Morbidities Experienced by Geriatric Combat Veterans

One disease of the circulatory system that is associated with geriatric combat veterans is ischemic heart disease. Ischemic heart disease (also known as coronary artery disease) has been linked to exposure to Agent Orange during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Coronary artery disease is common even among non-combat veterans. It is the number one cause of death in the United States (Coronary artery disease, 2017). While this morbidity is comparable to civilian counterparts, for geriatric combat veterans of the Vietnam War exposure to Agent Orange has become an uncontrollable risk factor.

            When compared to non-veteran populations, some respiratory morbidities are higher among veterans. One study revealed adjusted ratios of mesothelioma to be higher among veteran populations than among New York state or Los Angeles County totals (Spirtas, et al., 1994). While asbestos was once common in the United States in carpentry related taskings, it was also common in Naval shipyards. This translates to an increased risk of mesothelioma for Navy Veterans especially during and before the 1980s.

            Because of one of the more recent conflicts, veterans of the Gulf War have experienced chronic digestive symptoms (Weng, Guo, & Yang, 2015). These morbidities range from heartburn to irritable bowel syndrome. Many gastrointestinal symptoms experienced by these Gulf War veterans began while they were in country. Many veterans did not report this especially if there was minimal interference with day-to-day life.

            Another by-product of Agent Orange is early onset peripheral neuropathy. Some combat veterans of the Vietnam War began suffering from peripheral neuropathy within only one year after their time in country ended (Veterans' Diseases Associated with Agent Orange, 2015). Thus, many veterans have been suffering weakness, numbness, and pain in their extremities for a very long time (Peripheral neuropathy, n.d.). Most people do not develop peripheral neuropathy until they are over the age of 55 (Understanding peripheral neuropathy, n.d.).

            A morbidity of the endocrine system that is experienced by geriatric combat veterans is Hodgkin’s lymphoma. Hodgkin’s lymphoma is another morbidity that is secondary to Agent Orange exposure during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Also known as Hodgkin’s disease, this is a cancer of the lymphatic system (Hodgkin's lymphoma (Hodgkin's disease), n.d.). Research has shown a positive association between Agent Orange and the development of Hodgkin’s lymphoma (Hodgkin's disease and Agent Orange, 2016).

            Immune system disorders are dangerous because they reduce a person’s natural ability to fight diseases. While some studies have suggested a statistical difference in the immune systems of Vietnam veterans exposed to Agent Orange, follow-up studies do not support these findings (Veterans and Agent Orange, 2010). While Immune disorders in combat veterans may not be related to combat exposure, there is a link between autoimmune disease and prevalence in their descendants. Adult children of Vietnam veterans who were exposed to Agent Orange seem to have a higher prevalence of autoimmune disorders (Ornstein, Fresques, & Hixenbaugh, 2016).

            One disease of the skin that occurs more often in Vietnam War veterans is chloracne. Chloracne, for many Veterans, began soon after exposure to Agent Orange during their time in country (Veterans' Diseases Associated with Agent Orange, 2015). Chloracne is a rare skin condition that includes blackheads, cysts, and nodules (Chloracne or Acneform Disease and Agent Orange, 2017). Studies have shown a direct link with this skin condition and chemicals used in Agent Orange (Institute of Medicine, 1994).

            Amputation has been a historically unavoidable byproduct of combat. While amputations accounted for 5% of combat wounded during World War II, they rose to 19% during the Vietnam War (Burkhalter, 1994, p. 131).  Most of these service members had more than one limb amputated due to use of field-expedient tourniquets. Advancement in prosthetics has improved the day-to-day lives of many of these veterans.

            One of the greatest problems experienced by geriatric combat veterans is mental health ailments such as post-traumatic stress disorder (PTSD). There is a demonstrated long-term pattern of healthcare utilization by geriatric veterans with serious and chronic mental illnesses (Sajatovic, Popli, & Semple, 1996). Chronic mental health issues have led to an increase in suicides in Veterans. The rate of suicide among veterans reached 22 per day in 2010 (Lazar, 2014, p. 459).

