A Collaborative Model for Rural Health Care EducationCollege of Nursing

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 Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

• 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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Federally Designated Mental Health Care Shortage Areas • Nov 2001

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Populations•Mainly rural population

•Racially and ethnically diverse populations are growing in Washington

•Includes migrant and seasonal farm workers, often Hispanic

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

• Reservations in Idaho

6) Coeur d'Alene 7) Nez Perce

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

ID Potential 1. Identify existing video communication

systems

2. Identify the system goals and activities

3. Identify system movers

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Assess Capacity Systems Assessment

•ID Technologies

•ID Connectivity

•ID Interface capabilities

•ID Collaborative potential

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Collaboration1) Share Missions

May mean expanding your mission

2) Share Equipment

Technicians and costs

3) Share Sites

A Collaborative Model for Rural Health Care EducationCollege of Nursing

4) Share Personnel 5) Interagency collaboration

Multilevel mergers of visions and activities

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

•Five throughout Washington

Outcomes

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

•Gateways and Bridges

•Live video streaming options

A Collaborative Model for Rural Health Care EducationCollege of Nursing

bc

WSU Computer Center and Archived Files

Information Technology Department and IP systems

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

WECAN•Share Personnel•Share Equipment – begin

standardizing •Share Recruitment

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Inland Northwest Telehealth

•Bridge to Whets for programs

•Bridge to Hospitals

•Bridge to Videoconference

e

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

ConnectivityACore Courses

•Video streamed live to any household in Washington State

•Archived for rural students who are working

•Logged through Blackboard

A Collaborative Model for Rural Health Care EducationCollege of Nursing

ConnectivityBClinical Courses

•6 College of Nursing Sites

•18 WECAN Sites (+)

•89 Telehealth sites in hospitals

•104 Total locations

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Students C•Enrollments up 900%

•118% over projections

•Tuition exceeds $550,000 this year

•Turning away candidates

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Students

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Demographics•N=57

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

•female (86%)

•male (10%)

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Demographics•Hispanic = 3.9%

•Native American = 3.9%

•African American = 2 %

•Asian = 2%

•Caucasian = 88%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

“…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%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

“…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%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

Much less likely 4.3%

Somewhat likely 34.8%

About the same 17.4%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

“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%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

“ICN-Mira networkwas appropriate”

Strongly agree52.2%

Agree43.5%

Disagree4.3%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

Strongly agree43.5%

Not applicable 4.3%

Disagree17.4%

Agree34.8%

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

•Migrant clinics•Community mental health

centers •Prisons •Underserved areas

Graduates

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

•Linkage to regional educational

settings provides an invaluable

service in small remote

communities with limited

communications infrastructure

A Collaborative Model for Rural Health Care EducationCollege of Nursing

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

teleconferencing connections

A Collaborative Model for Rural Health Care EducationCollege of Nursing

•The ICN MIRA Network enabled

direct teaching in a synchronous,

real time mode to isolated

communities

A Collaborative Model for Rural Health Care EducationCollege of Nursing

•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

A Collaborative Model for Rural Health Care EducationCollege of Nursing

Michael Rice, PhD, ARNP, CS

ricem@wsu.edu

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