Troops returning from Iraq and Afghanistan with multiple traumatic injuries, including posttraumatic stress disorder and TBI, enter the VA Polytrauma System of Care aiming to maximize their independence and improve their ability to function within the context of personal goals.
But some may require additional emergency care at community hospitals, while others could opt to continue their rehabilitation at private facilities.
Although Shawna Clausen, MS, BSN, RN, CNL, CRRN, a clinical nurse leader for the Polytrauma Rehabilitation Center at the Minneapolis VA Medical Center, is confident in the ability of the VA to accommodate the rehabilitation needs of this growing patient population, she recognizes the importance of community support to their recovery.
“Nurses who work in community emergency departments and private rehab facilities may be involved in the care of polytrauma patients from OIF [Operation Iraqi Freedom] and OEF [Operation Enduring Freedom], and they should be aware of patterns of wartime injuries and blast injury,” she said. “It is important for everyone involved in the care of these patients to be aware of the potential for vision and hearing impairments, head injury and other injuries that may not be immediately apparent.”
Clausen added caregivers for this population of wounded troops should be aware of VA resources available in their communities.
System of Support
At the core of the VA Polytrauma System of Care are four polytrauma regional centers (PRCs). Located at the VA medical centers in Minneapolis, Richmond, VA, Tampa, FL, and Palo Alto, CA, each PRC contains a Polytrauma Network Site. The VA operates 17 additional network sites throughout the country, as well.
Most patients discharged home from the PRCs receive specialized follow-up care at the Polytrauma Network Sites on an outpatient basis. Some patients, however, due to the severity of their injuries, require ongoing sub-acute or long-term care.
“The PRCs are for the severely injured,” Clausen said. “We can see 12-18 patients at a time at the Minneapolis PRC. We’ll see patients and provide family support, using an interdisciplinary team of rehabilitation physicians, social work case managers, nurse case managers, rehabilitation nurses, physical therapists, occupational therapists, speech and language pathologists, neural psychologists, blind rehabilitation specialists and active-duty military liaisons to help with military benefits.”
Clausen said the PRCs also offer a residential rehabilitation program to help patients achieve a progressive return to everyday living, whether a patient’s personal goal is to transition back to active duty, enroll in school or enter a vocational training program.
Beyond the four PRCs and 22 Polytrauma Network Sites, the VA operates more than 80 Polytrauma Support Clinic Teams (PSCTs) and 50 “point-of-contact” sites nationwide.
“The PSCT sites provide continued support and offer some specialized outpatient care,” Clausen said. “They coordinate with PRC sites or Polytrauma Network Sites to help manage individualized care plans and assist in integration to the home or the community. The PSCT and point-of-contact sites are the frontline for caregivers in the community who need help identifying resources.”
Nursing Interventions
Clausen noted, as a general rule, that no two military service members with multiple traumatic injuries present with the same combination and severity of injuries.
“We create an individualized care plan for each patient,” she said. “It really starts before the patient arrives from the military treatment facility.”
Using video teleconferencing technology, a core care team at the Minneapolis PRC meets with the patient’s family and the patient, if appropriate, to begin the planning process and foster a sense of comfort about the patient’s future.
Once the patient arrives at the Minneapolis VA Medical Center and is transferred to the PRC, the care team completes necessary assessments and finalizes the care plan based on patient and family goals.
“The family really is at the center of the team,” Clausen said. “As nurses, we work with the family while completing comprehensive physical, neurological, psychosocial and spiritual assessments, and incorporating that information into the care plan. Nurses are integral members of the interdisciplinary team because they are the discipline that provides 24/7 care and are instrumental in generalizing the care plan to the nursing unit.”
Although each case is unique, common nursing interventions for this population of polytrauma patients include wound care management, nutritional support, bowel and bladder management, infection prevention, pain management and psychosocial support.
“We do intensity-based rehabilitation,” Clausen said. “It depends on the severity of the injuries. Patients with severe brain injuries can only tolerate so much. Others can handle more. We don’t want to over-stimulate or make them too tired to participate.”
Passion for Polytrauma Care
A nurse for 16 years – all but 1 of them at the Minneapolis VA Medical Center, including 12 years of acute rehabilitation experience – Clausen feels honored to be involved in the care of the nation’s veterans and active-duty service members.
“I am proud to be a VA nurse and of the safe, high-quality nursing care practiced in the VA system of care,” she said. “It is rewarding to have the opportunity to directly impact the care provided to polytrauma patients, assisting individuals to reach their optimal level of health and function.
“It’s important for nurses in the communities of these patients to be aware of the VA’s extensive polytrauma system of care,” she continued. “The VA provides lifetime care for veterans, and we can help paint a complete picture about the patient’s history and the actual event that caused the trauma.
“Without an understanding of the patient’s past, it can be difficult to assess the full extent of potential cognitive issues and psychosocial or emotional components – the ‘hidden’ injuries of these wars.”
Rich Magda is senior associate editor at ADVANCE.
