IU nursing students, community providers increase access to care in rural Indiana

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A partnership between the Indiana University Bloomington School of Nursing (IUSON), the Center for Rural Engagement, Southern Indiana Community Health Care (SICHC), and several community partners is providing much needed clinical experience to nursing students and improving access to health care for residents in Orange and Martin counties.

Amy Todd has been a nurse for 20 years, and she’s become very familiar with Martin County’s health care. “Being a rural community, we do not have a lot of resources,” she says. The resources they do have in their county of approximately 10,200 people include one physician and three nurse practitioners, and a stand-alone urgent care clinic with one nurse practitioner. “Some residents use the urgent care nurse practitioner as their primary care provider.”

Other health resources like the once-a-week availability of an obstetrician or the mental health care option in a neighboring county are under-utilized by residents out of concerns of privacy and stigma.

Though the services they need exist in the state, to make use of them can often be difficult or impossible. “There is not enough of the proper resources available to the patient population locally,” she says. “Access to care is a problem. Many patients must travel 75 miles or farther for proper care for their complex diagnosis.”

“Patients in rural communities are no different than those in urban settings. They need post-stroke care, mental health services, complex therapies, hospice services, specialized providers, pain management, just to name a few, but those services are not found locally,” says Todd.

There is a lack of access to health care especially in rural Indiana, which communities identify as one of their greatest needs.

Katherine Pope, Healthy Hoosier Communities Liaison, IU Center for Rural Engagement

IUSON associate professor Mary Lynn Davis-Ajami agrees. “Access to specialized services [is] severely limited,” she says. Her past experience working as a nurse in a rural hospital in North Carolina showed her the different way health care is conducted outside of urban areas. “I learned about the strength and sense of community that supported the families and individuals living there,” she says. “The health care system had fewer physicians per capita and smaller facilities with fewer high tech diagnostic tools … Labs were often sent off rather than run in-house, resulting in some delays in getting results back the same day.”

“There is a lack of access to health care especially in rural Indiana, which communities identify as one of their greatest needs,” says Katherine Pope, a registered nurse and health liaison at the Center for Rural Engagement. A report on community health priorities put together by the center shows that 70 percent of the Indiana Uplands counties—which include Orange and Martin counties—have identified access to health care as a top community health need. “Screenings can address chronic disease, maternal health, and substance use, while increasing access to care.”

For these communities, having the IUSON students provide their services makes a big impact. “Our work complements the work of the tremendous health care providers in the surrounding counties, and our faculty work hard to have our classes fit in with the health care priorities and needs identified by those living in the regions we enter,” says Davis-Ajami. “Our presence supports the individuals, families, communities, and health systems in the region,” she says. “We add value in the health and wellbeing of our rural neighbors and provide young energy and idealism for our partners.”

“It shows the community that they matter,” says Todd. “When an organization, such as Indiana University, invests in the county, it inspires and empowers many residents to do more and be more.”

The clinics, beyond supplementing essential health care in these counties, present excellent learning opportunities for students of IUSON. “Not everyone is from a rural community and learning about what people do and don’t have access to is very important in health care,” says Britney Arce, a clinical assistant professor at IUSON. Arce teaches the community portion of the IUSON course that brings the students to rural counties.

IUSON emphasizes an education that exposes students to a variety of nursing skills and techniques. “The clinicals in Orange and Martin County very much align with our learning outcomes for students to be a critical thinker, culturally sensitive, a knowledgeable care coordinator, and an individual who understands the impact of health care policy, finance, and regulatory environments on care delivery,” says Arce.

Population health and interprofessional partnerships are centrally important domains of nursing practice. These should take students into the community. Our surrounding communities include rural areas.

Mary Lynn Davis-Ajami, IU School of Nursing
“These efforts take the resources of the university—its nursing students and outstanding faculty—and create a partnership that aims to improve the health of rural Hoosiers,” says Pope. With a grant from the Indiana University Foundation Women’s Philanthropy Leadership Council, the center was able to fund the partnership, and Pope worked with the community and campus partners to coordinate the clinics. “It was definitely a collaborative partnership, and we couldn’t have done it without any of the partners,” she says.

“In this sort of endeavor, we see highly visible effects,” says Davis-Ajami. “The students see the power of positive human connections made with purposed intent to promote health and wellness ... More specifically we see increased community awareness about wellness, a closer collaboration between our school and the county public health departments, school systems, physician practices, and hospital systems.”

Partnerships like these that involve a range of organizations and funding could be a step forward in rural communities’ access to more than just health care. “This is not a silver bullet that will fix access to care, but if more partnerships are built in collaboration with communities, we will begin to make progress on providing adequate access to care in our rural communities,” says Pope.

“I have truly valued this experience and hope that we continue to develop ongoing partnerships and find more grants to foster more programs,” says Todd.

“It is an exciting time to partner with our neighbors in the surrounding rural communities and work side-by-side to build a better future in Indiana,” says Davis-Ajami.
The IU Center for Rural Engagement improves the lives of Hoosiers through collaborative initiatives that discover and deploy scalable and flexible solutions to common challenges facing rural communities. Working in full-spectrum community innovation through research, community-engaged teaching and student service, the center builds vision, harnesses assets and cultivates sustainable leadership structures within the communities with which it engages to ensure long-term success.