Conclusions and Final Thoughts

While there are several morbidities that seem to be consistent among civilian populations, there are several that are exacerbated by conditions experienced during combat. There seems to be a lack of foresight with use of chemicals such as Agent Orange. The military is learning from the mistakes of the past. All soldiers heading to combat are now assigned gas masks and chemical suites called JSLIST (Joint service lightweight integrated suit technology) and MOPP gear (mission oriented protective posture) for short.

Tricare and the VA have both made grand strides in delivery of mental healthcare as of late. Last year, the new Secretary of the VA, Dr. David Shulkin, opened access for mental healthcare to those with other than honorable discharges. This was important because many of these discharges came about because in the past, services didn’t recognize the need for mental healthcare and it was seen as a weakness by not only seniors but peers and subordinates. This is a stigma that we are still getting past, but we are heading in the right direction.

About the Author

Josh Johnson is a former combat medic in the U.S. Army with three combat tours, Joshua Johnson currently works as an Administrative Officer at the Robert J. Dole VA Medical Center in Wichita, Kansas. In addition, he is completing his M.H.A. degree at Saint Joseph’s College of Maine.

References

Burkhalter, W. F. (Ed.). (1994). Orthopedic surgery in Vietnam. Washington, D.C.: Medical Department, United States Army.

Chloracne or Acneform Disease and Agent Orange. (2017). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/chloracne.asp

Coronary artery disease. (2017). Retrieved from Medline Plus: https://medlineplus.gov/coronaryarterydisease.html

Hodgkin's disease and Agent Orange. (2016). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/hodgkins.asp

Hodgkin's lymphoma (Hodgkin's disease). (n.d.). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hodgkins-lymphoma/symptoms-causes/syc-20352646

Institute of Medicine. (1994). Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. Washington, D.C.: The National Academies Press.

Lazar, S. (2014). The mental health needs of military service members and veterans. Psychodyn Pschiatry, 459-478.

Ornstein, C., Fresques, H., & Hixenbaugh, M. (2016). The children of Agent Orange. Retrieved from Pro Publica: https://www.propublica.org/article/the-children-of-agent-orange

Peripheral neuropathy. (n.d.). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061

Sajatovic, M., Popli, A., & Semple, W. (1996). Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder. Pschiatric Services, 961-965.

Spirtas, R., Heineman, E. F., Bernstein, L., Beebe, G. W., Keehn, R. J., Stark, A., . . . Benichou, J. (1994). Malignant mesothelioma: attributable risk of asbestos exposure. Occupational and Environmental Medicine, 804-811.

Understanding peripheral neuropathy. (n.d.). Retrieved from American Academy of Neurology: http://patients.aan.com/globals/axon/assets/9585.pdf

Veterans and Agent Orange. (2010). Washington D.C.: National Academies Press. Retrieved from https://www.nap.edu/read/13166/chapter/1

Veterans' Diseases Associated with Agent Orange. (2015). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/

Weng, W., Guo, X., & Yang, Y. (2015). Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Military Medical Research, 1-8.

What an Emergency Room Nurse Thought Management Was

               Management is about trading in your scrubs, sneakers, and nursing station for a corner office on the 5^th floor. It’s about buying a new wardrobe filled with skirt and pant suits and walking down the hallway with a new pair of Christian Louboutins. Management gives me the opportunity to work Monday through Friday with holidays off, and a guarantee extended vacation. I am in charge of budgets, timelines, meetings, hiring new employees, and addressing issues on the unit to the best of my ability. Executives say they respect what I do and honor all my hard work. However, my ideas are often pushed to the side and ignored. Some of my staff look up to me as their leader, and some talk about how I don’t do anything right. Management does not allow me to be creative and implement new strategies or ideas. It does not allow me to fight for my staff and get them and the patients that they need. I am unable to push my employees to reach their full potential. When my employees make mistakes, I must discipline them according to policy without empathy or compassion to what is going on. I am a manager.

