August 31, 2023

State lawmakers commend practice for service to Near East Columbus community

Ohio State Total Health and Wellness, the nurse practitioner-led primary care practice hosted by The Ohio State University College of Nursing, today concluded a month-long celebration of its 10th anniversary with special presentations by state lawmakers.

State Rep. Dontavius L. Jarrells (D – 1st District) and State Sen. Hearcel F. Craig (D – 15th District) – both of whom represent the neighborhood around The Ohio State University Wexner Medical Center East Hospital, where Total Health and Wellness is located – presented Total Health and Wellness with legislative commendations praising the impact that the practice has had on the community.

Rep. Jarrells’s commendation said, in part, that Total Health and Wellness “has proven itself to be an invaluable resource” to the community and that its “inter-professional team approach to integrated physical and mental healthcare is a justifiable source of pride and an outstanding reflection on the practice … These diligent people have provided unparalleled care that has earned them the esteem of Columbus’ Near East Side neighborhood and the surrounding communities.”

Mary Justice, State Rep. Dontavius L. Jarrells, Candy Rinehart, Karen Rose
(L-R): Mary Justice, State Rep. Dontavius L. Jarrells, Candy Rinehart, Karen Rose

Sen. Craig’s citation said that, over the past ten years, “this outstanding program has expanded to provide historically underserved patients of all ages with an inter-professional team and integrated physical and mental health services. Thanks to the venerable and expert work of the care team, East Side residents have unparalleled access to the utmost state-of-the-art care to bridge the gap in health care access. Without the critical services like health and wellness education, mental health counseling and screenings that this practice provides, countless individuals and families would have insufficient access to the care needed to live healthy and prosperous lives.”

“We could not be more proud of or more grateful for the clinicians and partners who have helped build Total Health and Wellness into the trusted practice it is today,” said Karen Rose, PhD, RN, FGSA, FAAN, dean and professor at the College of Nursing. “They demonstrate every day how answering the calling to care can impact not just individual patients, but an entire community that counts on them to manage chronic conditions, help their children grow up healthy and respond to the existential healthcare challenges of the day. We are so excited about what the future holds for this extraordinary practice.”

Total Health and Wellness engages a care team of clinicians from a broad array of disciplines, including family nurse practitioners, certified nurse midwifes, psychiatric mental health nurse practitioners and mental health counselors, pharmacists, dietitians, community health workers and health science students. In 2019, Total Health and Wellness received the designation as a Federally Qualified Health Center (FQHC), one of only a few FQHCs led by nursing colleges in the country.

“Our first decade of service has been transformative for us in so many different and life-changing ways,” said Candy Rinehart, DNP, APRN-CNP, FAANP, chief executive officer of Total Health and Wellness. “When we started this practice, our dream was to show how a nurse practitioner-led, interdisciplinary, comprehensive care model could positively affect health outcomes in patients throughout the community. Our experience has been so much deeper than just that dream.

“Becoming an FQHC entrenched us as a primary option for our community. Incorporating telehealth as a connection path during the COVID-19 pandemic helped us broaden our access and impact, especially at a time when people really needed our support. And now, as we look at growth opportunities to extend our reach, we lean on the lessons we’ve learned, the relationships we’ve created and the trust we’ve built to help even more people and families live better, healthier lives.”

See a collection of photographs from this special event.

September 16, 2019
Grant supports the center’s primary care services to underserved populations

COLUMBUS, Ohio – The Health Resources & Services Administration (HRSA) has awarded full “Federally-Qualified Health Center” status (FQHC) to The Ohio State University College of Nursing’s Total Health and Wellness, a nurse practitioner-led comprehensive primary care health center at The Ohio State University Wexner Medical Center East Hospital.

The FQHC designation recognizes community-based healthcare providers who deliver primary care services in underserved populations. Total Health and Wellness is one of only 77 health centers in the country – out of approximately 700 applications – to receive this status this year. FQHCs are supported by federal HRSA Health Center Program grants, which come through the U.S. Department of Health and Human Services, aimed at expanding access of affordable, quality primary care to vulnerable areas.

