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Loren Kelly RN, MSN LeeAnna Vargas RN, MSN

Nursing Education and the Resurgence of Primary Care Nursing: Expanding the Role of the Registered Nurse. Loren Kelly RN, MSN LeeAnna Vargas RN, MSN. Objective.

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Loren Kelly RN, MSN LeeAnna Vargas RN, MSN

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  1. Nursing Education and the Resurgence of Primary Care Nursing:Expanding the Role of the Registered Nurse Loren Kelly RN, MSN LeeAnna Vargas RN, MSN

  2. Objective • At the end of the session participants will be ready to begin developing Primary Care Nursing Clinical Rotations in Community Settings.

  3. Knowledge • Defining Primary Care Nursing for students: • Potential Learning Activities In Didactic Settings • Workshop with HSLIC Librarians specializing in tribal communities and database • Primary care nurse experts provide presentations to students • Best Practices for Chronic Disease Management • Best Practices for primary prevention

  4. Primary Care Nursing • Position Statement by American Academy of Ambulatory Care Nursing in 2012: • “RNs enhance patient safety and the quality and effectiveness of care delivery and are thus essential and irreplaceable in the provision of patient services in the ambulatory setting” • The Josiah Macy Jr. Foundation made recommendations about RNs and primary care practice including: • Leaders of nursing schools, primary care practices, and health systems should actively facilitate culture change that elevates primary care in RN education and practice.​ • Nursing school leaders and faculty should elevate primary care content in the education of pre-licensure and RN-to-BSN [bachelor of science in nursing] nursing students. • Academia and health care organizations should partner to support and prepare nursing faculty to educate pre-licensure and RN-to-BSN students in primary care knowledge, skills, and perspective. • Leaders and faculty in nursing education and continuing education programs should include interprofessional education and teamwork in primary care nursing curriculum.

  5. Exemplars of Clinical Experiences in Primary Care • Women’s Health and Nurse Midwifery at Chinle Indian Health Service Unit • HIV/AIDS Prevention, Education, Outreach, Case Management and Quality Improvement at Chinle Indian Health Service Unit • Public Health Leadership with Public Health Nursing Leadership and Supervisors at Chinle IHS. • Native Medicine “shadow” experience

  6. Knowledge • Possible Clinical Sites: • Population-focused care • Case Management and Care Coordination • Public Health • ECHO • Unique experiences: international settings, ChinleHIS • Examples of Settings Used at UNM: First Nations Albuquerque Public School Nursing, Department of Health Refugee Health Program, Health Care for the Homeless, UNM Palliative Care, Occupational Health, Case Management, Chinle Indian Health Service, Acoma Laguna Canoncito Hospital and Ambulatory Care Programs in Diabetes Prevention, Public Health Nursing.

  7. Learning Activity • Work in groups for 5 minutes to brain storm about potential Primary Care Nursing clinical sites. Is there a great site that is already being used that has not been mentioned? What sites are available in urban versus rural settings? • Pick one site that your groups would like to share with our large group.

  8. Skills • Competency Established for Acute Care Skills: IV management, Assessment, medication reconciliation, wound care, interpersonal skills, motivational interviewing, creation and management of nursing care plans. • Community Assessment • Utilization of Standard Order Sets for Chronic Conditions • Interprofessional Collaboration

  9. Attitudes • Set the tone for entering clinical experiences in primary care. • Define clinical objectives • Important to develop clinical objectives in collaboration with clinical partner • Establish preceptor at the clinical site • Expose students to formative and summative evaluations • Consider placement in Curriculum • Highly specialized experiences • Interview process for selected clinical experiences to determine ability of student to successfully engage in the experience. • Utilize Your University Resources: Collaboration with UNM Center for Native American Health • Cultural Humility Training (possibly provided at the clinical partners facility) • It is important to stress difference between acute care versus primary care nursing.

  10. Attitudes • Attitudes During Clinical • Post Conferences Key • Tie in Didactic content • Provide opportunity for sharing diverse primary care experiences • Debrief & Reflection • Scaffolding of student learning from Level 1 – Level 5 for best preparation. • Weave in interprofessional collaborative clinical experiences • Receive Feedback from site preceptors • Student • Overall Clinical Evaluation • How can it be improved

  11. Examples • Clinical Objective • IPE-related: • Engage health and other professionals in shared patient-centered and population - focused problem-solving. • Perform effectively on teams and in different team roles in a variety of settings.​ • Assignment

  12. Learning Activity • Using the clinical site that your group selected establish 1-3 clinical objectives that include some of the exemplars that have been learned during this conference. • Be prepared to share with the larger group.

