RURAL TELEHEALTH: ENHANCING THE

ACADEMIC-PRACTICE PARTNERSHIP

FOR APRN EDUCATION

VICTORIA BRITSON PHD, APRN, CNP, FNP-BC, CNE

ROBIN ARENDS DNP, CNP, FNP-BC

NICOLE GIBSON DNP, CNP, NP-C

2016 International Rural Nursing Conference

Rapid City, South Dakota

July 19, 2016

DISCLOSURES

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant numberD09HP28685 and title “Rural Telehealth: Enhancing the Academic-Practice Partnership for APRN Education” for the amount of $1,236,870 for 3 years (2015-2018) with 0% financed by nongovernmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

No conflicts of interests are identified.

Additional Team Members:

Janice Conlee MS, NP-C, RN, Gloria Craig PhD, Jo Voss PhD, RN, CS, Nancy Swenson MA, MLS , Sheryl Marckstadt PhD, RN, CNP, FNP-BC, NP-C

OBJECTIVES

1. Discuss telehealth competencies for family nurse practitioner students and advanced practice preceptors.

Identify the proficiency needed for use of telehealth equipment.

2. Discuss essential components of a telehealth curriculum for family nurse practitioner students and advanced practice preceptors.

Describe knowledge needed for telehealth practice.

Recognize the phases of telehealth competency needed for family nurse practitioner clinical education.

Identify a clinical partner to assist in education and training of family nurse practitioner students and advanced practice preceptors.

BACKGROUND: TELEHEALTH IN RURAL SETTINGS

Increase access to care

Connect patients to primary healthcare providers

Increase access to preventative services

Consult with specialists

Increase continuity of care

Improve patient outcomes

Reduce disparities between rural and urban residents

Address the Institute for Healthcare Improvement Triple Aim: Better health, better healthcare, and lower costs

WHY EDUCATE NURSE PRACTITIONERS ON TELEHEALTH?

Rapid advances in technology.

Nurse practitioners may practice in rural and underserved communities.

These areas are remote and providers may not have access to consultants for challenging cases.

The novice nurse practitioner may not feel confident in their ability to manage complex acute and chronic disease processes upon entry into practice.

Many components require explicit education to provide safe, effective, ethical, cultural, and legal patient care.

Licensing

Credentialing

Skills

Managing patients remotely

WHY INCORPORATE TELEHEALTH INTO CURRICULUM?

Informatics is an AACN essential of graduate nursing education.

Telehealth was not a robust curricular component.

Telehealth was not an intentional clinical placement for nurse practitioner students.

An opportunity to shape curriculum and provide leadership in the development of

technology-enhanced practice for nurse practitioners.

Nurse practitioner students were interviewing for positions that use telehealth in the

practice without receiving the education and skills needed to achieve competency.

CURRENT ACADEMIC-PRACTICE PARTNERSHIPS

Existing collaboration with regional healthcare organizations to provide clinical

experience for nurse practitioner students.

A need was identified by a clinical partner to develop/enhance a standardized

orientation for providers regarding telehealth modalities.

Increase provider comfort

Increase telehealth utilization

Enhance patient outcomes

TELEHEALTH ACADEMIC-PRACTICE PARTNERSHIP

Established to:

Increase nurse practitioner student experience with telehealth modalities.

Increase pre-licensure knowledge and competency of nurse practitioner students.

Develop modules to assist providers to gain additional knowledge of telehealth.

Increase provider comfort and confidence in the delivery of telehealth.

Enhance patient outcomes for rural residents.

TELEHEALTH CURRICULUM DEVELOPMENT PROCESS

Literature search to determine curriculum and competencies.

No best practices emerged

No competencies for family nurse practitioners located

Development of a core faculty team.

Teach in nurse practitioner practicums

Educators with knowledge of curriculum concepts

Have experience utilizing telehealth

Development of an Advisory Board.

Community group compromised of providers, administrators, regulatory agencies, and insurance

representatives to guide development and implementation of curriculum.

DEVELOPMENT OF COMPETENCIES

Introductory concepts

Billing

Rural health considerations

Urban health considerations

Legislation

Licensure considerations

Insurance considerations

Establishing a professional presence on camera

Future trends

TELEHEALTH CURRICULUM DEVELOPMENT AND IMPLEMENTATION

Current didactic and clinical course concepts reviewed.

Telehealth concepts aligned with similar content taught in the practicum courses.

Curriculum increases in complexity as the students progress.

Simulation-based learning experiences.