HRSA awarded more than $50 million in New Access Point grants in this cycle, including $650,000 in grant support this year for Total Health and Wellness.

“This accomplishment does not happen without the dedication and passion of our interprofessional team of healthcare providers,” said Candy Rinehart, DNP, APRN-CNP, FAANP, CEO of the Total Health and Wellness practice. “Our patients count on us to provide them and their families with high-quality, compassionate care, and our team delivers great care daily.”

“Nurse practitioner-led practices are vital parts of our healthcare system that produce great population health outcomes,” said Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing. “We are so excited about this new status and the support that comes with it that will help us continue to further expand our terrific healthcare services to help even more families in the East side community live healthier lives.”

Total Health and Wellness opened in 2012 with a vision to expand primary care and treatment of chronic conditions to the Near East Side of Columbus. The care team includes family nurse practitioners, certified nurse midwives, psychiatric mental health nurse practitioners, mental health counselors, pharmacists, dietitians, and community health workers, as well as nursing and other health science students. Services range from family practice and chronic condition management (i.e. diabetes, cardiovascular disease, pulmonary disease) to physical exams, women’s health services (including prenatal care) and mental health programs. Its governing board includes patients and community members.

For more information visit the Total Health and Wellness website or call 614-685-9994.

December 07, 2018

The Ohio State University College of Nursing incorporates telehealth across nursing curricula with innovative techniques, tools, pedagogy and learning environments to prepare students for the healthcare of today and tomorrow.

Access to healthcare services is limited for 84 million people who live in the 7,176 Health Professional Shortage Areas (HPSAs) in the United States. Telehealth – the use of digital information and communication technologies to provide healthcare services remotely – offers a promising solution to address this crisis. While some institutions of higher education teach telehealth content, few are actively engaged in teaching their health sciences students through clinical opportunities, and fewer still are evaluating how students use telehealth to provide patient care. Meanwhile, Ohio State is preparing undergraduate, graduate and doctoral nursing students to deliver telehealth care using immersive, experiential learning strategies.

The use of telehealth in clinical nursing practice is spreading widely. For Alice Teall, DNP, APRN-CNP, FAANP, assistant professor in the College of Nursing, merely familiarizing her online students with the concept of telehealth was not enough. “The biggest push for me was not about introducing students to the concept, but ‘How are we going to know our online nurse practitioner students are prepared for practice?’” That question brought its own challenges: creating online learning environments for simulating care by telehealth, reimagining methods and tools to measure and assess student learning and performance with telehealth, and partnering with a team of faculty, clinicians, and instructional designers to expand nursing student opportunities to learn telehealth across on-campus programs.

 

 

Innovative pedagogy meets technology

Teall and faculty at the College of Nursing created, and continue to create, new educational materials to address these needs. Perhaps the most innovative has been their work with  “standardized patients” – actors hired to role-play as patients – to create videos and livecasts of patient case study situations. Using web conferencing, a standardized patient can appear onscreen in classrooms online or on campus, and can speak to each student individually or to groups of students.  Standardized patients are trained to act like real patients, and may forget things, answer the wrong questions, or act surly when in pain, so that students get to experience what it’s like to triage difficult situations.

The faculty have also created “store and forward” recordings of standardized patients that can be used to simulate real patient phone calls, questions, and concerns. Cases include behavioral health issues and pediatric exams, in which the student might need to engage with a concerned standardized patient parent to obtain information. Case recordings and the standardized patient scenarios are re-useable assets that instructors share to include telehealth opportunities across specialties and programs.

Instructors new to telehealth benefit from a “telehealth toolkit” Teall and others devised. It includes checklists, timelines and practical information, such as how to use telehealth equipment. “We started writing out everything we do in a checklist format so that faculty can replicate telehealth simulations and exams easily,” Teall related. This collection of pedagogy, case studies, and tools continues to grow and could be exported to other institutions to increase telehealth education nationally.

