As a psychiatric nurse practitioner, when I write on the subject of Veterans, I capitalize the word. The health systems that serve Veterans do so as well, thereby setting this patient population apart by denoting their importance to our country’s freedom. Indeed, that Veterans are unique is evidenced by the fact that only 20 million or so Americans (out of 327 million) have served in the U.S. Armed Forces. Many Veterans have also had occupational exposures that led to specific and unique health conditions. Often, these conditions were acquired as they risked life and limb to conserve our nation’s liberty by fighting in remote corners of the world.
Each Veteran’s experience, including their era and location of service, is often the key to providing Veteran-centric care, which is they key to providing culturally appropriate care. Knowledge of the cultures of our military branches (Army, Air Force, Navy, Marines and Coast Guard) promotes understanding of the missions of these branches, bringing about a mutual understanding of career experiences, deployment cycles, and the challenges that families face. And while Veterans’ experiences vary by era and location, there are many experiences and conditions our Veterans face after serving our country.
Post-traumatic stress disorder (PTSD) is one factor common to many of those who have served. This condition has been known by several different names over the years, dating back to the Civil War — shell shock, soldier’s heart and combat fatigue, to name a few. And while it has been recognized as a commonly occurring cluster of symptoms, the term PTSD did not appear in psychiatric nomenclature until 1980. By that time, its essential symptoms, including flashbacks, nightmares, negative mood and intrusive thoughts, were so frequently encountered that it became a new diagnosis in the Diagnostic and Statistical Manual (DSM II) of the American Psychiatric Association. Also referred to as the “book of human troubles,” the DSM II diagnosis was a relief to some Veterans. It also confirmed that many others, including Holocaust survivors and those who survived both physical and sexual assaults, were troubled by similar symptoms. However, many Veterans saw this new psychiatric diagnosis as adding stigma to the burden they were already living with. Some thought that by admitting to these symptoms, they would not qualify for further military promotions.
Treatment of PTSD and combatting its stigma are ongoing efforts, and fortunately, the latest research-based interventions see continued improvement and are accessible to Veterans through the Veterans Health Administration in 1,250 facilities. For those seeking more information, an excellent place to start is through the U.S. Department of Veterans Affairs: https://www.ptsd.va.gov/
It’s also important to note that Veterans face more than PTSD. A Veteran’s era of service contributes to later health and, often, a peek into era-specific health issues. For example, Korean Veterans fought in bitter cold conditions and lost limbs, toes and fingers to frostbite. Korean-era Vets also were the first to be exposed to Agent Orange. In the Vietnam era, this defoliating agent was widely used to deprive the enemy of concealment. While the risks of the herbicide were not deemed problematic at the time, some 2.5 million American vets were exposed to Agent Orange and now experience conditions such as Hodgkins lymphoma, prostate cancer and leukemia. Gulf War syndrome has been reported by Veterans serving during that conflict, and is a chronic, multisymptom illness comprised of fatigue, cognitive issues and muscle pain. Common to both the Iraq and Aghanistan wars are the signature wounds of traumatic brain injury (TBI) and PTSD. With the advent of improvised explosive devices and advances in trauma surgery, Soldiers, Marines and Airmen survived these wars at greater rates than could have been imagined, even 20 years before. But quality of life after the acute phase of treatment was found to be the biggest challenge. The VA is continuously improving its services for those with TBI.
Most Veterans like to be thanked for their military service, but another way to engage them is to ask what type of job (“MOS” or Military Occupational Specialty) they held. A good way to start a conversation with a Vet is to say, “Thanks for serving in Iraq. What was your MOS?” As health care providers, this can give us some insight into their medical background, potential exposure to chemicals and injuries, and ultimately improves quality of care. But the question does not need to be limited to the patient room — no matter who you are, Vets will appreciate your interest in them. And they certainly deserve our appreciation for preserving our liberty.
Teena McGuinness, PhD, CRNP, PMHNP-BC, FAANP, FAAN, joined UAB School of Nursing as a professor in 2007 and became chair of the Department of Family, Community and Health Systems in 2013. She is the founding faculty member for the PMHNP program and co-director of the School’s VA Nursing Academic Partnership (VANAP) Mental Health Nurse Practitioner Residency.