Veterans' needs drive the development of new nursing competencies
As the daughter of a 27-year veteran of the U.S. Air Force, and herself an intensive care nurse for more than 20 years, University of Alabama at Birmingham School of Nursing Professor Jacqueline Moss, Ph.D., is familiar with the U.S. military and caring for its veterans.
In a research partnership with the Veterans Health Administration, Moss has sought to understand veterans' struggles and to help find ways to address their issues. As an educator of nurses, she has worked to teach others that they must be specially attuned to recognizing and caring for this group.
To improve awareness of veterans' health care needs, Moss collaborated with colleagues, Associate Dean for Clinical and Global Partnership and Professor Cynthia Selleck, Ph.D., and Assistant Professor Randy Moore, R.N., to develop a set of competencies designed to help new nurses be better prepared to identify and assist veterans and their families across the health care continuum.
The resulting research paper, "Veteran Competencies for Undergraduate Nursing Education," was published in the October/December 2015 issue of Advances in Nursing Science and is featured as an "Editor's Pick" on the journal's website.
"There are 23 million military veterans living in the United States, and more than 16 percent have service-connected disabilities, yet only about 38 percent of those receive any portion of their health care at a VA facility," Moss said. "That means 62 percent are receiving care at community hospitals, university medicals centers, local clinics and the like. So any nurse anywhere can encounter a veteran."
In clinical settings outside the VA, Moss says, a veteran's prior military service often is not recognized—or even mentioned—so a nurse can be unaware of potential issues related to a patient's military service that can arise.
"Veterans come with unique backgrounds and needs, and it is imperative that nurses are adequately prepared to care for veteran patients and their families, regardless of the setting in which they practice," Moss added.
Using the Quality and Safety Education for Nursing Competencies as a framework, Moss and her colleagues developed a set of 10 competencies and associated knowledge, skills and attitudes new nurses need to be able to adequately care for veteran patients and their families.
The QSEN Competencies are guidelines that have been developed as part of a national project to prepare future nurses with the knowledge, skills and attitudes to continuously improve the quality and safety of the health care systems in which they work, and provide the best care possible for the patients they serve. The overall competencies are:
- Military and veteran culture
- Post-traumatic stress disorder
- Amputation and assistive devices
- Environmental and chemical exposures
- Substance use disorder
- Military sexual trauma
- Traumatic brain injury
- Serious illness at end of life
At their core, the competencies are the basic tools nurses need to help them recognize veterans, recognize whether they have a problem, and determine whether they can address it themselves or need to refer it to someone else.
"Wherever you practice, you are going to encounter veterans," Moss said. "Understanding their experiences and knowing what to look for, how to intervene and when to refer are extremely important skills for nurses, and we want to do our best to make sure they have these skills."
The UAB School of Nursing and its faculty are uniquely positioned for this and other veteran health care research. The school has a strong working relationship with the U.S. Department of Veterans Affairs, which since 2009 has included the VA Nursing Academic Partnership in conjunction with the Birmingham Veterans Affairs Medical Center. This partnership—which recently won the 2015 American Association of Colleges of Nursing Exemplary Academic-Partnership Award—is part of an initiative to facilitate stronger and mutually beneficial ties between schools of nursing and VA Medical Centers across the country, and it has provided unique insights that shaped the competencies.
This is something Moss hopes other schools of nursing and health care institutions hiring new graduates will note as they consider implementing the work.
"We hope schools of nursing will take these competencies and knowledge, skills and attitudes and see where they might be able to implement either some or all of these suggestions into their curriculum," Moss said. "We also hope institutions that are hiring new graduates may also look and see where they might be able to incorporate them into their new-hire orientations."