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Tranaka Fuqua

on 19 October 2013

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Transcript of Copy of VETERANS

There are 21.5 million veterans in the United States.
1.6 million are female and 2.3 being male.
9.2 million are 65+ and 1.8 million are younger than 35.

• 13% of the homeless adult population are veterans
• 20% of the male homeless population are veterans
• 68% reside in principal cities
• 32% reside in suburban/rural areas
• 51% of individual homeless veterans have disabilities
• 50% have serious mental illness
• 70% have substance abuse problems
• 51% are white males
• 50% are age 51 or older

National Findings :
Veterans In South Carolina:
Between 2005-2011, 49,000 veterans committed suicide.

Suicide rates have a correlation with PTSD and substance abuse.
Younger veterans are more at risk.
In 2010, approximately 18 veterans died daily from suicide. 1 out of 5 suicides of those were veterans.

With 70% of veterans suffering from substance abuse, alcohol is the most prevalent abuse noted.

In 2008, there was a reduction in tobacco and other illicit drug use, however, there was an increase in prescription drug use.

Most veterans were initially exposed to prescription drugs during pain management and treatment of other mental health disabilities.

Depression is under diagnosed in veterans.
Roughly 14% of veterans experience depression.
Women more likely than men.

45% of veterans suffer from PTSD
Veterans report that they cope with PTSD by substance abuse
Older veterans are more likely to suffer from PTSD
Common Causes:
Losing a loved one
Not being in control
Not receiving enough support
Many veterans suffer from symptoms of anxiety because of past events like combat or a traumatic training experience that may be painful to remember or accept.

Another reason for anxiety is changing jobs or family conflicts.

The real issues arise when severe anxiety creates tremors and then affect socialization and effectively building relationships.

The Disease Cycle of
Homeless Veterans:
Depression & PTSD
Chemical & Radiation exposure = Cancers
Air pollutants: lung problems
Occupational hazards: lead, noise, fuels
Hep C/Hep A
Other mental health issues
Loss of limb(s)
Wheelchair bound
Traumatic brain injury
Eyesight injury

Many different services are available for veterans.

Veterans' access to care is based on their discharge status, eligibility, where they
live, transportation, willingness to seek care, etc.
Veterans need housing, nutritional meals, basic health care coverage, substance abuse help, emotional care, mental health care, job help, educational assistance, and placement assignment.
150,000 homeless veterans get health care
40,000 homeless veterans receive compensation
15,000 residential rehab/beds

*Government help is given but very limited. It is very important to lend a hand to our veteran community.
A 28 year old male returned home from his deployment in Iraq two months ago after his tank exploded. He lost his left arm and best friend. His deployment was a total of 4 years with three 2-week trips home. Upon this arrival home, he found out that his wife has left him for his brother and his baby girl was born while he was in Iraq. He has a history of anxiety and substance abuse. He is unable to find a job, he has insufficient funds, he hasn't seen his daughter, his wife kicked him out of their house and now she's filing for a divorce. He has recently been diagnosed with PTSD and his parents won't let him come home because they are worried about his alcoholism and substance abuse issues. He is currently sitting in the ED passed out from alcohol intoxication and his blood is currently being tested for other drugs.
Nursing Considerations:
What are the ethical issues at hand?

What is a priority nursing health issue for this patient?

What types of assistance might the nurse provide and recommend?

What concern would you guess has priority from the individual and family's perspective?

Veteran Overview:
What is a Veteran?
A veteran is defined by federal law, moral code and military service as "Any, Any, Any"...
A military veteran is Any person who served for Any length of time in Any military service branch.

What is a War Veteran?
A war veteran is any GI (Government Issue) soldier sent to foreign soil or waters to participate in direct or to support activity against an enemy.
The operant condition: Any GI sent in harm's way.

What is a Combat Veteran?
A combat veteran is any GI who experiences any level of hostility for any duration resulting from offensive, defensive or friendly fire military action involving a real or perceived enemy in any foreign theater.

421,525 veterans in SC (2012)

Veterans' Readjustment Counseling Centers
Veteran Association Specialized Homelessness Programs
Veterans Helping Veterans
Veterans of Foreign Wars, VFW
DAV: Disabled American Veterans
Veteran Inpatient/Outpatient Centers
VA Nursing Homes
General Homeless Shelters
Veteran Outreach Centers
Community AA/NA Meetings
Wounded Warrior Project
Afterlife Care For Veteran Families
Burial Allowances
Vocational Rehabilitation
Financial Assistance Programs
Unemployment Benefits
As of 2009, 23 million American Veterans were homeless.
Veterans are more at risk than non veterans to become homeless.
Women veterans are four times more likely to become homeless than men veterans.

Common causes:
Physical health disabilities from war where roughly 1 out of 10 veterans were disabled during active combat.
Veterans' inability to secure jobs due to substance abuse issues.
Lack of income and advocacy services
Mental health issues
Limited formal education
What does this mean for U.S veterans?

The Few, The Proud, The Brave...THE FORGOTTEN.

Samantha Birch
Cassandra Clary
Tranaka Fuqua
Stephanie Hunter
Jennifer Johnson

More Interesting Facts:

Over 90% of homeless veterans are male.