            Over the last 11 weeks, Leadership in Healthcare Administration has taught me about being a leader. Prior to taking this class I was a firm believer that managers managed and were not considered leaders. From previous employments, mangers did their rounds and I never felt supported or heard. However, with the start of my new job I started to see a difference in management and what I learned in this course supported those observations. To manage effectively one must be a leader. A manager needs to lead along with handling budgets, staffing, schedules and meetings. Throughout this class, I have learned the roles and skills of a true leader and the influence they have to inspire the team.

            Leadership effectiveness in healthcare is an important role.  It merges the work of clinical staff and administrators in the success of the organization. Leaders have a large effect on inspiring the team, managing, reaching goals and changing the atmosphere of the facility. They are able to do this by tapping into many of the topics discussed throughout this semester. Leaders must shift between roles daily for each encounter they face. These roles include being an innovator/broker which focuses on creativity and communication, a monitor/coordinator focusing on project management and supervising. Leaders need to be a director/producer in order to achieve goals and facilitate and mentor which supports their managerial role. Along with switching between roles, groundbreakers need to be skilled in motivating, vision-setting, analyzing, and task managing. It is important to utilize these roles and apply their skills while dealing with the constant tensions within the organization. Tensions are required to balance each other out. Polarity maps help visualize the need for these tensions. Freedom and hold responsible is a good example a tension that complements each other. As a leader, we must give others the chance to grow and perfect their skills. By doing someone else’s work we are not holding them responsible and not allowing them to flourish. What surprised me most in leadership was the need for creativity and empathy. As I stated before, management at my current employment has confirmed the benefits of empathy and creativity in effective leadership. Leaders working among the staff have the power to voice their needs and implement new strategies. Open minded managers can take imperfections in the system and innovate creative alternatives to those problems. With flaws in the system, leaders must empathize with staff, patients and family. Staff who feel disconnected and not cared about tend to be distant and their work is less effective. Patients and family who feel uncared for, unheard and not a priority will not come back to the facility. Empathy is needed in leaders to connect with staff and patients and make them feel like they are important. Empathy will keep staff happy and patients and family coming back to the organization.

            Mangers are not the only leaders in a team. Staff who apply leadership qualities and values are leaders themselves. Anyone can be a leader. Throughout this course I have learned that management is more than pant suits and red bottom heals. Leaders who manage effectively are still wearing their scrubs and sneaks, working among staff and listening to patient needs. They may have a corner office on the 5^th level, but their real office is on the clinical floor. Healthcare is in need of leadership, and with the understanding and implementation of what I have been taught in this class, I know I will be a pronounced leader in healthcare.

 References

Belasen, A.T., Eisenberg B., Huppertz, J. (2016) Mastering   Leadership A vital Resource for Health Care Organizations.   Burlington MA: Jones and Bartlett Learning 978-1-284-04323-5

Patel, N. (2014, May 19). 8 must-have ingredients of a successful blog post. Entrepreneur. Retrieved from https://www.entrepreneur.com/article/233891

Contributed by Brianna Colleran, MHA Student, Saint Joseph's College

Making a Positive Disruption in Healthcare before it is too late

We are fast approaching a healthcare bubble that will eventually pop if healthcare leaders do not start to “think outside the box” in making a positive disruption in the healthcare industry. What will the future state of healthcare look like and how will it impact you and your family? We have all seen healthcare expenses continue to rise at an alarming rate, premiums continue to increase, quality of care is not consistent, and the future state of healthcare is truly unknown. Who will be responsible for helping resolve these issues before it is too late? Now is the time for healthcare leaders to step up to the plate and find creative ways to change healthcare instead of waiting around for someone else to make these changes, which are not occurring fast enough. Now is the time for Healthcare leaders to make a positive disruption in the Healthcare sector before it is too late!

