title: Understanding why veterans are reluctant to access help for alcohol problems: Considerations for nurse education.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  The study was undertaken in the north-east of England.
  
  
  METHODS
  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.
authors.affiliation: Northumbria University Newcastle, Coach Lane Campus East, Benton, Newcastle upon Tyne NE7 7XA, UK. Electronic address: matt.kiernan@northumbria.ac.uk.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kiernan
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle, Coach Lane Campus East, Benton, Newcastle upon Tyne NE7 7XA, UK. Electronic address: sandra2.moran@northumbria.ac.uk.
authors.forename: Sandra
authors.initials: S
authors.lastname: Moran
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle, Coach Lane Campus East, Benton, Newcastle upon Tyne NE7 7XA, UK. Electronic address: michael.hill@northumbria.ac.uk.
authors.forename: Mick
authors.initials: M
authors.lastname: Hill
mesh_terms: D000437:Alcoholism / Q000451:nursing* / Q000523:psychology*; D001294:Attitude to Health; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D014728:Veterans / Q000523:psychology*
keywords: Alcohol; Armed forces; Barriers to care; Nurse education; Qualitative research; Stigma; Substance misuse; Veterans