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VA Hudson Valley Health Care System in Castle Point, N.Y., offers palliative care for hospitalized veterans in facilities in Montrose and Castle Point; six community-based outpatient clinics also serve patients at home.

“It’s clear that our veterans have unique healthcare needs at the end of life. The horrors of war may have created problems in their lives, such as alcoholism, drug abuse, and homelessness. If we don’t ask them about their previous experiences, we would never know,” says Bonnie Walsh, RN, CHPN, assistant director at the United Hospice of Rockland in New City, N.Y., one of the hospices that works with the VA Hudson Valley. “To learn more about our veterans, we integrate a military service history into the assessment process.”

“We see veterans who are receiving palliative care at home and in the hospital who experience flashbacks, delusions, and hallucinations as a result of past war events,” says Joby David, RN, ANP, BC, palliative care coordinator at VA Hudson Valley Health Care System. “Some were able to block out war experiences while they were healthy, but when they are not well, they often can’t ignore them.”

When health professionals document each patient’s military service history, they ask questions such as, Where did the patient serve? What did the patient do while in the service? How has military service affected the patient? Was the patient a prisoner of war? Did the patient see combat, enemy fire, or casualties? Was the patient wounded or injured?

“Once we complete the veteran’s military history, we can make a service connection, identifying what his or her emotional, financial, and spiritual needs might be,” David says. The VA Hudson Valley’s palliative care team, which includes a nurse, medical provider, chaplain, psychologist, and social worker work together to address the veterans’ needs.

In 2003, the Veterans Administration committed to providing access to care for all veterans who needed palliative or hospice care. Recognizing that they couldn’t do it themselves, providers and clinicians at the VA Hudson Valley formed partnerships with more than 13 community hospices in Hudson Valley. They provide care for more than 125,000 veterans in Ulster, Sullivan, Westchester, Rockland, Putnam, Dutchess, and Orange counties; Pike, Pa.; Sussex, N.J.; and Fairfield, Conn., David says.

At VA Hudson Valley Health Care System, new nurses receive an orientation from David and experienced RNs receive ongoing in-service. “We must continue to raise everyone’s awareness, and I hope that we can continue to expand our partnerships to reach out to other rural areas of Hudson Valley,” David says.

For more on military assessment, visit www4.va.gov/oaa/ pocketcard. For more about veterans and palliative care, e-mail David at Joby.David@va.gov or Walsh at bwalsh@hospiceofrockland.org.

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Janice Petrella Lynch, RN, MSN, is a regional reporter. To comment, e-mail editorNJ@nursingspectrum.com.

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