How can this be done? Well, it cannot be done by following the same processes repeatedly yet expecting different results. Leaders cannot afford to wait for someone else to make innovative changes. Instead, each leader must personally create an environment which fosters creativity so that innovation can occur within their departments/facilities. Today more than ever, maximizing overall efficiency while still providing a high level of service is a focus for most hospitals, yet creativity in improving and/or creating new and improved processes are not occurring fast enough. Why? As our class HA511 noted and in speaking to my colleagues throughout the country, most leaders have become unbalanced in their leadership approach focusing more time as transactional leaders and are not focusing enough time on being a transformational leader due to today’s fast-paced environment. However, we do see some hospitals/leaders looking at best practices across their industry in utilizing proven methods that have been shown to work. While this is a great starting point to improve processes/outcomes in healthcare, more innovative solutions must be created from front line healthcare leaders and their staff for our healthcare system to take steps towards creating a much-needed positive disruption in the industry before it’s too late.

Now is the time for leaders to take time and make time in helping their staff meet as a team in discussing creative solutions focused around improving processes/workflow/patient outcomes. I truly believe that future leaders and healthcare organizations need to devote time in forming highly engaged and functional teams within their organization in setting up “think tanks” to help create a new positive disruption in how they will deliver more efficient care in the future. While leaders can and should utilize technology and technological advances to improve healthcare, they must never forget the importance of personal connection and creativity amongst their team as that is the true key to unlock creativity and is how we will save the future state of healthcare.

How can future leaders create innovative solutions focused around making a positive disruption in changing healthcare as we know it? This is a very tough question to answer, especially since the fasted paced environment that we are living in has programmed most leaders to become transactional, more than transformational. Understanding yourself is the first step needed to be innovative and impact change which I feel a lot of leaders unintentionally lack in today’s fast paced environment. A leader taking EQ tests can help them recognize their current mindset and manage those identified tendencies. By understanding your strengths and weaknesses as a leader, you will have a better chance of navigating through your emotional tendencies and work on creating a more balanced leadership approach. I feel for this to happen, leaders must humble themselves and keep an open mind. The next step is to understand the Competing Value Framework (CVF) model to help leaders view, then balance their leadership tendencies. This theory consists of four quadrants which are further broken down into eight competing roles to include; mentor, facilitator, innovator, broker, monitor, coordinator, director and producer. These eight competing roles are then broken down to transformational leadership and transactional leadership.

As I have discussed, leaders need to focus more time on the transformational leadership approach in helping their team “think outside the box” in solving problems and in improving healthcare as we know it before it’s too late. Once employees are engaged, appropriately trained and tap into their creative processes, they will be able to help come up with creative solutions to problems within their department/facility that were previously never thought of. If done correctly, this will in turn create a more efficient and effective system for the employee’s as well as their patients in creating a positive disruption.

Regulations and legislation are also stressing the current healthcare system, because hospitals now get reimbursed according to Key Performance Indicators (KPI) results that are set by organizations such as Medicare, Medicaid, Affordable Care Act and HCAPS. I have personally seen hospitals trying to prepare for these KPI’s in a silo, at the executive level only, which to me is not a smart approach. Instead, why wouldn’t they take a more collaborative approach across hospital divisions to see what suggestions each area has? Is it a lack of time? Well, one thing is for certain, if you do not make time to think of creative solutions to problems as a team, eventually you will be left behind as other organizations may already be focusing on fostering creativity throughout their entire organization.

 As one of my favorite quotes by Kenneth Blanchard goes, “None of us are as smart as all of us.” Therefore, it is so important for you as a leader to not constantly work in silos as that will greatly limit the possible creative solutions that your staff are able to come up with in addressing a specific barrier/topic at hand. We cannot tap into our staff’s creative process without making time to meet and discuss creative solutions to the problems at hand. I challenge each of you as leaders and/or future leaders to keep this in mind as you manage you teams/organizations into the future. Don’t wait around for change to occur on its own, instead create an environment for your team which fosters creative solutions in making a positive disruption within the healthcare sector before it’s too late. 

Contributed by Aaron Kawa, MHA Student