You Would Think Coming Home is the Easy Part: Cultural Competence for Healthcare Providers in Caring for Veterans and their Families

The horror of war transcends geography and culture. It is a merciless universal language, spoken and understood by veterans around the world. Military service, whether during war or peace time,-fraught with occupational and environmental hazards-can have a negative impact on veterans’ physical and mental health. In the United States, there are approximately 23 million living veterans (U.S. Census Bureau, 2010). Only 25% seek healthcare through the Veteran’s Administration (U.S. Department of Veterans Affairs, 2013). Over 17 million are treated by civilian providers.  The military has its own unique culture of language, learned behaviors, and rituals.  It is well documented that cultural competence reduces health disparities and increases access to care for diverse populations (Campinha-Bacote, 2011; Like, 2011). Cultural competence has a positive effect on outcomes, enabling providers to serve patients with a deeper understanding of and respect for health beliefs, practices, and cultural needs.  Yet, many healthcare providers, as well as nursing and medical students, report they lack knowledge specific to caring for veterans and their families (Brennan, 2010;Institute of Medicine, 2011).  

As military culture is distinctive, it is paramount that providers achieve true cultural competency with this important and vulnerable population. “For civilian health care providers, an understanding of military culture, an ability to listen and respond without judgment, and respect for a veteran’s military service are essential to caring for veterans” (Johnson, et al., 2013, ¶ 58). These qualities will also enhance veterans’ willingness to seek and obtain civilian health care.

The Road Home Program: The Center for Veterans and their Families at Rush (RHP) has taken this issue to heart and is piloting a hybrid military cultural competency training program for nursing staff, faculty, and students at Rush University Medical Center(RUMC) in Chicago, Illinois. Launched in early 2014, the RHP provides comprehensive diagnostic, treatment, and referral services at RUMC and through a network of collaborating community agencies. The ultimate goal is to ensure that veterans and their loved ones connect with the care, services, and resources that will ease or overcome the complex and far-reaching effects of their military service experience. The current client base has exceeded initial goals and serves over 100 veterans and their families.

The addition of educational resources for nurses, nursing students and eventually other civilian healthcare providers will serve as a “force multiplier” to positively influence the care of veterans on a local, national, and international basis.  Objectives of the course include understanding military culture, the unique healthcare needs of veterans and their families, conditions such as traumatic brain injury, poly-trauma, hazardous exposures, chronic pain, PTSD, military sexual trauma, substance use, suicidality, homelessness, and strategies to advocate for patients as they reintegrate to the civilian world.

The course presently offers a live 1.5 hour session and/or two online modules and provides inter professional continuing education credit. Outcome measures assess knowledge, attitudes (cultural competency), and behaviors of nurses toward veterans and their families over time. The course is unique as it was created and is taught by veterans. Generalist Entry-level Master’s (GEM) nursing students, once trained, are able to participate in teaching. As a result, several GEM students have undertaken Capstone projects focusing on veteran’s issues. These include expanding the basic course to other healthcare professions and civilian first responders; offering additional courses focusing on children of the military; veterans who identify as lesbian, gay, bisexual and transgender; adding a screening tool to the electronic medical record to identify veterans who come to the medical center for care; assisting providers with identifying and treating health conditions unique to the veteran’s theatre of service; and linking veterans and their families to appropriate services. To date, over 120 nurses and students have been trained.

Nurses around the world, by virtue of their charge, are most likely to have frequent encounters with veterans and their families.  It is “mission critical” that they are given the knowledge to promote beliefs and behaviors to provide veterans and their families with the finest, cutting edge care.