Nursing students, even those who will seek employment in urban areas, should have the opportunity to acquire knowledge about the sociocultural and lifestyle characteristics of persons residing in rural areas, as well as available health care resources. The literature has shown the value of providing curricular content on rural health care (Rutledge, Haney, Bordelon, Renaud, & Fowler, 2014). One resource that has shown value in meeting the health care needs for rural communities is telehealth, which increases access, lowers costs, and enhances patient outcomes (Rural Assistance Center, 2015). The purpose of this study was to evaluate the knowledge of senior baccalaureate nursing students and selected nursing faculty members regarding telehealth and rural nursing concepts before and after participation in a newly developed simulation scenario.
BACKGROUND
The emerging technological world of health care is serving as a driving force in efforts to create new teaching and learning opportunities (National League for Nursing, 2015). Efforts to integrate telehealth into the curriculum for prelicensure nursing students are timely and necessary (Grady & Schlachta-Fairchild, 2007). However, literature on the knowledge and skills of faculty and students with regard to telehealth is limited (Gallagher-Lepak, Scheibel, & Gibson, 2009; Talcott, O'Donnell, & Burns, 2013).
To address the gap in the literature regarding knowledge about telehealth and rural nursing, a simulation was developed to expose senior-level baccalaureate nursing students to new content on telehealth competencies, with a focus on rural nursing concepts. This study design was influenced by concepts from Rogers' (2003) Diffusion of Innovations Theory and Bandura's (1977) Social Learning Theory.
The simulation scenario was one of the final building blocks in a simulation plan developed and implemented as part of a multiyear Nurse Education, Practice, Quality, and Retention (NEPQR) grant funded by the Health Resources and Service Administration (Hendrickx, Foerster, Hansen, & Tschetter, 2014; Tschetter, Lubeck, & Fahrenwald, 2012). The six rural concepts integrated into the scenario were environment, health risk/issue, health care access, health care technology, nursing practice, and culture. The scenario also encompassed American Nurses Association's (1999) telehealth competencies: incorporating telehealth into the client assessment, desired outcomes, and referrals; assessing the suitability of telehealth technologies for the client; and determining whether telehealth and the use of interdisciplinary collaboration met desired outcomes. The use of home monitoring telehealth equipment, provided by a rural hospital partner, and data in the simulation scenario provided additional emphasis on rural health care technology.
Faculty developed the simulation scenario focused on the nursing activities of a posthospitalization home care visit to a patient with heart failure who lived in a rural setting. The realism of this scenario was enhanced by using a standardized patient to portray the client. The scenario allowed students to assess the current health and safety status of the client and intervene based on the client's care and telehealth data, therefore increasing complexity for students.
METHOD
Study Design and Sample
Institutional review board approval was approved for this study, which involved a convenience sample of faculty and students from a Midwest public university. Faculty and students were asked to complete a survey rating their knowledge regarding telehealth and rural nursing before and after participation in the simulation. All seven faculty members who participated in the simulation completed the surveys; 63 students completed the presimulation survey and 48 completed the postsimulation survey, for a retention rate of 76 percent.
Instrument
The researchers developed the survey based on a review of the literature. The survey consists of two sections related to knowledge of telehealth (21 items) and rural nursing (24 items). Responses are based on a 5-point Likert scale ranging from 1 (not at all knowledgeable) to 5 (very knowledgeable). Two panels of regional and national experts reviewed the survey for content validity. Six experts reviewed the telehealth section with a resulting scale content validity index of 0.86; five experts reviewed the rural nursing section with a resulting scale content validity index of 0.89. The telehealth knowledge scale yielded a Cronbach's alpha of .969; the rural knowledge scale yielded a Cronbach's alpha of .936. Further psychometric testing is currently under way.
Faculty and students were invited to complete the demographic form and the survey; none of those invited had participated in the newly developed simulation, nor had the faculty members assisted with its development. Participants were asked to complete the survey a second time following completion of the simulation.
Data Analysis
Data analysis was completed using SPSS software version 22. Descriptive statistics were conducted, and the two knowledge scales were totaled. A t test was conducted to compare differences between the pretest and posttest.
FINDINGS
When compared to the presimulation data, there was a statistically significant postsimulation increase in faculty knowledge regarding telehealth (t = -3.279, df = 6, p = .017) and rural nursing (t = -4.422, df = 6, p = .004). The same was true for student knowledge regarding telehealth (t = -8.138, df = 37, p = .000) and rural nursing (t= -6.546, df= 39, p= .000) following participation in the simulation.
DISCSUSSION
The findings validate the use of simulation to increase student knowledge of telehealth and rural nursing. A unique perspective of this study is provided by the inclusion of faculty members; the increase in their knowledge from pre- to postsimulation is interesting. Although more research needs to be done, the findings suggest that simulation may increase knowledge for faculty when the content covered is unfamiliar.
Current literature and findings from this study contribute to the timely discussion about the relevance for telehealth and rural nursing concepts in prelicensure nursing education. The National Advisory Committee on Rural Health and Human Services (2015) reinforced telehealth as an emerging focus for improving health care access, particularly in rural settings. Although literature exists to support the integration of telehealth in rural settings in graduate education (Rutledge et al., 2014), Reierson, Solli, and Bjork (2015) found that prelicensure students also recognize telenursing as an important component of nursing education and nursing care.
Senior-level students in the current study had been exposed to rural nursing concepts through theory courses and some clinical experiences in rural settings. However, the increase in their knowledge indicates that students may benefit from more exposure to rural nursing concepts earlier in the curriculum. Similarly, students may also benefit from earlier exposure to telehealth, an area they were not consistently exposed to prior to the simulation.
Limitations of this study include the small sample size of participating faculty members and the lack of available simulation scenarios focused on telehealth in a rural setting. In addition, although this study found an increase in knowledge after the simulation, knowledge retention was not assessed. The instrument used in this study was developed by the researchers and tested for validity; further psychometric testing is needed.
CONCLUSION
There is very limited research on student and faculty knowledge of telehealth and rural nursing. In this study, faculty members and students reported a statistically significant increase in knowledge following participation in the simulation. The findings suggest that exposure to rural nursing concepts and telehealth provided through this simulation enhanced student and faculty knowledge.
The results of this study validate the use of simulation to increase knowledge about telehealth and rural nursing concepts and indicate its value, suggesting that earlier placement in the curriculum may be warranted. Allowing faculty members the opportunity to participate in simulations may also be a way to increase faculty knowledge. Additional research needs to be done in this area.
REFERENCES