Developing Simulation-Based Telehealth Training for Next-Gen Nurses

January 24, 2024 - Telehealth has cemented itself as a vital tool in the effort to expand healthcare access and improve care outcomes. To keep up with the rise in adoption and use, healthcare organizations need trained clinicians who are comfortable with virtual technologies and care processes. A new nurse training program in the Midwest aims to meet this very need.

The need for practical telehealth training is urgent. While telehealth encompassed less than 1 percent of all visits in the last three quarters of 2019, this figure jumped to 31.2 percent in the second quarter of 2020 before declining to 5.8 percent in the third quarter of 2023, according to data from Epic Research. This highlights the critical role telehealth continues to play in healthcare delivery, particularly in mental and behavioral healthcare.

To provide the clinicians of tomorrow with telehealth training, Illinois State University (ISU) and OSF HealthCare are in the process of launching the Simulation to Address Rural Telehealth Education Development (STARTED) project.

“This project is really intended to develop and deliver simulation-based education to undergraduate, graduate, and healthcare practitioners regarding effective telehealth in their practice to diagnose, treat, manage, and support self-management care planning for patients living with chronic disease and who need remote healthcare access, specifically in rural healthcare areas,” said Susie Watkins, PhD, RN, associate dean for academics at ISU’s Mennonite College of Nursing, in an interview with mHealthIntelligence.

The program is part of ISU and OSF’s Connected Communities Initiative, launched in March 2023 to foster research, innovation, and economic development across the state. In addition to telehealth training, the STARTED project will focus on developing solutions to healthcare challenges in central Illinois’ rural communities using telehealth tools and processes, Watkins said.

Through the project, nursing students will be able to access web-based modules that will introduce them to telehealth technology and equipment and provide education on telehealth principles and best practices, including interpersonal skills like maintaining eye contact when communicating via a screen.

The students will also participate in simulation training involving 50 trained actors, termed standardized participants (SPs), who are trained to deliver various scenarios and portray multiple roles, from patients to family members to clinicians, when required.

The simulations will be based on real-life telehealth processes, with the students conducting synchronous and asynchronous telehealth visits. In the latter simulation, students will receive data on the telehealth platform, send it to an SP acting as a clinician at a distant site, review the information the clinician sends back, and make diagnostic, treatment, and order decisions based on that information.

OSF HealthCare collaborated with ISU to develop the modules and the simulations and provided the SPs, who will help assess the students.

“Our SPs will have a rubric in front of them in order to indicate whether or not students displayed the caring and empathy, and interpersonal pieces that are so important to make this type of program work, as well as being able to comfortably handle the equipment,” said Ann Willemsen-Dunlap, CRNA, PhD, director of professional development at OSF’s Jump Simulation Center, in an interview with mHealthIntelligence.

Further, the SPs will provide real-time, in-person feedback to the students, explaining how the virtual visit felt from the patient's perspective. The first year of the project will include 120 Bachelor of Science in Nursing (BSN) students and 24 family nurse practitioner (FNP) graduate students.

The primary goal of the collaboration is to meet healthcare needs in Illinois, where 11.3 percent of the population lives in non-metro areas. According to the Illinois Department of Public Health, rural Illinois residents are more likely to die from chronic diseases, like heart disease, cancer, chronic lower respiratory disease, and stroke, and face access barriers to mental health services.

“Some of the best ways that we can meet those healthcare needs is to deliver the care that's required via telehealth,” Willemsen-Dunlap said. “[But] there's actually no standardized curriculum available that programs like Susie's can pull in and open up. The impetus was, in fact, to create a curriculum that can help meet the needs of people all across the state by training both RNs and advanced practice nurses to work comfortably with this technology and support patients.”

Watkins echoed Willemsen-Dunlap, adding that the college’s lack of hands-on simulation training and standardized participants made it challenging to pilot the curriculum and determine how it impacts learning.

The STARTED training project will initially focus on opioid use disorder (OUD). Watkins noted that ISU had didactic content related to OUD care but no simulation-based training.

Nursing students participating in STARTED will receive instruction on how to address a client who is exhibiting signs and symptoms of opioid use withdrawal and conduct assessments using telehealth. They will also learn how to communicate with healthcare providers at distant sites using telehealth, who will develop care plan orders for the undergraduate nurses.

“We wanted to bolster the [treatment of] opioid use disorder,” Watkins said. “We also wanted to integrate telehealth technology because opioid use disorder is a chronic disease, and we also would like to teach our students how to deliver Narcan, [and] specifically practice and educate a patient with a Narcan device. So, if a client is struggling or they have a family there and they happen to need the Narcan delivery device, they would know how to use it.”

The opioid crisis continues to rage across the country, with 29 percent of 1,327 adults saying they or someone in their family have ever been addicted to opioids, a KFF survey conducted in July 2023 shows. About 42 percent of those addicted are rural residents.

“We are working hard to figure out how to meet the needs of rural residents and do it in a way that is economically sustainable,” said Willemsen-Dunlap. “And so, being able to bring telehealth to this is such an important step forward.”

Research has shown telehealth can help boost OUD care and outcomes. For instance, a study published last March revealed that Medicare beneficiaries who received OUD care through telehealth during the COVID-19 pandemic experienced a 33 percent lower risk of a fatal drug overdose.  

The organizations are in the development phase of the project. They plan to conduct a soft pilot in February, the first simulation with graduate family nurse practitioner students on March 7, and begin simulations with undergraduate students in April.

Watkins and Willemsen-Dunlap identified various challenges they are currently working to address as they ramp up to launch the training project.

First, there is the issue of a lack of space in the Mennonite College of Nursing simulation lab, where the project will be based. Watkins said that ISU is building additional space in the simulation lab, but it will not be done until July 2024.

“The reason we are adding that space onto our sim lab is because we are growing our programs to meet the nursing workforce needs,” she said. “We have been really challenged to grow because we don't have the simulation space. So, we are getting creative on the spaces that we will implement for this with the simulation because we'll have a full-fledged schedule already in progress for the spring semester with all of the other student simulations that happen.”

Another challenge is scheduling. ISU wants to be able to include more students in its interprofessional education courses, but the students have different theory and clinical schedules, Watkins explained.

As ISU and OSF HealthCare work through these challenges, they are also looking ahead at several long-term goals. One such goal is placing nursing students with clinicians working in healthcare deserts using telehealth.

“But we first have to get our students and clinicians prepared to use this type of equipment and really work in these medical desert areas with this type of technology,” Watkins noted.

Thus, with rural healthcare needs growing fast, Watkins believes that collaborative projects like STARTED can help expand access to hands-on training for newly minted clinicians entering an increasingly digital healthcare landscape.