From left: Dr. Aaron Sebach, dean of the College of Health Professions and Natural Sciences and Mobile Integrated Health Nurse Practitioner with TidalHealth; MSN NP student Meagan Prime; Salisbury Fire Department Paramedic Miranda Webster; and Chris Truitt, assistant chief of Emergency Medical Services.
A group of Wilmington University family nurse practitioner students took part in an inventive mobile integrated paramedicine clinical experience — the first of its kind in the country.
During the Spring 2022 semester, 17 Wilmington University family nurse practitioner (NP) students took part in an innovative mobile integrated health/community paramedicine clinical experience, the first of its kind in the country. The experience, facilitated by Dr. Aaron Sebach, dean of the College of Health Professions and Natural Sciences, paired WilmU family nurse practitioner students with the Salisbury Wicomico Integrated Firstcare Team (SWIFT) in Salisbury, Maryland. SWIFT is a partnership between TidalHealth and the Salisbury Fire Department and is staffed daily with an NP and paramedic.
SWIFT was established in 2017 with a primary goal of connecting with “high utilizers” of emergency medical services (EMS) in Salisbury. High utilizers are defined as those who call 911 five or more times in a six-month period. The team engages with these patients to address social determinants of health, or economic and social conditions that influence one’s health. Social determinants include housing and food insecurity, transportation, and health services like medication compliance and primary care.
SWIFT paramedics receive specialized training in community paramedicine, which is a relatively new discipline. Paramedics operate in expanded roles to improve care coordination and access to care by engaging a community’s underserved populations. With the SWIFT program, paramedics and NPs collaborate to provide chronic disease management and address social determinants of health to enhance the patient experience, improve the health of populations, and reduce the per capita cost of healthcare.
In August 2021, SWIFT expanded to offer a Minor Definitive Care Now (MDCN) program. Now, an NP and community paramedic respond to low priority 911 calls as determined by the Medical Priority Dispatch System, an evidence-based series of screening questions to predict the severity of a patient’s condition and determine the appropriate level of EMS response required. SWIFT responds in a dedicated EMS Chevrolet Suburban, allowing the fire department’s ambulances to remain in service and available for higher-acuity medical emergencies.
On-scene, the NP and community paramedic develop individualized treatment plans that include medication administration, wound care, and splinting, among others. Follow-up appointments are arranged with primary care providers or specialists, as needed. At the conclusion of each visit, home safety and social determinants of health assessments are performed. Based on these assessments, patients are referred to appropriate community resources.
Seeing the value of SWIFT, Dr. Sebach identified an ideal opportunity to expand interprofessional education (IPE) experiences for WilmU family NP students. IPE, pairing two or more disciplines to cultivate collaborative practice and improve patient centered care, is not new. The National League for Nursing (NLN) acknowledges the benefit of IPE and, therefore, encourages nurse educators to develop meaningful IPE experiences.
To date, nurse educators across the country have designed IPE experiences connecting nursing students and NP students with pharmacists, physical therapists, social workers, and occupational therapists. Dr. Sebach identified a nation-wide gap in IPE experiences pairing family NP students with community paramedics. Traditional family NP experiences occur in an office setting and not in the community, a patient’s residence, or in collaboration with paramedics and fire departments.
The number of students who expressed interest in the clinical experience was surprising. After posting an announcement in Canvas about the opportunity, Dr. Sebach’s inbox was flooded with emails from students.
Some students drove two hours one-way for the clinical experience while others booked hotel rooms. The commitment and interest from students underscored the value of this unique clinical experience.
Something as simple as installing a doorbell for a patient to be able to hear their meal deliveries makes a huge impact for patients.” — Kristen Abbott, Student
During the experience, WilmU family NP students responded to low-acuity 911 EMS calls. Once on the scene, they utilized their classroom training to obtain patient histories, conduct comprehensive physical examinations, develop differential diagnoses, establish evidence-based treatment plans, and collaborate with an interdisciplinary team. Examples of conditions treated included COVID-19, urinary tract infection, sprained ankle, nausea and vomiting, hypoglycemia, otitis media (ear infection), and more. Between 911 calls, students conducted home visits with SWIFT patients to address social determinants of health to promote health equity. The experience ended with a tour of the Salisbury Fire Department headquarters.
Students enjoyed their two-day clinical experiences. “This was a great experience in an excellent program that can connect with people who have community resources,” says Lisa Turner. “Often in the primary care setting or hospital, we have a limited time frame to get the big picture of issues the patient is experiencing. We often just have enough time to fix their immediate problems.”
Another student, Evgenia Khodukina, says, “As a future provider, it’s important for me to take the patient’s life outside of the office into consideration when managing their health problems.”
Adds Kristen Abbott, “I loved seeing the extent of the community outreach and interprofessional collaboration to help patients struggling to find resources and to stay out of the hospital. Something as simple as installing a doorbell for a patient to be able to hear their meal deliveries makes a huge impact for patients.”
A second goal of the clinical experience was realized by students, depicting alternative roles for family NPs outside of the traditional office setting.
Due to the overwhelming success of the clinical experience, Dr. Sebach and the NP faculty plan to offer it each semester. Wilmington University remains on the forefront of innovation in nursing education, offering unique experiences for students.
To learn more about the college, visit wilmu.edu/health.
— Dr. Aaron Sebach