URI nursing prepares for a future of home-based health care

Nurse practitioner students get advanced simulated training for emerging trend

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students practice providing home-based primary health care
URI College of Nursing students practice providing home-based primary health care on live actors while evaluators look on through one-way glass in the advanced simulation labs at the RI Nursing Education Center. (URI photo/Patrick Luce)

PROVIDENCE, June 14, 2018 — As the costs associated with health care continue to soar, providers and practitioners are placing a greater emphasis on providing quality patient care in the home, creating new opportunities and responsibilities for health care professionals.

Nurse practitioner students in the University of Rhode Island College of Nursing have a head start on preparing for the changing role, thanks to a $159,000 grant from the state Executive Office of Health and Human Services, part of the Healthcare Workforce Transformation project. Advanced simulation labs at the Rhode Island Nursing Education Center in Providence provide URI graduate nursing students with specific instruction on the unique challenges of home health care. They can then apply those skills directly in the field, said Denise Coppa, the College’s associate dean of graduate programs.

“These students will be prepared to deliver primary care in the home for a medically underserved population,” Coppa said.

She said 30 URI students are expected to be educated through two simulated experiences this year, compared to just eight students in 2017 who were placed with a nurse practitioner clinical faculty member delivering home-based care in the community. “A very important part of the role of a nurse practitioner is health promotion and prevention, a lot of which will be done in the home. The value of this program is showing our students that they see patients differently in home-based care,” Coppa said.

Simpl Simulation, a company that specializes in simulated clinical experiences for nursing students, provides the training during which students interact with actors in a simulated home care experience. In the recent session, two actors portrayed George and Reid, a married couple in their mid-60s, one of whom has just been discharged from the hospital after undergoing a hip replacement. The students simulate making the initial house call for George three days after his release.

The students visit with the couple in a lab simulation designed to resemble a typical apartment, complete with living room, bedroom, kitchen and bathroom. The lab contains all the furniture, appliances and even clutter you would expect to find in a typical home to create as realistic a scenario as possible. The students practice treating the patient and interviewing him and his husband to understand the challenges of George’s treatment and in the couple’s lives.

Meanwhile, evaluators observe the interaction through one-way glass and record the session for debriefing afterward, giving the students immediate feedback on their work from observers and the actors themselves.

“This provides students the opportunity to have a hands-on experience where it’s safe to make mistakes before they work with actual patients,” said Tonya Schneidereith, managing partner of Simpl Simulation. “It’s reflective learning; they can think about things they did right, and maybe things they didn’t do correctly, and correct that behavior. In a classroom, students are taught from a lecture and are expected to be able to apply it in a health care setting. This gives them an opportunity to actually apply it before practicing on a live patient.”

That experience is invaluable, said nurse practitioner graduate student Kristen Rameika of West Kingston. “Home-based care is seen more and more these days. Patients are being discharged from the hospital sooner,” Rameika said. “I believe the simulation training helps prepare us for barriers we will be facing when we graduate.”

Providing primary care in residential settings offers patients a more comfortable environment for healing that is also cost effective, Coppa said.

“Home-based care is saving millions, just by helping keep people out of emergency rooms when they don’t need to be there. There is a dramatic decrease in costs,” she said, noting that health care workers trained in home care are increasingly in demand. “Many of our students are going to be asked to do some form of home-based primary health care after they graduate.”