Joining Forces and the PTSD Toolkit

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Nurses Caring for Soldiers and Their Families

Historically, nurses have been caring for wounded warriors since Florence Nightingale went to the Crimean War. Today’s nurses in all healthcare settings are caring in some way for veterans from WWII, Korea, Vietnam, Iraq, Afghanistan and other sites of conflict. Nurses outside the military are neither typically familiar with the diagnosis and treatments the signature invisible wounds of recent conflicts, nor with the availability of resources: we now need to get them adequately informed and trained.

In 2012, the ANA began a national effort in coordination with the Departments of Veterans Affairs (VA) and Defense (DoD) to train nurses to understand the needs of those who have served, to recognize the warning signs of posttraumatic stress disorder (PTSD), depression, or suicide; and know where to send veterans and their families for help. The ANA’s Joining Forces initiative by hosting a meeting in March 2012 for nursing leaders to discuss strategies for a profession wide campaign to improve awareness of TBI and PTSD among nurses. These nurse leaders formed a Steering Committee and began meeting regularly by phone to explore how best practices can be incorporated into specialty settings.

ANA challenged professional nursing organizations to pledge to expand their knowledge and activities related to veterans’ health. To date over 200 organizations pledged to reach out to nurses with evidence based resources and training. Additionally, more than 650 nursing schools pledged to add TBI and PTSD to their curricula.

For a nationwide initiative that mobilizes 1% of our nation’s population, there is a clearly a corresponding need for funds. ANF, with ANA, has identified four broad needs for funding in order to:

  • Utilize nurses in every setting as a trusted source for information
  • Raise awareness among nurses and the public by providing education and/or resources to 3.1 million nurses
  • Promote evidence based care
  • Reduce the stigma of being diagnosed or treated
  • Increase the number of referrals for care in underserved communities
  • Develop sustainable models of care for non-military settings
  • Increase collaboration among health care organizations

The American Nurses Foundation (ANF) has prioritized support of the ANA Joining Forces Initiative as a key component to its mission of “transforming the nation’s health through the power of nursing.”

Invisible Wounds of War

The signature wounds of recent wars are often invisible. Their impact, however, has become increasingly visible in the public eye. More than 44,000 of our troops deployed to Iraq and Afghanistan have sustained at least moderate traumatic brain injuries (TBI). As many as one in six who served, i.e. more than 300,000 Americans, have been impacted by PTSD and TBI as a result of their service to this country. Similar numbers have been estimated for those exhibiting signs of post-deployment depression. These invisible wounds impact the military service member’s and veteran’s ability to function, can damage relationships with family and friends, complicate perceptions of pain and delay the healing of physical wounds.

Over two million soldiers have returned since 2001 and many times that number of Americans has been affected as spouses, parents, children, and friends. Families are coping with veterans’ mental illness, increased drug and alcohol dependence, higher rates of violence including homicide, child abuse and neglect, high risk behaviors that have resulted in increased numbers automobile accidents and drug overdoses, homelessness and divorce, and clinical levels of stress among the children. The costs of war extend beyond the veterans themselves to the communities in which they live.

Many veterans are not living with PTSD/TBI at all. In 2010, a DoD task force charged with studying military suicides reported that between 2005 and 2009 there were 1,100 military suicides – more than the number of soldiers killed in Afghanistan since 2001. Averaged, that meant a suicide every 36 hours. Since then, the numbers have risen.

You Can Help Right Now! 

Nurse Brian McMillion works with other military volunteers at the Stand Down event for homeless veterans in San Diego.
Photo by: Carolyn Jones, The American Nurse Project
Brian McMillion, a military nurse with the V.A. San Diego Health System, was told by his father at age 19 to "go to college or enlist in the military." He joined the military and worked in the staged ER, being the first person wounded soldiers would see when they woke up, often missing limbs and suffering enormous physical pain. Today, McMillion works with veterans returning from Iraq and Afghanistan, and has become intimately familiar with one of the most devastating effects of war: Post-Traumatic Stress Disorder (PTSD).

PTSD can occur when a person experiences or witnesses a threat of injury or death. It is estimated that half a million veterans and military service members suffer the debilitating agitation, nightmares, and emotional withdrawal that characterize this disorder.

McMillion not only sees the shattering effects of PTSD in the veterans he cares for – he has experienced it firsthand, having recently been diagnosed. "It is depression, it is anxiety, it is low frustration tolerance. It is having constant supervision," said McMillion. He sees every day how it takes over the lives of veterans.

On August 26, 2014, in conjunction with President Obama's address to the American Legion's 96th convention, the Foundation announced the launch of the toolkit, which was highlighted in a White House fact sheet, issued as part of the event, as an innovative way to address veterans' mental health. 

Press Releases  
 08/27/14 Press Release   ANF Launches E-tools, Interactive Website to Aid Nurses in Providing PTSD Care
In conjunction with President Obama’s address to the American Legion’s 96
th convention, the American Nurses Foundation, the charitable and philanthropic arm of ANA, on Aug. 26 announced the launch of an interactive, web-based post-traumatic stress disorder (PTSD) toolkit to help civilian RNs better assess and treat PTSD in the nation’s veterans and military service members.
The Foundation’s PTSD toolkit was highlighted in a White House fact sheet, issued as part of the event, as an innovative way to address veterans’ mental health. 
 06/20/13 Press Release   ANF to Develop E-tools to Aid Nurses in Post-traumatic Stress Disorder Treatment

See what ANA is doing for its 
Joining Forces initiative.