Sharon A.
Denham, PhD, RN, CNE
Texas Woman’s University Houston J. & Florence A. Doswell Endowed Chair in Nursing for
Teaching Excellence
Care for theFamily
International Veteran
Nursing AssociationFamily
August, 2019
PARTICIPANT OUTCOMES
OBJECTIVES
Identify veterans as a population at risk with distinct nursing care needs.
Increase nurses’ and nursing students’ awareness about risks associated with
military service, deployment, and being part of a military family.
Describe things to address in a nursing assessment, care plan, and interventions when
caring for a veteran or veteran’s family.
CRIMEAN
WAR
TEAM OF 34
NURSES
ACTIVE-DUTY FORCE IS DECREASING IN SIZE
ARMY IS THE LARGEST BRANCH OF ACTIVE DUTY (36% IN 2015)
LARGELY MALE DOMINATED (ABOUT 1/5 ARE WOMEN)
IN 2015: 44% WERE BETWEEN 18 - 44 YEARS OF AGE &
RACIAL/ETHNIC COMMUNITIES
MILITARY OFFICERS ARE BETTER EDUCATED (8 IN 10 HAVE BS; 42%
HAVE ADVANCED DEGREE)
ARMY NATIONAL GUARD = 42%
ARMY RESERVE = 24%
AIR NATIONAL GUARD = 13%
AIR FORCE RESERVE = 8%
NAVY RESERVE = 7%
MARINE CORPS RESERVE = 5%
COAST GUARD RESERVE = 1%
ACTIVE RESERVE (2015) = 826,106
INACTIVE RESERVE (2015) = 275,247
National Guard = 336,000
Army Reserves = 107,700
SIZE OF
BRANCH OF
WAR/CONFLICT NUMBER SERVING BATTLE DEATHS
SERVICE
REVOLUTIONARY WAR 1775 - 1783 4,435
WAR OF 1812 1812 - 1815 286,730 1,950
ARMY & NAVY
CIVIL WAR 1861 - 1865 2,213,363 140,414
ARMY, NAVY & MARINES
WORLD WAR I 1917 - 1918 4,734,991 53,402
ARMY, NAVY & MARINES
WORLD WAR II 1941 - 1946 16,112,566 291,557
ARMY, NAVY, MARINES & AIR FORCE
KOREAN WAR 1950 - 1953 5,720,000 33,739
ARMY, NAVY, MARINES & AIR FORCE
VIETNAM CONFLICT 1964 - 1973 8,744,000 47,434
ARMY & NAVY
PERSIAN GULF WAR 1990 - 1991 1,740,000 1,745
WAR TOTAL DEATHS BATTLE DEATHS WOUNDS NOT MORTAL
REVOLUTIONARY WAR 4,435 4,435 6,188
WAR OF 1812 2,260 2,260 4,505
CIVIL WAR 364,511 140,414 281,881
WORLD WAR I 116,516 53,402 204,002
WORLD WAR II 405,399 113,842 670,846
KOREAN WAR 36,574 2,835 103,284
HOSPITAL CARE: 153,303
VIETNAM CONFLICT 58,220 10,786 NO HOSPITAL CARE: 150,341
HOSPITAL CARE: 931
PERSIAN GULF WAR 2,586 841 NO HOSPITAL CARE: 2,518
HOSTILE NON-
WAR/CONFLI TOTAL WOUNDED IN
CASUALITIE HOSTILE GENDER AGE GRADE
CT DEATHS ACTION
S CASUALTIES
Operation <22 = 512
Enduring 22 - 24 = 537 E1 - E4 = 1,122
FEMALE = 49 FEMALE = 383
Freedom (OEF)
- THROUGH
1,845 502 MALE = 2,298
25 - 30 = 728
31 - 35 = 307
E5 - E9 = 930 2,347 MALE = 19,654
OFFICER = 295
JULY 2019 >35 = 307
<22 = 12
OPERATION 22 - 24 = 15 E1 - E4 =38
FEMALE = 1 FEMALE = 13
NEW DAWN 38 74 MALE = 73
25 - 30 = 26
31- 35 = 6
E5 - E9 = 27
OFFICER = 9
74 MALE = 284
(OND)
>35 = 15
OPERATION <22 = 15
22 - 24 = 13 E1 - E4 = 26 FEMALE = ??
