Militaries and the duty of care to enhanced veterans.

This article argues that there is a duty of care held by the State to military veterans who have been technologically enhanced as part of their military service. It suggests that enhancements may be permanent, persistent or protracted and demonstrates how enhancements generate additional moral responsibilities from the chain of command. The paper concludes by demonstrating how this institutional duty of care relates to issues such as informed consent.

Feasibility and challenges of inpatient psychotherapy for psychosis: lessons learned from a veterans health administration pilot randomized controlled trial.

BACKGROUND: In large health care systems, decision regarding broad implementation of psychotherapies for inpatients with psychosis require substantial evidence regarding effectiveness and feasibility for implementation. It is important to recognize challenges in conducting research to inform such decisions, including difficulties in obtaining consent from and engaging inpatients with psychosis in research. We set out to conduct a feasibility and effectiveness Hybrid Type I pilot randomized controlled trial of acceptance and commitment therapy (ACT) and a semi-formative evaluation of barriers and facilitators to implementation. FINDINGS: We developed a training protocol and refined an ACT treatment manual for inpatient treatment of psychosis for use at the Veterans Health Administration. While our findings on feasibility were mixed, we obtained supportive evidence of the acceptability and safety of ACT. Identified strengths of ACT included a focus on achievement of valued goals rather than symptoms. Weaknesses included that symptoms may limit patient's understanding of ACT. Facilitators included building trust and multi-stage informed consent processes. Barriers included restrictive eligibility criteria, rigid use of a manualized protocol, and individual therapy format. Conclusions are limited by our randomization of only 18 patient participants (with nine completing all aspects of the study) out of 80 planned. CONCLUSIONS: Future studies should include (1) multi-stage informed consent processes to build trust and alleviate patient fears, (2) relaxation of restrictions associated with obtaining efficacy/effectiveness data, and (3) use of Hybrid Type II and III designs.

The invisible wounds of war: caring for women veterans who have experienced military sexual trauma.

PURPOSE: The purpose of this case study is to raise awareness about military sexual trauma (MST) and posttraumatic stress disorder (PTSD), and the physical and psychological comorbidities associated with MST. DATA SOURCES: Health Science Data Sources-PubMed and authors' experiences. CONCLUSIONS: Women veterans are the fastest growing segment of the veteran population. Approximately 200,000 of the 2.6 million veterans who have deployed in support of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) are women. Many are seeking care in both the Veteran Administration and the civilian sector. It is estimated that upwards of 26,000 women have experienced some form of sexual assault in the military. MST can lead to multiple deleterious physical and psychological comorbidities. It is imperative that nurse practitioners (NPs) ask women about military service and utilize the Military Health History Pocket Card for Clinicians to ascertain service-connected health risks, primarily MST and PTSD. Prompt identification and intervention is key to reducing physical and psychological comorbidities. IMPLICATIONS FOR PRACTICE: This case study emphasizes the need for NPs to ask all women about military service and potential exposure to sexual trauma. It provides guidance on how to incorporate the Military Health History Pocket Card for Clinicians into practice.