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Coming to a medical-surgical unit near you: the aftereffects of war.

I have enjoyed reading the articles in this journal since I joined AMSN in 1992. It never crossed my mind that one day I would have the privilege to be writing the President's Messages! I was inducted as the AMSN President on October 7, 2012, at the AMSN Convention in Salt Lake City. I look forward to working with you and AMSN to advance the specialty of medical-surgical nursing. One of the benefits of attending a national convention that I especially enjoy is networking with other nurses, especially other medical-surgical nurses. Two encounters from the 21st AMSN Convention come to mind.

A military member approached me and thanked AMSN for recognizing the military during the opening ceremonies. I was very excited to inform her that AMSN was participating in the Joining Forces initiative. She was very pleased the organization was interested in this work. The second encounter was from a mother of a wounded warrior. She was also thankful AMSN was a partner in Joining Forces. She talked about her son's recent hospitalization in which he was not allowed to take his service dog with him. You could see the frustration in her eyes as she tried to explain the importance of this dog to her son's recovery. It occurred to me that we, as medical-surgical nurses, had to increase our knowledge and understanding to care for our veterans. It also reminded me of the importance of a united voice and the power of medical-surgical nurses to effect change.

You may think that you do not need to be concerned about caring for our veterans because you do not work in a military or government institution. But that may be far from the truth. Although the Veterans Administration (VA) system cares for over 8 million veterans, this is only 50% of our veterans (American Nurses Association [ANA], 2012). The rest will be coming to a med-surg unit near you. I would like to briefly discuss post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), and the White House initiative Joining Forces. Although these conditions can and do exist in the general population, the focus of this article will be in relation to our veterans.

Post-Traumatic Stress Disorder

Did you know that about 50,000 military members were wounded during the last 10 years of war?

Approximately one out of six veterans will be impacted by PTSD, making this a pressing national health crisis (Cooper, 2012). PTSD is defined as an anxiety disorder after seeing or living through a dangerous event (National Institute of Mental Health [NIMH], n.d.).

Several therapeutic approaches can be used in treating PTSD. Two medications, sertraline (Zoloft[R]) and paroxetine (Paxil[R]), are approved by the U.S. Food and Drug Administration for treating PTSD. Other medications, such as benzodiazepines, antipsychotics, and antidepressants, may be prescribed. Importantly, other psychological issues, such as depression, TBI, and substance abuse, can co-exist with PTSD. Cognitive-behavior therapy (CBT), which teaches alternative ways to think and react, also is recommended. CBT can include exposure therapy, cognitive restructuring, and stress inoculation (NIMH, n.d.). CBT can be provided in individual or group sessions.

Traumatic Brain Injury

TBI, defined as an injury to the brain caused by an external force, has been described as the signature wound of our veterans from Iraq and Afghanistan. TBI can be classified as mild (concussion), moderate, severe, or penetrating. The more common forms are mild-to-moderate TBI caused by proximity to an explosion, such as a mortor attack or roadside bomb. Initial signs and symptoms include headache, sleep disturbance, dizziness, nausea and vomiting, fatigue, visual disturbances, sensitivity to light, and ringing in the ears. The person can also experience mood swings, problems with concentration, and slowed thinking. Most veterans will recover from a TBI, although recovery is different for each individual (Defense and Veterans Brain Injury Center, n.d.).

Primary treatment for TBI centers on preventing further injury. Focus is on insuring proper oxygen supply, maintaining adequate blood flow, and controlling blood pressure (National Institute of Neurological Disorders and Stroke [NINDS], 2012). Imaging studies will help to determine the extent of the injury. Surgery may be required for severe head injuries.

Disabilities resulting from TBI can include problems with cognition, sensory processing, communication, and mental or behavioral issues (NINDS, 2012). The veteran also may experience headaches, weakness in a limb, sleeping difficulties, vertigo, and loss of balance. It is easy to understand how these disturbances can impact quality of life for our veterans and their families.

Joining Forces

You may be wondering how you can prepare yourself to care for our veterans. I would like to introduce you to the White House initiative, Joining Forces: Taking Action to Serve America's Military Families. The goals of this national initiative to support and honor our service members and their families include: (1) to educate, challenge, and spark action from all sectors of our society; and (2) to ensure military families have the support they earned (American Association of Colleges of Nursing, 2012; ANA, 2012). The three priority areas include employment, education, and wellness. I am very pleased to announce AMSN has joined this group of professional organizations to touch every nurse to raise awareness.

How will AMSN support you, the medical-surgical nurse, to increase awareness of the needs of our service members and their families? AMSN is committed to educating you to care for our Veterans and their families. AMSN will develop a section on its web site to disseminate up-to-date information as it relates to PTSD, TBI, and other psychological health conditions. Other avenues for education may include our publications and convention. If this is an area of interest to you, please consider contacting one of our publications to submit an article or submit an abstract for our 2013 annual convention.

As part of our strategic plan, AMSN is committed to being the leader influencing decisions that impact medical-surgical nursing. One of our goals, National Leadership and Influence, encourages alliances or affiliations that will allow AMSN to expand our reach and offer support to initiatives created by others. We believe Joining Forces is an important alliance for our members.

I hope you share my enthusiasm for the Joining Forces initiative. This is another avenue to demonstrate our commitment, compassion, and connection. Being informed about these health care needs and knowledgeable about community resources can have a lasting positive impact upon many members of our community. Stay tuned for the launch of this section on the AMSN web site!

REFERENCES

American Association of Colleges of Nursing. (2012). Support Joining Forces. Retrieved from http://www.aacn.nche.edu/joining-forces

American Nurses Association (ANA). (2012). ANA supports Joining Forces. Retrieved from http://www.nursingworld.org/MainMenu Categories/ThePracticeofProfessionalNursing/Improving-YourPractice/ ANA-Supports-Joining-Forces

Cooper, B. (2012). New commitments will improve health care for our heroes. Retrieved from http://www.whitehouse.gov/blog/2012/ 01/11/new-commitments-will-improve-health-care-our-heroes

Defense and Veterans Brain Injury Center. (n.d.). TBI basics. Retrieved from http://www.dvbic.org/tbi-basics

National Institute of Mental Health (NIMH). (n.d.) Post-traumatic stress disorder (PTSD). [Electronic Version], 1-14.

National Institute of Neurological Disorders and Stroke (NINDS). (2012). NINDS traumatic brain injury information page. Retrieved from http://www.ninds.nih.gov/disorders/tbi/tbi.htm

Kathleen Lattavo, MSN, RN, CNS-MS, CMSRN, RN-BC, ACNS-BC

President, AMSN
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Title Annotation:AMSN President's Message
Author:Lattavo, Kathleen
Publication:MedSurg Nursing
Article Type:Conference news
Geographic Code:1USA
Date:Nov 1, 2012
Words:1209
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