Taking Healthcare On the Road

John Shaw

Date

January 9, 2024

Topics

Area of Expertise

Brain Injury/Stroke

Health & Environment

Nursing Education

Primary Care

Federal grant to MGH Institute creates initiative to deliver community-based services to underserved neighborhoods with a focus on the health consequences of climate change while collaborating with Mass General Brigham Community Based Clinical Programs.

A grant from the U.S. Department of Health and Human Services’ Health Resources and Service Administration (HRSA) to bring awareness to the effects of climate change while increasing the nursing workforce in historically marginalized communities by developing a nurse led mobile-health service program is a glimpse into the future of healthcare.

“Impacting Health in Partnership: Nurses on the Move Toward Health Equity and Climate Justice” is a four-year, $3.1 million grant awarded to the MGH Institute’s School of Nursing and led by Project Director Dr. Kathy Sabo and in collaboration with Associate Dean of Graduate Programs and Community Engagement Dr. Patricia Reidy. It is an ambitious endeavor intended to knit together several of the school’s efforts to teach students how to provide optimal patient care.

“The health consequences of COVID-19, climate change. and environmental health inequities have emerged as a major public health concern especially in our low-income communities,” said Sabo, noting such conditions as heat-related illnesses, poor air-quality, food insecurity, and mental health needs on morbidity and mortality that need to be addressed. “Through this grant, students are providing nurse-led interprofessional mobile health services to mitigate the impact of climate change, environmental health inequities, and the consequences of COVID-19 with marginalized populations.”

The initiative has multiple segments:

Expand partnerships between the School of Nursing and community agencies with nurse-led mobile services by collaborating with the Mass General Brigham Mobile Health Services, and by leasing an Institute van to bring students into nearby communities
Integrate curricular content and experiential learning opportunities through the Institute’s Ruth Sleeper Nursing Center for Clinical Education and Wellness to ensure the knowledge, skills, and abilities necessary to care for low-income communities while addressing climate change and the consequences of the COVID pandemic relative to health equity, social determinants of health, and structural racism
Incorporate innovative technology to promote climate and environmental health and reduce health disparities as a consequence of the COVID pandemic by developing creative health promotion and education activities with mobile applications and social media, demonstrating telehealth competencies, and gaining telehealth field experiences
Provide continuing professional development activities and resources on climate change, environmental health, and the social determinants of health for faculty, clinical instructors, and community partners by collaborating with the Institute’s Center for Climate Change, Climate Justice, and Health and the MGH Center for Environment and Health
Develop a pipeline of nurse graduates with knowledge about the health consequences of climate change who will work in low-income/medically underserved communities and rural communities

Sabo noted the mobile aspect of the project will extend services from the Institute’s Sleeper Center, located within the pro-bono Dr. Charles A. and Ann Impact Practice Center, by offering pre-licensure and advanced practice nursing students unique intra- and inter-professional clinical experiences.

Nursing students in teal working with young kids — Nursing student Jiali Huang (front) works with Harvard-Kent Elementary School pupils while classmates (L-R) Monique Shelden, Jean Poulard, and Enrique Cruz wait to interact with other pupils.

Nursing student in teal shows a pupil something on a laptop — Nursing student Ademilola Oyetuga shows Harvard-Kent Elementary School pupils slides on her laptop during a recent visit.

Nurses giving a person a flu shot — IHP nursing student Shannon MacDowell (middle) and Mass General Hospital nurse practitioner Raquel Rein, MS-NU '12 (right), prepare a patient to receive a flu shot in the Mass General Brigham's Community Care Van, while MGH resident Dr. Nicolas Trad looks on.

Dozens of IHP nursing students also have been shuttled to several locations across Greater Boston to work with students and seniors. At the Harvard-Kent Elementary School in Charlestown, several students under the direction of Sabo, the Sleeper Center’s director, worked with a couple dozen first- and second-graders on health education strategies to prevent heat-related illness.

