Veteran Population Jennifer H. Stokes Liberty University Learning Outcomes After reviewing this presentation, the reader will be able to: 1. Describe characteristics of PTSD in women veterans. 2. Identify barriers to care in this population. 3. Evaluate all aspects of care that must be considered in caring for patients with PTSD. 4. Develop ways to apply current evidenced based practice guidelines in their current area of practice. Women Veterans Women veterans (WV) have been identified as a special population within the Department of Veteran Affairs Healthcare System (VHA). WV are one of the fastest growing groups of new users in the VHA, with particularly high rates of utilization among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). According to the National Center for Veteran Analysis and Statistics (NCVAS), in 2010, the number of WV was 2,204,790. In 2013, this number increased to 2,271,222. Women Veterans cont. According to Bean-Mayberry et al. (2011), Women are one of the fastest growing groups of new users in the Department of Veterans Affairs (VA) Healthcare System, with particularly high rates of utilization among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), (p. 86). WV and Post Traumatic Stress Disorder In FY 2009 and FY 2010 PTSD, hypertension, and depression were the top three diagnostic categories for women Veterans treated by VHA. Female veterans with PTSD have complex mental health profiles. PTSD can occur following the experience or witnessing of a life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood. Why so Important? Within the Primary Care (PC) setting, providers are more likely to identify at risk patients. Studies have shown that co-morbid conditions can be directly linked to the diagnoses of PTSD. For example, WV identified to have chronic gynecological problems may have undiagnosed PTSD. According to Cohen et al. (2013), there is a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression, (p. 469). Barriers to Care Due to the specialty nature of womens health, WV may be reluctant to engage services for the treatment of PTSD. Seeking care for the symptoms felt by those suffering from PTSD can be seen as a weakness. In the WV population, the fight for equality can deter their willingness to admit to any coping deficits. WV may not feel comfortable seeing care within the VA system as it provides a constant reminder of their military roots. Care Considerations Cultural and spiritual characteristics of patients are essential to providing holistic care. Tran, Kuhn, Walser, & Drescher (2012) in their study found, A more negative concept of God was associated with higher severity of PTSD and depressive symptoms, whereas, a more positive concept of God was associated with lower severity of depressive symptoms and was not significantly associated with PTSD symptoms, (p. 313). Incorporating a patients spiritual well-being is essential to successful outcomes. Care Considerations Social well-being should also be a key focus in treating WV diagnosed with PTSD. A sense of belonging or not belonging can be a significant barrier to positive treatment outcomes. The social stigmas that surround patients diagnosed with PTSD can cause patients to be noncompliant with treatment regiments. Lehavot, Der-Martirosian, Shipherd, Simpson, & Washington (2013) found, Screening positive for PTSD was associated with poorer health and increased VHA utilization whereas greater military social support was associated with better health and less frequent VHA utilization, (p. 774). Cultural Considerations The care delivered to a patient is only as good as its applicability. Plans of care must be formulated to the patient and their specific needs and goals. Understanding the culture in which the patient lives and breaths is as important as their living and breathing. Campinha-Bacote (2011) stated, At the core of both patient centeredness and cultural competence is the importance of seeing the patient as a unique person, (para. 1). Skills in cultural competence are as essential and performing basic life support. Trends in Treatment Cognitive behavioral therapy has been identified as successful in the treatment of PTSD in WV. Group therapy allows for the WV to feel that she is not alone and there are others like her. This allows for effective sharing of her current health state. Patients diagnosed with PTSD will need both pharmacological and non-pharmacological treatment to provide for the best possible outcomes. Healthcare providers must foster therapeutic relationships that will allow for open communication with patients and their families Education for patients and families is key to positive outcomes. Thoughts for Improvement Incorporating a multidisciplinary approach in the treatment of any disease has been found to be beneficial towards patient outcomes. For example, a shared medical appointment that incorporates group therapy, nursing, and a pharmacists. This would allow patients to have all needs met at this one appointment. Healthcare providers must ensure that all avenues of care are incorporated in the treatment plan. This includes cultural and spiritual. This plan must also include the patient and any support systems they may have at their disposal. Patient buy-in is imperative to compliance with any established treatment regiment. References Bean-Mayberry, B., Yano, E. M., Washington , D. L., Golzweig, C., Bautman, F., Huang, C., , & Shekelle, P. G. (2011). Systematic review of women veterans health: update on successes and gaps. Womens Health Issues, 21(4), 84-97. Retrieved from http://dx.doi.org/10.1016/j.whi.2011.04.022 Bomyea, J., & Lang, A. J. (2012). Emerging interventions for PTSD: Future directions for clinical care and research. Neuropharmacology, 62(2), 607-616. Retrieved from http://dx.doi.org/10.1016/j.neuropharm.2011.05.028 Bonner, L. M., Lanto, A. B., Bolkan, C., Watson, G. S., Campbell, D. G., Chaney, E. F., , Rubenstein, L. V. (2013). Help-seeking from clergy and spiritual counselors among veterans with depression and PTSD in primary care. Journal of Religion and Health, 52(3), 707-718. Retrieved from http://link.springer.com.ezproxy.liberty.edu:2048/article/10.1007%2Fs10943-012-9671-0 Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online Journal of Issues in Nursing, 16(2), 5. DOI: 10.3912/OJIN.Vol16No02Man05 References Lehvaot, K., Der-Martirosian, C., Simpson, T, L., Shipher, J. C., & Washington, D. L. (2013). The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans. Journal of Traumatic Stress, 26(6), 772-775. DOI: 10.1002/jts.21859 Mohr, S. (2011). Integration of spirituality and religion in the care of patients with severe mental disorders. Religions, 2(1), 549-565. doi:10.3390/rel2040549 Tran, C. T., Kuhn, E., Walser, R. D., & Drescher, K. D. (2013). The relationship between religiosity, PTSD, and depressive symptoms in veterans in PTSD residential treatment . The Journal of Psychology and Theology, 40(4), 313. Retrieved from http://go.galegroup.com.ezproxy.liberty.edu:2048/ps/i.do?action=interpret&id=GALE%7CA3145 65111&v=2.1&u=vic_liberty&it=r&p=AONE&sw=w&authCount=1 US Department of Veterans Affairs (2014). Facts and statistics about women veterans. Retrieved from http://www.womenshealth.va.gov/WOMENSHEALTH/latestinformation/facts.asp#sthash.JBIaMI Nr.dpuf