Public Health Advanced Practice Nursing - Rural Outreach

Rationale -The purpose of this proposal is to request funding to enhance advanced nursing education and practice in Kentucky through the Master of Science in Nursing degree program by (a) adding a public health advanced practice nursing tract (b) adding 3 educational outreach sites, (c) increasing enrollment of the minority/disadvantaged students in the project by 10% per project year, (d) developing interdisciplinary course options with the new Kentucky School of Public Health; and e) working with the school systems to develop Kids in Health Careers projects. Emphasis will be placed on the recruitment of a minimum of 32 students from rural counties throughout Kentucky. This outreach program will be offered at sites in northeast, Kentucky. in conjunction with Morehead State University, 70 miles from the Lexington campus; western Kentucky at the Madisonville Community College, Madisonville, located 200 miles from the Lexington campus; and southern Kentucky at Southeastern Community College, Corbin, 125 miles from the Lexington Campus. These regions are composed of 49 Appalachian counties as well as 51 other rural communities. Need -The urgency to resolve the health care crisis has turned policy makers' attention to alternative approaches that would decrease the need for institutionalized health care. Policy makers have begun to look at community-wide and community coalition-focused approaches that emphasize health promotion and protection, disease prevention, and community-oriented interventions. Initiatives such as national and health care reform legislation, the PEW Health Professions Committee Reports (1991-1995), and the latest 10M (1988) study on the future of public health care have underscored the need for new approaches to solving the health care problems of the nation. The Healthy People 2010 draft focuses on "healthy people in healthy communities" (2000). The Kentucky Public Health Improvement Plan (1998) sets a new direction in Kentucky with its emphasis on revitalizing the public health focus and offering services related to the core functions of public health. These initiatives have resulted in new rules governing public sector health care (ASTDN, 1998), leading to new choices for the consumer and new challenges in managed care, health care networks, and public health nationally and in the Commonwealth of Kentucky (HRSA 1997; Kentucky Public Health Improvement Plan, 1998). It is within this context that public health advanced practice nurses can playa pivotal role, melding an aggregate approach to problems with specialized clinical problem-solving skills in community settings. This provider is well suited to serve as the link for the public health system and vulnerable populations with the new integrated health systems networks, state and local health departments and managed care partnerships. Unfortunately, according to the most recent national data available only 17% of all nurses currently work in community/public health, and only 7% of those hold advanced degrees. This leaves a dearth of nurses nation wide to provide leadership and direction to be able to work with special populations (e.g. the homeless, near poor, rural elderly, HIV infected, special care needs and poor children, and the underinsured) who stand to benefit most from community-focused efforts in rural areas, especially in the arena of health promotion and disease prevention. Kentucky is part of the Public Health Service, Region IV (Florida, Georgia, South Carolina, North Carolina, Kentucky, Tennessee, Alabama, and Mississippi). This region, is moving rapidly into the managed care arena. The public health systems are redefining themselves and their role as partners with managed care to provide a continuum of care based on population risks. The states in this region are primarily rural and exhibit the same public health problems as those reflected in Kentucky data, with a 20% poverty level and 13% elderly population (Good Samaritan, 1997). The number of public health advanced practice nurses in Kentucky represent only 5% of the 1700 nurses working in public health in Kentucky. All community/public health nurses represent only 3% of the total nurse work force in Kentucky as contrasted to the national average of 17%. Impact - This project is expected to have a direct impact on the supply of master's prepared public health advanced practice nurses with preparation as specialists in population focused practice, or public arena managed care. These nurses will be available in rural and underserved areas of Kentucky and Region IV. There are 1178 potential applicants for this track. Objectives - The following are the initial overall project objectives of the Public Health Advanced Practice Nurse track of The College of Nursing graduate program. These objectives reflect the full scope of work for the project. 1. To offer the public health advanced practice nursing track in 3 new educational sites and the Lexington campus for the graduate program. 2. To prepare public health advanced practice nurses to meet the health needs of rural communities. 3. To implement the PHAPN curriculum over three years. 4. To use innovative approaches to teaching/learning. Method - The community based model for offering outreach programs developed at Wayne State University is the model used for this project. This model requires the total program to be offered at the outreach sites with the goal of making the greatest impact possible on the community served (Reilly, 1990). Web based, web enhanced and problem based learning teaching approaches will be used to implement the curriculum via telecommunications and teleconferencing. Evaluation - Kaluzney and Veney's model for program evaluation will be used to evaluate the project. The model calls for the collection and analysis of information to determine project relevance, progress, efficiency, effectiveness and impact.