College of Nursing A Collaborative Model for Rural Health Care Education.

A Collaborative Model for Rural Health Care EducationCollege of Nursing


Copyright Statement

Copyright Michael J. Rice, 2002. This work is the intellectual property of the author. Permission is granted for this material to be shared for non-commercial, educational purposes, provided that this copyright appears on the reproduced materials and notice is given that the copying is by permission of the author. To disseminate otherwise or to republish requires written permission from the author.


A Collaborative Modelfor Rural Health Care

EducationMichael J. Rice, PhD, ARNP, CS

Intercollegiate College of NursingWashington State University College of

NursingThis study was partially supported by grant # D09 HP 00159-02 from

HRSA


Problem Develop an educational model to address the health care education needs of rural America

•Must be readily accessible

•Must be cost effective

•Must develop self sustaining program


Background •Goal of Healthy People 2010 is to eliminate health inequalities among different American population groups (USDHHS, 2001)

•Lower Medicare reimbursement (37.5 percent less) and aging health care facilities reduce access to care in rural communities


• The land mass of Washington state is greater than 7 states on the eastern seaboard

• 100,000+ sq. miles

• population of under two million

Wenatchee * Spokane *

Yakima * Pullman *Tri-Cities *

Washington State


Washington State • 36 areas in 39 counties are

designated as medically underserved

• 15% of eastern counties have no primary care facilities

• Only 18 % of all nurses areemployed in rural areas

• Over 25.3 % of all individuals in the rural areas live 200 % the federal poverty level


Federally Designated Mental Health Care Shortage Areas • Nov 2001


Populations•Mainly rural population

•Racially and ethnically diverse populations are growing in Washington

•Includes migrant and seasonal farm workers, often Hispanic


• Four major Native American reservations in Washington 1) Colville2) Spokane3) Kalispel4) Yakama

• Reservations in Idaho

6) Coeur d'Alene 7) Nez Perce


Project Objectives

To develop systems for rural areas in which IP Videoconferencing can be used to:

1) provide clinical course supervision,

2) provide supervised clinical hours required for the Certification


Project Objectives

To develop systems for rural areas in which IP Videoconferencing can be used to:

3) facilitate program delivery meeting Washington State’s requirements for obtaining an ARNP license as a Psychiatric Nurse Practitioner


ID Potential 1. Identify existing video communication

systems

2. Identify the system goals and activities

3. Identify system movers


Assess Capacity Systems Assessment

•ID Technologies

•ID Connectivity

•ID Interface capabilities

•ID Collaborative potential


Collaboration1) Share Missions

May mean expanding your mission

2) Share Equipment

Technicians and costs

3) Share Sites


4) Share Personnel 5) Interagency collaboration

Multilevel mergers of visions and activities


•Use of Lay and professional Medical Psychiatric Support groups (LAMPS) as advisory groups

•Five throughout Washington

Outcomes


aMerger of Washington Higher Education Television Systems (WHETS) with ISDN and internet protocols (IP) for course delivery

•Gateways and Bridges

•Live video streaming options


bc

WSU Computer Center and Archived Files

Information Technology Department and IP systems


dCollaboration of WSU CooperativeExtension and College of Nursing •Share Sites via merger with

WECAN•Share Personnel•Share Equipment – begin

standardizing •Share Recruitment


Inland Northwest Telehealth

•Bridge to Whets for programs

•Bridge to Hospitals

•Bridge to Videoconference

e


Evaluation•Evaluate outcomes using modified

Current Student Inventory based on the Flashlight Project and

•Government Performance and Results Act (GPRA) of 1993 and P.L. 105-392, Subtitle B, the Nursing Education and Practice Improvement Act of 1998


ConnectivityACore Courses

•Video streamed live to any household in Washington State

•Archived for rural students who are working

•Logged through Blackboard


ConnectivityBClinical Courses

•6 College of Nursing Sites

•18 WECAN Sites (+)

•89 Telehealth sites in hospitals

•104 Total locations


Students C•Enrollments up 900%

•118% over projections

•Tuition exceeds $550,000 this year

•Turning away candidates


Students


Demographics•N=57

•Mean age of 40-49 years- range of 20 to 59 years

•female (86%)

•male (10%)


Demographics•Hispanic = 3.9%

•Native American = 3.9%

•African American = 2 %

•Asian = 2%

•Caucasian = 88%


0 - 5 miles: 3.3%6 - 10 miles: 10.0%

11 - 20 miles: 3.3%21 - 50 miles: 3.3%51 - 100 miles: 10.0%

>100 miles: 70.0%

Distance from main campus


Location

Ma i n c a mp u s

2 7 %

Di sta n c e L e a rn i n g si te

1 0%

R e mo te C a mp u s

6 0%

R u ra l Ho sp i ta l si te

3 %Remote campus 60.0%

Main campus26.7%

Rural hospital site 3.3%

Distance Learning site: 10.0%

LocationLocation


“…able to take course via interactive teleconference….”

Strongly agree 53.3%

Not applicable 20.0%

Disagree 10.0%

Agree 13.3%

Strongly disagree 3.3%


Student costper week

Frequency % Valid % Cumulative %

$ 0 3 10.0 10.0 10.0

$ 1-5 11 36.7 36.7 46.7

$ 6-10 9 30.0 30.0 76.7

$11-16 1 3.3 3.3 80.0

$17-25 4 13.3 13.3 93.3

$26-32 1 3.3 3.3 96.7

$33-40 1 3.3 3.3 100.0

Total 30 100.0 100.0


“…able to juggle my course work and home responsibilities….”

Much less likely 4.3%

Much more likely 60.9%

Somewhat likely 17.4%

About the same 17.4%


“…spend more time studying….”Much more likely 43.5%

Much less likely 4.3%

Somewhat likely 34.8%

About the same 17.4%


“How many hours do you work for pay?”

40+ hrs/week26.1%

32-40 hrs/week 26.1%

0 hrs/week or no response 26.1%

1-15 hrs/week4.3%

16-23 hrs/week8.7%

24-31 hrs/week13.0%


“ICN-Mira networkwas appropriate”

Strongly agree52.2%

Agree43.5%

Disagree4.3%


“…spent less time travelingto and from campus….”

Strongly agree43.5%

Not applicable 4.3%

Disagree17.4%

Agree34.8%


90% located in rural and medically underserved areas Practice locations include:

•Migrant clinics•Community mental health

centers •Prisons •Underserved areas

Graduates


Summary• MIRA Model benefits rural students

place bound by jobs, geographical barriers and family obligations

• MIRA Model for collaborative use of technologies can address and solve the rural health care needs of presently medically underserved areas


•Linkage to regional educational

settings provides an invaluable

service in small remote

communities with limited

communications infrastructure


•Recruitment and retention can be overcome in rural and remote communities using IP

teleconferencing connections


•The ICN MIRA Network enabled

direct teaching in a synchronous,

real time mode to isolated

communities


•The use of IP based Telehealth

provides an avenue for solving

the problem of lack of access by

providing care and clinical sites

for rural individuals


Michael Rice, PhD, ARNP, CS

[email protected]

(509) 324.7256 Washington State UniversityCollege of NursingVancouver, WA Campus

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