In late 2012, the Manhattan VA hospital, NY Harbor Healthcare System, opened an ED treatment area for female veterans, one of the first of 117 VA EDs to provide a private place for women. According to the Veterans Health Administration, women represent nearly 15% of military personnel, and one in five experience military sexual trauma during their service.
Aware that female veterans were in crisis because of multiple medical, emotional and psychological problems, and concerned the women felt uncomfortable being treated at a unisex ED, Curt Dill, MD, and Nancy Lutwak, MD, decided to provide a place where women would feel safe from unwanted male scrutiny in the waiting room and treatment area.
To meet this goal, an ED observation area was converted into a place where women were cared for by an all-female staff of nurses, physicians, psychologists and psychiatrists.
MST screening by a confidential listener is an important part of this process and is performed with a few questions, Lutwak said. If the healthcare provider asking them is clearly compassionate and has developed a rapport with the patient, there tends to be greater comfort answering them.
Lutwak, who serves as the womens health ED champion, said the program had been well received before Superstorm Sandy hit and flooded the hospitals ground floor, damaging essential equipment. This necessitated closure of the medical center for several months.
The full-service ED reopened during May 2013 with ongoing plans to include construction of a suite of interconnecting rooms with a larger self-contained womens area and a telecommunications system to provide therapy for greater numbers of MST survivors at other Harbor sites, she said. All treatment for physical and mental health problems and mental health conditions related to MST are free of charge, even for veterans not eligible for other VA services.
Lutwak said 4,665 female veterans were treated in VA hospital clinics in 2011.
This number grew by an additional 1,885 during the first quarter of 2012, according to our records, she said.
MST coordinator role
According to Marion C. Creasap, RN, PMHNP-BC, MST coordinator for the Manhattan VA Hospital and a psychiatric NP who treats and counsels both male and female veterans, MST includes sexual harassment that may include threats, sexual comments, unwanted touching and pressuring for sexual favors in exchange for preferential treatment by a superior officer or another person in a supervisory position.
Should sexual trauma occur due to alcohol or other related substances, its still considered MST, she said.
When requested, Creasap meets with individuals to assess their symptoms. Through an application process, she coordinates follow-up services that can include appointments at the hospitals PTSD womens clinic, therapy sessions for men and women and participation at a six- to eight-week residential program with locations throughout the U.S.
During the past two years, hospital statistics show 68% of female veterans received outpatient MST-related treatment within the NY Harbor Healthcare System.
These women range in age from early 20s to 50s with a few in their 60s and 70s, Creasap said. Veterans dont have to report MST at the time it occurred to be treated, and for some, disclosure may take 20 years or more after the trauma has occurred.
She said survivors have told her they feel less vulnerable through our team efforts to reduce feelings of guilt and shame.
Chief nurses respond
On a national basis, every clinical services employee in the VA is mandated to attend a MST course, and every patient must be screened for MST, said Cynthia Caroselli, PhD, RN, associate director for patient services and CNE for the VA NY Harbor Healthcare System.
Our nurses are sensitive and compassionate about womens health issues and are good at establishing a sense of safety that lends itself well to working with MST patients, she said.
Caroselli said the VA has a large number of resources that include skilled service providers and mental health programs. The MST program and other services for female veterans are expected to grow on a local and regional basis.
When women realize the VA is a safe place and theyre pleased with their experiences at one of our Manhattan, Brooklyn and Queens campuses, theyll be sure to tell others, she said.
Christine Engstrom, PhD, RN, CRNP, AOCN, the national acting chief nursing services officer with the VA in Washington, D.C., said the existing MST services and other programs for female veterans have created a national trend.
Were seeing more women veterans requesting services due to the gender-specific changes weve made within the VA, she said. As privacy, dignity and compassionate care are important values within the VA system, were changing the way we look at and treat women by making patient areas more comfortable for them. We provide many services for younger women and accommodate the needs of those with children, and weve expanded services for homeless female veterans, many of them young women.
Engstrom said word about the program has been spreading throughout the VAs patient population.
Through our national media department, VA website and word of mouth, were letting women know our service supports at VA hospitals and clinics are not just for men anymore, she said.
Joan Fox Rose, MA, RN, is a freelance writer.