthcare needs are being met

WWIIKorean ConflictVietnam Era Source: Office of the Actuary, Veteran Population Projections Model (VetPop2014), Table 2L Projected Percent of Veteran Population by Period of Service 2013 to % 10%10% 20%20% 30%30% 40%40% 50%50% 60%60% Fiscal Year Pe r centage Gulf War Era

Auburn University School of Nursing Students Course description Age range of years old Lack of experience and knowledge of Veterans/ war issues Junior level student- first semester in professional program Changing landscape of Veterans in community settings versus Veteran Administration Hospitals

NATIONAL EXPERIENCE

Academic-Practice Partnership with WRNMMC Overall goal of partnership: Better prepare nurses in the community to care for the returning Service Member, Veteran, Wounded Warriors, and their family members Overall goal of partnership: Better prepare nurses in the community to care for the returning Service Member, Veteran, Wounded Warriors, and their family members Partnership proposed in the Spring of First of its kind between the Nation’s largest Military Treatment Center and an academic institution Partnership proposed in the Spring of First of its kind between the Nation’s largest Military Treatment Center and an academic institution WRNMMC/ Auburn University/ AUM identified the benefit of partnering together to create national competencies (QSEN model utilized: knowledge, skills, attitudes) WRNMMC/ Auburn University/ AUM identified the benefit of partnering together to create national competencies (QSEN model utilized: knowledge, skills, attitudes) Competency document will be expanded to expert care providers to validate and refine for use in clinical practice Competency document will be expanded to expert care providers to validate and refine for use in clinical practice

Pre-Deployment Experiences Students discuss the military population in the Students discuss the military population in the context of lifestyles and culture; mental health Online program modules are completed on Military Culture, Traumatic Stress Disorder, Traumatic Amputation, Traumatic Brain Injury Online program modules are completed on Military Culture, Traumatic Stress Disorder, Traumatic Amputation, Traumatic Brain Injury Facilitated contact with Veteran group activities Facilitated contact with Veteran group activities Formal Research Study: pre-deployment survey Formal Research Study: pre-deployment survey

Deployment Experiences Tour of war memorials in Washington DC area Tour of war memorials in Washington DC area Introduction to Key Personnel at WRNMMC Introduction to Key Personnel at WRNMMC Tour National Intrepid Center of Excellence Tour National Intrepid Center of Excellence Panel Discussions Panel Discussions Clinical Rotations: Intensive Care, Mental Health, Surgical Unit, Physical Therapy Clinical Rotations: Intensive Care, Mental Health, Surgical Unit, Physical Therapy Social Activities with student group and with Veterans Social Activities with student group and with Veterans Trip to Capitol Hill—Met with Representative Trip to Capitol Hill—Met with Representative

Post-Deployment Experiences Reflection exercises for purpose of creating competencies Formal Study: post-deployment survey (perceived competency to care for wounded warriors) Formal Study: post-deployment survey (perceived competency to care for wounded warriors) Taped Documentary of Student Reflections (AU) Taped Documentary of Student Reflections (AU) Professional poster display

LOCAL EXPERIENCE

Academic-Practice Partnership with Auburn High School Advanced Placement History Class Library of Congress tapings Library of Congress tapings Interviewed 68 Vietnam Veterans/ 137 high school history students participating over 2 days Interviewed 68 Vietnam Veterans/ 137 high school history students participating over 2 days Interviewed at the high school with reception area Interviewed at the high school with reception area High school students referenced videos in their research projects post interviews—demonstrated influence of nursing student’s research on high school academic outcomes High school students referenced videos in their research projects post interviews—demonstrated influence of nursing student’s research on high school academic outcomes

The Health Promotion Assignment 7 page research professional paper and construction of a poster 7 page research professional paper and construction of a poster Health promotion focus: Vietnam Veteran healthcare (Fall semester: acute conditions during war/ Spring semester: chronic conditions) Health promotion focus: Vietnam Veteran healthcare (Fall semester: acute conditions during war/ Spring semester: chronic conditions) “TED” style talks on topics to be viewed by history class “TED” style talks on topics to be viewed by history class

FUTURE PLANS Post 9-11/ Gulf War era Veterans focus of high school project Post 9-11/ Gulf War era Veterans focus of high school project Pair up “TED” talks with posters in more modular format to improve history student learning Pair up “TED” talks with posters in more modular format to improve history student learning Focus on “attitude/ affective” domain for Project SERVE for 2017 Focus on “attitude/ affective” domain for Project SERVE for 2017 Design more interactions between students and Veterans through community groups/ Auburn University Extension system Design more interactions between students and Veterans through community groups/ Auburn University Extension system

Contact Information Dr. Libba Reed McMillan