[Unless otherwise noted, the information in this section is from Isserman and Martin, 2022].

Military members, veterans, and their families belong to a unique American subculture. Military culture, which is acquired through training and experiences that are integrated into the service members’ mind, body, and spirit, is comprised of implicit values and beliefs shared through time-honored rituals, customs, and organizational traditions. For many healthcare providers, practicing culturally competent care can be challenging, especially if a provider has limited personal experience with the difficulties faced by service members and veterans.

While there is great diversity among the various sectors of the armed forces, there are implicit cultural values and beliefs shared across all components and service branches. For example, the concept of service before self is a core military value that stresses integrity and requires service members to place their duty responsibilities before their own personal interests and desires. These values are ingrained early in military training and remain with military members and their families even after transitioning from military service to veteran status.

Numerous studies have identified the need for healthcare professionals to acquire what is referred to as “military/veteran cultural competence” to effectively engage with this population. This allows clinicians to understand the importance of recognizing how a client’s life experiences and relationships have been impacted by military service and veteran status.

Military cultural competence means developing an understanding of the basics of military life. This includes becoming familiar with the impact military lifestyles and duties have on behavioral and physical health, combat-related exposures, and family separations. Understanding workplace challenges confronting the armed forces—issues like sexual violence, addiction, and suicide are critically important.

Service members, veterans, and their family members expect providers to have a basic appreciation, understanding, and interest in their military-related experiences. This includes listening to their experiences, even when these stories may be horrific or painful. It is critical that healthcare providers not let their own personal biases interfere with an understanding of a client’s unique military duty or military life experiences.

Healthcare providers can break down military cultural barriers by initiating discussions about specific problems related to trauma, military sexual trauma, intimate partner violence, PTSD, and behavioral health issues. Be aware that a client may be affected by conditions such as moral injury and challenges faced during deployment.

Key points about military/veteran cultural competence:

• Screen clients for military or veteran status.
• Become knowledgeable about military culture.
• Understand the cultural stigma clients face in reaching out to therapists for counseling.
• Understand any preconceptions you may hold about the military.
• Learn about the values and factors that impact a military client’s behavioral and relational difficulties.

The American Academy of Nursing (AAN) encourages healthcare providers to ask patients if they are servicemembers, veterans, or family members of veterans. Called “Have You Ever Served in the Military?”, the AAN program provides screening and intake questions and information on general areas of concern for all veterans, such as posttraumatic stress, military sexual trauma, and blast concussions/traumatic brain injury (TBI), as well as health concerns for related to specific conflicts or deployment conditions. The goal is to increase provider awareness of service-related healthcare issues.

The first set of questions recommended by the AAN are as follows (AAN, 2017):

• Have you or has someone close to you ever served in the military?
• When did you serve? Which branch?
• What did you do while you were in the military?
• Were you assigned to a hostile or combative area?
• Did you experience enemy fire, see combat, or witness casualties?
• Were you wounded, injured, or hospitalized?
• Did you participate in any experimental projects or tests?
• Were you exposed to noise, chemicals, gases, demolition of munitions, pesticides, or other hazardous substances?
• Have you ever used the VA for healthcare?
• When was your last visit to the VA?
• Do you have a service-connected disability or condition? Do you have a claim pending? If so, what is the nature of the claim?
• Do you have a VA primary care provider?
• Do you have a safe place to go when you leave today?
• Do you need assistance in caring for yourself or members of your household?

Healthcare providers can learn to recognize and successfully address the physical, mental, and emotional health needs of veterans by learning about military culture. Providers may have their own biases about military service, which they can examine using the Self Awareness Exercise available from the Uniformed Services University. There are many ways that providers can indicate respect and care for military veterans and their loved ones, from asking open-ended questions and recognizing the strengths that are emphasized in military culture. Rapport is key to engaging patients and improving their outcomes (Kleiman and Dolans, 2023).