INHERENT FEMALE = 7
RESOLVE 16 68 MALE = 77
25 - 30 = 22
31 - 35 = 11
E5 - E9 = 38 84 MALE = 71
NON-SPECIFIED = 8
OFFICER = 20
(OIR) >35 = 23
<22 = 1,283
OPERATION 22 - 24 = 1,073
E1 -E4 = 2,539
IRAQI FEMALE = 110 25 - 30 = 1,126 FEMALE = 627
FREEDOM 3,481 929 MALE = 4,300 31-35 = 427
E5 -E9 = 1,444
OFFICER = 427
4,410 MALE = 31,219
>35 = 501
(OIF)
DEFENSE CASUALTY ANALYSIS SYSTEM
https://dcas.dmdc.osd.mil/dcas/pages/casualties_oif.xhtml
US MILITARY CASUALTIES - OPERATION ENDURING FREEDOM
NON - HOSTILE DEATHS
AS OF JULY 26, 2019
CASUALTY CATEGORIES ARMY NAVY MARINES AIRFORCE TOTALS
NON-HOSTILE
Accident 194 24 52 34 304
ILLNESS/INJURY 39 12 5 5 61
HOMICIDE 10 0 3 0 13
SELF-INFLICTED 83 6 19 5 113
UNDETERMINED 7 1 1 1 10
PENDING 0 1 0 0 1
TOTAL NON-HOSTILE DEATHS 333 44 80 45 502
WOMEN IN THE MILITARY
▸ 2011 = 203,000 (14.5% of active duty force)
▸ Women make up 2.7% of military frontline units
▸ Most are in medical (30.5%) or administrative specialties (30.1%) - most female officers are in the medical field
▸ Nearly one-third (31%) of active-duty women are black compared with only 16% of men
▸ About 97% feel proud of their service
▸ Military women less likely than male counterparts to be married (46% vs. 58%), those who marry are more likely than men to wed
someone who is in active-duty military (48% vs. 7%)
▸ About 50% say they experienced strains in family relations; 42% feel they have suffered from post- traumatic stress
PEW SOCIAL & DEMOGRAPHIC TRENDS
https://pewresearch.org/wp-content/uploads/sites/3/2011/12/women-in-the-military.pdf
WOMEN VETERANS
‣ The largest living cohort of female Veterans served during the Post-9/11 period (September 2001 or later).
‣ 9% of Veterans are females - Median age is 51 years.
‣ Female Veterans = More likely to be Nonwhite non-Hispanic, more likely to be divorced or separated, less likely to be uninsured, less likely to live below
poverty, and have higher personal incomes than female non-Veterans.
‣ Expect number of females in military to double in next 25 years
‣ Female Veterans were - More likely to have completed some college, a bachelor’s degree, or an advanced degree, or be enrolled in college.
‣ About 45% of Veteran men and 31% of Veteran women have access to public and private healthcare insurance.
‣ Female Veterans are more likely to work in management, business, science, and arts occupations than employed male Veterans.
‣ Female Veterans are more likely to have a service-connected disability rating.
‣ Female Veterans are less likely to use VA health care at all OR more likely to use VA health care services only.
‣ Female Veterans are more likely to have no personal income and live in poverty.
Musculoskeletal Injuries - Acute Incidents and Chronic Body Stresses
• Almost 50% of military experience 1+ injury each year.
Military/Veteran Risks
• Results in over 2,000,000 medical encounters annually.
• Requires 90-120 or more days of restricted work or lost duty time, and treatment costs. Injuries
• Most = Overuse strains, sprains, & stress fractures; most to lower extremities. ‣ Shrapnel & gunshot wounds
• More than 50% of injuries are exercise or sports-related (e.g., running). ‣ Lost limbs
• Back and shoulder injuries are common (e.g., lifting & carrying activities).
‣ Head and brain injuries
Occupational Hazards: Asbestos, Industrial Solvents, Lead, Radiation, ‣ Tinnitus - hearing loss
Fuels, PCBs, Noise/Vibration, Chemical Agent Resistant Coating (CARC) ‣ Sprains & strains
‣ Limited range of motion (i.e., ankles, knees)
Infectious Diseases: Malaria, Brucellosis, Campylobacter jejuni, Coxiella burnetii,
Mycobacterium tuberculosis, nontyphoid Salmonella, Shigella, visceral
Leishmaniasis, West Nile Virus Female Risks: Hazardous Exposures
‣ Military Sexual Trauma
• Asbestos
Mental Health ‣ Urinary Track Infections
• Burn Pit Smoke
‣ Mental Health Disorders
‣ Depression ‣ Prosthetics Based on Male
• Cold Injuries
‣ Traumatic Brain Injury • Contaminated Water (benzene,
Physiology
‣ Post-traumatic Stress trichloroethylene, vinyl chloride)
‣ Back Injuries
• Endemic Diseases
‣ Alcohol Abuse/Binge Drinking ‣ Unemployment
• Heat Stroke/Exhaustion
‣ Substance Abuse ‣ Homelessness
• Hexavalent Chromium
‣ Suicide • Mustard Gas
• Nerve Agents
Other Risks: • Pesticides
‣ Deployments • Radiation (Ioning and Non-Ionizing)
‣ Multiple deployments • Sand, Dust, Smoke, and Particulates
Men die by suicide 3.5 times higher than women ‣ Reintegration into civilian life • TCDD and other dioxins
‣ Employment post separation
Veterans have a 41 - 61% higher suicide rate than those ‣ Chronic pain
that have not served in the military ‣ Amputations Homelessness
‣ Disfigurement
Survive injuries at the cost of a traumatic limb amputation and associated mental scarring
VETERAN FAMILIES
‣ Male Veterans = 17,790,975 & Female Veterans= 1,595,614 (National Center for Veterans Analysis & Statistics, 2016)
‣ Normal life: Training and medical evaluations that maintain personal and unit readiness levels.
