Developing Nursing Care of the Wounded Warrior Competencies: Using Evidence to Inform Practice

Practicing nurses and nursing students make a dramatic and positive impact on the long-term health of hundreds of thousands of veterans. It is imperative that professional nursing trains and develops nurses to meet the needs of the changing landscape facing our nation as the current conflicts draw down and our nation’s Heroes return to their hometown. Health care providers and nursing students throughout this country need to have fundamental understanding about nursing care of the wounded warrior and family, to effectively recognize emotional, physical, and spiritual conditions and develop nursing interventions that positively impact health care outcomes for our veterans.  There is a need for the development of competencies constructed to provide care for the wounded warrior.  Competency development must use evidence to inform practice and recognize the patient as a full partner in the care process.

Therefore, a collaborative inter-professional academic-practice partnership model comprising two baccalaureate nursing programs in the Southeast and a military medical center was established. The objective of this partnership is to collaboratively develop inter-professional training that provides the best opportunities for nursing  students to conceptualize the challenges faced by returning Service Members and Veterans, enrich nursing education to ensure that current and future nurses are educated and trained in the unique clinical challenges, contribute to establishing best practices associated with caring for military service members, veterans, and their families, and disseminate the most up-to-date information as it relates to traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and amputations. 

The student experience includes three phases; pre-“deployment”, deployment, and post-deployment.  The pre-deployment phase includes activities and readings that introduce the nursing student to (a) military culture, (b) deployment and the effects on the veteran and family, (c) providing nursing care to veterans with war-related injury to include poly-trauma, amputations, post-traumatic stress disorder, and traumatic brain injuries, (d) explore evidence-based practice regarding war, and (e) prepare to lead changes in community hospitals to care for the veteran and family.  Additionally, data is collected as a pre-deployment survey (question locally) to assess student perception of perceived competency in providing care for wounded warriors. The deployment phase (engage regionally)included the 7-day experience where students were on-site at the national military medical center in units spanning all phases of care for the wounded to include acute, chronic, psychological services, and community integration agencies.  The post-deployment phase included a post- survey assessing student perception of perceived competency in caring for the wounded warrior, reflective journaling, an educational tool designed for warrior education on self-care, and submittal of qualitative statements used to construct national nursing competencies for students caring for the wounded (apply globally).  Competencies are built on Quality and Safety Education in Nursing (QSEN, 2004) core Competencies using the categories of knowledge, skills and attitudes.