Nurses in Action: Insights Into Providing Care to Veterans
November 2021 APNA News: Members’ Corner
Serving the mental health of veterans during the pandemic presents additional considerations. There are many nurses in the PMH community who use their expertise — including in administration, education, practice, and research — to support the mental health of veterans, active duty military, and their families, thank you for the care you provide!
APNA members Melissa Ashley, MSN, FNP-BC, PMHNP-BC, a Psychiatric-Mental Health Nurse Practitioner at the Birmingham VA Medical Center in Alabama; Steven Julaka, MSN, CRNP, PMHNP-BC, Instructor at the School of Nursing, The University of Alabama at Birmingham; and Laura Woodward, MSN, CRNP, PMHNP-BC, Instructor at the School of Nursing, The University of Alabama at Birmingham presented the session Understanding Suicide Risks in Veterans during the COVID-19 Pandemic at the APNA 35th Annual Conference in October. Below, they share their thoughts and strategies on serving military veterans during the pandemic.
What are special considerations for clinicians working with military veterans during the pandemic?
Veterans often have a higher incidence of mental health issues and physical comorbidities due to mental/physical trauma associated with their service. Veterans have higher rates of unemployment, and are at an increased risk of homelessness with food insecurity. The pandemic has placed additional strain on veterans by worsening these issues.
Clinicians should screen all adult patients to identify veteran status. Once identified, they should try to obtain further information about [the patient’s] service history, access to Veterans Affairs services, service connection, and needs. Clinicians should screen for PTSD, depression, anxiety, and suicidal ideations. They should be aware that the patient’s medical conditions could be due to their service and if so, encourage them to seek available VA services.
Veterans as a whole tend to have higher access to firearms, which puts them at a higher risk of suicide. With the pandemic causing increased purchasing of firearms and ammunition, screening for firearm safety and suicidality is extremely important for the veteran population. Clinicians in rural areas are charged with increased responsibility: They sometimes are the only provider the veteran comes in contact with, especially during the pandemic.
What do you find rewarding about working with veterans?
Working with veterans, specifically younger veterans, was rewarding for us. Engaging with and developing a therapeutic relationship was especially rewarding to us during the pandemic as there were some veterans that had very little contact with others outside of VA interactions. It was an honor to discuss the veteran’s mental health concerns and to reassure them that they were not alone. Being able to follow the progress of many veterans and seeing their improvement over time was extremely rewarding. It helped us feel as if we (as residents) were making a tangible difference in their life.
It was an honor to discuss the veteran’s mental health concerns and to reassure them that they were not alone.
Do you have a success story or a strategy you have used that worked well?
A key strategy we utilized while working with veterans was to maintain patience and provide a judgment-free setting that allowed for open and honest communication with the patients. Through this strategy, trust was built with the patient which allowed them to discuss their true feelings and symptoms. Having honest communication regarding symptoms helped us to get to the heart of issues and enabled us to provide the highest level of care. Our strategy was to establish a trusting relationship with the patient, communicate that we understood their needs, and to carefully explain the treatment options. Then the patient chose the option they were most comfortable with. We found this strategy helped the patient to invest in the treatment plan.
One success story: During the pandemic, we had a veteran with suicidal ideation come to the clinic. He was able to get the help needed at the time to keep him safe. We were able to follow him through the rest of the residency. He progressed so well that he no longer had suicidal ideation, had effective coping skills, and had made positive strides in his mental wellness through several programs available from the VA.