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Review of Literature: Patients in rural and frontier settings face challenges when seeking access to health care. Rural and Frontier dwelling patients may travel long distances to seek primary, specialty, and emergent care. Weather, road conditions, time, and money are challenges which impact the ability to seek healthcare at remote locations. Rural and frontier dwelling patients may need to consider travel expenses such as gas, motel rooms, and time from work when traveling long distances for healthcare. Healthcare providers face similar challenges when traveling to rural and frontier locations. Providers need to consider time away from their primary clinic as well as travel costs to deliver care in rural and frontier settings (Perle & Nierenberg, 2013). Telehealth provides a solution to these challenges. However, many established healthcare providers are not trained on how to conduct a visit through telehealth modalities and use of telehealth equipment. In addition, the benefits, areas of weakness for telehealth, and appropriate use of telehealth for the treatment of acute and chronic conditions are not consistently present in Advanced Practice Registered Nurse curriculum (Sabesan, Simcox, & Marr, 2011). It is important for emerging healthcare providers to have telehealth knowledge and competence to impact health outcomes, provide continuity of care, minimize disease complications, and reduce readmissions (Banburry, Roots, & Nancarrow, 2014).
Summary: Nurse practitioner faculty toured regional healthcare systems to determine the types of telehealth modalities currently being employed to deliver healthcare. Grant funding was utilized to purchase telehealth equipment for incorporation of telehealth curriculum in a family nurse practitioner program. A consultant, with experience in the development and implementation of telehealth curriculum, guided and assisted faculty in the development of telehealth curriculum for the family nurse practitioner program. The family nurse practitioner practicum curriculum is delivered over the course of three semesters, with each semester moving from straight-forward to complex health care processes. The telehealth curriculum was created to augment the established curriculum plan in the practicum courses. Practicum 1 includes an introduction to telehealth and the equipment used to deliver telehealth. Practicum 2 includes information on the rural or frontier providers accessing a hub setting to impact patient outcomes. Practicum 3 includes information for the hub provider to assist in care delivery over telehealth modalities. Content material is delivered through didactic lecture which includes discussion and presentation. Simulation activities associated with each practicum was also created to complement the didactic material. Additionally, in practicum 3, students are matched with a clinical preceptor who utilizes telehealth modalities within their current clinical practice. This allows students to apply the foundational knowledge of telehealth care and delivery they received in an academic setting into the clinical setting. Pre and post surveys that reflected telehealth competencies expected to be gained from the experiences were used to measure and monitor student outcomes. In addition, Plan-Do-Study-Act cycle of Rapid-Cycle Improvement was utilized to make changes in the curriculum based on student outcomes.
Discussion: Healthcare providers need to have foundational knowledge of telehealth modalities and feel competent and confident in utilizing this technology to provide care for rural and frontier dwelling patients. Often, failure to utilize technology is a result of not be familiar or comfortable with the equipment. On-the-job telehealth education may increase stress as the individual may feel overwhelmed with information (Hawkins, 2012). Family nurse practitioner student curriculum that integrates telehealth modalities increases confidence and competence for family nurse practitioner students as they transition into practice. This knowledge, confidence, and competence can equate into the increased use of telehealth equipment to impact rural and frontier populations, and family nurse practitioners can lead the healthcare team to embrace utilization of telehealth (Rutledge, Bordelon, Renaud, & Fowler, 2014). Family nurse practitioner students who transition into practice may be empowered to utilize telehealth modalities due to their educational preparation that integrated telehealth modalities. This telehealth education may lead to the increased use of telehealth as family nurse practitioner students transition to practice an increase in their willingness to train additional providers on this important, emerging healthcare practice.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters