Students from multiple disciplines provide whole-person health care to veterans and rural residents

By:    Date: 01-01-2015

Students studying nursing, medicine, social work and nutrition unite through UA’s Inter-Professional Rural Health course.

BY OLIVIA GRIDER AND SHANNON AUVIL | PHOTOS BY MATTHEW WOOD AND SHANNON AUVIL

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University of Alabama students are collaborating across disciplines to meet the health needs of veterans and rural residents.

Students studying nursing, medicine, social work and nutrition take UA’s cross-listed Inter-professional Rural Health course, which prepares them to work as a team to improve patient care. They then perform clinical rotations at the Tuscaloosa VA Medical Center and in rural communities, providing primary care and mental health care to veterans, their families and people with multiple chronic conditions.

“West Alabama desperately needs more health-care providers equipped with the knowledge and experience to treat veterans and rural populations,” said Kristin Pettey, director of rural health at the VA Medical Center. “In West Alabama, a huge portion of the landscape is rural. The focus of the Rural Health Training Initiative is to train nursing, social work and medical students on the culture of veterans and, specifically, those who are residing in rural areas.”

Students use telemedicine for interacting and collaborating as part of inter-professional grand rounds teams. Each team is composed of graduate-level students in nursing, medicine, social work and nutrition. Students sign on to a secure online room at the
same time, but in multiple locations. They work with their team members to develop an individualized plan of care for each patient.

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HERE AND BELOW: Student Paul Strickland and staff at the VA Medical Center utilizing telemedicine; ABOVE: UA student Daphne Cockrell outside the Tuscaloosa VA Medical Center’s mobile clinic

Students present their recommendations to UA faculty and then to patients’ primary care providers for approval. Primary care providers give permission to move forward with plans of care, and students work with patients on achieving their goals, said Leigh Ann
Chandler Poole, assistant professor and coordinator of the nurse practitioner concentration in mental health and primary care for rural populations. Many other faculty members and community partners also contribute to the collaborative-medicine program.

“Everyone has something to add according to their discipline,” Poole said. “Social work may look at the family dynamic of the patient, and nutrition thinks about whether the patient’s diet is appropriate for addressing his or her multiple chronic conditions. Nurse-practitioner students and medical students look at healthcare and health-promotion needs. We’re preparing these students to work together as a team and to be able to use new, emerging technology to provide inter-professional care.”

Cindy Huggins, a registered dietitian pursuing a master’s degree in human nutrition, said it is becoming more evident that patients with multiple chronic conditions need care from more than one health practitioner. “Through this training, I have expanded my knowledge of each discipline’s role as a health-care provider,” Huggins said. “More importantly, I am learning how to be more effective as a practitioner by working closely with other practitioners.”

140347_MW_service_learning_magThe students’ training experiences are made possible by funding from two federal agencies that have the same goal – improvement of patient care in rural areas. The Rural Health Training Initiative, a pilot program funded by the U.S. Department of Veterans Affairs in conjunction with the Tuscaloosa VA Medical Center, focuses on inter-professional training specific to the rural veteran population, while the Advancing Nursing Education grant through the U.S. Department of Health and Human Services’ Health Resources and Services Administration is designed to help train students and residents on caring for patients with multiple chronic conditions.

Students in UA’s highly selective Rural Medical Scholars Program, which has a mission of producing physicians for rural Alabama and is open to students from the state’s rural areas, spend time traveling with the Tuscaloosa VA Medical Center’s mobile unit. The unit visits four rural communities each week and serves as a primary-care clinic, with a nurse practitioner or doctor in Tuscaloosa conducting a virtual office visit via telemedicine.

Pre-med students also spend time shadowing health-care providers at the Tuscaloosa VA Medical Center as they interact with patients in the mobile clinic. The mobile unit contains two computer screens, one equipped with a Webcam, so the provider and patient can look at one another.

“I was excited to see the use of telemedicine,” said Paul Strickland, who is pursuing a master’s degree in human environmental science with a focus on rural community health. “Residents of rural areas often have difficulty accessing care, but the mobile unit is able to provide rural veterans with much of the same services they could receive from the main hospital, without the burden of travel.”

Before interactive activities begin, students learn about one another’s disciplines in the classroom. Students in one discipline often do not understand exactly what another disciplines does, and vice versa. “The goal is to help everyone know a little bit more about each other’s professions so they can work better together,” Poole said.

To help prepare students, members of UA’s theatre program pose as patients who are rural veterans with multiple chronic conditions. Health students break into inter-professional teams and interact with the simulated patients, creating plans of care and evaluations. Faculty members from all disciplines observe the students, and a debriefing occurs after the simulation.

Cara Lutzow, a nurse-practitioner graduate student who trained with VA inter-professional team members to understand the role of a psychiatric and family-practice nurse practitioner, said the experience taught her the importance of treating the whole person and improving quality of life. “Most patients have multiple chronic conditions including type 2 diabetes, hypertension, combat-related post-traumatic stress disorder and major depressive disorder,” Lutzow said. “This requires providers to not only treat the acute problems, but be able to see the patients as whole pictures and improve their total wellness.”

Strickland said the service-learning aspects of the inter-professional course gave him a valuable understanding of a population subset he will work with as a physician. “Before this experience, I had only seen veterans in clinical settings a few times,” he said. “It’s one thing to read about disparities in care or illnesses prevalent in veterans, but it’s another thing completely to actually experience those things yourself and see different ways health-care providers can address these issues.

Huggins said the skills she developed have made her a better health-care provider. “Inter-professional collaboration is the future. It is exciting to be a part of cutting-edge health care.”

Pettey said one aim of the VA Medical Center’s collaboration with UA is to generate more health-care providers who will work with veterans in medically underserved areas of Alabama. “Our goal is to capture students’ interest in working in these rural areas,” she said. “Fifty percent of the veteran population lives rurally in West Alabama. The program is so important to the VA because we want nurse practitioner, social work and medical trainees to want to work for the VA or rural clinics post-graduation.”

The initiative seems to be meeting this objective. Strickland said those he has worked with at the VA are dedicated to the patients they serve, and this has inspired him. “I’m planning to become a family-practice physician in a rural area, with a goal of making a positive impact on the state of health care in Alabama,” he said.

For more information about UA’s collaborative-medicine initiatives, contact Leigh Ann Chandler Poole at 205-348-9877 or lacpoole@ua.edu.