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Integra(ng A Mul(modal Technology Educa(onal Experience into a
BSN DNP Program
Shelley Y. Hawkins, PhD, FNP-‐BC, GNP, FAANP Associate Professor of Nursing
Director, DNP & MSN NP Programs University of San Diego Hahn School of Nursing & Health Science
USD BSN DNP Program • 3 yr full-‐@me program
– FNP, PMHNP (78 credits) – PNP/FNP, AGNP/FNP (81 credits)
• DNP core courses (1st year) – Health Care Informa@cs; Transla@onal Science; Program Planning &
Evalua@on; Financial Planning; Strategic Planning; Health Policy; Epidemiology
• APN core courses (1st year) • Clinical courses (2nd & 3rd years; minimum 1,080 clock hours)
• DNP seminar (extends 8 semesters)
• DNP/EBP Project (variable # hours) – Dissemina@on: manuscript, podium/poster presenta@on, & community stakeholder presenta@on
Relevant Exis@ng Resources
• Cohort of highly seasoned PhD/DNP NP faculty • DNP program director with telehealth prac@ce experience & research program
• State-‐of-‐art simula@on lab with NP faculty-‐trained SP’s • Partnerships with health care systems using telehealth (Kaiser, Minute Clinic, VA, SRS)
• HCI program
Knowledge, Skills, & A]tudes U@lize the QSEN competencies as a framework for developing essen@al knowledge, skills, and a]tudes for a mul@modal telehealth educa@onal experience in
a BSN DNP NP program.
Developing KSA’s for Telehealth Clinical Prac@ce Competency
• Telehealth simula@on experience
• Dedicated telehealth clinical prac@ce placement
• Telehealth clinical prac@ce paper
• DNP project (op@onal)
Informa@cs Competency • Knowledge:
– Analyze benefits and limita@ons of telehealth used in the delivery of chronic illness pa@ent care.
• Skills: – Par@cipate in the selec@on, implementa@on and evalua@on of telehealth devices for chronic illness care.
– Demonstrate competence in using telehealth. • AKtudes:
– Value the use of telehealth in chronic illness pa@ent care.
Evidence-‐Based Prac@ce Competency
• Knowledge: – Summarize current evidence regarding use of telehealth for chronic illness pa@ent self-‐care.
• Skills: – Engage in the IRB process to conduct EBP project.
• AKtudes: – Champion the incorpora@on of telehealth for chronic illness pa@ent self-‐care.
Quality Competency • Knowledge:
– Analyze ethical issues related to using telehealth for chronic illness pa@ent self-‐care.
• Skills: – Demonstrate behaviors that promote confiden@ality when using telehealth.
• AKtudes: – Appreciate the value of adhering to HIPAA when using telehealth for pa@ent care.
Safety Competency
• Knowledge: – Develop pa@ent care algorithms for selected chronic illnesses.
• Skills: – Demonstrate appropriate management of telehealth device alarms and/or alert systems.
• AKtudes: – Encourage pa@ents to report compliance issues related to telehealth devices.
Teamwork & Collabora@on Competency
• Knowledge: – Analyze health care system facilitators and barriers regarding use of telehealth.
• Skills: – Interact with mul@disciplinary team members to promote quality, safe telehealth pa@ent care.
• AKtudes: – Value the role and responsibili@es of all team members for pa@ent telehealth experiences.
Pa@ent Centered-‐Care Competency
• Knowledge: – Explore using telehealth to improve ac@ve par@cipa@on of pa@ents with chronic illnesses.
• Skills: – Elicit pa@ent values and preferences when providing chronic illness pa@ent care using telehealth.
• AKtudes: – Value the ac@ve partnership in promo@ng pa@ent self-‐care.
Assemble & convene team mee@ng
Installa@on of Skype on laptops
Develop 120 minute telehealth module Develop HTN case study
Standardized pa@ent training PBL NP team training
Developing Telehealth Simula@on Experience
Team mee@ng
HCI student training
Team training sessions
HTN Simula@on Educa@on
Telehealth Learning Module
• Benefits of using telehealth • Promo@ng success of telehealth clinical prac@ce • Telehealth uses, modali@es, & requirements
Benefits of Using Telehealth • Increases access to pa@ents – Brings technology/care to pa@ent instead of bringing pa@ent to technology/care
– Reduces pa@ent travel @me
• Improves pa@ent management with chronic condi@ons – Provides early warning system to providers to mobilize care
– Decreases hospital readmissions – Decreases all-‐cause mortality
Promo@ng Success of Telehealth Clinical Prac@ce
• Champion change and posi@ve a]tudes • Enhance knowledge and skills • Iden@fy appropriate pa@ents and providers • Assemble interprofessional team • Ensure data protec@on and privacy • Develop business plan
Pu]ng it All Together: Uses, Modali@es, Investments
Source: Marke@ng and Planning Leadership Council interviews and analysis.
