Understanding why veterans are reluctant to access help for alcohol problems: Considerations for nurse education

Background: To effectively engage veterans with substance misuse services, nurses need to understand their unique needs and the potential barriers that prevent them from accessing care. Nurses need to have an understanding and awareness of the cultural sensitivities associated with having been a member of the armed forces. Objectives: The aim of this study was to investigate the perceived barriers to care amongst those planning, commissioning and delivering services for veterans with substance misuse problems, and to identify and explore subject areas which nurse educators should consider for inclusion in nursing and health education programmes. Design: The findings reported in this paper come from one phase of a larger three phase research project and used an applied qualitative research approached based on methods developed for applied social policy research. Settings: The study was undertaken in the north-east of England. Participants: The study consisted of a purposive sample of planners, commissioners of services, and service providers in the North East of England. Methods: Data was collected using a semi-structured interview schedule. Framework analysis was used to analyse the data. Results: Complexity of services and care, complexity of need and a lack of understanding of veterans were identified as factors that made accessing substance misuse care difficult. To help nurses better understand the unique needs of veterans three educational topics were identified for consideration in pre-registration nurse education: understanding military and veteran culture and the nature of modern warfare, the military 'veteran as institutionalised' hypothesis and stigma. Conclusions: Health and social services can struggle to truly understand the unique needs and experiences of the veteran community. We have identified three broad subject areas that should be considered as the theoretical basis for a veteran specific education programme within pre and post-registration nurse education. (C) 2016 Elsevier Ltd. All rights reserved.