An academic-community interprofessional telehealth online training partnership: Impact on students and providers.

Telehealth can be used to improve rural communities' access to specialized healthcare services and ameliorate rural care barriers. Use of telehealth quickly increased with the COVID-19 pandemic, and universities shifted to online instruction for the safety of students and faculty. This rapid uptake of telehealth and online instruction has created an urgent need for examples of online training for health professional students in telehealth. Participants for this study included 44 students enrolled in an interprofessional online mental health telehealth course and four health care professionals from rural clinics. Qualitative data were collected and analyzed from students and providers. Four primary themes were identified: student benefits from the IPE telehealth course, patient benefits, clinic benefits, and technological challenges. Student subthemes included learning skills needed for telehealth, improving team skills, learning about professional roles and responsibilities, and understanding rural health needs. Clinic benefits included improving telehealth readiness. This study presents an early example of online interprofessional mental health telehealth training using an academic-community partnership. Our pilot findings suggest that this course experience resulted in positive benefits for students and rural clinic providers.

Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce.

BACKGROUND: Multiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas. PURPOSE: Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings. METHODS: Data were obtained from the 2011-2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18-64 years (n = 34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings. RESULTS: Urban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p < 0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p < 0.0001). CONCLUSIONS: Strategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.

Rural-Urban Differences in Adverse Childhood Experiences Across a National Sample of Children.

PURPOSE: The purpose of this study was to examine the prevalence of adverse childhood experiences (ACEs) exposure in 34 states and the District of Columbia, and whether exposure differs between rural and urban residents. METHODS: This cross-sectional study used data from the 2016 National Survey of Children's Health (NSCH), restricted to states in which rural versus urban residence was indicated in the public use data (n = 25,977 respondents). Bivariate analyses were used to estimate unadjusted associations. Multivariable regression models were run to examine the association between residence (rural or urban) and ACE counts of 4 or more. FINDINGS: Compared to urban children, rural children had higher rates of exposure to the majority of the ACEs examined: parental separation/divorce, parental death, household incarceration, household violence, household mental illness, household substance abuse, and economic hardship. In adjusted analysis, there was no significant difference for rural children compared to urban children. The odds of 4 or more ACEs decrease as poverty levels decline, with children residing 0%-99% below the federal poverty line more likely to have reported 4 or more ACEs, compared to children residing 400% or above the federal poverty line (aOR 4.02; CI: 2.65-6.11). CONCLUSIONS: Our findings suggest that poverty is a key policy lever that may mitigate the burden of ACE exposure. The findings of this study may be instructive for policymakers and program planners as they develop interventions to stop, reduce, or mitigate ACE exposure and the long-term impact of ACEs among children in rural America.

Transformative Learning in an Online Doctor of Nursing Practice Population Health Course.

BACKGROUND: Population health is a critical component of Doctor of Nursing Practice (DNP) education, providing the foundation for clinical prevention, health equity, responsible policy, and practice change. Many DNP learners enter population health courses focused on individual patient care in microsystems. Transformative learning broadens learners' perspectives about health determinants and implications for health system transformation. METHOD: Transformative learning strategies were imbedded in a 10-week, online population health course. Students engaged with readings and multimedia content and wrote anonymous reflective analyses about population health determinants. Qualitative survey data were explored for transformative content using line-by-line content analysis. The stages of transformative learning were used as a priori codes. RESULTS: Learners questioned their own beliefs and epistemologies and demonstrated all aspects of transformative learning, although not equally across course topics. CONCLUSION: To achieve the promised outcomes of DNP education, population health content should be professionally transformative and integrated across the curriculum. [J Nurs Educ. 2019;58(8):481-484.].

Prevalence of adverse childhood experiences (ACEs) among US children.

OBJECTIVE: The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs. METHODS: Data were drawn from the nationally representative 2016 National Survey of Children's Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs. RESULTS: The study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child's age, family structure, poverty, type of health insurance, and SHCN status. CONCLUSIONS: We found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.

Factors related to smoking in college women.

Cigarette smoking among American women attending college has increased dramatically since the 1980's. To develop effective smoking prevention and cessation programs, a better understanding of factors associated with smoking in college women is needed. Therefore, the purpose of this study was to examine if selected factors (stress, stress management, nutrition, physical activity, alcohol consumption, and race) were related to smoking in college women. A sample of 354 college women in a southeastern state, 18-22 years of age, participated in the study. Logistic regression analysis indicated that White race (p = < .001), alcohol consumption (p = .0013), and limited physical activity (p = .0078) were significantly associated with smoking. Physically active college women were 2 times less likely to be smokers. However, physical activity mediated the effect of stress and stress management on smoking. Additionally, stress management confounded the effect of stress on smoking. Therefore, in addition to alcohol avoidance, exercise (as a stress management strategy) may be an important component of primary prevention and smoking cessation programs for college women.