2. Creating Culturally Competent Midwives for Rural Virginia Carolyn M. Rutledge, PhD, CFNP Laurel Garzon, PhD, CPNP Juliana Fehr, PhD, CNM, FACNM

3. Goals of Program To extend the Midwifery program at Shenandoah University to rural areas through creative programs and collaboration with Old Dominion University’s Distance Education program To extend the Midwifery program at Shenandoah University to rural areas through creative programs and collaboration with Old Dominion University’s Distance Education program To improve the cultural competency of midwifery students using Standardized Patients To improve the cultural competency of midwifery students using Standardized Patients

4. History This program focuses on This program focuses on the Healthy People 2010 the Healthy People 2010 goal to “Eliminate Health goal to “Eliminate Health Disparities” Disparities” This project is supported in part by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number ID09HP035580100 and titled Educating Culturally Competent Nurse Midwives for Virginia for 7/1/04 – 6/30/07. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should be any endorsements be inferred by the Division of Nursing, BHPr, DHHS or the U.S. Government.” This project is supported in part by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number ID09HP035580100 and titled Educating Culturally Competent Nurse Midwives for Virginia for 7/1/04 – 6/30/07. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should be any endorsements be inferred by the Division of Nursing, BHPr, DHHS or the U.S. Government.”

5. Background There is a lack of quality maternal care in Rural Virginia There is a lack of quality maternal care in Rural Virginia Infant mortality rate is as high as 44/1,000 births in some of the Virginia MUA’s Infant mortality rate is as high as 44/1,000 births in some of the Virginia MUA’s Obstetric care in rural areas is unraveling Obstetric care in rural areas is unraveling

6. Addressing Problem with Collaboration Shenandoah University (SU) and Old Dominion University (ODU) worked collaboratively on Midwifery Initiative Shenandoah University (SU) and Old Dominion University (ODU) worked collaboratively on Midwifery Initiative Both schools recruited students to their programs Both schools recruited students to their programs Students at ODU took their didactic courses through the distance learning program where classes were televised at local community colleges throughout Virginia Students at ODU took their didactic courses through the distance learning program where classes were televised at local community colleges throughout Virginia

7. Addressing Problem Both groups of students completed the Midwifery portion of their training at SU Both groups of students completed the Midwifery portion of their training at SU Students participated in learning opportunities/ clinical rotations in their own communities Students participated in learning opportunities/ clinical rotations in their own communities Students attended classes for two weeks each semester at SU Students attended classes for two weeks each semester at SU By allowing students to learn in own rural environments, 84% have stayed after completing education By allowing students to learn in own rural environments, 84% have stayed after completing education

8. Increasing Cultural Competency Standardized Patients (4 patients during 2 weeks at SU each semester) Standardized Patients (4 patients during 2 weeks at SU each semester) Clinical Notes/SOAP Notes Clinical Notes/SOAP Notes Projects Projects

9. Purpose of Standardized Patient Program To provide a non-threatening opportunity for midwifery students to practice caring for patients of various cultures To provide a non-threatening opportunity for midwifery students to practice caring for patients of various cultures  Learn about cultural issues they may be unfamiliar with  Practice skills they have learned  Receive feedback  Focus on issues they may find uncomfortable To provide a standardized format so that all students will receive the same experience To provide a standardized format so that all students will receive the same experience To evaluate the student’s ability to provide culturally competent care To evaluate the student’s ability to provide culturally competent care

10. Standardized Patient (SP) Program Developed to teach students (MD, NP, RN, PA) to conduct histories and physicals using lay people trained as actors Developed to teach students (MD, NP, RN, PA) to conduct histories and physicals using lay people trained as actors In collaboration with Eastern Virginia Medical School (EVMS) In collaboration with Eastern Virginia Medical School (EVMS) Used by ODU to educate Undergraduate Nurses, Nurse Practitioners and Midwives Used by ODU to educate Undergraduate Nurses, Nurse Practitioners and Midwives Patient scenarios are either presented at EVMS or transported five hours to Shenandoah University by van Patient scenarios are either presented at EVMS or transported five hours to Shenandoah University by van

11. Development of Standardized Patient The case is developed by faculty in the school of nursing at ODU based on information obtained through focus groups The case is developed by faculty in the school of nursing at ODU based on information obtained through focus groups The staff at EVMS hires and trains actors from the community to depict the cases The staff at EVMS hires and trains actors from the community to depict the cases

12. Presentation of the Cases The students meet with the patient individually or in groups, review their chart, and gather information The students meet with the patient individually or in groups, review their chart, and gather information

13. Patient Assessment Students gather data about the patient’s health, health behaviors, health beliefs, family, and culture Students gather data about the patient’s health, health behaviors, health beliefs, family, and culture

14. Physical Assessment Students can also gather physical data Students can also gather physical data

15. Feedback The standardized patients provide students with feedback on their performance including: The standardized patients provide students with feedback on their performance including:  Addressing sensitive cultural issues  Thoroughness of interview  Verbal and nonverbal communication

16. Evaluation of Students Assessed by Standardized Patient immediately after encounter using a flow sheets Assessed by Standardized Patient immediately after encounter using a flow sheets Feedback from NP faculty on SOAP Note Feedback from NP faculty on SOAP Note Student conducted self-assessment Student conducted self-assessment

17. Example of Scenario for Standardized Patient Pregnancy with Cultural Issues Pregnancy with Cultural Issues Teen Pregnancy Teen Pregnancy STD’s STD’s Low SES Low SES Domestic Violence Domestic Violence Teen Contraception Teen Contraception Lesbian Lesbian Cultural Beliefs and healthcare Cultural Beliefs and healthcare

18. Students Comments on Learning “The healthcare provider must recognize that though this may be unusual for her culture, it is not for the patient’s.” “The healthcare provider must recognize that though this may be unusual for her culture, it is not for the patient’s.” “I found it frustrating not knowing community resources to help this patient get her medication and proper foods.” “I found it frustrating not knowing community resources to help this patient get her medication and proper foods.” “Thinking about community services and what is out there to help the uninsured is something I need to know more about.” “Thinking about community services and what is out there to help the uninsured is something I need to know more about.” “Her diet is impacted by her cultural background and financial situation.” “Her diet is impacted by her cultural background and financial situation.” “I would like to participate in more sessions like this and will pay myself.” “I would like to participate in more sessions like this and will pay myself.”

19. Future Plans Developing more cases based on focus groups Developing more cases based on focus groups  Disability  Other ethnicities  Underserved  Religious issues impacting health Creating video clips to go on Monarch General Hospital (a computer generated virtual learning platform) Creating video clips to go on Monarch General Hospital (a computer generated virtual learning platform) Getting input from consultant and advisors on cases Getting input from consultant and advisors on cases