VA Pacific Islands Health Care System & University of Hawai'i at Mānoa School of Nursing & Dental Hygiene

The VA Pacific Islands Health Care System (VA-PIHCS) and University of Hawai'i at Mānoa School of Nursing & Dental Hygiene (SONDH) propose to plan, develop, implement, and evaluate an academic partnership to build sustained capacity for nursing practice and education in Hawai'i and the Pacific Islands. Through this effort, we will develop a culturally competent program specific to the needs of our rural, geographically isolated region in alignment with the purposes of the VA Nursing Academy: Enhancing Academic Partnerships Program. The outcomes of this three year effort will be improved access and quality of care for veterans in the Pacific Region.

The academic partnership between the VA-PIHCS and SONDH has four goals. First, the program will admit an additional 40 baccalaureate nursing students over the three years of this program. Second, the partnership will expand educational opportunities for SONDH students through the development of new clinical practicum sites, participation in telehealth, and the creation of a VA based student summer internship program. Third, the program will expand faculty and professional development at VA-PIHCS by hiring five faculty for year 1 and an additional five for years 2 and 3 and by implementing a Virtual Learning Community for professional development, career ladder progression, and partner collaboration. Fourth, the synergy created by this program will increase the pool of RN applicants for VA-PIHCS positions and support retention of VA-PIHCS nurses. The achievement of these goals will contribute to quality, safe, evidence based care for the veterans at the VA-PIHCS.

The framework for this partnership is based on the Community-as-Partner model that includes four central concepts-person, environment, health, and nursing (Anderson, 2008). The persons are the nursing students, faculty, veterans, and VA-PIHCS nurses and the environment is the SONDH and the VA Pacific Islands Health Care System. Health is defined as "resources for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources and physical capabilities" (WHO, 1986). Nursing in this model is defined as primary prevention (activities aimed at preventing diseases), secondary prevention (interventions to detect early to prevent further insult), and tertiary prevention (to maintain level of health and restore to a healthier state) (Anderson, 2008). The proposed program model creates links between the person and environment to improve health while addressing nursing shortage in the VA and Nation (Figure1).

Figure 1. Community-as-a-Partner Model where Students, Nurses, and Faculty come together in the Virtual Learning Community and in Clinical Experiences.

This Virtual Learning Community provides both educational opportunities and clinical innovations. It is the central focus of the SONDH and VA-PIHCS academic partnership, where the synergy between persons, environment and technology creates a place to learn and grow together. The Virtual Learning Community will be the vehicle that drives learning and education (for VA-PIHCS nurses and SONDH students), professional development of VA-PIHCS nursing staff, communication among all the members of the community, and evaluation of the project.

The SONDH will increase the baccalaureate enrollment by 20 students in year 1 and 2, graduating an additional 40 new nurses by the end of BS program cycle. The program creates new clinical rotations for baccalaureate nursing students at all levels (1st year, 2nd year, and 3rd year) in various inpatient and outpatient settings at the VA-PIHCS with its long standing Joint Venture with Tripler Army Medical Center (TAMC). The goal is to increase the number of SONDH students that complete clinical practicum's at the VA-PIHCS from a baseline of 2% to 15% in year 1, 20% in year 2 and 25% in year 3. The focus of the clinical experiences will be on primary care (primary prevention), chronic disease management (secondary and tertiary prevention), geriatrics (primary, secondary and tertiary prevention), mental health (primary, secondary and tertiary prevention), and telehealth (primary, secondary and tertiary prevention).

In years 2-3 of this program, the SONDH and VA-PIHCS will develop and offer a summer student nurse internship program for students who have completed the first 2 years of their 3 year nursing program. The program will allow students to participate in an intensive 6 week full time summer work experience at the VA-PIHCS. Students will have the opportunity to sharpen their nursing skills and, under the guidance of VA-based faculty,. At the end of this internship program, students will be invited to share their experiences with other students, faculty, veterans and VA-PIHCS staff at a designated event.

The academic partnership will create the Virtual Learning Community to provide a portal to enhance the education of the VA-PIHCS nurses and will support implementation of a new clinical ladder system within the VA-PIHCS system. The Virtual Learning Community will enhance professional developmental activities for VA PIHCS nurses and expand their clinical opportunities at VA with the ultimate goal of increasing VA nurse recruitment and retention.

The academic partnership will expand faculty at SONDH, faculty at the VA-PIHCS, and provide professional development at the VA-PIHCS including those nurses who live in remote areas such as Guam and Samoa. The VA-PIHCS faculty will have Adjunct Clinical Faculty appointments at the SONDH and participate in new faculty orientation and development sessions. The VA-PIHCS faculty will assist with the creation, implementation and evaluation of new clinical sites at the facilities to enhance the baccalaureate education of student nurses. They will function as the lines of communication for the academic partnership opportunities to all VA-PIHCS nurses. They will plan, develop and implement professional development activities for VA-PIHCS via the virtual learning community. Finally, they will participate in the evaluation process of the program and assist with the program reports. The SONDH faculty will be the communication link between the program and the SONDH students and faculty. They will organize and implement clinical rotations for all levels of nursing students based on learning needs and opportunities available at VA-PIHCS. They will participate with VA-PIHCS in the development of the student nurse internship program. They will also facilitate virtual learning community professional development activities for VA-PIHCS nurses and will supervise students during clinical practicums at the VA-PIHCS.