Ohio State’s innovative online programs immerse students from across the country in learning telehealth technology. Online nursing graduate students attend lectures about telehealth technologies. They practice e-visit videoconferencing and simulate providing care using telehealth exam stations. Later, they are precepted in clinical experiences using telehealth. During the final two semesters of the program they complete objective, structured clinical exams on their use of telehealth technologies and their etiquette as telehealth providers.

 

Ohio State’s Lima campus telehealth clinic

Ohio State’s commitment to telehealth goes beyond teaching: they have their own telehealth clinic. In early 2018, the College of Nursing opened a telehealth clinic on their Lima campus (a rural extension campus in an HPSA) to provide care to their students, faculty and staff. The clinic is staffed by a nurse and linked via state-of-the-art telehealth equipment to Total Health and Wellness (THW), a nurse practitioner-led, interprofessional clinic operated by the college that is designated as a Federally Qualified Health Center Look Alike. Using Bluetooth technology, a nurse practitioner at THW can assess the heart sounds of a patient being examined by a nurse from 100 miles away as clearly as if she were in the room. The nurse at the clinic acts as the nurse practitioner’s hands, performing the exam using Bluetooth-enabled devices such as an otoscope, blood pressure cuff and stethoscope. Meanwhile, both nurse and patient can see and talk to the nurse practitioner from the clinic, who appears on a two-way video conferencing screen. Interdisciplinary health sciences students are precepted as healthcare providers at the clinic.

What’s it like to use the telehealth clinic? “The patients love it,” Teall said. And as the on-screen nurse practitioner, she has enjoyed using the state-of-the-art equipment. This video equipment has no lag time, echo or scratchy sound to distract the patient—“That would never work,” Teall asserted—“You (the patient) don’t want to share personal information with someone who sounds like the Wizard of Oz.” Instead, “I’ve had people who have said, ‘Oh my gosh, this really is like you are sitting right here.” And there are advantages, such as the Bluetooth otoscope which magnifies the image of the eardrum and shows it in high definition, “so that the patient and I can really see it,” Teall says. Nursing students learn the special techniques of using this equipment, both in the nurse and nurse practitioner roles. For instance, Teall says, it’s important for nurses to learn not to step between the stethoscope and the broadcasting equipment, or to look at the video screen when they should be looking in the patient’s ear. Equally important, nursing students learn new ways of using telecommunications to talk to their patients and put them at ease.

 

Telehealth etiquette

Students learn and practice telehealth techniques so that they will be knowledgeable and comfortable when the time comes, and so that they can help patients feel comfortable, too. For instance, Teall explained, “If you are sitting in front of a camera as the provider and the patient is on the other side of the screen, you have to remember that all they can see is your head. So, when you start charting or documenting their visit using your computer, it’s important to say, ‘I’m going to turn my head. I’m going to put this into the computer now.’ Otherwise, all the patient sees is their provider not looking at them anymore.” Explaining the moves you’re making with equipment off-camera helps build patient trust, as does explaining off-camera sounds. If someone enters the room, Teall advises students to introduce any new people who enter the room before they are in sight, and explain why they’re there.

Students practice presenting as an onscreen healthcare provider. “The telehealth exam station transmits high-def sound and picture,” Teall explained, and it takes a bit of getting used to. “You have to not wear jewelry,” because clinking sounds can amplify greatly, and “sometimes you think you’re looking at the person, but you might not be if you are not looking at the webcam. So, we have to teach students to look directly at the camera and not necessarily at the picture on the screen; otherwise the person thinks you’re always looking at their shirt.” During online exams, students are graded in part on their etiquette, which includes how they communicate with patients and the attending nurse at the clinic.

When learning to care for patients calling in from remote locations, students are taught to ask, “Are you in a secure place? Are you in a place where we can talk confidentially?” Even if the patient can’t talk out loud, a secure conversation may be possible via texting. Practicing scenarios like these can help future healthcare providers keep a level head when treating telehealth patients in emergency situations.