  13. References • Advisory Committee on Interdisciplinary, Community-Based Linkages. (2013). Redesigning health professions education and practice to prepare the interprofessional team to care for populations. Twelfth annual report to the Secretary of the U.S. Department of Health and Human Services and to Congress. Retrieved from www.hrsa.gov/advisorycommittees/bhpradvisory/acicbl/Reports/twelfthreport_.pdf • Advisory Committee on Interdisciplinary, Community-Based Linkages. (2014). Transforming interprofessional health education and practice: moving learners from the campus to the community to improve population health. Thirteenth annual report, retrieved from www.hrsa.gov/advisorycommittees/bhpradvisory/acicbl/Reports/thirteenthreport.pdf • Fraher, E., Spetz, J., & Naylor, M. (2015). Nursing in a transformed health care system: new roles, new rules. Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. Retrieved from http://ldi.upenn.edu/brief/nursing-transformed-healthcare-system-new-roles-new-rules • American Association of Colleges of Nursing. (2016). Advancing healthcare transformation: A new era for academic nursing. Washington, DC: Author. American Association of Colleges of Nursing. (2017). Expectation for practice experiences in the RN to baccalaureate curriculum. Retrieved from www.aacnnursing.org/Portals/42/News/White-Papers/RN-BSN-Expectations-WhitePaper.pdf?ver=2017-10-18-151759-487 • Barton, A. ( 2017). Role of the RN in Promary Care: Implications for Nursing Education .Journal of Nursing Education. 2017;56(3):127-128 · https://doi.org/10.3928/01484834-20170222-01 • Beck Dallaghan, G. L., Alerte, A. M., Ryan, M. S, Patterson, P. B., Petershack, J., Christy, C. et al. (2017). Recruiting and retaining community-based preceptors: A multicenter qualitative action study of pediatric preceptors. Academic Medicine, 92, 1168-1174. • Core Competencies for Interprofessional Collaborative Practice (2016). Retrieved 6.7.18 from https://www.ipecollaborative.org/resources.html

  14. References • Clark-Dufner, P., & Lord, C. (2016). Opportunities, challenges and realities of community based clinical training for today’s health professions learner & preceptor. Presentation to the Advisory Committee on Interdisciplinary, Community-Based Linkages, May 25, 2016. Retrieved from www.hrsa.gov/advisorycommittees/bhpradvisory/acicbl/Meetings/clarkdufner0516.pdf • GeisingerProvenHealth. (n.d.). Navigator embedded case manager certification program. Retrieved from http://www.geisinger.org/professionals/consulting/Emmbedded_CareCourse.pdf • Bainbridge L. (2010). Interprofessional education for interprofessional practice: Will future health care providers embrace collaboration as one answer to improved quality of care? University of British Columbia Medical Journal, 2(1), 9-10. Retrieved from http://www.ubcmj.com/pdf/ubcmj_2_1_2010_9-10.pdf. • Langlois, J. & Thach, S. (2003). Bringing faculty development to community-based preceptors. Academic Medicine, 78(2), 50-5. • Latessa, R., Beaty, N., Colvini, G, & Janes, C. (2007). The satisfaction, motivation, and future of community preceptors: The North Carolina Experience. Academic Medicine, 82(7), 698-703. • Mallette, S., Loury, S., Engelke, M., & Andrews, A. (2005). The integrative clinical preceptor model: a new method for teaching undergraduate community health nursing. Nurse Education, 30(1), 21-6. • McAndrew. M. (2010). Community-based dental education and the importance of faculty development. Journal of Dental Education. 74, 980-985.   • Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C.E., Rohrbach, V., & Von Kohorn, I. (2012). Core principles & values of effective team-based health care. Discussion Paper, Institute of Medicine, Washington, DC. Retrieved from www.iom.edu/tbc. • Tufts University School of Medicine. (2013). Community service learning. Retrieved from http://medicine.tufts.edu/Global-and-Local-Engagement/Community-Service-Learning

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