University of Iowa Nursing practicum exposes students to military culture and veterans' health needs across the state of Iowa through community engagement.

Iowa City VA Health Care System (ICVAHCS), 67th Troop Command-Iowa National Guard, and Iowa City Community School District partnerships connect students with active-duty, veteran, and military family health needs.

 

Stephanie Latham, adjunct lecturer of nursing at the University of Iowa, was preparing to start a residency at the Department of Veteran's Affairs (VA) in Iowa City when a nurse executive approached her about an opportunity for collaboration. Between the University of Iowa College of Nursing and the Iowa City VA Health System (ICVAHCS), there was potential for pre-licensure Bachelor's of Science in Nursing (BSN) students to build awareness around veterans' health issues. 

"With my doctorate in advanced public health nursing, it was a perfect fit," Latham said. "I'm passionate about veteran populations and public health. It was a win-win."

Latham began thinking about creating a community-engaged nursing practicum focused on veteran and military health, utilizing resources from her doctoral program that she could share with students. 

"I had previous experience as a VA employee and was completing my doctoral residency at the ICVAHS in suicide prevention with a veteran emphasis," Latham said. "So, I could utilize that as a springboard to collaborate with community partners with whom the class worked." 

Latham then started looking to build connections and cross-collaboration in public health to identify and impact the needs of veterans in populations often missed by community health needs assessments.

"Veterans are part of our population and have specific health needs," Latham said. "They are in our communities, and we must have that awareness to look at how communities support these individuals, what kind of funding is available, how we use and collect data, and how to move forward."

BUILDING PARTNERSHIPS DRIVEN BY FAMILY

Latham met her husband when he was a member of the Iowa National Guard, and their children were middle and high school age when he was activated to serve as part of Operation Iraqi Freedom. 

"When we met and were first married, I never considered that he might go to war someday," Latham said. "He was going to do flood duty and things like that, but going to war in another country was never part of the landscape for us. When that changed, I quickly realized that our family and other Iowa National Guard families did not have the necessary resources to help cope."

The experience impacted Latham's children, who didn't have a peer group at school that understood the challenges of being in a military family.

"They were in a school with only two or three other children with those experiences," Latham said. "So, I reached out to staff at their schools to raise awareness, but at that time (2003), there was very little understanding of how experiences of military-connected children differed from that of other children. This experience was important to my eventual collaboration with the Department of Defense Education Activity (DoDEA) and the School Liaison Officer at the Rock Island Arsenal (RIA)."

"One of the things we don't have in Iowa is an active-duty base, so many of the resources you would see in other states, we don't have in Iowa, Latham said. "In Iowa, there is a substantial population of Iowa National Guard members, but there is a deficit in Iowa communities related to knowledge and resources important to supporting military-connected children," Latham said. 

Understanding the importance of community collaboration and engagement, Latham connected with DoDEA and the School Liaison Officer at the RIA to begin a conversation about addressing the needs of military-connected children in Iowa, which led to a collaboration with the Iowa Department of Education. 

"The Iowa Department of Education had completed the Project AWARE Iowa grant program, and data collected through this grant program demonstrated that military children in Iowa were struggling," Latham said.

"Through these conversations, it became evident that members of our school districts in Iowa do not have sufficient information about working with military-connected children," Latham said. "It became an excellent experience for students to recognize that they have knowledge that Iowa school nurses don't have, but desperately need, and created an opportunity for pre-licensure BSN students to share new information with their future colleagues and peers."

Engagement at the state and national level with members of the military and education "communities" was an important step. The next involved reaching out to the Iowa Community School District to create an opportunity for students to work with seasoned school nurses working with this population and provide education to address this knowledge deficit.

"When I started teaching, I never would have considered partnering with a community school district," Latham said. "It wouldn't have occurred to me, so I think this demonstrates the importance of throwing your net wide and asking, why aren't we engaging with our community more?" 

IN THE CLASSROOM

College of Nursing students assigned to fulfill practicum requirements via Latham's class had an opportunity to learn about military and veteran health challenges unique to those populations. 

On the first day of class, Latham would ask her students about their understanding of the VA.

"It was fun because I always knew their response was going to be negative, and it was because that's what we hear in the media," Latham said. "There are many negative perceptions about veterans' health care through the VA. Part of the problem is that we don't do a good enough job promoting all of the good things about the VA. For instance, they are one of the leaders in health care research in this country."

