primary care - Oxley College of Health Sciences

primary care

Advanced practice nursing students bring care into the community

Students in The University of Tulsa’s family nurse practitioner (FNP) program receive individual attention and the tools necessary to help them elevate nursing core values to the advanced practice, primary care level. These students are challenged to pay forward their knowledge and skills in assessment, diagnosis and prescribing through ongoing opportunities to make their communities a better place for all.

A high school student sitting on an exam table beside a family nurse practitioner student and a nursing professorOn July 7, a group of first-year FNP students spent the morning providing sports physicals free of charge to students at Will Rogers College High School, a Title 1 institution. This was the third time FNP students had undertaken this service-learning initiative. Because of the COVID-19 health crisis, this latest effort was conducted with full safety protocols in place: masks, gloves and sanitizer for both the nurse practitioner students and the high school students, who also maintained a safe physical distance from each other while waiting their turn.

Increasing access to care

The FNP program’s director, Sheryl Stansifer, launched this initiative two years ago when she learned that many students at Will Rogers were returning to school in August without a completed sports physical. The lack of such a physical, which typically costs $20 or more, means a young person cannot participate in school sports.

 

Will Rogers’ athletic director, Krystel Markwardt, enthused about the impact of “this wonderful program,” noting that “our students come from diverse economic backgrounds, and their families couldn’t afford to pay for physicals. The FNP students work quickly and efficiently, and their efforts mean our athletes are able to compete in the summer and be prepared for early fall sports.” As Stansifer pointed out, the issue is “bigger than playing basketball or joining the swim team. For many kids, getting involved in sports means they will stay in school and graduate.”

Developing primary care skills

The benefits of this service-learning project are tangible for both the young athletes and the FNP students. Sports physicals are a common component of primary care, and all of TU’s FNP students must complete pediatric assessments and be checked off on sports physicals. Providing sports physicals to the Will Rogers students enables the future FNPs to satisfy that requirement.

family nurse practitioner student holds an instrument as she tests a high school student's visionFrankie Frieda, one of the FNP students who took part in the most recent venture, noted that “this kind of activity is very beneficial for us. It helps us prepare for when we’re doing these things in our own practices and careers. It’s great experience and we’re so happy to be able to come out and do this today.”

In addition, Stansifer commented, delivering these physicals “enables faculty members to assess FNP students’ interactions with the patients/athletes and their ability to complete the forms accurately. Because so many health care teams comprise a variety of professionals, having an opportunity to collaborate with the school’s athletic trainer adds a critical interdisciplinary component to their development.”

Community care

Two FNP students who participated in the Will Rogers project during a previous semester are Alejandra Paredes and Vicky Cha. Originally from Peru (she moved to the United States when she was 13), Paredes has been a registered nurse (RN) since 2014. Cha is a first-generation Hmong-American who grew up in California.

“I always knew my career end-goal was to become a nurse practitioner (NP),” Paredes said. “I wanted to gain experience as an RN so I could become a better NP. I am looking forward to having more autonomy in the care that I deliver to my patients, and it’s important to me to be able to help them focus on health maintenance and disease prevention, while being mindful of individuals’ emotional, physical and spiritual health.” One of Cha’s major goals, meanwhile, is to bring health care to people who are often on the margins, a mission she finds supported at TU. “I admire the TU School of Nursing’s mission to not only cultivate students to become leaders in health care, but also to give back to their communities.”

Vicky Cha and Alejandra Paredes wearing white lab coats and standing side by side
Vicky Cha and Alejandra Paredes

This is something Cha experienced first hand with the Will Rogers service-learning initiative, and which resonated on a personal level. “My parents were Hmong refugees and I grew up with minimal resources. One of the biggest struggles was not being able to take part in sports because my parents couldn’t afford the fees and transportation. Providing free sports physicals for Will Rogers students, many of whom have a background similar to mine, exemplifies one of the most rewarding aspects of nursing: making a positive impact on another person’s life.”

Reflecting on her experience providing physicals for these youth, Paredes arrived at a similar conclusion: “I believe that caring for others, regardless of social, racial or economic background, is a core value of nursing.”


