Nursing and the First Lady are “Joining Forces”

April 12th, 2012


By , BSN, RN

"Quite simply, nurses are the frontline of America's health care,” First Lady Michelle Obama said yesterday while on the campus of the University of Pennsylvania Nursing School. "When my daughters were born, it was nurses that spent the most time with me and my husband. They were the first ones to notice when something wasn't right, or when we needed a little extra time.”

And it is that ability to notice when something isn’t right or that someone needs a little extra time that she counting on to help with a new plan that is part of the “Joining Forces” program created by Obama and Dr. Jill Biden, wife of the Vice President Joe Biden. Joining Forces is a comprehensive national initiative to mobilize all sectors of society to give service members and their families opportunities and support.

The newest goal of Joining Forces is the enlistment of nurses to recognize and treat post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI). It is believed the injuries have affected one in six of the troops returning from Afghanistan and Iraq—or more than 300,000 veterans. However, the number may be much higher.

The First Lady and Dr. Biden announced that 150 nursing organizations and 450 nursing schools in 50 states have committed to training nurses to recognize the signs and symptoms of PTSD.

Though the Department of Defense and the Veterans Administration continue their strong efforts to address PTSD and TBI, we know that more than half of today's Iraq and Afghanistan veterans seek care from health care providers outside of the VA system. There are veterans in every corner of this country and if we are going to fully understand the issues they face, we've got to meet our veterans where they live. That means health care providers across the country need to have some fundamental understanding about PTSD and TBI so they recognize the conditions and then positively impact the health care outcome for veterans.

The Obama-Biden effort aims at expanding the network of professionals prepared to help. And it uses nurses, who are increasingly the primary providers of health care.

Back in January, Obama announced the largest coordinated commitment of America's medical colleges to support veterans and military families. Led by the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM), 130 of the nation's medical and osteopathic colleges committed to train students in treating brain injuries, PTSD and other mental-health issues affecting returning service members. Now nurses, over 3,000, 000 strong in the U.S., are committed to the cause.

According to “Joining Forces,” we must act now to ensure the nation's current and future health care providers are familiar with issues impacting our veterans and families. This is so important because this is going to be a long term care issue since the servicemen and women coming back from the war are almost all in their 20s an 30s.

Defining PTSD

When a trauma occurs, its effects may last well after the event itself ends. PTSD begins with an acute stress disorder (ASD), wherein the person involved experiences, witnesses or is confronted with a traumatic event and the response is intense fear, helplessness, or horror, according to the American Psychiatric Association. War is, without a doubt, a traumatic event.

It is not known why traumatic events cause PTSD in some people but not others. Psychological, genetic, physical, and social factors are all involved and we know that PTSD changes the body's response to stress.

The symptoms of PTSD fall into three main categories:

  1. Reliving the event, which disturbs day-to-day activity.
    • Flashback episodes, where the event seems to happen over and over.
    • Repeated upsetting memories of the event.
    • Repeated nightmares of the event.
    • Strong, uncomfortable reactions to situation that remind you of the event.
  2. Avoidance
    • Emotional numbness or not caring about anything.
    • Feelings of detachment
    • Inability to remember important aspects of the trauma.
    • A lack of interest in normal activities.
    • Avoiding places, people or thoughts that are reminder of the event.
    • Feeling like there is no future.
  3. Arousal
    • Difficulty concentrating.
    • Startling easily.
    • Having an exaggerated response to being startled.
    • Hypervigilance.
    • Irritability or anger outbursts.
    • Trouble falling or staying asleep.

The goal of these new healthcare provider involvement initiatives is simple: leverage the full capacity of the nation's health care providers to improve care for the country’s veterans and active duty service members. This commitment will help train the nation's future doctors and nurses about military cultural issues; develop new research and clinical trials to better understand and treat PTSD and TBI; and share information and best practices through a collaborative forum that has not previously existed.

The VA is helping with this effort by offering a web-based curriculum with courses related to PTSD and trauma. The course is called PTSD 101 and it is presented recognized experts in PTSD. It has been develop specifically for clinicians who provide care for clients who have experienced trauma, and it is appropriate for both seasoned PTSD professionals and those new to PTSD treatment or military personnel. The courses are free and continuing education units are available for most of the work.

“The goal is to raise awareness among every nurse throughout the country to recognize the signs and symptoms and lower the stigma of getting care,” said Amy Garcia, chief nursing officer for the American Nurses Association, one of the organizations supporting the “Joining Forces” initiative.

According to Garcia, one in every 100 Americans is a nurse. Many don’t work in fields where they would be exposed to head injury or behavioral health disorders. “We want to make sure they understand about new treatments and new science so they can make appropriate referrals,” Garcia said.

All training on PTSD is voluntary and there is no federal funding being used for the programs. But, even if there was, who among us could really say we shouldn’t be doing this—helping our U.S. servicemen and women return to lives at home, as healthily as possible.

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