The Interprofessional Care Access Network (I-CAN): achieving client health outcomes by addressing social determinants in the community.

Four health professions schools at an academic health science university and a partner state university collaborated to develop the Interprofessional Care Access Network (I-CAN), a model of healthcare delivery and interprofessional education that addresses the Triple Aims for vulnerable populations in three underserved neighborhoods. Program goals were achieved through community-based partnerships and the development of a health-care workforce prepared for competent practice in emerging models of care. In the first three years, almost 600 nursing, medicine, dentistry, and pharmacy students worked with clients referred from community partners, providing interprofessional care coordination addressing life instability and social determinants of health. The evaluation has demonstrated substantial improvement of health-related outcomes for clients who began in the first three years of the program and specifically those who completed intake and follow-up documentation (N = 38). There were substantial reductions in the aggregate number of emergency department visits, emergency medical service calls, and hospitalizations when compared to the 6 months prior to starting I-CAN. Estimated cost savings for the 38 clients, based on minimal estimated costs for these indicators alone, were over $224,000. A three-year qualitative review of client progress notes indicated that as a result of interprofessional student team interventions, many clients improved access to health insurance and primary care, and stabilized housing. Since the evaluation was completed, three programs have been added in rural and urban communities, demonstrating the model is scalable and replicable.

Moral distress in public health practice: Case studies from nursing education.

Moral distress in critical care nursing has been well studied; however, there is a gap in the literature related to moral distress among nurses and nursing students practicing in the community. This paper describes moral distress experienced during participation in the Interprofessional Care Access Network, a community-based nurse-led education and practice program providing longitudinal care coordination for underserved individuals and families in rural communities and urban neighborhoods. Two case studies represent client situations resulting in moral distress for nursing faculty and students. Contributing factors include unaddressed social determinants creating barriers to health and health care; inexperience and discomfort with people living in extreme poverty; lack of access to critical services for the most vulnerable; and powerlessness to influence discriminatory systems. Strategies are described to reduce moral distress and build moral resilience among students and faculty practicing in the community. Research is needed to expand understanding of causes, interventions, and consequences of moral distress in public health nursing.

Case Studies of Interprofessional Education Initiatives From Five Countries.

BACKGROUND: Although teamwork and interprofessional collaboration are critical to patient safety, nursing, medical, and allied health graduates often feel ill-prepared to confidently communicate and collaborate with other team members. While interprofessional education (IPE) has been advocated as a way of addressing this issue, there are multiple barriers to its systematic and sustained integration in undergraduate healthcare programs. Despite these challenges, examples of effective IPE initiatives have emerged. INNOVATION: This article profiles seven case studies of innovative interprofessional education activities that have been successfully implemented across five countries, for a variety of learners, using different delivery modalities, and with evaluation results attesting to their success. CONCLUSIONS: The case studies demonstrate innovative ideas that have the potential to overcome some of the barriers to IPE through the use of creative and targeted approaches. This article provides a wealth of ideas for the successful design and implementation of IPE initiatives and will be of benefit to educators wishing to expand their repertoire of teaching approaches. CLINICAL RELEVANCE: A body of research attests to the relationship between interprofessional communication, teamwork, and patient outcomes. IPE is imperative for facilitating the development of nursing graduates' communication and teamwork skills; however, innovative approaches are needed to overcome the perceived and actual impediments to its implementation.

Community-Academic Partnerships: Developing a Service-Learning Framework.

Academic partnerships with hospitals and health care agencies for authentic clinical learning have become a major focus of schools of nursing and professional nursing organizations. Formal academic partnerships in community settings are less common despite evolving models of care delivery outside of inpatient settings. Community-Academic partnerships are commonly developed as a means to engage nursing students in service-learning experiences with an emphasis on student outcomes. The benefit of service-learning projects on community partners and populations receiving the service is largely unknown primarily due to the lack of structure for identifying and measuring outcomes specific to service-learning. Nursing students and their faculty engaged in service-learning have a unique opportunity to collaborate with community partners to evaluate benefits of service-learning projects on those receiving the service. This article describes the development of a service-learning framework as a first step toward successful measurement of the benefits of undergraduate nursing students' service-learning projects on community agencies and the people they serve through a collaborative community-academic partnership.

An academic-practice model to improve the health of underserved neighborhoods.

The Interprofessional Care Access Network is an innovative model for academic-practice partnership providing care coordination for vulnerable and underserved clients and populations in identified neighborhoods. Interprofessional student teams, including health professions students from nursing, medicine, pharmacy, and dentistry, collaborate with community service organizations and primary care clinics to address social determinants of health identified as barriers to achieving health care outcomes and Triple Aim goals. Teams are supervised by a nursing faculty in residence and address issues such as housing, health insurance, food security, and lack of primary care. Two case studies demonstrate the potential impact of the project.

Preparing nursing students for the future: an innovative approach to clinical education.

A clinical education model was developed and implemented by nursing faculty in the Oregon Consortium for Nursing Education undergraduate curriculum to improve clinical learning for preparation of nurses to practice in the 21st century. This clinical education model, developed though collaborative work by nursing practice and education representatives throughout the state, moves away from a "random access opportunity" model of clinical education reliant on "total patient care" experiences to an intentional design of clinical learning activities based on course competencies appropriate to student level. Five elements of the model were proposed: case-based, concept-based, intervention skill-based, focused direct client care and integrative experiences. Different elements are dominant in early, middle and late clinical experiences to best support the developmental level of the student. Expectations for faculty, students and clinical staff were also developed to enhance best practices in clinical learning. Preparation of clinical partners for a change in clinical learning and student accountability are essential for optimal learning. This paper provides an overview of the model with clinical application examples for each element with a particular emphasis on case-based, concept-based and integrative clinical experiences.

Influence of a poverty simulation on nursing student attitudes toward poverty.

This study aimed to determine a poverty simulation's influence on nursing students' attitudes toward poverty. Five cohorts of baccalaureate nursing students participated in the study; two cohorts (experimental group, n = 103) participated in the simulation and three did not (control group, n = 75). The Attitudes Towards Poverty Short Form was administered before the simulation and 6 weeks later; higher scores indicated more positive attitudes toward poverty. Experimental group pretest scores were higher. Higher pretest global scores were negatively correlated with religious affiliation (Spearman's rho = -0.294, p = 0.000) and positively correlated with prior poverty exposure (Spearman's rho = 0.284, p = 0.000) and liberal political views (Spearman's rho = 0.444, p = 0.000). Controlling for pretest differences, posttest mean scores for the experimental group (78.73) were significantly higher (p = 0.007). The poverty simulation is an engaging learning experience providing an opportunity for students to gain sensitivity in working with this population.