Learning that the VA leads the nation in evidence-based research and is the 'first and foremost' in addressing veterans' health issues was a transitional moment for students. 

"It was, for students, such an eye-opener," Latham said. "It was uplifting to see the transition in their perspective to one of 'why wouldn't every veteran want to get their care through the VA?' because it showed how much they had learned about veteran health and VA health care by the end of the term."

"It was essential to have that opportunity to take students with a negative mindset and be able to teach them about the culture," Latham said.

Latham challenged students to analyze their perception of what culture means and expand their thinking to recognize that there are different cultural subsets within each Armed Forces branch. 

Along with an understanding of military culture and language, students also discussed working with and recognizing differences among veterans based on their branch of service, area of service, and even rank in service. 

Increasing students' understanding in these areas led to an insight into why asking about veteran/military status is crucial to those who have served.

"Students were afraid to approach someone and ask about veteran status," Latham said. "Because what if they were, and then what did they say? 

"Asking the question is one of the most important things they can do for veteran and military patients," Latham said. "It demonstrates to members of this population that, as health care clinicians, we recognize the impact of their military service. It also helps students understand that people need to know they are valued."

IN THE FIELD

The Iowa National Guard hosted students at an event highlighting different roles and responsibilities. This experience allowed students to see a mock field hospital, mass casualty dummies used for training, transportation assets used in the field to transport the injured, and weapons and artillery used.

"The students were shocked," Latham said. "As nurses, we are constantly busy with call lights and people barraging us with different needs, but a nurse or a medical person in the military is doing all that while potentially under fire."

The nursing students were unfamiliar with the expanded military roles, such as corpsman. The members of the National Guard who worked with the students enjoyed having the opportunity to be able to share their experiences with people who were potential future caregivers.

"It was a great experience for everyone," Latham said.

Students also had an opportunity to hear directly from members of the Iowa National Guard about the real-world impact of post-traumatic stress syndrome (PTSD), a topic often removed from public consciousness beyond television and popular media depictions.

"I think students were surprised by how vulnerable and open they were in discussing their personal experiences and the impact of PTSD on their lives and that of their family members," Latham said. 

Students then learned about the role of the Iowa National Guard in preparing for and providing service during public health events, including the VA's "Fourth Mission," which is to provide local, state, and national support during events such as the pandemic. 

"Everybody was trying to figure out how to function in this new normal, but for the military, being prepared for the unexpected is a requirement, making them an excellent resource, especially with the pandemic," Latham said. 

Later in the semester, the partnership with ICVAHCS allowed students to experience multiple services provided by the Iowa City VA. Services included telehealth, women's health, suicide prevention, transplant, mental health, homeless services, diabetes care, and primary care, which are crucial to enhancing understanding of local resources available to veterans.

"It was like the Wizard of Oz pulling back the curtain," Latham said. "The VA is right here, and nobody seems to notice unless they come through the doors because they are getting care." 

Many veterans do not enroll in VA services, despite being eligible due to stigma or a belief that the healthcare is for those more in need than they are. 

Latham was inspired to advance veterans' access to healthcare through the experience of her father-in-law, an advocate for other veterans despite hesitating to access services as a veteran himself. 

"At the end of his life, there were so many resources and things that he should have or could have had available to him if he had taken action and registered with the VA," Latham said. "Instead, he didn't, and then we ran behind the train, trying to play catch up, and this ultimately affected his quality of life, which would have been so much better if he had not waited."

IMPACTING IOWA COMMUNITIES

Following the community-engaged practicum, some students considered career paths supporting military families, veteran communities, and the armed forces.

"They talked about recognizing the importance of bringing veterans' health awareness out into their community wherever they were going to work," Latham said. "One student said it was an essential connection because she never thought about veteran impact in obstetrics and delivery or that she should be assessing veterans' status. Understanding how PTSD can affect a new mother or father and knowing that resources are out there is critical."

Latham recommends faculty across disciplines incorporate community engagement into their classrooms while taking advantage of University of Iowa resources and the ability to impact communities through outside partnerships. 

"The opportunities we get through strengthening those relationships with our community partners benefit everyone," Latham said. "It helps students and the University of Iowa, benefits our partners while also addressing funding issues, research needs, and all those different things that, if we are not out there engaging with our community partners, we may not know." 

Story by James Dykeman