Advertisement

“Have You Ever Served in the Military?” campaign in partnership with the Joining Forces Initiative

      The “call to action” for all Americans to “join forces” to ensure that our veterans and military and their families have the opportunities, resources, and support they have earned has been energizing. By bringing attention to the unique needs and strengths of Americans who have served in the Armed Forces, their spouses, and families, Joining Forces seeks to strengthen our nation by creating connections between civilian communities and the military/veteran population that will endure. Joining Forces is a national effort led by First Lady Michelle Obama and Dr. Jill Biden that highlights the needs of our American heroes and their families in the areas of employment, education, and wellness.
      Nurses are on the front lines of providing care for our military veterans, whether they work in the Military Health System, the Veterans Health Administration, or in the civilian community. The American Academy of Nursing is adding its strength to the Joining Forces effort by launching the “Have You Ever Served in the Military?” campaign to ensure that all providers identify the veterans in their patient population to ensure appropriate care for military-related conditions.

      Background and Problem Identification

      Military service, whether in peace time or during war, in and of itself is an occupation that is fraught with stressors, toxic exposures, hazards, and safety risks not commonly encountered in the civilian population (

      Veterans Benefits. (2013). Compensation for Service Connected Disabilities or Death, Title 38 US Code Chapter 11, 36–396, Washington, DC: Government Printing Office.

      ). For example, exposure to industrial solvents may cause skin or neurologic damage; noise from weapons, equipment, and other machinery can impair hearing, and vibration using power hand tools or operating machinery such as helicopters can lead to hand-arm vibration syndrome or low back pain (

      Veterans Benefits. (2013). Compensation for Service Connected Disabilities or Death, Title 38 US Code Chapter 11, 36–396, Washington, DC: Government Printing Office.

      ). War-time exposures have included Agent Orange during the Vietnam War, and there are current concerns about lung disease after exposure to burn pits in Iraq and Afghanistan (

      Kime, P. (2013, April 26). IG: Afghanistan FOB's broken incinerators force troops to keep using burn pits. Military Times. Retrieved from http://www.militarytimes.com/article/20130426/NEWS/304260026/IG-Afghanistan-FOB-s-broken-incinerators-force-troops-keep-using-burn-pits.

      ).
      There are over 23 million veterans of U.S. military service living in America and more than 1.4 million serving on active duty (

      Department of Defense. (2013). Armed Forces Strengths Statistical Information Analysis Division. Retrieved from http://www.siadapp.dmdc.osd.mil/personnel/MILITARY/miltop.htm.

      ). Fewer than 22% of this population uses the health care services provided by the Veterans Health Administration. Veterans Affairs (VA) has also reported that 40% of veterans rated for compensable disabilities associated with their military service did not use health services or programs provided by the department (
      U.S. Department of Veteran Affairs
      National Survey of Veterans National Center for Veterans Analysis and Statistics.
      ,

      U.S. Department of Veterans Affairs. (2013). U.S. Veteran Compensation Programs. Children with Birth Defects Services. Retrieved from (http://www.veteranprograms.com/id114.html).

      ). One of the most challenging and pressing issues for VA is to identify veterans and link them to the resources developed for their care and treatment within the VA system.
      America has relied on its citizen soldiers in many conflicts; these are the approximately 500,000 men and women of the National Guard and Reserve Components (Army, Navy, Air Force, and Marines). While on active duty, these service men and women are eligible to obtain health care from the Military Health Service, and upon release from active duty, they return to their previous source of health care. Typically, they receive civilian employer-provided health care and seek care from civilian providers who may not be aware of their active duty tenure or exposures as a result of active duty. Although National Guard and Reserve Component Veterans from Operation Iraqi Freedom or Operation Enduring Freedom are eligible to register for care from the Veterans Health Administration upon release from active duty, not all take advantage of this opportunity.

      Policy Solution

      The nation's medical and nursing schools have pledged to support the Joining Forces initiative by including curricular content that includes military-related occupational exposures and hazards (

      Daniel, L. (2012, April 11). Nursing community pledges support for troops, families. American Forces Press Service, US Department of Defense News.

