Veteran Health Needs, Nursing Ethics, and Confidentiality

Veteran Health Needs and Early Intervention

Returning veterans and their families need early identification and treatment, as well as continuity of care. Early identification of mental health issues is critical, but it must take place within a veterans' healthcare system that is responsive to and understanding of the issues arising during and after deployment. The veterans' healthcare system should become more robust and seamlessly integrated with the mental and physical health services delivered during deployment.

Both veterans and their families need early intervention. Reunification with families is a critical period that must be addressed as a situation capable of presenting specific risks for exacerbating underlying mental health issues. For example, separation of family members during deployment creates "boundary ambiguity" and role ambiguity within families, and reunions can themselves be traumatic (State of Rhode Island, n.d.). Depending on the length of the separation, family reunion can be strained, and rates of divorce are high. Mental health issues are a core concern, as rates of PTSD and suicide are high (State of Rhode Island, n.d.). Returning veterans and their family members suffer from elevated rates of mental illness, including substance abuse. Domestic violence may also be a critical concern for veterans and family members (State of Rhode Island, n.d.).

Therefore, returning veterans and their families need structures, programs, and interventions that offer social support systems and methods of coping with the strain of reunification. Mental health assessments should be regular, ongoing, and treated as normative rather than exceptional.

Continuity of Care for Veterans and Families

In addition to early identification of psychological and family health needs, veterans and their families require continuity of care at the structural level. Jackonis, Deyton, and Hess (2008) point out the need for "an integrated health care financing and delivery system to ensure a continuum of care for service members, veterans, dependents, and other family members" (p. 677). Communication among members of the care team can be facilitated by a more robust health informatics system linking different healthcare providers. Because veterans and their families move frequently, continuity of care remains a core concern for nurse advocates.

Nursing Ethics: Confidentiality Versus Duty to Warn

The ethical scenario involving HIV disclosure reveals the conflict between privacy and confidentiality on one hand, and beneficence, non-malfeasance, and justice on the other. Confidentiality is a core ethical principle of nursing. However, withholding information from a third party can also constitute an ethical violation. "With regard to public health, or the safety of others, the nurse may have to reveal information for the greater good within the bounds of the law" (Slate, 2015). In this case, the nurse has an ethical and legal obligation to inform because failing to do so could lead to the sister contracting HIV. As Melroe (1990) points out, "legal precedents with other sexually transmitted diseases have been established that place the burden upon the clinician to warn in order to prevent litigation" (p. 58). The nurse's obligation is to all patients; protecting the confidentiality of one patient should not come at the expense of protecting the health of another.

Begley (2010) notes that good nursing practice entails autonomy, advocacy, accountability, and assertiveness. The autonomy of the patient and the patient's right to self-determination are coupled with the nurse's own ability and competency to act in accordance with legal and professional guidelines. If the nurse wishes to consult a supervisor, that is appropriate, but such consultation should not be considered a prerequisite in this case. Advocacy refers to the willingness of the nurse to be proactive and speak out against injustice. Ideally, therefore, the nurse will communicate with the boyfriend and make clear that it is her professional duty to inform the sister. Transparent and honest communication creates the respectful environment that is conducive to ethical nurse–patient relationships.