The general shortage of primary care providers is well documented within the United States, where over the past ten years, work force issues have been raised regarding the availability and specialization of healthcare providers and the training of those providers for vulnerable populations in rural primary care. Additionally, lack of health insurance coverage and adequate provider training in rural healthcare including substance use disorders, and mental health is seen as a significant barrier to accessing needed healthcare for these communities.
Purpose:
The purpose of the development of an innovative model, implementation of the model and measurement of process and outcomes for graduate nursing students that participated was demonstrate theory to practice for healthcare in rural isolated communities. Our project model provides graduate nursing students traineeships by using a process that includes specific recruiting, selection, and matching students with designated preceptors to serve in rural clinical primary care sites. This innovative model serves to not only bridge the gap theory to practice by evaluating graduate nursing student attitudes and beliefs regarding primary care practice in rural underserved areas; preceptor mentorship practice and clinical training effects on student performance and clinical competency.
Methods:
The development of this model was is guided by five dimensions: 1) a strategy for placement of graduate nursing students in clinical sites that serve rural underserved populations; 2) expansion of clinical placements for graduate nursing students; 3) strategies to ensure clinical preceptors will be recruited, oriented, evaluated and retained; 4) rapid quality improvement strategies implemented to test the effectiveness of clinical training and 5) implementation of evidence-based competency-based assessments and clinical evaluations tools will assess student performance and readiness to practice. The methods also include continuous preceptor and faculty development on innovative teaching strategies to enhance student clinical leadership skills, team building and collaborative problem-solving, culturally appropriate care, integration of telehealth and IT assisted patient learning and care management into students’ clinical practice. Process measures items were derived from standardized improvement approaches (Langley, Moen, Nolan, Nolan, Norma & Provost, 2009). Outcome measures items were selected to align with domains and core competencies of advanced nursing practice as supported the by the National Organization of Nurse Practitioners Faculties (NONPF) and widely used evidenced based practice standards (Scarpa & Connelly, 2011; NONPF, 2012, Melnyk, Gallagher-Ford, & Fineout-Overholt, 2013). Evaluation of the project is currently completed through continuous monitoring of quantitative and qualitative approaches that monitor student transition from theory to practice, clinical performance, progress and preceptor mentorship. Student and preceptor received continuous daily and weekly outcome and process measures ranging from 0-5, with 5 representing clinical autonomy. Progress was collected after each clinical rotation monitoring care encompassing quantitative and qualitative approaches that monitor student care and progress and effect of preceptor mentorship. For the observation component of this project, qualitative data was collected via anonymous surveys analyzing nursing students, preceptors, and community members’ knowledge and experience concerning rural health. Participating students, preceptors, and community members received a letter of consent and were debriefed. Surveys and questionnaires received IRB approval prior to project conception.
Results:
Initial results reveal that all graduate nursing students successful in transitioning from theory to practice at their specific rural setting in both clinical and cultural dimensions of advanced practice. Final results from 2018 will be presented if this poster abstract is accepted.
Discussion:
We hope this innovative model will serve as a replicable model for successful transitioning of graduate nursing students (from theory to practice) in rural culture and care of families and communities in isolated rural areas. Through the implementation of this model our graduate nursing students have not only gained experience working in rural areas but have also received training in opioid use disorders, mental health issues specific to these communities, use of telemedicine, and other clinical skills necessary for their career. Through collaboration with rural clinical partners, this model has enhanced primary care services and made a profound acceleration in theory to practice challenges for graduate nursing students. Three of our graduates have received job offers from the clinics in which they completed their traineeship. Our hope is that we will continue to have positive process and outcome measure results, other programs in graduate nursing can adapt our innovations if needed and nurse researchers can benefit from many of the strategies used to collaborate with isolated rural communities globally.
Background:
The general shortage of primary care providers is well documented within the United States, where over the past ten years, work force issues have been raised regarding the availability and specialization of healthcare providers and the training of those providers for vulnerable populations in rural primary care. Additionally, lack of health insurance coverage and adequate provider training in rural healthcare including substance use disorders, and mental health is seen as a significant barrier to accessing needed healthcare for these communities.
Purpose:
The purpose of the development of an innovative model, implementation of the model and measurement of process and outcomes for graduate nursing students that participated was demonstrate theory to practice for healthcare in rural isolated communities. Our project model provides graduate nursing students traineeships by using a process that includes specific recruiting, selection, and matching students with designated preceptors to serve in rural clinical primary care sites. This innovative model serves to not only bridge the gap theory to practice by evaluating graduate nursing student attitudes and beliefs regarding primary care practice in rural underserved areas; preceptor mentorship practice and clinical training effects on student performance and clinical competency.
Methods:
The development of this model was is guided by five dimensions: 1) a strategy for placement of graduate nursing students in clinical sites that serve rural underserved populations; 2) expansion of clinical placements for graduate nursing students; 3) strategies to ensure clinical preceptors will be recruited, oriented, evaluated and retained; 4) rapid quality improvement strategies implemented to test the effectiveness of clinical training and 5) implementation of evidence-based competency-based assessments and clinical evaluations tools will assess student performance and readiness to practice. The methods also include continuous preceptor and faculty development on innovative teaching strategies to enhance student clinical leadership skills, team building and collaborative problem-solving, culturally appropriate care, integration of telehealth and IT assisted patient learning and care management into students’ clinical practice. Process measures items were derived from standardized improvement approaches (Langley, Moen, Nolan, Nolan, Norma & Provost, 2009). Outcome measures items were selected to align with domains and core competencies of advanced nursing practice as supported the by the National Organization of Nurse Practitioners Faculties (NONPF) and widely used evidenced based practice standards (Scarpa & Connelly, 2011; NONPF, 2012, Melnyk, Gallagher-Ford, & Fineout-Overholt, 2013). Evaluation of the project is currently completed through continuous monitoring of quantitative and qualitative approaches that monitor student transition from theory to practice, clinical performance, progress and preceptor mentorship. Student and preceptor received continuous daily and weekly outcome and process measures ranging from 0-5, with 5 representing clinical autonomy. Progress was collected after each clinical rotation monitoring care encompassing quantitative and qualitative approaches that monitor student care and progress and effect of preceptor mentorship. For the observation component of this project, qualitative data was collected via anonymous surveys analyzing nursing students, preceptors, and community members’ knowledge and experience concerning rural health. Participating students, preceptors, and community members received a letter of consent and were debriefed. Surveys and questionnaires received IRB approval prior to project conception.
Results:
Initial results reveal that all graduate nursing students successful in transitioning from theory to practice at their specific rural setting in both clinical and cultural dimensions of advanced practice. Final results from 2018 will be presented if this poster abstract is accepted.
Discussion:
We hope this innovative model will serve as a replicable model for successful transitioning of graduate nursing students (from theory to practice) in rural culture and care of families and communities in isolated rural areas. Through the implementation of this model our graduate nursing students have not only gained experience working in rural areas but have also received training in opioid use disorders, mental health issues specific to these communities, use of telemedicine, and other clinical skills necessary for their career. Through collaboration with rural clinical partners, this model has enhanced primary care services and made a profound acceleration in theory to practice challenges for graduate nursing students. Three of our graduates have received job offers from the clinics in which they completed their traineeship. Our hope is that we will continue to have positive process and outcome measure results, other programs in graduate nursing can adapt our innovations if needed and nurse researchers can benefit from many of the strategies used to collaborate with isolated rural communities globally.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters