Welcome back to unit three, segment two. In the first segment of this unit we focused on patient centric care and cultural competence. Once piece of cultural competence when, or cultural humility, when you engage with veterans, is this idea what military culture really is. And how might I, as a civilian who never experienced the military, might start to understand and engage with a veteran as I take care of them in the health care arena. There's a couple of videos that you could watch outside of class that really focus on this area of military culture and assisting service members and veterans. So when you think about the military, there's a whole culture. There's been movies thought about this. There's historical documents that you can read when you really want to think about what it means to be a member of any armed forces. They have their own vocabulary. There's some things you can assume. However, you make assumptions, you have to be careful. But in general, there's a ready acceptance of hierarchy when in the military, especially given the tradition of many of the US armed forces. There's a norms of behavior, there's a expectation about how people act when they act and there's a certain belief system. We talked a little bit earlier in unit one about the different branches and what their distinction and characteristics are. And then there's often a subculture that those of us who never engaged in military service really still have difficulty understanding. And one of those is the subculture of those who are officers or the leaders versus those who have enlisted in the military. In this article by doctors Howell and Saint, who are professors of internal medicine, and Dr. Howell is also a professor of history at the University of Michigan, they talk about how important it is in fact, how in the national discussion, about how we think about troops and people who are actively engaged in our armed service. How our choice in language actually has implications about how we view budgetary decisions, and how we talk about troops. So, this is an interesting article in the Detroit News. There's also an aspect of socialization. We have seen the movies, we understand there's a process of going from a civilian to being in active member of a organization. We think of those things as boot camp or basic training. Some of us in the health professional fields have even adopted those terms when we think about some of our simulations that we might do at nursing school or in medical school, we often call those boot camp exercises. But really the idea about that within the military structure is this idea about how you bring one from civilian to active duty service man. It's this idea of de-civilianization. You want to strip away that identity in order for you to fully engage and interact with a new group. It incorporates this idea of military culture and it really puts into place this idea of collectivism. That we all have a single goal, we're all members of a team, and it fosters co-dependency within various groups. If you do a simple word cloud based on all of our military services, you'd get an idea about what those values are, you can see them displayed here. There's really this Incredible idea about what it means to be committed to one's work. To have, to serve, to honor, what is the duty, etc. And this plays out sometimes when they have to engage in the healthcare system. They will often use this language when they're explaining, both good things, and bad things about what's happening to them, so here's from a veteran focus group for a veteran in their late 60's, early 70's, who said I was going through the VA at a certain place. I thought I was in basic training. Really, it was because the way people treated me. They were yelling at me, everything they just didn't care. So they're talking about actually reliving an experience that in this case might not have been good, about how they engage with certain experiences that they have later in life. When you think about yourself in trying to develop military humility or competence, you want to think about your own values and how those might conflict with military culture and values. Most of us in the health care professions have a college degree. We've decided that we were going to go to undergrad. We've decided that we were going to explore professional degrees. And we're confronted with those who say, nope, my duty is to serve to my country and I might enlist in the armed services. We've already started to differentiate ourselves. Luckily, we have some of those health professionals who have done both, but we have to understand that we bring a different idea. We have to understand how our own values about a particular conflict about cultural norms, how that might engage how that might show up when we take care of patients, and you want to seek information from veterans in particular about how their military service might effect them in the current era. If you continue to think about this idea of military competence or humility, one of the things that actually is at times quite active in our culture of the negative stereotypes that one might think about someone who's an active duty service person or a veteran. And we want to actually think about those in a conscious way and not keep them unconscious and buried, where we can't mitigate our behaviors and relationship to that. And also, we want to intervene with sensitivity to hopefully reduce our biases and prejudice. This is a process that you'll develop over time and something that you need to work on. Whether you're incredibly in favor of various military conflicts or engagements or not, these are all things that might impact your care of active duty service people or veterans. One of those things that might come up is sorta what do you think about when you see this picture? What actually are the biases, the stereotypes? As you look at this video, what are you thinking about? It gives you a different connotation about what people bring to the healthcare encounter. So over the course of unit three, we've really thought about this idea of what it means to be patient centered, how cultural competence is an important piece of patient centered communication, and then finally how military competence or military interest in terms of understanding what a patient brings who might have served in the armed forces, might have, what impact that might have on the health care environment. Here in this photo you see Mrs. Allen, who is a 70 year old veteran who served at a young age in the military. She was a nurse in Vietnam and had lots of experiences related to that. And I want you to think about in the discussion group this week, about what are those fundamental things that she might bring in terms of her advocacy work in terms of veteran centered care, or how that advocacy work might impact her own care in terms of mental health. You want to remember, as we think about ending a segment and a unit, that you have an opportunity to evaluate your peers. There's a nice rubric in terms of how you actually are going to score those in order to really get a deeper understanding of how the process of self reflection should go. So we've now completed unit three. In this unit, we've talked about patient's inner care, patient's inner communication skills, cultural humility, and military competence. These are important concepts to really understand how you are going to use those skills and behaviors to express yourself in a patient centered way. How are you going to bring your understanding of your experiences and your thoughts about various aspects of a patients care, and really using your communication skills to better understand a patient, so that both of you can really partner to come up with the best healthcare outcomes.