ABSTRACT
Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.
Subject(s)
Community Mental Health Services , Health Services Accessibility , Hispanic or Latino , Nurse Practitioners , Patient-Centered Care , Female , Humans , Male , Ambulatory Care Facilities , Electronic Health Records , Mental Health , Rural Population , Medically Underserved Area , Texas , Medically UninsuredABSTRACT
ABSTRACT: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity. Effective nurse training for PPH management can reduce negative health impacts on childbearing women. This article discusses a framework for the development of an innovative immersive virtual reality simulator for PPH management training. The simulator should consist of: 1) a virtual world, including virtual physical and social environments, and simulated patients, and 2) a smart platform, providing automatic instructions, adaptive scenarios, and intelligent performance debriefing and evaluations. This simulator will provide a realistic virtual environment for nurses to practice PPH management and promote women's health.
ABSTRACT
BACKGROUND: Unclear guidance continues faculty role preparation for promoting students' successful transition to practice. OBJECTIVES: To examine nurse educator competencies and their role in students' transition to practice. DESIGN: This study utilized Arksey and O'Malley's methodological framework for conducting a scoping review. The review is reported using the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR), including the PRISMA-ScR checklist. METHODS: A comprehensive systematic search of MEDLINE, EMBASE, PsycINFO, ERIC, and CINAHL was performed for nurse educator competency. For the original search, no limitations were placed on dates. Two authors independently assessed eligibility via abstract review. The reference lists of the included studies were also examined. RESULTS: Eleven articles were included in the review dating from 1992 to 2021. Three themes in the literature were identified by the authors: (1) the need for appropriate mentorship, (2) lack of preparation of educators who transition directly from clinical practice, and (3) lack of use and/or vague operationalization of the National League for Nursing nurse educator competencies. CONCLUSION: Evidence regarding requisite competencies of nurse educators is limited. Further research on the competencies required for nurse educators to facilitate successful student transitions to practice is needed.