“We’re doing this education in places like Charlestown and Chelsea that are urban heat islands, and experience much warmer temperatures,” Sabo said. “Young children are at risk, so having our students teach them age-appropriate strategies that they can use to prevent heat-related illness.”

Monique Selden-Riley was taking a break from talking with the youngsters, watching classmates Ricky Cruz, Yasmiri Rosario, and Ademilola Oyetuga carry on the instruction in the public school’s gymnasium. “Being able to engage in the community is a real important part of helping us feel like we’re actually making an impact, you can see the impact right here,” said Selden-Riley, who will graduate in 2025 with a masters in nursing. “It’s really cool.”

“And it’s important we talk to them about this at this age,” said Rosario as she and her classmates were distributing bookbags filled with information, “so they can tell their parents what they learned today.”

Pre-license nursing students have done blood pressure clinics and delivered health education sessions at six community sites, including the Chelsea Boys & Girls Club. The advance-practice nursing students are conducting home visits in elderly housing and extending services to clients served by the Impact Practice Center. Occupational therapy, audiology, and physician assistant students also are participating with the IHP van, extending the Institute’s interprofessional mission of bringing students from multiple programs together to learn the benefits of a team-based approach to care that studies show improve patient outcomes.

Reidy noted that Dr. Mary Beth Kadlec, an assistant professor of occupational therapy, has participated in the home visits. “She brings a broadened perspective of health care because of her background, allowing us to provide more comprehensive services,” said Reidy, who noted that Dr. Emily Jo Venskytis, Director of Clinical Education and Assistant Professor of Audiology, and Dr. Gwen Larson, an instructor of physical therapy and the Community Outreach Coordinator for Tedy’s Team Center of Excellence in Stroke Recovery on the IHP campus, also have assisted with students and clients.

Given the increased focus on how global warming is affecting peoples’ health, the grant’s work with the IHP’s Climate Center takes on even more significant meaning. Dr. Suellen Breakey, the center’s associate director and an associate professor of nursing, has led clinical education workshops, shared resources, and begun integrating climate content into the curriculum.

"As faculty educating the next generation of nurses, we have an obligation to ensure that students understand the ways in which climate change is a threat to public health and achieving health equity,” said Breakey. “Ensuring that students have the knowledge and skills to lead in addressing these negative health impacts across practice settings is a necessary first step to improving the health and well-being of individuals, communities, and populations with whom they work.”

Riding with Mass General Brigham

In addition to the IHP mobile van, advanced practice nursing students participate on the MGB Community Care Van to learn about the MGB community-based clinical programs.

For Dr. Priya Sarin Gupta, Medical Director for the MGB Mobile Health Services and a primary care physician at MGH Charlestown HealthCare Center, the collaboration is a combination of what the health system and the Institute are striving to accomplish.

“We are taking a data-driven, community-informed approach to deliver on our mission to bring care to populations in communities with barriers preventing them from accessing clinical care,” she said. “These ‘clinics on wheels’ are also serving to help educate the next generation of community health providers and leaders from the MGH Institute.”

At a recent visit to Hyde Park High School in Boston, nurse practitioner student Shannon MacDowell was working with Raquel Rein, a Mass General Hospital NP who earned a Master of Science in Nursing from the MGH Institute in 2012, inside the MGB van. Despite the cramped quarters inside, the third-year student assisted Rein in providing services to the high school’s staff who had walked outside to the van before the high school students arrived.

“The mobile van is a fantastic experience because I am a firm believer in promoting preventative care so that people do not end up in hospitals,” said MacDowell.

“We have been lucky to have Shannon, and she has helped our high-volume clinics with care she has provided,” said Rein. “It has been my pleasure to work with Shannon and be part of helping future generation of NPs from the IHP learn the needs of the Boston communities we serve.”

“Our aim is to improve the health outcomes of communities served and prepare a nursing workforce to care for a complex, diverse society,” said Reidy. “It’s exciting to see it happening with this grant.”

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