Clinical Inquiry on Chronic Multi system Illness in Veterans

Clinical Inquiry on Chronic Multi system Illness in Veterans

Please use the attached paper as the topic for the literature review. Additionally, attached is the rubric that must be followed.

Assignment: Benchmark Part B: Literature Review: Here is what should be in your paper: APA formatting use APA 7th edition: Use subheading: You are going to look for studies that evaluated the intervention in your PICOT and summarize the studies.

  1. Introduction: Describe the clinical issue or problem you are addressing. What is the problem that you are addressing?
  2. Methods: Describe the criteria you used in choosing your articles: Discuss the databases used in the search, key words, numbers of articles retrieved and the inclusion/exclusion criteria (Few sentences).
  3. Synthesize the Literature: is divided into two parts:


– Part A: Literature synthesis: Discuss the main components (of each article (subjects, methods, key findings) and provide rationale for how this supports your PICOT: Summarize each article author(year) conducted what type of research that evaluated what. Study was conducted …. setting. Sample consisted of what? Instrument used and the results reveals what?

Part B: Compare & Contrast: Focus on the intervention for example the populations are adults with DM, and your PICOT Intervention is the effect of physical activity/diet on adult population with DM and your outcomes is decrease in weight and HbA1C Clinical Inquiry on Chronic Multi system Illness in Veterans

– all your articles will focus on studies done on adult population with DM that evaluated physical activity/diet and the outcomes of decrease in weight and Hba1c

  1. Areas of Further Study: Analyze the evidence presented in your articles to identify what is known, unknown, and requires further study.

Make sure to find research studies and not systematic reviews evaluating the intervention in your PICOT.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Veterans are vulnerable to fragmented care, which puts them at higher risk for multisystem illnesses. The population is also vulnerable to fragmented medical services because they have a higher likelihood of accessing multiple healthcare sources through private insurance companies and Medicare. Various scholars recommended telephone follow-ups as effective strategies of improving clinical outcomes among veterans by reducing the incidences of multisystem illnesses. Veterans’ access to non-VA healthcare, for instance, was expanded by the Veterans’ Choice Act in 2014. The provision allowed the Veterans to have the much-waited travels or long wait times to receive care outside the purview of VA. The result of fragmented care precipitates various health problems for Veterans, including putting them at high risk for multisystem illnesses. The paper shall use the Population, Intervention, Comparison, Outcome, and Time (PICOT) model to describe the set of interventions instituted to manage multisystem illnesses among Veterans.

The literature review seeks to identify the impacts of using telephone for follow-up among veterans’ vis-à-vis clinic appointments and the impacts of these interventions in decreasing the remission of CMI symptoms in the targeted population. The paper will rely on literature review of five different peer-reviewed articles deciphering on the research methodologies, study designs, objectives, and findings. The article will conclude by providing appropriate recommendations for further studies and implications for future research.Clinical Inquiry on Chronic Multi system Illness in Veterans

PICOT Question

“In US veterans of all ages (P), does the implementation of telephone follow-ups, home visits, and CBT (I) compared to just clinic appointments (C) result in the remission of CMI symptoms (O) within a span of one year (T)?”

Population: among veterans of all ages

Intervention: does the implementation of telephone follow-ups, home visits, and CBT Comparison: compared to just clinic appointments

Outcome: result in the remission of CMI symptoms

Time: within a span of one year


Search Methods and Strategies

To obtain credible information on multisystem illnesses affecting Veterans and how these are affected by telephone use for follow-ups, reputable search engines will have to be selected. The process consists of developing a feasible research question and solid knowledge of the sources of information like search engines and reputable databases (Khalid, 2017). The author searched for relevant literature in the following databases; Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, and Cochrane using the following keywords; “chronic multisystem illnesses”, “chronic multisystem symptoms”, “remission”, “veterans”, “cognitive behavioral therapy”, “home visit”, “follow-up”, and “telephone follow-up”. The selected databases were appropriate because they provided new and adequate research resources from reputable institutions.

Inclusion and exclusion criteria

The sources for use in this review will have to be published within the recent seven years. The databases should present their articles in the English language. The sources to be used will have to be published in the recent seven years to provide the most recent data. The investigators manually filtered other results to meet the inclusion criteria’ specifications and their ability to answer the PICOT questions. The review will select at least five recent journals and peer-reviewed articles. Once the required article for inclusion has been identified, it will incorporate knowledge and formalize it to answer the research question. The information will then be organized into useful data, themes, and patterns for effective presentation.

