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Date of Report: 08/01/2003
Source: Delta Region AETC
In January, a new nurse practitioner was hired to start an HIV outpatient clinic in a regional hospital in a Louisiana city of about 50,000. This new NP was a recent graduate with a critical care nursing background and no HIV experience.
This is a familiar situation for Delta AIDS Education and Training Center (DAETC). Medical providers are often hired with little or no HIV experience. These medical providers need ongoing training using a variety of teaching modalities. To meet this need, DAETC creates a trusting, ongoing, professional peer relationship to guide longitudinal training, needs assessment and program implementation over time.
The nurse practitioner first received training manuals from DAETC. She then visited a DAETC training site in New Orleans for a multi-day preceptorship consisting of didactic lectures, case studies involving interactive discussion, experiential learning activities centered on medication adherence issues, and clinical training involving a one-on-one mentoring experience in the HIV clinic with HIV faculty. The nurse practitioner developed a relationship with her preceptors, and upon return to her practice, used their clinical consultations when necessary.
During the first year, follow-up training consisted of onsite clinical consultation and chart review, telephone and e-mail consultation, provision of updated medical education materials based on USPHS guidelines, and an annual HIV Update conference in New Orleans.
Over a one-year period, a pilot outcome evaluation was conducted to assess the effect of the program on provider knowledge and clinical care. Aggregate scores improved significantly on a pre/ post-test of knowledge and in select indicators for clinical practice.
Traditionally, training programs consist of a series of didactic sessions for multiple individuals with little opportunity for participant feedback or active interaction. This innovative strategy, creating personal relationships between DAETC clinical trainers and new providers, facilitates the use of clinical consultation where there may have been a reluctance to otherwise utilize this service.
The nurse practitioner resigned one and a half years after beginning the clinic that now serves more than 250 patients. Completing intensive training with a particular clinician, only to have a change in staff result in the need to begin all over again, is also a familiar scenario for DAETC. Fortunately, this training strategy effectively supports healthcare providers during this transition insuring the essential goal of continuity of quality patient care.
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