Chronic Multi system Illness in Veterans
Use a national, state or local population health care database to research indicators of disparity. Choose a mortality/morbidity indicator to identify a clinical problem or issue that you want to explore pertaining to a population of focus. Use this indicator to begin to formulate a PICOT and conduct research on the population.
Write a 750-1,000-word paper that analyzes your research and focuses on the population you have chosen. Describe the population\’s demographics and health concerns, and explain how nursing science, health determinants, and epidemiologic, genomic, and genetic data may impact population health management for the selected population. Provide an overview of a potential solution for solving the health issue related to your population and the intended PICOT statement. Describe how the solution incorporates health policies and goals that support health care equity for the population of focus.Chronic Multi system Illness in Veterans
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Clinical Inquiry (PICOT) on Chronic Multisystem Illness (CMI) in Veterans
As a healthcare person, it is not uncommon to realize during clinical practice that some clinical problems are unique or more common to a particular population demographic. By studying their demographic factors, common characteristics, and social determinants of health, it is therefore possible to come up with solutions to these clinical problems. However, it has to be ensured that the proposed solutions are efficacious and effective. This can only be done by ascertaining that the interventions proposed as a solution to the clinical problem(s) are evidence-based. This means that their efficacy must be backed by scholarly peer-reviewed scientific evidence in the form of research. Finding this evidence requires that the process of clinical inquiry be entered into. This involves the use of the PICOT model or Population, Intervention, Comparison, Outcome, and Timeframe (Melnyk & Fineout-Overholt, 2017). This paper identifies the population of US War Veterans as a population of interest with the clinical problem of chronic multisystem illness (CMI). It lays down the proposed solution and the clinical inquiry in terms of the PICOT statement.
Veteran Population Demographics and Health Concerns
In 18 years between the year 2000 and 2018, the population of veterans in the US declined from 26.4 million to 18 million. This was 7% of the adult population then. Despite this general decline in the veteran population, the number of women veterans increased to 1.7 million or 9% of the veterans. In the census results published in 2018, the median age of veterans was 65 years (USCB, 2020). This effectively means that a good majority of veterans are elderly and therefore live with pre-existing conditions in addition to service-related mental health conditions such as post-traumatic stress disorder or PTSD (Sadock et al., 2015). But these veterans have also been found to have other significant health concerns. In a study by McAndrew et al. (2016), the researchers found that Iraq and Afghanistan war veterans suffered from pain that was unexplained by any other psychological or physical condition that is specific. They concluded that the pain was part of a wider symptom profile of a condition referred to as chronic multisymptom illness or CMI. Their data analysis revealed that more than 9 out of 10 (90%) of veterans who had chronic pain easily met the diagnostic criteria for CMI. The CMI symptoms could not be accounted for by either PTSD or pre-deployment symptomatology (McAndrew et al., 2016). CMI is therefore the identified clinical health problem that is the focus of this paper’s clinical inquiry in terms of the PICOT model.Chronic Multi system Illness in Veterans
Role of Nursing Science and Other Factors on Veteran Population Health Management
As nursing science advances, better interventions become available to manage veteran health problems. For instance, contemporary innovative technologies that enable nurses to follow up on the veterans without necessarily having them present physically have been revolutionary. An example is telehealth which spares the veterans the effort of having to move to the clinic or hospital every follow-up visit. As seen above, the median age of veterans is 65 years. This is also the age in which there is a significantly increased risk of accidental falls that can lead to disability or even death (Kenny et al., 2017). The social determinants of health of socioeconomic status, access to quality healthcare, and physical living conditions also greatly impact veteran health management. Most of these veterans are not working and cannot afford healthcare coverage. An even larger number are homeless as they cannot afford housing. This exacerbates their health condition with regard to CMI in this case. Knowledge of the incidence, prevalence, and other epidemiologic parameters is also very helpful in determining how these health issues affecting veterans are managed. Lastly but not least, genetic and genomic data enables us to understand any hereditary factors that may be interacting with the environment to produce the phenotypic expression of symptoms relating to CMI. This understanding is important in coming up with evidence-based interventions. In essence, therefore; nursing science, epidemiology, social determinants of health, genetic and genomic data all have a considerable impact in the health management of the population of US veterans that is still living.Chronic Multi system Illness in Veterans
The potential Solution to CMI in Veterans and the PICOT Statement
Seeing as it is that the underlying cause of all the symptoms that veterans often present with is the psychological trauma they experienced at war, the intervention centers on the thought process. In other words, the solution to this clinical problem of CMI in veterans can be found in changing the thought process and remodelling it to produce more positive behavior or actions. This is what is referred to as cognitive remodelling, restructuring, or re-engineering (Corey, 2017). To this end, the potential solution to the clinical problem of CMI in veterans will adopt a nurse-led bundled approach of telephone follow-up, psychotherapy in the form of cognitive behavioral therapy or CBT, and physical home visits. The picot statement will therefore be as follows: “In US veterans of all ages (P), does the implementation of telephone follow-ups, home visits, and CBT (I) compared to just clinic appointments (C) result in the remission of CMI symptoms (O) within a span of one year (T)?”
Health Policies, Goals, and Equity
The above solution incorporates health policies and goals in that the symptoms that are of a psychological nature or psychosomatic in orientation are tackled by using behavioral interventions. This is what policy protocols in guidelines as well as in the DSM-5 advocate for. The policies and goals support healthcare equity among veterans in that they do not divide the symptomatology or therapy according to ones ethnicity or race.
References
Corey, G. (2017). Theory and practice of counselling and psychotherapy, 10th ed. Cengage Learning.Chronic Multi system Illness in Veterans
Kenny, R., Romero-Ortuno, R., & Kumar, P. (2017). Falls in older adults. Medicine, 45(1), 28-33. https://doi.org/10.1016/j.mpmed.2016.10.007
McAndrew, L.M., Helmer, D.A., Phillips, L.A., Chandler, H.K., Ray, K., & Quigley, K.S. (2016). Iraq and Afghanistan veterans report symptoms consistent with chronic multisymptom illness one year after deployment. Journal of Rehabilitation Research and Development, 53(1), 59-70. https://doi.org/10.1682/JRRD.2014.10.0255
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences/ clinical psychiatry, 11th ed. Wolters Kluwer.
United States Census Bureau [USCB] (June 2, 2020). Census bureau releases new report on veterans. https://www.census.gov/newsroom/press-releases/2020/veterans-report.html#:~:text=The%20report%2C%20Those%20Who%20Served,U.S.%20armed%20forces%20in%202018.&text=About%201.7%20million%2C%20or%209,veterans%2C%20were%20women%20in%202018
Chronic Multi system Illness in Veterans