Ohio State’s innovative online pedagogy includes simulated patient exams using telehealth stations on campus that are like those used at the Lima telehealth clinic. “Patients” range from patient actors to real people with medical conditions who have volunteered to help educate student nurses. “Pregnancy is one of the cases that we do,” Teall related. “Every 15 to 20 minutes, one of our students calls in, and the student has to orchestrate a prenatal visit. That’s how we know they can do it.” The student might listen to the baby’s heartbeat remotely and ask the mother questions about her health. Care is taken to educate students on implicit bias and cultural sensitivity as well.

 

Telehealth in your pocket

Ohio State is preparing students to attend to patients at a distance using technologies available almost everywhere: internet and cellphones. “This is about how to increase access to care. People who have low access to care, whether the reasons are geographic or financial, usually have a smartphone. And when a parent can access a provider by calling on their phone, there’s research that says if they share a picture or video of their child, this gives them more confidence that the provider knows what’s going on and it gives the provider more confidence that they were able to assess their child better,” Teall said. Parents using smartphone apps may be less likely to unnecessarily take a child to the ER or repeat a hospital visit.

 

The future

The College of Nursing seeks to further its mission of transforming health and transforming lives by educating the nursing workforce of the future in telehealth so that they may provide care at a distance and address the health professional shortage crisis. Faculty continue to expand the library of telehealth exam simulation cases, and to reimagine telehealth pedagogy. Future goals include expanding, refining and publishing their telehealth toolkit of educational methods, clinical practice tools and techniques. The college’s approach to telehealth education is scalable, cost-effective and is producing great results and marketability for its graduates, who have practical experience in telehealth and are ready to work as providers of telehealth care to those in need.

March 26, 2018

Open house planned for April 2, 2018

Ohio State Lima students, employees and dependents will now have access to onsite healthcare in the Student Services Center on campus through the Ohio State Total Health and Wellness at Lima health center, utilizing telehealth equipment connected to the Columbus campus.

The media and interested community members are welcome to an open house to celebrate the grand opening from 11 a.m. to 12:15 p.m., Monday, April 2, 2018. A ribbon-cutting ceremony and short program will be held at 11 a.m. in the west end of the Student Services Center. Jessica Campbell, RN, will be onsite to answer questions, and the telehealth equipment will be available for demonstrations.

“Onsite healthcare adds another dimension of health and wellness to the Ohio State Lima campus,” said Interim Dean and Director Joseph Brandesky. “Our students and employees now come from more than half of the 88 counties in Ohio. Some of them drive long distances or those living near campus are a fair distance from their primary healthcare providers. The facility provides a means for them to address day-to-day health concerns.” 

With Ohio State Total Health and Wellness at Lima, the Ohio State College of Nursing will offer a nurse-practitioner-led comprehensive primary-care practice as part of a pilot program that takes a telehealth approach to health and wellness. 

“We are so excited to bring primary-care health services to Lima through our nurse practitioner-led facility,” said Ohio State College of Nursing Dean Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, who also serves Ohio State as vice president for health promotion and chief wellness officer. “Our team approach to care benefits patients in many ways by focusing treatment on the whole person.”

Ohio State Total Health and Wellness at Lima offers an interprofessional team approach to integrated physical and mental healthcare for students, employees and their dependents. A registered nurse will be available on-site and a certified nurse practitioner will be accessible through a remote telecommunications system. 

“Offering telehealth services gives us a wonderful opportunity to extend our primary care services and provide that team approach to healthcare,” said Candy Rinehart, DNP, FNP, ADM-BC, FAANP, executive director of Advanced Practice and Community Partnership, nurse practitioner and director of Ohio State Total Health and Wellness at Ohio State Hospitals East. “In addition to family nurse practitioners, we can access mental health nurse practitioners, pharmacists, dietitians, social workers and other providers to support total patient care. Exams and conversations will take place in real time, with our registered nurse serving as our hands in the clinic, and the nurse practitioner in Columbus providing direction for both the exam and treatment.”

