Background: This study aimed to describe the five-year trend in healthcare access, health-related quality of life (HRQoL), and health outcomes in women Veterans.Methods: A retrospective, pooled, cross-sectional study design was employed. Fiveyear trend was assessed using 2013 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) data. Bivariate, multivariable logistic regression, and ordinary least squares regression analyses were conducted.Results: A total of 6561 women Veterans, aged 18 to 64 years (3534 in 2013 and 3027 in 2017) were included. Compared to 2013, more women Veterans in 2017 reported increased healthcare insurance and decreased cost as a barrier to care.Women Veterans with health insurance were less likely to report cost as a barrier to care. There were no statistically significant differences in HRQoL in bivariate or ordinary least squares regression analyses between BRFSS years. Conclusion: Federal policy and Veterans Health Administration expansion have hadan impact on improving healthcare access to women Veterans. However, increased healthcare access alone does not translate into improved HRQoL or health outcomes for women Veterans. Future policies should not only focus on increasing healthcare access, but also improving health outcomes, especially HRQoL. The quality of the healthcare accessed must be a focus for future research and policy. K E Y W O R D Shealth insurance, HRQoL, trend, women Veterans

Continuing education alone may not advance care of the veteran. A multipronged approach to include mandatory documentation of military status and coaching of providers by those experienced with the military way of life may be used to augment staff preparedness.

Background: Continued restrictions imposed on face-to-face learning related to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) pandemic resulted in a decision to permanently transition a graduate nursing education advanced assessment course from a hybrid to an online learning modality. Purpose: The purpose of this article is to describe the transition of the physical examination skills lab from face-to-face to online, compare advanced practice nursing student performance outcomes, and evaluate faculty satisfaction and student satisfaction and confidence in learning. Methods: A retrospective comparison design was used to evaluate student outcomes. Surveys were used to evaluate faculty satisfaction and student satisfaction and confidence. Results: Academic performance, including the psychomotor performance proficiency of advanced assessment skills, was comparable between the modalities. Students were satisfied with and confident in their learning of skills. Faculty support online delivery despite increased workload. Conclusions: Continued use of the online learning modality for teaching advanced physical examination skills is warranted.

Federal, state, and educational policy, as well as public and professional initiatives, should influence how care is delivered to veterans from non-Veteran Health Administration (VHA) advanced practice registered nurses (APRNs) located in civilian health care facilities. Due to the MISSION Act, more veterans are receiving care outside the VHA, but little is known about the readiness of APRNs to address the needs of this population. This mixed-methods study describes the perceptions of 340 non-VHA APRNs concerning practice, clinical needs, and challenges they face while delivering care to veterans. Survey results show only 8% of APRNs consistently asked about military service; less than 1% asked if the patient has a family member with military history; and only 25% applied research by inquiring into military history when patients presented with conditions like chronic pain, interpersonal violence, or insomnia. Technology use via mobile application was minimally reported (<1%). “Missing in Action,” the overarching theme from qualitative data, included three subthemes: (a) absence facilitated collaboration with VHA, (b) concerns regarding personal competency in the care of the military person, and (c) lack of recognition of the significance of the need to know about military status. Practice implications proffered include implementation of mandatory inquiry into military service and enactment of APRN veteran-centric nursing competencies. Education actions involve updating graduate nursing programs to include veteran health content and increased policy awareness. Future research should encompass replication of this study in specific APRN roles and consist of ongoing evaluation of veteran care by the civilian sector as the MISSION Act is implemented.

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