杜克大学护理学院获得390万美元的HRSA合作协议，向北卡罗来纳州农村地区提供护士领导的护理模式

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Beginning in May 2023, students at Duke University School of Nursing (DUSON) will have the opportunity to participate in weeklong immersion experiences in rural and underserved communities in North Carolina, thanks to a $3.9 million award from the Health Resources and Services Administration (HRSA).

Donna Biederman, DrPH, MN, RN, CPH, FAAN, associate professor, and her team at DUSON received a cooperative agreement award that will establish the Mobile Prevention and Care Team (M-PACT) Clinic and provide care and health promotion activities to urban underserved and rural populations in North Carolina including Granville, Vance, Harnett and Pamlico counties. Priority populations also include veterans; homeless and low-income people in Durham and Latino immigrants through the Mexican consulate in Raleigh. The four-year renewable cooperative agreement will also allow for an array of support efforts to educate and train instructors and students about social determinants of health (SDOH) – the external conditions in which people are born, live, work and age – and how they present and be effectively mitigated in these communities in particular.

“We really wanted to bring this kind of educational opportunity to our faculty, staff and students,” Biederman said. She notes that the award offers three main instructional avenues: the M-PACT scholars program, didactic training using case studies to infuse SDOH into the ABSN curriculum and continuing professional development for faculty and staff that addresses health equity and health literacy via interactive theater.

Pervasive poverty and lack of transportation are two major SDOH that affect rural NC. “Folks in rural areas have fewer resources to maintain a healthy lifestyle than those in more urban areas, where you have more access to healthy foods, gyms, and sidewalks,” said Heather Mountz, MPH, CPH, D-Community Health Improvement Partnership Program (D-CHIPP) coordinator, who is assisting Biederman in the launch of the program. Offering a free mobile clinic helps these isolated and underserved populations access health care and resources that can improve health outcomes.

DUSON will partner with Durham Technical Community College who will provide a mobile van unit for the excursion and immersion events. The clinical excursions will be to sites within 90 minutes of Durham with weeklong immersion programs farther away. Along with the van, pop-up tents will be used to draw people to the site, where they will be able to get physical assessments, screenings, referrals and educational materials.  The van has an exam table to allow for physical examinations and private consults.

However, the mobile clinic is not dependent on the van. “The idea of a mobile clinic doesn’t mean you have to have a clinic with wheels on it,” Biederman said. “A mobile clinic could also mean going to a church or high school and providing services for four hours on a Tuesday afternoon after the PTA meeting.” Another facet of the funding includes hiring a RN who will work at Granville-Vance Public Health. The RN will partner with a nurse practitioner to extend access to medical care via telemedicine technology.

The M-PACT Clinic scholars program will comprise of six cohorts of 10 students each over the life of the cooperative agreement. ABSN students can apply in January 2023 for scholarships, which cover two master-level clinical electives and include excursion and immersion clinical experiences. We will add MSN students in 2024. In addition to providing care and health promotion activities, the M-PACT Clinic will serve as a recruitment tool by showcasing the role of the RN in rural settings.

Immersions are important because students are able to witness first-hand what it is like to live in rural communities with limited resources. “It really highlights some challenges of living in these situations, but also the resilience and the opportunities that people have as well,” Biederman said. “A lot of people have developed really strong relationships and partnerships and have a lot of great things going on. It allows students to see that resilience factor.”

Partnering with existing trusted community groups will be a critical part of the success of the M-PACT Clinic. “Mobile clinics can offer options to populations such as immigrants, who may mistrust the health system or may be worried about their immigration status or incurring charges they cannot pay,” said Lariza Garzon, director of Hispanic Federation’s North Carolina and Mid-South operations and former director of Episcopal Farmworker Ministry.

