Background

1. Integrating Collaborative Health Care Training Using Telehealth into an Advanced Practice Nursing Curriculum Rex E. Gantenbein PhD Barbara J. Robinson PhD Robert L. Wolverton EdD Center for Rural Health Research and Education University of Wyoming Ann Marie Hart PhD FNP Dana Murphy-Parker MS APRN BC Fay W. Whitney School of Nursing University of Wyoming Matt J. Gray PhD Department of Psychology University of Wyoming Background Collaboration among health care practitioners improves outcomes for individuals with chronic conditions and concurrent mental health issues. In rural areas, shortages of mental health providers preclude co-location or local referrals. Telehealth can address this issue by providing remote access to specialty care through cooperation between a primary care and a mental health provider. We have developed a model for integrating training in telehealth collaboration into curricula for Family Nurse Practitioners (FNPs) and Psychiatric/Mental Health Nurse Practitioners (P/MHNPs) at the University of Wyoming. The model includes theory, implementation, and clinical considerations for collaboration among FNPs and P/MHNPs in rural settings. The 90-minute course includes reference materials, video presentations from clinical faculty members engaged in telehealth, and patient simulations demonstrating collaboration over distance between providers. Methods The model was presented in May 2009 to 15 students in the FNP and P/MHNP programs in the Fay W. Whitney School of Nursing at Wyoming. The training was evaluated through a pre-post survey to determine the students’ knowledge of, and receptivity to, the course content and to the use of telehealth in a collaborative paradigm for rural health care. Students reported their perceptions and concerns, the acceptability of course content, and the perceived value of telehealth in rural mental health and primary care. Findings • Participants indicated high satisfaction with the content and delivery of the course, as well as increased understanding of the use of telehealth for rural health care delivery. The chart below summarizes the pre/post responses. • Post-test comments included: • Great for rural patient. • Wonderful, potential ways to learn, communicate and treat. • If I work in … and live in …, telehealth could be set up in my home office, so when I could not travel in the snow I could still see my patients • I can see it being helpful for specialty consultations. My concerns would be how the medical records are handled. • I could see this being beneficial to patients especially in mental health. Also once patients are established it could work for patients in follow up. • Wow! I feel that this is a wonderful technological advance for rural Wyoming!! How wonderful to be able to serve rural clients in this way • Both are wonderful, potential ways to learn, communicate & treat • I think the training was well done. Good examples used • Training in telehealth is going to be important so that the new users have a better understanding of its capabilities and integration. • I don’t think that telehealth is ideal as having a clinician available. However, I do think that due to provider shortages—especially in rural areas, that it makes services available that ordinarily would not be. • I feel that something will be lost in the therapeutic relationship—in my experience I do not get the same connection with awareness of what patients are experiencing via telehealth. In addition, I live in a tiny town that receives telepsych services, which takes away from my job opportunities. Conclusions The pre/post-test evaluation showed an overall increase in the participants’ understanding and acceptance of collaboration via telehealth between primary care and mental health practitioners. The videoconferencing link to the clinical faculty member clearly demonstrated the application and utility of the technology, while the patient simulations prompted numerous questions from the students regarding both clinical and technical issues. We are continuing to use the model in the FNP and P/MHNP programs and are adapting it for use in programs for other health care profession students to demonstrate telehealth’s value and to give the students exposure to videoconferencing technology. This project was funded in part by a Special Projects grant from the Northwest Regional Telehealth Resource Center with funds from the HRSA Office for the Advancement of Telehealth, and by grant 5D06RH08996 from the HRSA Rural Health Network Development Program.