40% of all homeless veterans are African American or Hispanic, despite only
accounting for 10.4% and 3.4% of the U.S. veteran population, respectively.
9% of veterans are between the ages of 18 and 30, 41% are between 31 and 50 (when “only 5% of all veterans are between the ages of 18 and 30, and less than 23% are between 31 and 50.”)
Nearly half of homeless veterans served during the Vietnam era. Two-thirds served our country for at least three years, and one-third were stationed in a war zone.
Veteran Health Care In SC:
South Carolina Inpatient admissions,
statewide, fiscal year 2009: 9,930

Charleston: 4,417
Columbia: 5,513

Outpatient visits, statewide, fiscal year 2009: 1,329,000
Wartime Veterans: 318,951

Male: 376,644

Female: 44,881
• 13% of the homeless adult population are veterans
• 20% of the male homeless population are veterans
• 68% reside in principal cities
• 32% reside in suburban/rural areas
• 51% of individual homeless veterans have disabilities
• 50% have serious mental illness
• 70% have substance abuse problems

What Do These Statistics Imply?

They imply veterans in SC are utilizing the
resources available for them.

27.3% are tri-morbid, meaning they suffer from mental illness, physical illness, and substance abuse at the same time.

1. Again, around 70% of veterans are surveyed to have alcohol/substance abuse issues.

2. About 56% of veterans have "serious health conditions" such as immobility (26.3%), Heart disease (15.8%), Hepatitis C (10.6%), Liver Disease (6.8%), Emphysema(6.1%), Frostbite (5.4%-decreased in recent years due to development of homeless shelters), TB (4.4%), HIV/AIDS (3.6%).

3. Just under half of veterans (especially those recently from Iraq) have reported mental illness, brain damage(27%), and/or are being treated by a mental illness institution (46%).

Homeless Veteran Morbidity Overview:
Metcalf, H. (2013). South carolina division of veterans' affairs. Retrieved from
Department of Veterans Affairs. (2010, November). Department of Veterans
Affairs State Summary. In United States Department of Veterans Affairs. Retrieved October 1, 2013, from http://www.va.gov/opa/publications/factsheets/ss_southcarolina.pdf
Department of Veterans Affairs. (2013, August 30). Veteran Population In
South Carolina. In United States Department of Veterans Affairs. Retrieved October 5, 2013, from http://www.va.gov/vetdata/Veteran_Population.asp
U.S. Department of Veterans Affairs. (2011, November). National Survey of
Homeless Veterans. In United States Department of Veterans Affairs. Retrieved September 23, 2013, from http://www.va.gov/HOMELESS/docs/NationalSurveyofHomelessVeterans_FINAL.pdf
National Coalition for Homeless Veterans. (2012, May). Background &
Statistics for Homeless Veterans. In National Coalition for Homeless Veterans. Retrieved September 13, 2013, from http://nchv.org/index.php/news/media/background_and_statistics/
The Plea of The Veteran...
As of September 30, 2008, the estimated number of living veterans was 23,440,000. Of those, 8,493,700 received VA benefits and services in 2008. Some received services from one program only, while others qualified for and received multiple program services.
As of September 30, 2008, the estimated number of living veterans was 23,440,000. Of those, 8,493,700 received VA benefits and services in 2008. Some received services from one program only, while others qualified for and received multiple program services.
Between 2000 and 2009, the unemployment rate of veterans rose from 3% to 8%. The non-veteran population went from 4% to 9%.
National Center for Veterans Analysis and Statistics. (2010, December).
National Center for Veterans Analysis and Statistics: Selected Research Highlights. In U.S. Department of Veteran Affairs. Retrieved October 9, 2013, from http://www.va.gov/vetdata/docs/QuickFacts/Reports-slideshow.pdf
Suicide prevention is one of the most major challenges for clinicians while dealing with veterans in the clinical setting.

Primary Prevention:
The goal is to promote awareness.

Educate the public that suicide is a public health problem that is preventable.
Reduction of number of new cases
Effective identification and treatment of psychiatric and mood disorders

Conduct Screenings for Veterans:
 -Beck Hopelessness Scale
 -Clinical Interviews

“Modification of social, economic, and biological conditions, such as reduction of poverty, violence, divorce rates, and promotion of a healthy lifestyle…”

Secondary Prevention:
The goal is to decrease the likelihood of a suicide attempt in the high-risk patients (veterans).

Direct Talks
Work to improve the coping strategies of persons who would seriously consider suicide
Ask about depression, assess suicide plans and methods
Offer hope for a better life after current problems are resolved

Refer refer refer!
Reduce sadness and provide assurance that others care
Lethal Means Reduction
Reduce the odds that a suicide attempter will use highly lethal means
Firearm access is associated with increased suicide risk!!
• “Delay action until depression passes”

Secondary Prevention Con't:

Assess where the patient is on the continuum of suicidal behavior (ideas to gestures, to risky lifestyles, suicide plans, suicide attempts, and, finally, suicide completion)
“Best predictor of suicidal behavior is a history of a suicide attempt and current suicidal thoughts”
Provide treatment of existing psychiatric illnesses
Routinely ask patient about current depression, hopelessness, and suicidal ideation
Risk of suicide should be considered imminent
If the patient reports the intention to die, has a suicidal plan, has lethal means available, expressions of despair and hopelessness
Comorbid depression and alcoholism may indicate short-term risk of suicide

Tertiary Prevention:
The goal is to diminish the consequences of suicide attempts.

Assessment of family members who may be influenced by the suicide attempt and may attempt suicide themselves

“Veteran” is an all-encompassing term that lumps every former service member into a group of special individuals. Every person has their reason for serving and every person has their reason for getting out.
Morbidity Summary:
Goals for primary, secondary, and tertiary prevention of societal violence and
related community. (n.d.). Retrieved October 13, 2013, from http://wps.prenhall.com/wps/media/objects/4038/4135376/tools/Tables/Table_32-6.pdf
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