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Nursing students’ initiative improves health-care access

  
https://www.infirmiere-canadienne.com/blogs/ic-contenu/2015/11/04/une-initiative-etudiante-ameliore-lacces-aux-soins

A community-based workshop designed to empower

Nov 04, 2015, By: Kristina Rozintseva, RN, BScN, Françoise Filion, RN, MScN

Understanding the intricacies of the health-care system and accessing appropriate services can be a daunting challenge. In fact, in a national survey conducted in 2003, 15 per cent of the general Canadian population reported difficulty accessing routine care, and 23 per cent reported difficulties with immediate care (Sanmartin & Ross, 2006). It is not surprising to learn that specific groups are at a higher risk. For instance, new immigrants are almost 2½ times as likely to report difficulties accessing immediate care than are Canadian-born respondents (Sanmartin & Ross, 2006). In another study, Hod and Goldfarb-Rumyantzev (2014) found that low education and low income decrease the likelihood of positive outcomes for an individual who needs a kidney transplant.

In a community health placement during their final year of studies, six nursing students had been working at the Welcome Hall Mission, a community-based organization that serves vulnerable populations in Montreal. Among the services it offers is a socio-professional integration (SPI) program for adults who want to return to the workforce and achieve personal, social and professional autonomy. The clients are new immigrants, people experiencing mental health problems and individuals with low educational levels. In our daily dealings with these clients, we recognized that accessing health-care services and understanding the health-care system was difficult for them. For our class project, lasting 12 weeks, we wanted to develop a workshop that addressed these gaps. We received approval from two of our instructors and began working on the workshop content under their supervision.

Implementation

One of our goals was to accommodate the learning styles of the clients. In getting to know them, we became aware that some had limited attention spans and that knowledge transfer would be challenging. In addition, although the group was bilingual, many clients preferred one language over the other.

We developed a simple bilingual PowerPoint presentation, based on our research into the use of health-care resources and how the health system is organized in our province. We decided to focus on when and how to access basic services such as telehealth, emergency departments, clinics, family physicians’ offices and pharmacies. We wanted to discuss the differences between generic and brand-name medications and initiate discussions about other health and wellness supports, including community gardens and free meditation and fitness classes. We chose an interactive format that would encourage open dialogue with the presenters. Each participant would receive a fact sheet, which we would help them complete by identifying the locations and phone numbers of the pertinent resources in their neighbourhoods.

We sought feedback on the workshop content from the SPI program educators, the liaison RN at the Welcome Hall Mission and our nursing professors. We were encouraged to cut back on the amount of information we intended to cover in the two-hour session and to ensure the language we used was simple and direct. We were successful in obtaining funding from a local business to cover our printing costs.

Evaluation

We offered the workshop twice to different groups enrolled in the SPI program. Three students presented each time. In total, 24 clients attended the workshop.

We measured the effectiveness of the project with a two-part anonymous questionnaire, distributed during the workshop. Each part had statements about aspects of the presentation and a Likert-scale format with five scoring options.

Responses to the first part of the questionnaire, which evaluated process (e.g., the presenters’ style, level of engagement of the participants), indicated that more than 80 per cent of the participants found the workshop interesting and helpful.

The second part of the questionnaire contained these statements:

  • I know 3 ways to access services
  • I know when to go to my local clinic for help
  • I find the fact sheet helpful and will use it as a resource
  • I know 3 items that I would need to bring for a hospital visit

Participants were asked to respond to the first two statements at the beginning of the workshop and again at the end. An increase of 41 percentage points was seen in participants at the end of the presentation who strongly agreed with the statement “I know 3 ways to access services.” Seventy-five per cent of participants selected “strongly agree” at the end of the presentation in response to the statement “I know when to go to my local clinic for help,” an increase of 20 percentage points. Eighty-eight per cent found the fact sheet helpful and intended to use it; 92 per cent indicated they were aware of three items they would need to bring with them to hospital.

In their responses to an open-ended question about what information covered in the workshop was new to them, they mentioned the availability of local telehealth support, the importance of vaccinations, the array of services offered by local clinics, and the number of services paid for by the province.

Lessons learned

Some participants found it difficult to navigate the Likert-scale format of the questionnaire, but we were able to address these concerns in one-on-one explanations of the scoring. If we were to be involved in similar projects in the future, we might select another scoring system.

We have not had any contact with the workshops participants since, but it would be interesting to know if they are using health-care services appropriately as a result of what they learned and also to measure their use of community resources post-workshop over several months.

Next steps

Sustainability of the project was important to us. We left the PowerPoint and other materials with the SPI educators with the hope they would be used with other clients. We were pleased to be invited to share our project at a student research day event put on by Centre de santé et de services sociaux Cavendish.

We believe that this simple initiative was successful in accomplishing what we set out to do and that it will have a positive long-term impact on the health status of our group of participants. The project was important for us in that it took us beyond the hospital bed and clinic and into the community. The opportunity was thoroughly satisfying and confirmed the benefits of community partnerships.

Acknowledgment

The authors thank RNs Stephanie Avery, Kandise Belisle, Tamara Beradino, Stephanie Cabrera, Janine Lloyd and Qiang Miao, who were members of the nursing student group; Diana Gausden, an instructor who guided the group throughout the process; and the staff and clients at the Welcome Hall Mission for their support.

References

Hod, T., & Goldfarb-Rumyantzev, A. S. (2014). The role of disparities and socioeconomic factors in access to kidney transplantation and its outcomeRenal Failure, 36(8).

Sanmartin, C., & Ross, N. (2006). Experiencing difficulties accessing first-contact health services in CanadaHealthcare Policy, 1(2), 103-119.


Kristina Rozintseva, RN, BScN, is a nurse clinician working in transplant at the McGill University Health Centre. She was one of the students involved in the project.
Françoise Filion, RN, MScN, is a full-time faculty lecturer at the Ingram school of nursing, McGill University. She is the coordinator of the community health nursing project course.

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#nursing-research
#quality-improvement
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