Latinx immigrants in rural areas are often uninsured or underinsured and rely on community organizations to obtain information about preventive health, chronic diseases, family planning and diseases, said Garzon. Episcopal Farmworker Ministry partners with DUSON to bring services to migrant workers in Dunn, NC. M-PACT will offer a safer option to many who might not receive health care otherwise. “A mobile clinic is the ideal setting to get the community the services that they need while also meeting them in the places where they feel comfortable and supported,” she said.

In addition to the M-PACT clinic, the cooperative agreement will fund faculty and staff development using interactive theater in which scenarios are created that highlight social issues that are more common to rural communities and underserved populations. The participants interact with the actors in character to probe and discuss the ways in which SDOH can make a situation more complex.

Training nurses to better understand SDOH is intended to result in future nursing care that is more responsive and knowledgeable about underserved and marginalized populations, and DUSON’s community partners realize the impact this can have. “It is critical for public health to continue to nurture a future public health nursing workforce,” said Lisa Harrison, health director of Granville Vance Public Health, a DUSON partner. “Having opportunities like the M-PACT Clinic will provide a path for those interested in rural health, health equity, social determinants of health and population health to be excited about connections in these local communities.”

Biederman said the award was the result of much collaboration and partnership within DUSON and beyond. Devon Noonan, PhD, MPH, FNP-BC, associate professor and Dorothy L. Powell Term Chair of Nursing was essential to the Granville-Vance portion of the proposal, and Irene Felsman, DNP, MPH, RN, BSN, assistant professor was key in Pamlico County and the migrant farm worker site. Other key faculty members include Iris Padilla, PhD, MSN, APRN, FNP-BC, FAANP; Jacquelyn McMillian-Bohler, PhD, MSN, BSN, CNM, CNE; and Brigit Carter, PhD, MSN, RN, CCRN, FAAN.“ Our D-CHIPP affiliated faculty and staff were instrumental – they are incredibly knowledgeable about SDOH and already had established relationships that made the brainstorming and conceptualization easier,” Biederman said”.

全文翻译（仅供参考）

从2023年5月开始，杜克大学护理学院（DUSON）的学生将有机会在北卡罗来纳州的农村和服务不足的社区参加为期一周的沉浸式体验，这要感谢卫生资源和服务管理局（HRSA）提供的390万美元奖金。

Donna Biederman, DrPH, MN, RN, CPH, FAAN, 副教授，和她在DUSON的团队获得了合作协议奖，将建立移动预防和护理团队（M-PACT）诊所，为北卡罗来纳州包括格兰维尔、万斯、哈尼特和帕姆利科县的城市服务不足和农村人口提供护理和健康促进活动。重点人群还包括退伍军人；达勒姆的无家可归者和低收入者以及通过墨西哥驻罗利领事馆的拉丁裔移民。这项为期四年、可续签的合作协议还将允许开展一系列支持工作，教育和培训教员和学生了解健康的社会决定因素（SDOH）--人们出生、生活、工作和衰老的外部条件--以及它们如何在这些社区特别是呈现和有效缓解。

"我们真的想为我们的教职员工和学生带来这种教育机会，"比德曼说。她指出，该奖项提供了三个主要的教学途径：M-PACT学者项目，利用案例研究将SDOH渗透到ABSN课程的教学培训，以及通过互动戏剧解决健康公平和健康知识的教职员工的持续专业发展。

普遍的贫困和缺乏交通是影响北卡罗来纳州农村地区的两个主要SDOH。"农村地区的人们比城市地区的人们拥有更少的资源来保持健康的生活方式，在城市地区，你可以获得更多的健康食品、健身房和人行道，"D-社区健康改善合作计划（D-CHIPP）协调员Heather Mountz, MPH, CPH说，她正在协助Biederman启动该计划。提供免费的移动诊所有助于这些孤立和服务不足的人群获得医疗保健和资源，从而改善健康状况。

DUSON将与达勒姆技术社区学院合作，后者将为游览和浸入式活动提供一个移动货车单元。临床考察将在达勒姆90分钟内进行，而为期一周的沉浸式项目则在更远的地方进行。与面包车一起，弹出式帐篷将被用来吸引人们到现场，在那里他们将能够得到身体评估、筛查、转诊和教育材料。货车上有一张检查台，可以进行身体检查和私人咨询。

