By Jimmy CreedUniversity of Alabama at Birmingham (UAB) School of Nursing Professor Jacqueline Moss, PhD, RN, FAAN, is familiar with the United States military and its Veterans.
As the daughter of a 27-year Veteran of the United States Air Force, she learned first-hand of their backgrounds and their home lives. As an intensive care unit nurse for more than 20 years, she saw their suffering and treated their pain. In research partnership with the Veteran’s Health Administration, she has sought to understand their struggles and help find ways to address their issues. And as an educator of nurses, she has diligently worked to teach others that they must be specially attuned to recognizing and caring for this extraordinary group.
To improve awareness of Veterans’ health-care needs, Moss collaborated with colleagues, Associate Dean for Clinical and Global Partnership and Professor Cynthia Selleck, PhD, RN, FAAN, and Assistant Professor Randy Moore, DNP, RN, CCRN, 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,” has been published in the October/December 2015 issue of Advances in Nursing Science and currently is featured as an “Editor’s Pick” on the journal’s web site.
“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 said, a Veteran’s prior military service often isn’t 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 (QSEN) Competencies as a framework, Moss and her colleagues developed an initial 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.
At the outset, Moss and her colleagues asked nursing professionals in the Birmingham, Ala., area who are experts in caring for Veterans, for their review and feedback on the initial set of 10 Veteran Competencies and associated knowledge, skills and attitudes, they developed. These reviewers provided suggested wording changes to some of the knowledge, skills and attitudes and also added an 11th competency encompassing serious illness, especially at the end of life.
The 11 competencies were then sent to faculty members at nursing schools around the country that had academic partnerships with the VA. The faculty were asked to rate the competency areas and knowledge, skills and attitudes for relevance and also to suggest changes in wording for the competencies.
“What we got back from them was very rich,” Moss said. “They gave us excellent feedback and felt that most of the areas we put forth were either relevant or extremely relevant.”
One of the suggestions from the reviewers was to combine the areas of Veteran and military culture into one competency, which produced the final set of 10 competencies and associated knowledge, skills and attitudes for each. The overall competencies are:
- Military and Veteran Culture
- Post Traumatic Stress Disorder
- Amputation and Assistive Devices
- Environmental/Chemical Exposures
- Substance Use Disorder
- Military Sexual Trauma
- Traumatic Brain Injury
- Suicide
- Homelessness
- Serious Illness at End of Life
“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 Veterans health care research, Moss said. 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 (VANAP) in conjunction with the Birmingham Veterans Affairs Medical Center. This partnership -- which recently won the 2015 American Association of Colleges of Nursing (AACN) 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, 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.
“What we hope is going to happen is that schools of nursing with 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 that institutions that are hiring new graduates may also look and see where they might be able to incorporate them into their new-hire orientations.”
