Carolyn M. Rutledge

Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations.

Abstract Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practices.

Integrative simulation: a novel approach to educating culturally competent nurses.

Nursing education faces many challenges as a result of the population ’s increased cultural diversification. Of primary importance is the need to prepare culturally competent nurses to provide care in both urban and remote rural areas. This paper presents a HRSA funded program that utilises simulations to provide culturally diverse learning opportunities for both university-based and distance learning students. Cases are developed using focus groups and individual interviews. The information is used with standardised patients to develop vignettes that are loaded into a web-based virtual hospital where students conduct interviews with culturally diverse patients. The information obtained during the interview is then used to provide hands-on care to a high performance simulator (simulated mannequin). The encounters are videotaped for use in debriefing sessions with the students, for educational programs in the classroom, and for video-streaming to web-based distance students. Students in the debriefing sessions and classroom participate in a review of the videotape using the Personal Response System to respond to question. Through the culturally enhanced integrated simulation, students have an opportunity to address clinical situations and the impact of culture in a relatively safe non-threatening environment where the impact of their biases can be explored.

The impact of student learning styles on interviewing skills and academic performance

Background: Many U.S. medical schools struggle to identify how to teach students the content and skills needed to communicate effectively with patients. Some schools have developed predoctoral curricula emphasizing both biomedical and psychosocial dimensions of patient care. It is important to identify whether this approach has a measurable impact on doctor‐patient communication. Purpose: This study examined the impact of learning styles on 200 Ist‐year medical students’ academic performance and interviewing skills. Methods: Analysis of variance were conducted comparing academic performance and interviewing skills across 4 learning styles in Kolb ‘s Learning Style Inventory. Results: Findings revealed statistically significant differences in academic performance (p < .05) and interviewing skills (p < .05) by students’ learning styles. Conclusions: Students possess different learning styles that influence their success in medical school. Educators can vary their teaching methods to ensure that students, re...

Vulnerable Goth Teens: The Role of Schools in This Psychosocial High‐Risk Culture

BACKGROUND In recent years, a number of tragedies have been linked to the Goth culture. Most alarming have been the acts of violence, suicide, and self-harm found among teens. Teachers, parents, administrators, and fellow students are at a loss on how to relate to such students. They are unsure what role they might play in addressing some of the psychosocial issues they encounter. The purposes of this article are to describe characteristics of Goth teens, identify psychosocial risks for these teens, and describe roles school personnel can play. METHODS This article provides a review of the Goth culture, risk factors for Goth teens, and methods school personnel can use in identifying and addressing the psychosocial needs of this group. RESULTS The Goth culture attracts teens who are depressed, feel persecuted, have a distrust of society, or have suffered past abuse. They then surround themselves with people, music, Web sites, and activities that foster angry or depressed feelings. They have a higher prevalence of depression, self-harm, suicide, and violence than non-Goth teens. CONCLUSIONS School personnel are in a position to make a difference. By preparing themselves with knowledge, skills, materials, and referral sources, they can serve as liaisons. They have a specific role in advocating for the health and safety of students, identifying students who are at risk, disseminating new knowledge, and providing guidance in the management of the troubled teens.

Psychosocial Correlates of Insomnia Severity in Primary Care

Purpose: Insomnia is a substantive primary care issue that leads to adverse outcomes. These can be improved by addressing factors that accentuate insomnia severity. Accordingly, this study identifies correlates of insomnia severity and determines whether these relationships vary with sociodemographic attributes. Methods: This correlational cross-sectional study was conducted in a hospital-sponsored primary care clinic and 2 urban, academic family practice centers. Participants consisted of 236 patients 18 years old or older with clinically significant insomnia (Insomnia Severity Index scores of 7 or more). Surveys instruments included the Insomnia Severity Index, SF-8 (Medical Outcomes Study SF-8 global health status measure), CES-D (Center for Epidemiologic Studies-Depression Scale), DBAS (Dysfunctional Beliefs about Sleep scale), SE-S (Self-Efficacy for Sleep Scale), and a researcher-designed demographic survey. Analytic techniques included descriptive statistics to characterize the study sample, Pearson or Spearman Correlation Coefficients to examine individual associations with insomnia severity, and step-wise linear regression to identify net predictors. Results: Insomnia severity was significantly correlated with health status, depression, self-efficacy, and dysfunctional beliefs (P < .001) but not with sociodemographic attributes. Linear regression demonstrated insomnia severity was best predicted by low self-efficacy and high depression scores. Discussion: These findings indicate that clinicians treating insomnia should not only manage comorbid depression but also facilitate self-efficacy for sleep-inducing behavioral change.

