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A powerful question: “Have you ever served in the military?”


Countless history and physical forms, nursing admission databases, and self-prepared health histories may be missing a critical element—the question “Have you ever served in the military?” If your patient answers “yes,” you may have cracked the code of stories yet untold that can reveal a history of risks of illnesses both observed and hidden. The United States has nearly 22 million military veterans; it’s crucial for healthcare providers to find out if a patient may have suffered impairment from the hazards and effects of war.

For 3 years, First Lady Michelle Obama and Dr. Jill Biden have ignited action from all sectors of society to meet the unique needs of our military service members by launching the Joining Forces initiative. Together, they are helping our troops and their families receive the recognition and support they deserve for their sacrifice to protect our country. Joining Forces has been a powerful force to create awareness in three major areas—employment, education, and wellness. Partnerships with private-sector employers are helping to create job opportunities for veterans and military spouses; schools are providing support for military-connected children who must change schools; and institutions of higher education are helping troops pursue an education after returning home.

One of the biggest challenges is promoting wellness in times of emotional, physical, and financial stress. Seeking a solution, Mrs. Obama and Mrs. Biden turned to nurses. Two years ago, they secured a commitment from more than 500 nursing schools and 150 state and national nursing organizations to educate nurses and students on how to identify and care for veterans and their families, with special emphasis on posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and other combat-related conditions.

Last fall, the nursing profession again responded. The American Academy of Nursing’s (AAN) Military and Veterans Expert Panel recognized that war wounds can go undetected—partly because less than a third of veterans seek care in the Veteran’s Health Administration, where clinicians are more adept at detecting service-connected conditions and consequences. Similarly, veterans who saw active duty in the National Guard and Reserve Components receive health care in the private sector once they return to civilian life. So the challenge lies in improving identification of service-related occupational and environmental hazards within the larger healthcare system.

To close this potential gap, AAN launched the “Have you ever served in the military?” campaign in partnership with Joining Forces to address general areas of concern for all veterans—PTSD, blast concussions and TBI, military sexual trauma, and higher suicide risk. Exposure to toxic substances may take years to manifest. Agent Orange, used in Vietnam and Korea, has been linked to various cancers, birth defects, type 2 diabetes, ischemic heart disease, and peripheral neuropathy.

Veterans exposed to open-air burn pits in Iraq and Afghan­istan are at higher risk for respiratory illness and cancers, including leukemia. Gulf War veterans may suffer Gulf War Syndrome—an array of undiagnosed and unexplained illnesses, respiratory symptoms, cancers, and neurodegenerative diseases. Veterans who served in Southwest Asia and Afghanistan may have contracted infectious diseases; those recently deployed in Iraq and Afghanistan may have been exposed to rabies. Vietnam veterans who were exposed to blood and human body fluids may be infected with hepa­titis C. World War II veterans may have an increased cancer risk from nuclear-weapons testing and occupation of Hiroshima or Nagasaki. We have a duty to help unmask these and other health problems.

Just as our military service members are on the front lines of security every day, nurses are on the front lines of healthcare delivery. Join the campaign. Make sure you and your colleagues ask patients, “Have you ever served in the military?” If the answer is yes, find out when, where, and how the patient was injured or affected by those experiences. For a pocket card to help assess patients for military-related health conditions, visit Remember—nurses can be the pivotal point-of-care clinicians who make a difference in a veteran’s health.

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN

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