Equity Access

It is increasingly recognized that health care providers should graduate with a baseline expertise needed to provide high quality care to patients with disabilities. Disability-related content in nursing curricula and clinical encounters with this patient population are often limited. These educational gaps have repercussions for developing the skills needed to care for people with disabilities. Registered nurses working with individuals with disabilities without any prior experience during their undergraduate training may adversely impact their patients. Equity Access is a Duquesne University School of Nursing educational program developed by Drs Kronk and Colbert, which educates nurses on the specialized knowledge and skills needed to provide high-quality care for people with disabilities. The program was launched with online educational modules described previously1 and has subsequently grown to include additional components. Program Overview The use of simulation in nursing education can complement and extend the training that students receive in the classroom and at clinical sites. Few programs have ventured to employ people with disabilities to provide an authentic encounter with this population. Indeed, when our program was launched, no other nursing schools in the Pittsburgh region had established such a program. The mission of the Consultant with Disability Simulation Program (CDSP) is to provide authentic encounters within the simulation environment to undergraduate and graduate nursing students for the purpose of improving the care of individuals with disabilities and their families. This is achieved through collaborative and compassionate learning encounters that enhance the students’ knowledge and refine clinical skills needed to care for individuals with disabilities. We strive to build a workforce of competent practitioners fluent in the art and science of disability healthcare. The goals of the program are to: (1) build a community of consultants with disabilities; (2) enhance the simulation-based health care environment by delivering high-quality authentic simulation experiences; (3) teach competencies that will improve health care delivery services to individuals with disabilities; and (4) disseminate knowledge about this simulation methodology. Our paid consultants self-identify as having a disability (eg, multiple sclerosis, end stage renal disease, stroke, spina bifida) and represent the life span from young to older adults. Consultants are authentic in the interactions with nursing students with respect to their own health, or if they are portraying themselves with an additional acute condition they are provided written prompts to assist in the assessment process. Prior to the simulation session, undergraduate students are prepared by a didactic lecture; graduate students review an online video about the program and have a pre-briefing session. Emphasis is placed on the debriefing sessions that include feedback from the consultants. Evaluation Results In this article, we highlight our experience with CDSP in training undergraduate nursing students on how to care for people with disabilities in our Health Assessment and Population Health courses. We share promising results from a pilot telehealth simulation. (Please note that results from a different pilot study with students in our Family Nurse Practitioner Program have been reported previously.2) The evaluation data were collected under two protocols approved by the Duquesne University Intuitional Review Board. Health Assessment and Population Health In post-encounter surveys collected since inception of the program in fall 2020, 68% of undergraduate students (N = 1466) indicate that on a scale from 0 to 100, the average degree of knowledge on disability health care they had prior to the simulation (mean = 59.9%); their knowledge level after the encounter (mean = 87.2%); the impact the encounter had on their learning (mean = 91.8%); and the impact the encounter will have on their future practice (mean = 94.8%). Telehealth Pilot Study During the COVID-19 pandemic, the use of telehealth grew exponentially, particularly for people with disabilities.3 Incorporating telehealth into simulation encounters can provide a unique opportunity for learning about caring for this underserved population, while providing both students and people with disabilities a way to engage remotely while overcoming barriers to care. Accordingly, in 2021, we piloted simulated telehealth encounters with people with disabilities via virtual encounters on a video conferencing platform. A cohort of 32 second-degree students in our Role Preparation II course engaged in the telehealth simulation. The authentic encounters with the consultants were conducted in groups of 3-5 students via Zoom. Each interaction lasted for 50 minutes, took place once a week over a 5-week period. A total of five consultants, two accompanied by their caregivers, engaged in the online simulation scenarios. All were compensated for their time. Two trained instructors facilitated the simulation. An instructor-designed satisfaction survey was administered post-simulation session. The survey included 4 quantitative items and 2 open ended questions The quantitative assessment was completed using a 5-point Likert scale ranging from very satisfactory (5), satisfactory (4), neutral (3), unsatisfactory (2), and very unsatisfactory (1). Results indicated that 73% of participants were satisfied, and 25% were very satisfied with the simulated telehealth session. With respect to the skills practice, 25% rated it very satisfactory, 73% satisfactory, and 2% neutral. To date, comments from undergraduate nursing students included that “It was helpful to have instructors in the room to help stimulate critical thinking if we got stuck with what questions to ask.” Faculty members have commented that these simulations offered “real life” experiences to students, with some reporting changes that they had made in assessment and treatment of diverse patients in their own clinical practice. Consultant comments included that they want to “encourage students to have empathy and develop sensitive and thoughtful communication skills.” Conclusion Establishing our CDSP has been an essential part of our efforts to educate nursing students on the specialized knowledge and skills needed to provide high-quality care for people with disabilities. Under the auspices of our growing family of Equity Access initiatives, this innovative program allows prelicensure nursing students to experience simulated health care encounters with individuals with disabilities. These authentic encounters have occurred both in-person and also piloted online, with promising results reported here, and can serve as an exemplar to other schools. Next steps will include systematically evaluating the impact on the development of the Core Competencies for Disability Health Care Education.4 Our longer-term goal is to disseminate this approach and document its longitudinal impacts on the health of people with disabilities. Comprehensive dissemination would require making training materials and scenarios available to other schools of nursing as well as interdisciplinary outreach to other health professions. Nurses can play a leadership role in advocating for curricular changes in the service of providing high-quality care to this diverse population with complex health care needs.