Using standardized patients to teach and evaluate nurse practitioner students on cultural competency.

With the increasing diversity in the American population, it is imperative that nurse practitioners learn to manage patients with varying healthcare beliefs and needs. In order to develop culturally competent nurse practitioners, a number of methods have been developed. Many of the current methods focus on improving the awareness and knowledge of nurse practitioners regarding diverse populations. However, very few of the current programs focus on improving the skills and increasing the encounters the students have with diverse populations. This paper focuses on providing nurse practitioner students with diverse encounters using culturally enhanced standardized patient scenarios. The standardized patient programs provide nurse practitioner students with the opportunity to develop knowledge and skills related to cultural competency in a safe environment where the students can practice communication and physical assessment skills as they receive feedback from the patients they are seeing.

Effectiveness of nurse practitioner coordinated team group visits for type 2 diabetes in medically underserved Appalachia

Purpose: To study the effectiveness of multidisciplinary nurse practitioner coordinated team (NPCT) group visits in medically underserved Appalachia on the health, knowledge, and self‐efficacy of patients with type 2 diabetes (DM). The study also identified perceived barriers to participating in the diabetes programs. Data sources: A researcher‐developed tool was used to assess demographic data, clinical data, and barriers to care. The participants completed the Diabetes Knowledge Tests and the Diabetes Empowerment Scales. Two groups were assessed. One group participated in the diabetes intervention, and the other received usual care. Both groups completed the instruments prior to the intervention and after the intervention was completed. Conclusions: The group that participated in the intervention had better clinical outcomes (blood glucose and A1Cs), greater knowledge, and better self‐efficacy following the intervention than the usual care groups. This suggests that the intervention was important in improving outcomes of patients with type 2 DM. Barriers to care included fuel, time, family, work, and transportation. Barriers need to be addressed in order to have more patients participate in such programs. Implications for practice: NPCT group visits may represent an effective means of integrating diabetes self‐management education and medical management in a family practice clinic in medically underserved areas.

Acceptability of Behavioral Treatments for Insomnia

Background: Behavioral treatments for insomnia are safe and efficacious but may not be embraced by patients in primary care. Understanding factors associated with acceptability can enhance successful use of these modalities. The objective of this study was to identify demographic and clinical/psychosocial correlates of behavioral insomnia treatment acceptability. Methods: This nonexperimental, inventory-based, cross-sectional study enrolled patients from a hospital-sponsored primary care clinic and 2 urban academic family practices. Participants (n = 236) were 18 years of age or older who had clinically significant insomnia (Insomnia Severity Index score ≥ 8) and were recruited consecutively at these sites. A study coordinator obtained informed consent then distributed survey materials. Participants received a

Educating Advanced Practice Nurses in Using Social Media in Rural Health Care

10 honorarium. The main outcome measure was the Acceptability Insomnia Treatment Acceptability Scale-Behavioral subscale (ITAS-B). Results: Only acceptability of medications (r = 0.259) and dysfunctional beliefs (r = 0.234) scores had significant bivariate correlations with ITAS-B scores (P < .001). Medication acceptability, dysfunctional beliefs, and self-efficacy accounted for 12.45% of ITAS-B variance in linear regression. Conclusions: Screening for dysfunctional beliefs about sleep may identify patients with interest in behavioral approaches. Improving self-efficacy for sleep may improve acceptance of behavioral insomnia therapies. Interest in behavioral and medication treatments are not mutually exclusive. However, the modest variance reported here suggests other factors impact acceptance of behavioral treatments.

Telehealth stroke education for rural elderly Virginians.

Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting.