Libba Reed McMillan, RN PhD Integration of End of Life Care of Military Members and Veterans into a Baccalaureate Nursing Concepts Course Libba Reed McMillan, RN PhD Associate Professor Auburn University School of Nursing Auburn, Alabama United States of America 1

Greetings from Auburn, Alabama United States of America

Learning Objectives At the end of this presentation, learners will be able to: 1.Describe 5 unique end of life issues of veterans and military members 2.Identify ways to incorporate end of life care of Veterans and military members in nursing curricula. 3.Appraise ways to develop academic-practice partnerships with community, institutional, and academic resources to impact geriatric and/or end-of-life care of Veterans and military members.

Statement of the Problem: Unique End of Life Issues of Veterans and Military Members The specific war issues and conditions (Vietnam, WWII, Korea, Gulf War, OEF/OIF) and perceived acknowledgement by the healthcare professional can impact the Veteran and/or caregiver’s sense of pride and shame -- impacting their sense of grief/ bereavement. The grief experience may be impacted if death is experienced as a result of injury or loss associated with Veteran military service. Nursing students must learn to recognize unique characteristics of persons who have entered the military. Nursing students must use empathic communication skills to talk effectively with a Veteran or family member—the ‘right” things to say/ what to avoid. Veteran interventions might include those experiencing flashbacks or post traumatic stress disorder

Purpose of the Assignment: A View of Our Baccalaureate Nursing Program Goal: Health care providers and nursing students need to have a fundamental understanding about nursing care of these military members/ Veterans and family members/ caregivers, to effectively recognize emotional, physical, and spiritual conditions and develop nursing interventions that positively impact end-of-life outcomes. Purpose: describe infusion of unique Veteran-specific end-of-life concepts in addition to existing grief, loss and bereavement content in a baccalaureate nursing program. Need: incorporate a specific Veteran focus stems from a high percentage of Veterans living in the surrounding area(s) of our State land-grant university.

Pre-test Survey Unique Needs of Veterans at the End of Life HPNA Hospice and Palliative Nurses Association Note: Permission granted to use the survey and present results from HPNA; Auburn University Institutional Review Board (IRB) data collection Acknowledgement: Some material presented today was derived from the work of Marlene Foreman’s Module HPNA 0059 “Unique Needs of Veterans at the End of Life”

QUESTION 1 1. I enter the patient's home and notice objective signs of pain. I ask the veteran if she is in pain and the answer is "No". This may be suggestive of a. Stoicism b. Camaraderie. c. PTSD. d. Avoidance.

QUESTION 2 2. It is important that we all know about care of veterans at the end of life because a. most veterans die in VA hospitals. b. they present more problems than other patients. c. we need to be thankful for their service. d. about 96% of veterans die outside of VA institutions.

QUESTION 3 3. A unique health issue related to WWII Veterans is a. wounds. b. weather conditions. c. mustard gas exposure. d. infectious diseases.

QUESTION 4 4. Among the most dangerous military jobs of the cold war was a. fear of radiation. b. clean-up in Nagasaki and Hiroshima. c. tension related to possible nuclear war. d. fear of the unknown.

QUESTION 5 5. Korean War Veterans may continue to have lasting effects of   a. battle wounds. b. cold injuries and frostbite. c. amputation. d. long combat exposure.  

QUESTION 6 6. The longest war era was a. WWI. b. Korea. c. Vietnam. d. Operation Iraqi Freedom.

QUESTION 7 7. One of the most frustrating effects of the Vietnam War was a. America's reaction to the returning Veterans. b. Substance abuse. c. Agent Orange. d. Maintaining troop alliances on return home.

QUESTION 8 8. Health issues related to the Vietnam War include a. Agent Orange, Mustard Gas, Nuclear Weapons. b. Mustard Gas, Agent Orange, Hepatitis C. c. Nuclear Weapons, Agent Orange, PTSD. d. PTSD, Agent Orange, Hepatitis C.  

QUESTION 9 9. Agent Orange was used in Vietnam as an a. anti-infective agent. b. combat deterrent. c. provide smoke screen to confuse the enemy. d. pesticide to kill foliage.

QUESTION 10 10. A unique health risk of military preparing to deploy to the Gulf War is a. symptoms related to vaccinations. b. joint pain and headache. c. infections. d. substance abuse.

ANSWERS AND STUDENT PERFORMANCE Question Correct Response % Correct Answers from Students 1. I enter the patient's home and notice objective signs of pain. I ask the veteran if she is in pain and the answer is "No". This may be suggestive of: A. Stoicism 70% 2. It is important that we all know about care of veterans at the end of life because D. About 96% of veterans die outside of VA institutions. 79% 3. A unique health issue related to WWII Veterans is C. Mustard gas exposure 4. Among the most dangerous military jobs of the cold war was; B. Clean-up in Nagasaki and Hiroshima. 48% 5. Korean War Veterans may continue to have lasting effects of:   B. Cold injuries and frostbite. 38% 6. The longest war era was C. Vietnam. 39%

ANSWERS AND STUDENT PERFORMANCE Question Correct Response % Correct Answers from Students 7. One of the most frustrating effects of the Vietnam War was: A. America's reaction to the returning Veterans. 51% 8. Health issues related to the Vietnam War include: D. PTSD, Agent Orange, Hepatitis C 71% 9. Agent Orange was used in Vietnam as an: D. Pesticide to kill foliage. 61% 10. . A unique health risk of military preparing to deploy to the Gulf War is: A. Symptoms related to vaccinations. 56%

Future Directions Add more content into curriculum related to providing nursing care to the Veteran Add more content into curriculum related to end- of life needs of unique populations Continue development of electives related to Veteran health—such as Project SERVE and Project SALUTE Develop academic- practice partnerships with Veteran organizations, such as the Veteran Administration facilities, Veteran State Homes, Community organizations Collect qualitative and quantitative data measuring student perception and understanding of caring for the Veteran.

Resources

Auburn University School of Nursing Contact Information Libba Reed McMillan Associate Professor Auburn University School of Nursing Auburn, Alabama reedreb@auburn.edu 334.844.5973 office