Enteral feedings are used for patients who are unable to eat food by mouth and are provided by a tube into the gastrointestinal (GI) tract. While enteral feeding creates unique considerations for any patient population, military veterans using enteral feeding will have additional considerations that are unique to their specific background.
Veteran-Specific Considerations
While veterans may develop needs for enteral feedings because of disease processes that naturally occur with any patient, this patient population may also develop the need for enteral feedings due to service-related causes.
Orofacial or neck trauma may occur from combat-related injuries, resulting in a functioning GI tract, but an inability to take food through the mouth. Internal or penetrating trauma may also affect other parts of the GI tract, making enteral feeding necessary. Neurological trauma affecting cognitive abilities or motor function may also increase the risk of aspiration to the extent that enteral feedings are necessary.
In addition to trauma-related considerations, veterans may also be more likely to experience exposure to potential carcinogens or other disease risk factors that may cause a higher prevalence of diseases in this population that can require enteral feedings.
Metabolic Needs
Because veterans may be likely to require enteral feedings at an earlier age than other patients, they can be younger and have increased metabolic needs compared to most patients using enteral feeding. Additionally, combat-related injuries, such as orofacial trauma, may allow veterans to continue the active lifestyle they are accustomed to. The younger age and increased activity of veterans using enteral feedings can make it necessary to increase caloric intake in this population.
Meeting the need: Be sure to consider the veteran's age and activity when determining their metabolic needs.
Independence in Care
Independence is an enteral feeding-related consideration for any population. However, its impact on veteran populations may be more significant than other populations. Because veterans are likely to be younger and more active, they may consider independence an essential component of their lives that enteral feedings could threaten. These patients will value the ability to administer their own enteral feedings and will not want to depend on healthcare providers to administer their feedings or other care.
Meeting the need: Teach veterans how to independently administer their enteral feedings and be sensitive to "over-helping."
Mobility
The same factors that make independence an important consideration for veteran populations make mobility another important factor. The young age and active lifestyle that are more common in veteran populations mean that they are likely to value their mobility, and inhibited mobility will negatively impact their quality of life. Many enteral feeding options require feeding pumps that are restrictive and inhibit mobility. Currently, there is only one 100% portable feeding pump commercially available that allows veterans a high degree of mobility.
Meeting the need: Provide veterans with portable feeding options that can meet an active lifestyle's demands.
Susceptibility to Trauma Triggers
Many veterans have experienced significantly more trauma than most patients healthcare providers care for. Post-traumatic stress disorder (PTSD) is estimated to occur in 30.9% of male veterans and 26.9% of female veterans. PTSD causes panic attacks and emotional distress that is triggered by reminders of the trauma. Components of enteral feedings, such as insertion of a feeding tube or the visual stimuli, may trigger subconscious trauma and cause patient distress. Carefully considering the patient's history of trauma and adjusting care appropriately is important when providing enteral feedings for veterans.
Meeting the need: Practice trauma-informed care, and consider potential trauma triggers when providing treatments.
Psychosocial Effects
Feeding tubes and enteral feeding can cause impaired body image and concerns about how one is perceived socially. A visible feeding tube or having to disclose that one is using enteral feedings can not only cause concerns about one's self-image but can also cause concerns that one is perceived as an invalid. Veterans, whose military careers are often centered around physical ability, may be particularly sensitive to the psychosocial implications of enteral feedings.
Younger patients are also often more concerned about the psychosocial impact of enteral feedings. As veterans may require enteral feedings at a younger age, this is another factor that compounds the psychosocial implications.
Meeting the need: Choose feeding methods and tubes that are discrete and do not draw attention to the need for enteral feedings.
Personalized Care
Medical care is shifting towards a personalized care model that includes specific patients' needs based on their unique physical and psychosocial backgrounds. Veterans have particular needs, and considerations that clinicians are providing enteral feedings should consider. By factoring in the experiences and background that veterans have, clinicians can provide patient-specific care.
Learn more about how we are supporting our veterans’ to live life more fully!