Use Cases
Mod
ali/es
Telehealth Use Cases, Relevant Modali(es, and Investment Required
Videoconference Asynchronous Store-‐and-‐Forward
Remote Device Telephone
Professional Consulta@on
Diagnosis & Treatment
Educa@on & Engagement
Ongoing Monitoring & Care
Coordina@on
Pa(ent Portal
Mobile App
• Need soeware, secure internet access for pa@ents
• Home and hospital-‐based technology
• Need addi@onal bandwidth, storage space
• Can replace non-‐urgent phone calls and visits
• More expensive hardware investment
• Used for high-‐risk pa@ents in non-‐hospital site
• Lifle tech investment, requires proper staffing
• Used for pre-‐visit triage
• High security needs require significant investment
• Must integrate EHR
• Minimal hardware investment for providers
• Complex security and data storage issues
Investment
Source: 2015, The Advisory Board Company
Telehealth Simula@on Experience • Student prep for HTN telehealth simula@on lab: – Comple@on of 120 minute telehealth module – Relevant HTN readings
• Faculty (F) and student (S) “pre-‐briefing” • F/S small group with SP using Skype & EMR • F/S debriefing session: – Pa@ent management – Telehealth
• F/S evalua@ons
Telehealth Clinical Prac@ce
• 54 hour telehealth clinical experience with NP: • Kaiser (HF, DM, HTN) • Minute Clinic (acute) • VA (HF, DM, HTN, MH) • SRS (HF, HTN, COPD) • VITAS (Hospice, Pallia@ve)
Telehealth Clinical Prac@ce Paper
• QSEN Competencies-‐basis for paper – Descrip@on of telehealth – Benefits and challenges – Evalua@on of interprofessional team – Evalua@on of experience for pa@ent & student – Recommenda@ons
DNP Project Op@ons
• “Se]ngs” – Telehealth clinical site w/preceptor – DNP program director research partnerships – HCI program director prac@ce
• “Support courses” – Telehealth elec@ve – Other HCI courses
References • Advisory Board Commifee. (2015). Telehealth Industry Trends 2015. Retrieved from
hfp://www.advisory.com/research/marke@ng-‐and-‐planning-‐leadership-‐council/resources/2015/telehealth-‐industry-‐trends. May 1, 2015.
• American Associa@on of Colleges of Nursing. (2012). Graduate level QSEN competencies: Knowledge, skills, and a]tudes. Retrieved from hfp://www.aacn.nche.edu/faculty/qsen/competencies.pdf. May 8, 2015.
• American Associa@on of Colleges of Nursing. (2006). The Essen@als of Doctoral Educa@on for Advanced Nursing Prac@ce. Retrieved from hfp://www.aacn.nche.edu/publica@ons/posi@on/[email protected]. May, 8, 2015.
• Birz, S. (2014). Lessons learned: Informa@on technology meets nursing educa@on. Retrieved from hfp://www.nursezone.com/nursing-‐news-‐events/devices-‐and-‐technology/ Lessons-‐Learned-‐Informa@on-‐Technology-‐Meets-‐Nursing-‐Educa@on%5F23998.aspx on May 8, 2015.
• Crundall-‐Goode, A. & Goode, K. (2014). Using telehealth for heart failure: Barriers, pioalls, and nursing service models. Bri/sh Journal of Cardiac Nursing, 9(8), 396-‐406.
• Fairbrother ,P., Ure , J., Hanley, J. et al. (2014). Telemonitoring for chronic heart failure: The views of pa@ents and healthcare professionals—a qualita@ve study. Journal of Clinical Nursing, 23(1–2),132–414. doi: 10.1111/jocn.12137.
• Gallagher-‐Lepak, S., Scheibel, P., & Gibson, C. (2009). Integra@ng telehealth into nursing curricula: Can you hear me now? Online Journal of Nursing Informa/cs, 13(2). Doi: hfp:ojni.org/13_2/GallagherLepak,pdf.
References • Hawkins, S. (2012). Telehealth nurse prac@@oner student clinical experiences: An essen@al educa@onal
component of today’s nursing educa@on. Nurse Educa/on Today, 32(8), 842-‐845. Doi: 10.1016/j.nedt.2012.03.008.
• Healthcare Informa@on and Management Systems Society. (2015). Nursing informa@cs competences. Retrieved from hfp://www.himss.org/resourcelibrary/TopicList.aspx?MetaDataID=788 on May 12, 2015.
• Henderson, K., Davis, T., Smith, M., & King, M. (2014). Nurse prac@@oners in telehealth: Bridging the gaps in healthcare delivery. The Journal of Nurse Prac//oners, 10(10), 846-‐850.
• McNeill, A., Underwood, A., Wisniewski, A., Sitzenstock, S. & Fairchild, R. (2013). Development of a social networking site for pa@ents and families: A doctoral level nursing informa@cs project. Online Journal of Nursing Informa/cs, 17 (1). doi: hfp://ojni.org/issues/?p=2394.
• Miller, L., S@mely, M. Matheny, P. Pope, M., McAtee, R., & Miller K. (2014). Novice nurse preparedness to effec@vely use electronic health records in acute care se]ngs: Cri@cal informa@cs knowledge and skill gaps. Online Journal of Nursing Informa/cs, 18(2), 1-‐?. Doi: hfp://0-‐search.ebscohost.com.sally.sandiego.edu/login.aspx?direct=true&db=rzh&AN=2012814602&site=ehost-‐live
• Palkie, B. (2013, Winter). The perceived knowledge of health informa@cs competencies by health informa@on management professionals. Educa/onal Perspec/ves in Health Informa/cs and Informa/on Management, 1-‐11.
• Smith, S., Drake, L., Harris, J., Watson, K., & Pohlner, P. (2011). Clinical informa@cs: A workforce priority for 21st century healthcare. Australian Health Review, 35, 130–135.
Thank you!
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