      ) to meet the unique health needs of service members. Although the initiative includes outreach to current providers, additional efforts are required to move beyond education into action at the provider-patient level. “The Have You Ever Served?” campaign takes a simplistic approach by asking providers to routinely ask all patients (men and women) if they have ever served in the military.
      Almost one in eight Americans is a veteran or related to one (

      Newport, F., (2012). In U.S., 24% of Men, 2% of Women Are Veterans. Gallop Politics. Retrieved from http://www.gallup.com/poll/158729/men-women-veterans.aspx.

      ). This single question (i.e., “Have you ever served in the military?”) on intake can be crucial to timely and adequate assessments, diagnosis, and treatment of an individual for military occupational health exposures. Health care providers, especially those in the civilian sector, and their veteran patients may not know the full effects and complexities of the occupational and environmental risks encountered in the military and the consequences they pose to health and future well-being. Military service has many unknown challenges and dangers that contribute to health problems that may not occur until well after the individual has left the armed forces. For example, recent studies also indicate that some birth defects found in children of veterans can be linked to exposures encountered during their parent's military service (
      Institute of Medicine
      Veterans and Agent Orange Update 2010 (Eight Biennial Update).
      ).
      Nurses have a vital role to play in the evolving campaign for more educated providers who are aware of the multifaceted and complex needs of this growing population. Nurses in all settings are often the first health care provider an individual sees and often do initial health assessments and office intakes. They may be viewed as “gatekeepers” and key referral pivot points for referring military veterans to the appropriate source of health care for military-related conditions.
      Nurses and other health care providers who are armed with the “Have You Ever Served in the Military?” pocket guide will be provided with questions to ask about common military-related exposures and with phone numbers and websites for referral purposes. Issues include post-traumatic stress disorder, homelessness, hepatitis C, assault, and trauma. Additionally, follow-up probing questions are also included on the guide. The pocket guide will assist health care providers in what to ask if patients respond “yes” to the have you ever served question.
      The legacy of Florence Nightingale is for the nursing profession to be on the front lines in providing care for our military veterans. Today is no different; nurses can and must be vigilant in asking their patients if they have served and must know about military-related exposures and appropriate treatment as well as proper referral sources. The American Academy of Nursing is launching the “Have You Ever Served in the Military?” campaign in support of the Joining Forces Initiative.

      References

      1. Daniel, L. (2012, April 11). Nursing community pledges support for troops, families. American Forces Press Service, US Department of Defense News.

      2. Department of Defense. (2013). Armed Forces Strengths Statistical Information Analysis Division. Retrieved from http://www.siadapp.dmdc.osd.mil/personnel/MILITARY/miltop.htm.

        • Institute of Medicine
        Veterans and Agent Orange Update 2010 (Eight Biennial Update).
        2011 (Washington, DC: The National Academies Press Inc.)
      3. Veterans Benefits. (2013). Compensation for Service Connected Disabilities or Death, Title 38 US Code Chapter 11, 36–396, Washington, DC: Government Printing Office.

      4. Kime, P. (2013, April 26). IG: Afghanistan FOB's broken incinerators force troops to keep using burn pits. Military Times. Retrieved from http://www.militarytimes.com/article/20130426/NEWS/304260026/IG-Afghanistan-FOB-s-broken-incinerators-force-troops-keep-using-burn-pits.

      5. Newport, F., (2012). In U.S., 24% of Men, 2% of Women Are Veterans. Gallop Politics. Retrieved from http://www.gallup.com/poll/158729/men-women-veterans.aspx.

        • U.S. Department of Veteran Affairs
        National Survey of Veterans National Center for Veterans Analysis and Statistics.
        2010 (Washington, DC)
      6. U.S. Department of Veterans Affairs. (2013). U.S. Veteran Compensation Programs. Children with Birth Defects Services. Retrieved from (http://www.veteranprograms.com/id114.html).