Significance
To identify risky behaviors of college age students using evidence-based clinical preventative service screening tools and provide education using Brief Action Planning (BAP) as the supportive technique for students to make actions plans to change unhealthy behaviors and sustain a culture of health.
Background
Evidence-based clinical preventative services, such as screening for disease and immunizations are vital to decreasing death and disability and improve health (Office of Disease Prevention and Health Promotion, 2018). Obesity is a major concern in the United States. In 2012, “40% of college-aged adults (18-24) were classified as either overweight or obese” (Harmon, Forthofer, Bantum, & Nigg, 2016, p. 2). According to Harmon, Forthofer, and Bantum (2016) college is the pivotal time that obesity prevention could change the course of weight gain and increase risk of obesity related health problems. College years are the peak time for the onset of depression and in particular its first onset. It is crucial for University settings to prevent, identify and treat depression (Cuijpers et al., 2016). Rates of high-risk drinking are the highest among college students between ages 18-22 years (Cleveland, Turrisi, Reavy, Ackerman, & Buxton, 2018; Wrye & Pruitt, 2018). Therefore, it is beneficial for college students to have screening with a focus on alcohol use and related risk factors such as risky behaviors (Cleveland, Turrisi, Reavy, Ackerman, & Buxton, 2018). There is a gap in the literature regarding sexual behavior and the undergraduate student.
PACE- Partnership to Advance Collaborative Education is an interprofessional collaborative practice model (IPCP) created in 2017 by faculty at a large suburban University School of Nursing. The launch of the PACE Campus Center for Health and Wellness, located at the campus recreation center, was an innovative paradigm shift to partner with the Campus Recreation Center and the Student Health Service Center. This IPCP model is a nurse practitioner led team with the aim to identify risky and unhealthy behaviors among college age students with the goal to promote health and prevent disease for this population.
Campus students often underestimate their risk for poor health; they are considered a high risk and vulnerable population. College students have a low propensity toward preventive health laying the foundation for poor health behaviors which may lead to chronic disease.
(Center for Disease Control and Prevention [CDC], 2017) given their scholastic, social, emotional demands, and limited time to access healthcare. College students have a low propensity toward preventive health laying the foundation for poor health behaviors which may lead to chronic disease.
The PACE Campus program offers free health screenings using evidenced-based clinical preventative services and has expanded to campus sites beyond the campus recreation center to reach a more generalized campus population. The purpose of the PACE program aims are in alignment with recommendations from the Institute of Medicine and National Research Council. This council released a report in 2015 that concluded young adulthood is a critical period with development issues and unique needs. Young adults’ aged 18-26 should be treated as a separate subpopulation in policy, planning, programming, and research. The council recommends action to improve health care for young adults; improving the transition from pediatric to adult health care, enhancing preventive care, and developing evidence-based practices (Stroud, Walker, Davis, & Irwin, 2015). Additionally, PACE aligns with Healthy People 2020 goal to increase the availability of resources and education to close the gap between current preventative services and what students actually receive by improving access to care, promote healthy behaviors, prevent disease and increase health equity (Office of Disease Prevention and Health Promotion [ODPHP], 2018).
This unique partnership consists of the Assistant Vice President of Student Health Services, the Director of Campus Recreation, the School of Nursing, and Nurse Practitioner faculty. Health and wellness screening is provided by adult and family nurse practitioner students, assisted by undergraduate registered nurses enrolled in the baccalaureate program, and students from the Heath Education Internship Program with the goal to target key physical, psychological, and social concerns of campus students. The campus model collaborative initiative allows the students to translate theory into clinical practice with a focus on the significance of health and wellness. PACE remains in progress this semester with continuation of data collection.
The PACE Program has effectively built a strong foundation for generating the delivery of an evidenced-based health and wellness screening process for high risk health conditions that include: immunizations, disease, obesity, vision, hemoglobin A1c, cholesterol, smoking, drinking, drugs, and sexual activity, depression, trauma, anxiety, and sleep disturbances.
