More than 5 million military veterans live in rural areas of the country and experience difficulties obtaining access to health services and wellness promotion efforts. Nurses are among those trying to change that fact.
“Rural nurses need to be aware of the veterans [in their communities] and their needs,” said Angeline Bushy, PhD, RN, PHCNS-BC, FAAN, chair of community health nursing at the University of Central Florida’s College of Nursing in Orlando. “When we meet a patient for the first time, one of the first questions we should ask is, ‘Have you ever served?’”
Then the nurse can thank patients for their service and ask where the veteran served, in what branch of the military and if they saw combat.
“That can be a clue to what is going on and the emotional and physical challenge the person is dealing with,” Bushy said. She incorporates that advice into her classes.
Cindi Warburton, DNP, FNP-C, emergency department manager at St. Charles Health System in Bend, Ore., studied the state’s rural women veterans’ healthcare for her doctoral clinical inquiry project. She found community providers in rural Oregon did not ask about patients’ military service.
Many of the women Warburton interviewed suffered from depression or post-traumatic stress disorder, but the providers tended to treat the condition and not delve into the reasons behind it, she said.
“Getting somebody who is a veteran who may have PTSD or military sexual trauma-related health outcomes connected back to the VA would be important, and that wasn’t happening,” said Warburton, a Jonas Center for Nursing and Veteran Healthcare Scholar in 2013. She received a scholarship, honed her leadership skills and worked with Oregon’s Campaign for Action.
Warburton developed a veteran screening tool used at the clinic where she worked. She gave testimony to the Oregon state legislature about her findings, which led to funding for further research by other individuals. She also created educational materials and met with clinicians at other community health clinics and provided information about identifying veterans, treating health issues particular to the veteran population and connecting them to VA services.
The U.S. Department of Veterans Affairs reports that 5.3 million vets, or 24%, live in rural areas. About 57% of these veterans are enrolled in the VA healthcare system, with the number enrolled increasing by 7% from 2006 to 2014. About 6% of rural vets enrolled in the VA are women. That meshes with Warburton’s finding that most women veterans were using community providers.
“They felt like going through the VA was not convenient or welcoming,” Warburton said. “Some wanted to leave their military experience behind them and some felt that benefit should be used by veterans who need it more.”
More than half of rural vets cared for at VA facilities are ages 65 and older, and the VA reports rural veterans have greater healthcare needs and lower quality-of-life scores than urban-living vets.
Veterans may need to drive many miles to a VA facility and miss a couple of days of work making the trek, said Bushy, a veteran who recently was appointed to serve on the U.S. Veterans Rural Health Advisory Committee. As a member of the committee, she hopes to provide insights into veteran and rural residents’ needs, having lived in such communities in the past. Since joining the committee, she has learned about challenges veterans are facing with seeking care from community providers and the shortage of primary care providers.
“We’re looking to see what’s there and how it can be improved,” Bushy said. “There are best practice models out there, and rather than putting something new in place, let’s see what’s there and how it can be improved.”