Linking global and local learning has become increasingly relevant as public health concerns and diverse cultural beliefs in communities emerge across the globe. This phenomenon requires nurses and their interprofessional colleagues to work together towards a global understanding of transnational health issues, social determinants of health, and solutions to address health care needs at the local level. Students who represent the health care workforce of the future need exposure to training in public health concerns with cultural sensitivity so they can be prepared to think globally and act locally. In 2017, the National League for Nursing released A Vision for Expanding U.S. Nursing Education for Global Health Engagement, which introduced the concept of “glocal” recognizing that, while many nursing programs might not have resources for all students to participate in international travel, these students could still have opportunities for this type of learning in their own communities. Further, this vision statement advocated for forming alliances among academic-community partners to work with vulnerable populations for improving “glocal” health and providing valuable learning opportunities within an interprofessional context.
Purpose:
The purpose of this presentation is to discuss engagement outcomes associated with integration of students from multiple disciplines at an academic health center in an interprofessional education (IPE) experience within a collaborative practice (IPCP) model to care for an underserved, vulnerable population of heart failure patients.
Methods:
We used an action research design to test the efficacy of an innovative clinic using an IPCP care delivery model. The overall intent of the IPCP model was to address the Quadruple Aim of improving patient experience, enhancing patient health outcomes, reducing cost of care, and addressing clinician well-being. Within the clinic, students from six disciplines (nursing, medicine, social work, public health, health services administration, and health professions) completed clinical rotations with the IPCP team. A focus of the clinical rotations was to prepare students to work in an IPCP model to provide holistic and culturally sensitive care to a vulnerable population of heart failure patients the majority of whom were uninsured, underinsured, and/or homeless. The study took place at an academic health center in the southeastern United States within the auspices of a robust academic-practice partnership involving a school of nursing and a 1,157 bed teaching hospital. Student engagement was measured using the Attitudes Toward Health Care Teams Scale (ATHCTS), which rates the IPCP experience from 1 to 5, with higher scores showing more alignment with IPCP. The ATHCTS measures 4 dimensions to include team efficiency, team value, comfort with IPCP pre-rotation, and comfort with IPCP post-rotation. Qualitative comments were also gathered from student experiences. In addition, the number of clinical rotations completed, and number and types of student projects designed and executed to benefit our patient population were counted and examined.
Results:
Three years of study data (2014-2017) reflect positive student engagement resulting from the IPE and IPCP experiences. Eighteen students from 6 disciplines completed one or more full semester rotations in the clinic. Of the 18 students, 20 ATHCTS surveys were completed (2 students completed multiple rotations). Student engagement was indicated by the increasing ATHCTS scores over time. Students with more than 180 hours of clinic time had higher ATHCTS scores than those with 90 hours or less in all 4 dimensions. Team efficiency (3.9 to 4.6) and team value (4.1 to 5.0) scores demonstrated collaboration with the clinic staff. Comfort level with interprofessional competencies improved after the clinic rotations in all 4 dimensions.
Qualitative survey comments suggested the clinical experiences provided students a different perspective on how patient's utilize care and how best to coordinate services to meet patient needs. The clinical experiences gave students a better understanding on how to enhance access to health care for vulnerable populations and the advocacy role of multiple health care providers. Overall, the students considered the IPCP approach as individualized and coordinated to truly help patients succeed. Students reported the clinical experiences to be memorable for the rest of their careers.
The 18 students completed 16 projects focusing mostly on patient education and clinic quality improvement themes, which benefited our patient population. Project topics included the creation of flu vaccination informational materials, medication adherence guidelines, understanding how to use the local public transportation system, examining reasons for hospital re-admissions, and improving clinic appointment no-show rates.
Student contributions to the overall improvement in Quadruple Aim outcomes of patient experience/access to care, population health outcomes, cost of care, and clinician well-being were also noted along with recruitment of student participants into the IPCP team after graduation.
Conclusion:
An innovative IPCP model of care is an effective approach to integrate students from multiple disciplines and engage them in IPE to improve health outcomes and care transitions in vulnerable populations. Learning to work as effective team members in a mentored interprofessional experience is a unique way to address health needs of the community and facilitate a better understanding of glocal health.