Supporting Ambulatory Care BSN Education in a Globally Diverse Clinic

Purpose: An ongoing challenge in ambulatory care education is to provide clinical experiences that allow students to fully use their clinical and critical-thinking competencies. It is a vital part of ambulatory care that RNs be able to work at the highest level of competency (Flinter, et al., 2017), and learners need role models who can demonstrate the potential in this arena. Creating this optimal learning environment can be a challenge in any setting but is even more so when the clients being served are low-income patients from a variety of global origins. In an RN pre-licensure population management course, an innovative approach used in this setting allows the student to practice a high-level RN role and implement the principles of cultural humility. This clinical experience is structured to allow the student to implement team-based primary care coordination for patients with social, economic, and cultural barriers.
Description: In this setting, students integrate their knowledge of pharmacology, pathophysiology, psychology, population/public health, and chronic disease management to provide patient care through telehealth/virtual means as well as in-person. Whether virtual or in-person, the clinical day begins with the student preparing for the assigned patients by reviewing the reason for the visit, administering pertinent physical assessment, and providing medication reconciliation. The student then gives a report to the provider using the SBAR (situation, background, assessment, recommendation) format, and participates in the visit if possible. This participation may take the form of acting as scribe for the provider, which further reinforces the student’s familiarity with medical terminology. At the visit conclusion, the student then provides follow-up education, health navigation, and care coordination.
The clinic through which students rotate serves community members who are uninsured and cannot afford episodic care at retail clinics. Because the clinic serves clients from many countries, students learn how to provide linguistically appropriate and culturally informed care. They are immersed in the refugee, migrant, immigrant, asylum seeker, and undocumented patient experience in the context of social and structural determinants of health, provisioning of care, care coordination, and patient navigation.
Evaluation: This clinical experience is part of an academic course in which students evaluate their overall clinical experience. In written and verbal comments, students provide overwhelmingly positive feedback regarding improvement in their understanding and skills in working with culturally diverse patients. In this instance, the academic-clinical collaboration is facilitated by the faculty member’s dual role as clinic administrator and course co-coordinator. This allows for a full understanding and implementation of the clinical goals and objectives. Specifically, the faculty member is able to seamlessly incorporate topics addressed in the classroom such as telehealth competencies and principles of social determinants of health. In the absence of this built-in connection, these topics would need to be specifically reinforced with the clinical partner, and specific interventions to facilitate that process will be shared.