If you are an RN who wants to excel in primary care delivery, consider getting the advanced practice knowledge, skills and experience you need in TU’s family nurse practitioner program.

 

Educating parents in order to boost childhood vaccination rates

According to the Centers for Disease Control and Prevention (and many other reputable health organizations around the world), vaccines are safe and effective for preventing disease at the individual and population levels. So why, given this straightforward, scientifically proven and cost-effective medical intervention are so many children in the United States going unvaccinated and why has that trend been increasing since 2001? The recent eruption of measles in New York City is but one troubling example of the toll the decision to not vaccinate can take. How, many health care workers and public health planners are asking, can childhood vaccination rates be increased?

Second-year doctor of nursing practice (DNP) student Shelby Pope believes the answer to the second question resides in education – specifically, by sharing evidence-based data with parents so they can make informed decisions.

“Two essential components of modern nursing are communication and patient education,” Pope observed. “Time and again, these have been shown to be central to safe and effective care.” For her family nurse practitioner (FNP) practice-improvement project, Pope – who served in the United States Army as a chaplain’s assistant before becoming a nurse – intends to use these tools to help increase childhood vaccination rates.

Social determinants

“I have always been pretty passionate about vaccines, even before I decided to go the advanced practice route,” Pope commented. “Vaccines are one of the greatest gifts of modern medicine.”

At the heart of Pope’s project is the recognition that various “social determinants” play a significant role in vaccination rates. Researchers, she points out, have shown that children from households below the federal poverty line have lower combine seven-vaccine series coverage (62.8%) compared with children living at or above the poverty line (73.8%). Another influential factor is health insurance. Uninsured families have the lowest vaccination rates (48.5%); those with private insurance have the highest (76%).

Methodology

In addition to working full time with St. John Clinic Urgent Care in Tulsa, Pope is currently laying the groundwork for her investigation. She intends to set it in a primary care office that has a high ratio of uninsured pediatric patients or in a health department that serves the local community, ideally in or near her present home community of Skiatook. “In either case,” she noted, “it will be important for the quality of my study’s findings and potential impact to ensure diversity in practice types, practice settings and patient populations.”

Once Pope has identified and secured a location, the next step will be an initial chart review documenting the ratio of vaccine-compliant patients. “Then, once I have completed the education component, I will conduct a second chart review to compare pre- and post-intervention rates. This comparison will enable me to gauge my project’s effectiveness and identify areas for improvement.”

Multimodal education

Pope proposes taking a “multimodal educational approach.” This will consist of verbal education for health providers that’s based on the latest research. In addition, Pope is planning for parents to employ visual education using electronic media and written education using printed handouts.

For the electronic media portion, Pope has chosen a free app called Vaccines on the Go: What You Should Know, which was developed at Children’s Hospital of Philadelphia (CHOP). Some of the information contained in this app are vaccines and the diseases they prevent, safety concerns associated with vaccines and recommended immunization schedules broken out by age group.

“I recognize,” Pope said, “that not everyone will have a computer, smartphone or other mobile devices in order to access this app. Therefore, I’m building into my project the ability for parents to have the option of touring the app on a tablet at the health care office prior to their appointment time.”

In addition to using digital technology, Pope will provide printed handouts from CHOP’s Vaccine Education Center. She will also give written instructions on how to find accurate medical information in the internet.

Investing in our communities

While Pope’s project is driven by science, that is not her only motivation. Her research also is infused with a profound ethical orientation toward what she regards as her professional duty.

“If more people aren’t willing to get out into their community, change just isn’t going to happen. You can only talk so much and expect things to happen. And they just don’t. That’s why it’s important for nurse practitioners to invest in their communities and track ‘which of my patients are really struggling?’ and ‘why are they struggling?’ and ‘what do these people have in common?’ and ‘how can I address those issues?’”


Now in her second year in TU’s DNP program, Pope transferred here from an online DNP program. Two of the major reasons for her decision were the emphasis at TU on in-class learning and the university’s commitment to arranging career-relevant clinical placements for every student, something that is very challenging for nurse practitioner students. If you are interested in taking your nursing career to the next level, find out more about our ACEN-certified DNP program.