Reviewed content in the telehealth curriculum as well as practicum content to determine appropriate simulation experiences.

Follows the curriculum and clinical experience to increase in complexity.

Clinical placement of students.

Intentional placement in sites that utilize telehealth.

Collaboration with clinical partner to determine appropriate sites and locations.

EVALUATION OF CURRICULUM

Pre and post surveys to measure student competency.

Self assessment data.

Number of sites with preceptor use of telehealth.

Number of telehealth visits students engaged in with

their preceptor.

CHALLENGES

Site Visits

Academic institutions did not want faculty from another school to visit simulation centers.

Curriculum

Nurse practitioner curriculum was full prior to the addition of telehealth concepts.

Telehealth is not tested on the certification exams.

Students may not see a need for this if their provider preceptors do not use.

Medical emergency prevented a fall visit from consultant to help with curriculum development.

Simulation Experience

Issues with firewalls.

Microphones are very sensitive.

Need to disconnect the stethoscope to avoid reverberation.

CHALLENGES

Equipment

Multiple pieces of equipment available from multiple vendors.

Shipping issues

Training

Faculty needed to be trained on equipment prior to student training.

Campuses are separated by more than 400 miles.

Preceptor placement

New clinical sites

Telehealth visits may not occur daily

Limited number of provider preceptors who use telehealth.

ACHIEVEMENTS

Curriculum

Integrated into 3 practicum courses.

Students able to discuss telehealth concepts after the courses.

Training

11 faculty trained on the equipment.

Able to effectively teach equipment use to students for

simulation in the Spring 2016.

Equipment purchased and set-up at 3 sites.

Brookings

Rapid City

Sioux Falls

ACHIEVEMENTS

Simulation

Fall simulation was adapted into hands-on training

Spring simulation included first and third practicum nurse

practitioner students

NP students demonstrated understanding of equipment

use and telehealth principles

NP students appeared on camera in a professional manner

ACHIEVEMENTS

Preceptors

7 students were able to utilize telehealth in their preceptored clinical experiences.

Consultant

Assisted in creation of competencies and curriculum.

Site visit June 2016 to assist in development of preceptor modules.

Continued Learning Opportunities

Faculty team attended national conferences to learn about practices in other academic and

healthcare institutions.

Dissemination

WHERE DO WE GO FROM HERE?

Development of preceptor modules.

Addition to undergraduate curriculum?

Simulation between interprofessional programs and colleges?

Simulation between different campuses to allow connection across the state?

Continue to expand curriculum based on the needs and changes within the

healthcare system.

REFERENCES

American Association of Colleges of Nursing (2011). The essentials of master’s education in nursing. Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Banburry, A., Roots, A, & Nancarrow, S. (2014). Rapid review of applications of e-health and remote monitoring for rural patients.The Australian Journal of Rural Health, 22(5), 211-222.

Hawkins, S.Y. (2012). Telehealth nurse practitioner student clinical experiences: An essential educational component for today’s health care setting. Nurse Education Today, 32(8), 842-845.

Hill, R. D., Luptak, M. K., Rupper, R. W., Bair, B., Peterson, C., Dailey, N., & Hcien, B.L. (2101). Review of Veterans Health Administration telemedicine interventions. American Journal of Managed Care, 16(12), e302-e310.

Institute for Healthcare Improvement (2016). The IHI triple aim. Retrieved from http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx

Kowitlawakul, Y. (2011). The technology acceptance model: Predicting nurses’ intention to use telemedicine technology. CIN: Computers, Informatics, Nursing, 29(7), 411-418.

Perle, J.G., & Nierenberg, B. (2013). How psychological telehealth can alleviate society’s mental health burden: A literature review. Journal of Technology in Human Services, 31(1), 22-41.

Rutledge, C.M., Bordelon, M., Renaud, M., & Fowler, C. (2014). Telehealth: Preparing advanced practice nurses to address healthcare needs in rural and underserved populations. International Journal of Nursing Education Scholarship 11(1), 1-9.

Sabesan, S., Simcox, K., & Marr, I. (2012). Medical oncology clinics through videoconferencing: An acceptable telehealth model for rural health patients and health workers. Internal Medicine Journal, 42(7), 780-785.

Van Vleet, A., & Paradise, J. (2015). Tapping nurse practitioners to meet the rising demand for primary care. The Kaiser Family Foundation. Retrieved from http://kff.org/medicaid/issue-brief/tapping-nurse-practitioners-to-meet-rising-demand-for-primary-care/

QUESTIONS?