Rural Telehealth Team Education for Baccalaureate and Nurse Practitioner Students

Background: Rural areas face health care workforce shortages. Nursing students seeking rural employment require instruction and clinical experience in using telehealth to work in health care teams. Method: An innovative telehealth consultation simulation paired nurse practitioner (NP) students with prelicensure baccalaureate nursing degree (BSN) students. The simulation aimed to enhance NP student proficiency and confidence in telehealth consultation skills and to foster professional role development through exposure to telehealth nursing roles for RNs and NPs. On-campus BSN students assumed the role of the RN in a rural clinic and consulted with off-campus NP students using telehealth technology in the care of a standardized patient. Results: Participants demonstrated level-appropriate proficiency and reported confidence in telehealth consultation and favorable attitudes toward intraprofessional communication. Conclusion: An intraprofessional educational model allowing BSN and NP students to develop telehealth consultation skills successfully addressed a gap in preparing nursing students to meet rural health care workforce needs.12 month embargo; Published online: 30 April 2020This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Influence of increased plasma osmolality on sympathetic outflow during apnea

Animal models have shown that peripheral chemoreceptors alter their firing patterns in response to changes in plasma osmolality, which, in turn, may modulate sympathetic outflow. The purpose of this study was to test the hypothesis that increases in plasma osmolality augment muscle sympathetic nerve activity (MSNA) responses to chemoreceptor activation. MSNA was recorded from the peroneal nerve (microneurography) during a 23-min intravenous hypertonic saline infusion (3% NaCl; HSI). Chemoreceptor activation was elicited by voluntary end-expiratory apnea. MSNA responses to end-expiratory apnea were calculated as the absolute increase from the preceding baseline period. Plasma osmolality significantly increased from pre- to post-HSI (284 ± 1 to 290 ± 1 mOsm/kg H2O; P < 0.01). There was a significant overall effect of osmolality on sympathetic activity (P < 0.01). Duration of the voluntary end-expiratory apnea was not different after HSI (pre = 40 ± 5 s; post = 41 ± 4 s). MSNA responses to end-expiratory apnea were not different after HSI, expressed as an absolute change in burst frequency (n = 11; pre = 8 ± 2; post = 11 ± 1 burst/min) and as a percent increase in total activity (pre = 51 ± 4% AU; post = 53 ± 4% AU). A second group of subjects (n = 8) participated in 23-min volume/time-control intravenous isotonic saline infusions (0.9% NaCl). Isotonic saline volume-control infusions yielded no change in plasma osmolality or MSNA at rest. Furthermore, MSNA responses to apnea following isotonic saline infusion were not different. In summary, elevated plasma osmolality increased MSNA at rest and during apnea, but contrary to the hypothesis, MSNA responsiveness to apnea was not augmented. Therefore, this study does not support a neural interaction between plasma osmolality and chemoreceptor stimulation