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Nursing schools, organizations pledge to help veterans and their families

Monday June 4, 2012
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When Joshua Thomas returned from war after serving in the U.S. Army, his mother instinctively knew he was not the same. He would not talk about what he saw or did in either Iraq or Afghanistan. He rarely slept and, when he did, it was with a gun. He isolated himself from his friends and family. He talked about suicide and had a plan to kill himself.

Thomas’ mother, Jodi Harner, recognized her son had post-traumatic stress disorder. On a couple of occasions when she thought he was near a breaking point, Harner took him to local VA hospitals. The VA near their home in Florida gave him a prescription for psychiatric medications and put him on a waiting list for inpatient treatment. But Thomas did not want inpatient treatment because he knew he would have to talk about his war experiences.

Fortunately, his mother found an alternative experimental treatment called Accelerated Resolution Therapy and encouraged him to enroll in a study through the University of South Florida’s College of Nursing in Tampa, Fla.

The therapy did not require Thomas to talk about painful memories, such as seeing his best friend killed by a suicide bomber in Iraq. Instead, during ART, a patient mentally visualizes an unpleasant or disturbing memory and replaces it with a more pleasurable one while following a therapist’s hand movements with his or her eyes. Rather than envisioning his friend being killed, Thomas said he replaced it with a memory of playing cards together.

A USF brochure on the treatment describes ART as a "new eye movement, exposure-based therapy, [that] is brief … [and] does not require an established client/therapist relationship." Although it might sound too good to be true, Thomas and Harner said it works. "It saved my life; that’s all I can say," Thomas said when interviewed by Nurse.com. After only two treatments, Thomas said he can drive a car, leave the house, go to parties and tolerate loud noises, things he couldn’t do before. He isn’t cured, but said he is making progress.

Stepping up to the plate

On April 11, first lady Michelle Obama mentioned Thomas’ experience with ART during an event at the University of Pennsylvania. While there, she and second lady Jill Biden announced that, in response to the White House’s Joining Forces initiative to improve the lives of veterans of the Iraq and Afghanistan wars and their families, more than 500 schools of nursing and almost 200 nursing organizations had pledged their support.

Key nursing leaders embraced the chance to help veterans heal from the wars’ physical and psychological wounds. They told Obama and Biden they could count on nursing organizations, associations and schools to educate the country’s 3.1 million nurses about traumatic brain injury and PTSD — the signature wounds of the Iraq and Afghanistan wars — along with other combat-related issues such as chronic pain management.

"It was pretty clear among the disciplines that nurses understood early on where we wanted to go," said Navy Capt. Bradley Cooper, executive director of Joining Forces. "We recognized that nurses could lend a hand in the fastest and most vibrant way."

In addition to USF, other schools of nursing and nursing organizations already are helping veterans. Penn School of Nursing, the American Association of Colleges of Nursing and the American Psychiatric Nurses Association have ongoing research and/or web-based materials pertaining to veterans and their families. The University of San Diego Hahn School of Nursing and Health Science has several nursing-led programs that assist veterans and their families. With a large active-duty military population, the San Diego region has been dealing with the aftermath of war for more than a decade.

As the conflicts wind down, more active-duty service members are leaving the military and seeking care in civilian healthcare settings, said Joseph Burkard, RN, DNSc, CRNA, an associate professor at USD and an advanced practice clinician/researcher at the University of California, San Diego.

"They are so young and they have so many issues with alcohol and drug abuse," said Burkard, who served in the military for 31 years. "We see a lot of domestic violence, and we are seeing a lot of homeless veterans."

Burkard and other RNs at USD are training nurses in civilian settings to identify the symptoms and comorbidities of TBI, PTSD and chronic pain syndromes. "We’re trying to establish collaborations with some of the larger healthcare facilities in town so we can identify the providers who will be treating veterans," he said. "A lot of the nonmilitary practitioners don’t understand the complexity of these injuries."

The wars’ signature, often silent wounds

Thomas already was experiencing symptoms of PTSD when he returned from his first deployment in Iraq, his mother said. He was traumatized further in Afghanistan when a roadside bomb exploded while he was driving a military vehicle. He was treated in a combat hospital and then went back to the isolated outpost where he was stationed. His fellow soldiers soon noticed he was becoming forgetful, but Thomas said he concealed his memory loss from his superiors because he didn’t want to be sent home early and leave his fellow soldiers.

When Thomas did return home, it was with TBI and PTSD, his mother said. He was not alone. TBI and PTSD have "impacted 1 in 6 of our troops returning from Afghanistan and Iraq — more than 300,000 veterans," according to statistics from the White House website. "And since 2000, more than 44,000 of those troops have suffered at least a moderate-grade TBI. Only 40% of veterans with PTSD or TBI will seek treatment, Cooper said.

Cathy Rick, RN, PhD(h), NEA-BC, FACHE, FAAN, CNO of the Department of Veterans Affairs, the agency responsible for the healthcare of the country’s military veterans, said the majority of veterans receive care not from the VA, but in civilian settings closer to home such as schools, clinics, hospitals and physician offices.

Rick said the VA will help nursing organizations and schools of nursing that have signed on with Joining Forces become better versed in the needs of military service members and their families. For example, nurses in the private sector may not think to ask women whether they have served in the military and may not understand why many veterans and active-duty members are reluctant to seek help for mental health problems, she said.

The ART study is one of five sub-studies that fall under the RESTORE LIVES center housed in the USF College of Nursing and funded by the Department of Defense. Like the VA’s Rick, nurse researcher Maureen Groer, RN, PhD, FAAN, the principle investigator of USF’s Nursing Health Initiative for Empowering Women Veterans study, wants to get the word out that healthcare providers need to ask women whether they served in the military.

"A lot of them don’t want to talk about their experiences, but it may be an important factor in their long-term health," she said.

Maintaining the momentum

The American Nurses Association is taking the lead in coordinating and sharing the efforts of the various nursing entities that have committed to Joining Forces, said ANA president Karen Daley, RN, MPH, PhD, FAAN. The ANA has created a web portal at nursingworld.org that will be the central depository for sharing information about the best ways to assist veterans and military families. “We want to share best practices and raise awareness across the country,” Daley said. “We want every nurse in the country to be alert to the needs of military veterans and to know how to screen these patients appropriately, initiate care and make necessary referrals.” •


Janet Boivin, RN, BSN, BA, is a freelance writer and staff nurse at the Family Health Partnership Clinic in Woodstock, Ill.Write to editor@nurse.com or post a comment below.