Implications for Future Research

The use of telephones for follow-up among veterans of all ages introduced the concept of telemedicine and telenursing. The impacts of telenursing and telemedicine on the access of healthcare services by veterans of all ages is not adequately researched. Future studies should assess the role of telephone in improving health outcomes for veterans.Clinical Inquiry on Chronic Multi system Illness in Veterans


Literature Synthesis Part A

Yu et al. (2015) conducted a study in 2014 aimed at developing a booklet and telephone follow-up strategies to enhance adherence to medical regimen. The paper recruited 160 participants who were assigned in the control and experimental groups. The generalized estimation equation and an independent t-test were used to compare outcome variations. There was greater improvement among the members of the experimental group compared to the control. Yu et al. (2015) provided clues for healthcare workers to intervene effectively in clinical work.

McAndrew et al. (2016) reported that many veterans in Iraqi who returned from service reported experiencing chronic pain. The authors noted that it remained unknown whether the chronic pain experienced by Iraqi returning veterans precipitated chronic multisystem illnesses (CMI). The prospective longitudinal study used qualitative and quantitative research methods to determine the frequency of CMI among then Iraqi veterans returning from service. McAndrew at al. (2016) found that 49.5% of the Iraqi veterans experienced mild to moderate CMI one year after deployment. The study revealed that PTSD and predeployment physical status played an insignificant role in CMI among the veterans.

Kahn et al. (2016) reported that veterans in Global War were at higher risk of significant psychological and physical impacts. The authors sought to evaluate the impacts of web-based self-directed instruction approaches in wellness based on the body and mind of Global War veterans. The researchers recruited 160 participants who were veterans drawn from four different regions in the US. The veterans were randomly allocated to 1 to 4 research arms including waitlist control, Mission Reconnect program, and Prevention and Relationship Enhancement Program. The Mission Reconnect Dyads were provided with mobile and web-based apps coupled with audio instruction in mindfulness procedures for 16 weeks. Khan et al. (2016) found modest declines in eh use of Mission Reconnect in 16 weeks. There was significant reduction in pain, depression, and anxiety in veterans assigned to MR arms.

Kargar et al. (2015) conducted a study in 2015 in attempts to describe the impacts of nurse-led telephone follow-ups on anxiety, depression, and stress among hemodialysis patients. Double blind randomized clinical trials consisting of 60 patients were conducted among the trial and control group. The authors used a DASS scale to compare outcomes among the two groups. Kargar et al. (2015) found that there was significant difference between the two categories regarding DASS scale dimensions score.

Literature Synthesis Part B

Various interventions were discussed in the selected literature in attempts to determine the impacts of telephone use for follow-up among veterans. Kargar et al. (2015) noted that the use of DASS scales could be used to enhance the effectiveness of various healthcare interventions meant for improvement of quality and patient safety. Yu et al. (2019) established that the development of a standard booklet for multisystem illnesses among veterans could enhance clinical outcomes. McAndrew at al. (2016) reported that there was need to conduct evaluation of veterans for CMI to enhance operational efficiency. The authors suggested that management interventions should incorporate CMI. Kahn et al. (2016) suggested that innovative approaches should be adopted in managing veterans and their families over time to enhance improved adjustment and well-being.Clinical Inquiry on Chronic Multi system Illness in Veterans


Veterans have unique healthcare needs due to the fragmentation of care making interventions into their healthcare a significant concern. This paper sought to determine the effectiveness of using telephone for follow-up among veterans of all ages compared to traditional approaches. The report established that telephones provided a more effective approach of enhancing access to healthcare by veterans of all ages compared to traditional methods. The report recommends the development of better regulations and accreditations for telemedicine and telenursing to enhance effectiveness.


Khaldi, K. (2017). Quantitative, Qualitative, or Mixed Research: Which Research Paradigm to Use? Journal of Educational and Social Research, 7(2), 15-24.

Kargar Jahromi, M., Javadpour, S., Taheri, L., & Poorgholami, F. (2015). Effect of Nurse-Led Telephone Follow ups (Tele-Nursing) on Depression, Anxiety and Stress in Hemodialysis Patients. Global Journal of Health Science8(3), 168. doi: 10.5539/gjhs.v8n3p168

Kahn J., Collinge W., and Soltysik (2016). Post-9/11 Veterans and Their Partners Improve Mental Health Outcomes with a Self-directed Mobile and Web-based Wellness Training Program: A Randomized Controlled Trial.