PACE NP students are educated by faculty to incorporate the evidence-based practice technique called, Brief Action Planning (BAP) to assist campus students to make concrete plans that address unhealthy behaviors identified from the screening that are most important to them. Student nurse practitioners follow up two weeks post the screening to assess how effective the student is with following their plan to change their risky behaviors.
This NP led IPCP model provides expanded opportunities for evolving nurse leaders, such as the PEER internship, the RN and the NP students involved in this program. The PACE Campus program provides students the opportunity to demonstrate team building, cooperative problem-solving, while understanding the need to create a sustainable culture of health and wellness among this population to ultimately improve future health outcomes. Students who participate in these PACE Program have expanded opportunities to gain knowledge about evidenced-based clinical practice, skills, and attitudes to assimilate didactic course work in the clinical environment with faculty guidance. It is known that close student-faculty mentorship is a significant factor for student learning and success (Faculty focus, 2016).
Methods
Design: Descriptive Cross sectional quantitative study, anonymous, voluntary
Sample: A convenience sample of campus students (N=177) walking into the campus recreation center.
Setting: The PACE Campus Center located at a large suburban university Recreation Health and Wellness Center, and remote screenings at the Student Activities Center (SAC).
Intervention: NP students and undergraduate registered nurses performed a voluntary, health risk and preventive health screening on college-aged students. An evidence-based screening protocol, composed of standardized tools that measured preventive health behaviors, health risks and point of care testing, was implemented.
Risk factors, areas of opportunity to improve health behaviors, follow-up recommendations, and appropriate referrals were identified and discussed with students.
A PACE Campus survey was administered post screening and assessed student demographics, reasons for seeking screening, and their satisfaction with the screening.
Purpose
To identify unhealthy and risky behaviors and facilitators that increase campus students’ access to health promotion and wellness, implementation of BAP, and their satisfaction with screening at a campus wellness center.
Results
The PACE Campus screening survey identified the following results from the data collected in the fall 2017 and spring 2018 semesters (n= 177).
|
Screening Result (%) |
Fall 2017 (n=66) |
Spring 2018 (n=111) |
|
BMI ≥ 25 |
39.4% |
77% |
|
Unprotected Sexual Activity last 12 months |
38.8% |
55.4% |
|
Multiple sexual partners in last 12 months |
39.6% |
39% |
|
Depression |
40.5% |
6% |
|
General Anxiety Disorder |
33.3% |
37% |
|
Drug Use |
3% |
24% |
|
Alcohol Use |
34.8% |
36% |
|
Trauma |
6.1% |
10% |
|
Sleep Disturbances |
10.6% |
11% |
|
Pre-diabetes |
10.6% |
12.5% |
|
Elevated Cholesterol |
9.1% |
12.8% |
Significant health risk factors and poor preventive health actions were identified in this population of college-age students. Results demonstrated that the preventative screenings indicated that 50-89% of students used BAP to engage in health care recommendations and change unhealthy behaviors leading to a decrease in future health related problems. Results indicated that campus students had a high rate of compliance (> 90% compliance) with the action plan the student developed to modify their risky behavior following the brief motivational technique guided by the NP students at the end of the screening.
The PACE Campus study revealed that students attending the campus recreation center (n=177) accessed care because it was convenient (43.5%). It was found that the following factors influenced students’ decision to attend the PACE Campus Center: (1) concern about overall health (34.6%), (2) need to manage stress (25%), (3) lose weight (17.5%), and (4) feel worried about having medical diseases (24.5%), and (5) concern about sleep problems (21.5%).
Conclusion
In this population it is vital to identify high risk behaviors and develop plans to change these high-risk behaviors. Increasing access for screening through PACE Campus has the potential to lead to timely referral, treatment, and behavioral health changes in college aged students. This program has the potential to create a sustainable culture of health and wellness among college aged adults to decrease future health related problems.