The new facility will be located in the west end of the Student Services Center. Renovations to a conference room have resulted in space for an examining room, office and storage area. The state-of-the-art telehealth equipment will allow the nurse practitioner and the patient to interact much like they would in person. What the onsite registered nurse sees as she conducts an exam in Lima is instantly available to the nurse practitioner in Columbus.

Ohio State Total Health and Wellness at Lima will be open 15 hours a week. Services will include health and wellness screenings, education and vaccines, physical exams, evidence-based management of new health problems or complaints, contraception counseling and management, integration of mental health services to complement Ohio State Lima’s Counseling and Consultation Services and healthy lifestyle programs. Patients are seen by appointment only. Please call 567-242-6546 to schedule a visit.

Ohio State Lima is the first regional campus to offer telehealth through the three-year pilot program funded and administered through the College of Nursing. Future plans call for Ohio State Total Health and Wellness facilities using telehealth technology at all of Ohio State’s regional campuses.

August 16, 2017

The Ohio State University Total Health and Wellness Center at University Hospital East has qualified to provide expanded primary-care services to patients regardless of their ability to pay after receiving a significant federal designation.

The Total Health and Wellness Center (THW), established in late 2012 as Ohio State’s first health practice to be run entirely by nurses, has been awarded Federal Qualified Health Center Look-Alike status by the Health Resources and Services Administration Bureau of Primary Health Care. Under this designation, THW is recognized as an organization that provides high-quality preventive and primary healthcare to patients regardless of their ability to pay. 

With Look-Alike designation, THW will receive increased reimbursements, improve access to qualified healthcare providers and develop a pharmacy with reduced pricing on prescription and non-prescription medications for patients. 

“We are very dedicated to continuing to provide critically needed comprehensive primary-care services to optimize health and well-being in our community,” said Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, vice president for health promotion and dean of the College of Nursing. “Our team approach to care is led by nurse practitioners and includes interprofessional health professionals who are dedicated to providing the best evidence-based physical and mental healthcare.”

THW is located at University Hospital East and operated by The Ohio State University College of Nursing. Led by Director Candy Rinehart, DNP, FNP, ADM-BC, FAANP, the center offers a distinctive nurse practitioner-led comprehensive primary-care practice with a multidisciplinary team providing an evidence-based approach to integrated physical and mental healthcare for people across the lifespan. The staff at the center is composed of family nurse practitioners, psychiatric mental health nurse practitioners and mental health counselors, pharmacists, dietitians and social workers, as well as nursing and other health science students. 

“The Total Health and Wellness Center provides timely access to comprehensive healthcare for our local community for both prevention and chronic-disease care,” said THW Board President Carolyn Slack. “The community’s response has been exciting, and the practice is growing, primarily by word of mouth. The center and Ohio State are strong assets that our community trusts.”

THW serves neighboring communities in Columbus and Franklin County, including patients covered by commercial insurance, Medicaid or Medicare, and the uninsured. Services include: 

  • family practice care to individuals of all ages, including children and adolescents
  • health and wellness screening and education
  • management of new health concerns
  • care and ongoing management of chronic conditions such as diabetes, asthma, heart failure and others
  • routine physical exams, health and wellness screenings and vaccines
  • basic women’s services, including pap smears and birth control, as well as plans to soon provide prenatal care
  • health education to help reach optimal wellness
  • mental health counseling and evidence-based programs for conditions such as depression and anxiety
  • healthy lifestyle programs

The THW is the 50th health center in Ohio to receive FQHC designation, which indicates that it meets all of the eligibility requirements of an organization that receives a Public Health Service Section 330 grant, but does not receive grant funding. With this designation, the THW will ensure healthcare for underserved communities and vulnerable populations.

THW has provided nearly 16,000 patient visits since it was established. For more information, visit the Total Health and Wellness webpage.