然而，流动诊所并不依赖于这辆面包车。"比德曼说："流动诊所的想法并不意味着你必须有一个带轮子的诊所。"流动诊所也可能意味着去教堂或高中，在周二下午的PTA会议后提供四个小时的服务。" 该资金的另一个方面包括雇用一名护士，她将在格兰维尔-万斯公共卫生局工作。该护士将与一名执业护士合作，通过远程医疗技术扩大医疗服务的范围。

在合作协议的有效期内，M-PACT诊所学者计划将由六批学生组成，每批10人。ABSN学生可以在2023年1月申请奖学金，其中包括两门硕士级临床选修课，并包括游览和沉浸式临床经验。我们将在2024年增加MSN学生。除了提供护理和健康促进活动外，M-PACT诊所将通过展示农村环境中护士的作用来作为一个招聘工具。

沉浸式教学很重要，因为学生能够亲眼目睹在资源有限的农村社区生活是什么样子。"它真的强调了生活在这些情况下的一些挑战，但也强调了人们的复原力和机会，"比德曼说。"很多人已经建立了真正强大的关系和伙伴关系，并有很多伟大的事情正在进行。它让学生看到这种复原力的因素。"

与现有的可信赖的社区团体合作将是M-PACT诊所成功的一个关键部分。"移动诊所可以为移民等人群提供选择，他们可能不信任卫生系统，或者担心他们的移民身份或产生他们无法支付的费用，"西班牙裔联合会北卡罗来纳州和中南地区业务主任、圣公会农民工部前主任Lariza Garzon说。

加松说，农村地区的拉丁裔移民往往没有保险或保险不足，他们依靠社区组织获得有关预防保健、慢性疾病、计划生育和疾病的信息。圣公会农民工部与DUSON合作，为北卡罗来纳州邓恩市的移民工人带来服务。M-PACT将为许多人提供一个更安全的选择，否则他们可能无法获得医疗保健。"她说："流动诊所是一个理想的环境，可以让社区获得他们需要的服务，同时在他们感到舒适和支持的地方与他们见面。

除了M-PACT诊所，该合作协议还将资助教职员工利用互动式戏剧进行发展，在互动式戏剧中创造的情景突出了农村社区和服务不足人群中更常见的社会问题。参与者与演员的角色互动，探究和讨论SDOH使情况更加复杂的方式。

培训护士更好地理解SDOH，是为了使未来的护理工作对服务不足和被边缘化的人群有更多的反应和了解，DUSON的社区合作伙伴意识到这可能产生的影响。"公共卫生继续培养未来的公共卫生护理队伍是至关重要的，"DUSON的合作伙伴格兰维尔-万斯公共卫生的卫生总监丽莎-哈里森说。"拥有像M-PACT诊所这样的机会，将为那些对农村卫生、健康公平、健康的社会决定因素和人口健康感兴趣的人提供一条路径，使他们对在这些地方社区的联系感到兴奋。"

比德曼说，这个奖项是DUSON内部和外部大量合作和伙伴关系的结果。Devon Noonan, PhD, MPH, FNP-BC, Vice Professor and Dorothy L. Powell Term Chair of Nursing was essential to the Granville-Vance part of the proposal, and Irene Felsman, DNP, MPH, RN, BSN, assistant professor was key in Pamlico County and the migrant farm worker site. 其他关键教师包括Iris Padilla, PhD, MSN, APRN, FNP-BC, FAANP; Jacquelyn McMillian-Bohler, PhD, MSN, BSN, CNM, CNE; 和Brigit Carter, PhD, MSN, RN, CCRN, FAAN"。Biederman说："我们的D-CHIPP附属教职员工发挥了重要作用--他们对SDOH有着令人难以置信的了解，并且已经建立了关系，使头脑风暴和概念化更加容易”。

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