McAndrew L., Helmer D., Philips A., Chandler H., and Ray Kathleen (2016).  Iraq and Afghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment. Psychology Publications

Yu, M., Chair, S., Chan, C., & Choi, K. (2015). A health education booklet and telephone follow-ups can improve medication adherence, health-related quality of life, and psychological status of patients with heart failure. Heart & Lung44(5), 400-407. doi: 10.1016/j.hrtlng.2015.05.004

Being a healthcare professional for many years, it is common to realize that during clinical practice that there are some clinical problems which are more common within a particular subset of the population. I live in a largely military town and am surrounded by veterans.  Many suffering from a condition known as CMI which stands for Chronic Multisystem Illness.  By studying this specific population in regard to their common characteristics, demographic factors, and health determinants we can develop effective and efficacious solutions to their health problems that are evidenced based.  Solutions that are evidenced based means that their efficacy has been supported by scholarly peer-reviewed scientific evidence., Using the PICOT model (Population, Intervention, Comparison, Outcome, and Timeframe) is a must when doing any clinical inquiry to identify this evidence (Melnyk & Fineout-Overholt, 2017).Clinical Inquiry on Chronic Multi system Illness in Veterans

Veteran Population Demographics and Health Concerns

According to the United States Census Bureau, the population of veterans in the US is approximately 18 million, this represents about 7% of the adult population and within this population the median age is 65 years old (USCB, 2020). Based upon that data, a vast majority of our veterans are considered elderly. Just like other elderly individuals veterans could potentially have pre-existing medical conditions however, veterans may also have some service-related mental health conditions as well.  These conditions could include such things as post-traumatic stress disorder or PTSD. In addition to the medical conditions mentioned above, a subset of veterans have also been found to have some other fairly significant health concerns. Research conducted in 2016 by McAndrew et al., found that many veterans returning from the wars in the Middle East suffered from pain that was unexplained by any other psychological or physical condition (McAndrew et al., 2016). Part of their conclusion was that the pain was part of a wider symptom profile referred to as CMI and as many as 90% of veterans that had chronic pain which could not be accounted for by either PTSD or pre-deployment symptomatology easily met the diagnostic criteria for CMI. (McAndrew et al., 2016).

Nursing Science Impact on Veteran Health Management

The management of veteran health issues has always been challenging however as nursing science develops newer and better interventions there should be a shift to more availability. Telehealth is a prime example of an intervention that increases the availability for care. Being able to remotely see a provider spares the veterans the effort of having to go to the clinic or hospital every follow-up visit. Access to quality healthcare, physical living conditions, and socioeconomic status along with some other social determinates of health greatly impact the health management of veterans. All of these factors can contribute to the exacerbation of their health conditions including their CMI. Additionally, being aware of the incidence, prevalence of this condition help in the determination of how this health issue is managed. Finally, we must understand any hereditary factors that may be involved in the expression of symptoms of CMI. Taking all of these aspects into account is important when developing evidence-based interventions.

Potential Solutions to CMI in Veterans and the PICOT Statement

Psychological trauma veterans experienced at war is often considered as the underlying cause of most if not all the symptoms that veterans present with in regard to CMI, interventions must be centered around the thought process. By changing the thought process that are meant to produce more positive behaviors or actions the hope is that the CMI symptoms will decrease. This is what is referred to as cognitive remodelling, restructuring, or re-engineering (Corey, 2017). To assist in this approach, one potential solution to the clinical problem is to institute a nurse driven multi-pronged process.  Some of these interventions include the use of telephone follow-up, psychotherapy in the form of cognitive behavioral therapy or CBT, and actual in-home visits by licenced personnel. The picot statement will therefore be as follows: “In US veterans of all ages (P), does the implementation of telephone follow-ups, home visits, and CBT (I) compared to just clinic appointments (C) result in the remission of CMI symptoms (O) within a span of one year (T)?”Clinical Inquiry on Chronic Multi system Illness in Veterans

Health Policies, Goals, and Equity

The solution addressed above is by no means the only approach that needs to be used to tackle CMI however it is meant as a part of the solution. The ultimate goal of any intervention is to reduce the prevalence of this condition.  Using evidenced based approaches that have been adequately researched will help with the effectiveness and equality of any potential interventions and hopefully will not discriminate against any veteran.


Corey, G. (2017). Theory and practice of counselling and psychotherapy, 10th ed. Cengage Learning.

McAndrew, L.M., Helmer, D.A., Phillips, L.A., Chandler, H.K., Ray, K., & Quigley, K.S. (2016). Iraq and Afghanistan veterans report symptoms consistent with chronic multisymptom illness one year after deployment. Journal of Rehabilitation Research and Development, 53(1), 59-70.

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

United States Census Bureau [USCB] (June 2, 2020). Census bureau releases new report on veterans.

Clinical Inquiry on Chronic Multi system Illness in Veterans