‣ Military Deployment: Activities required to move military personnel and materials from a home installation to a specified
destination. (It has come to mean the preparations & personal needs to care for at home before, during and after deployment).
‣ Deployment: Can be a stressful time for service members and families when the realities of deployment are faced (eg., what it
means for them).
‣ Post-deployment: Reintegration into family life and the community, reintegration into regular military duties (i.e, families may
experience stress during this phase).
FAMILY - CARE SERVICES
‣ State Area Command (STARC) within the State National Guard Military Headquarters —- Usually activate a Family Assistance Center (FAC) when a reserve
unit is mobilized (e.g., current information about availability of family supports within the state).
‣ Other Services: Professional counseling about financial management; re-location services; information for families with member with a special need;
career resource center; professional counseling; family advocacy programs, legal assistance.
‣ Risks —- Number of deployments, length of deployments, risks associated with deployments.
‣ Emotional Cycles: Frequent moves, absence of a parent, stress related to fear and anger, managing detachment & withdrawal, loneliness, additional family
duties, learning new skills, make new friends, changes in schools for children, fear & anxiety, financial difficulties, understanding what military person is
facing, children’s responses (depend on age, maturity, behavioral/mental health concerns).
‣ Living with Post-traumatic Stress and Related Problems (e.g., anger, sleep, depression, substance abuse, suicide risk).
‣ Traumatic Brain Injury (i.e., associated symptoms - mild, moderate, severe).
‣ Suicide Risks
‣ Children’s Coping: Communication, listen & watch, observe temperament (i.e., altered sleeping, anger, clinging behaviors, physical complaints, needs for
attention, sadness).
▸ Suicide (28.1%)
MILITARY DEATHS
▸ Transport accidents (18.3%) Death Gratuity
A payment of $100,000 (tax free) — Paid to the next of kin for the following:
• A member who dies while on active duty or while on authorized travel
▸ Other accidents (9.3%)
• A reservist who dies while on inactive duty training or on authorized travel
• A ROTC member who dies while performing annual training duty under orders for a period of more
▸ Combat (9.0%) than 13 days, or on authorized travel
• A person who has been accepted to active duty and dies while traveling to or from that place or
under orders
▸ Cancer (8%)
Tricare
Surviving spouses & unmarried children of deceased active duty or retired service members are
eligible if the sponsor was serving or was ordered to active duty for more than 30 days at time of death.
• Claims are cost-shared at the active duty family member rate for three years after death of active
duty sponsor, and thereafter at the retiree rate.
• Widows or widowers remain eligible until they remarry (loss of benefits remains applicable even
if remarriage ends in death or divorce).
• Children remain eligible until age 21, unless they meet the exceptions above.
Death Pension
Benefit paid to eligible dependents of deceased wartime veterans. You may be eligible if:
• The deceased veteran was discharged from service under other than dishonorable conditions, AND
• They served 90 days or more of active duty with at least 1 day during a period of war time (however,
the law requires that anyone who enlists after September 7, 1980 generally has to serve at least 24
months or their full enlistment in order to receive any benefits based on that period of service. AND
• You are the surviving spouse or unmarried child of the deceased veteran, AND
• Your countable income is below a yearly limit set by law.
NEEDS FOR VETERAN-CENTRIC
▸ CONTENT IN NURSING CURRICULA
Over 22 million veterans reside in the U.S. (National Center for Veterans Analysis and Statistics, 2015) —- What is the potential
number of family members (MAYBE = 44 million persons???)
▸ Some Veterans seek health care at the Veteran Health Administration and civilian treatment centers.
▸ Nurses need knowledge about Veteran’s complex health issues, mental and behavioral adjustment disorders, wartime era, and
civilian reintegration obstacles that can magnify their health condition.
ASSESSMENT QUESTIONS
▸ #1 —- Are you a Veteran?
▸ #2 —- Are you part of a military family?
[email protected]
