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KU School of Nursing delivers first Project ECHO series, on stress

July 12, 2019

By Kristi Birch

Melissa Hoffman, DNP, APRN, Cara Busenhart, Ph.D., APRN, Mary Icenogle, BSN, RN, and JoAnn Peterson, DNP, APRN
Melissa Hoffman, DNP, APRN, Cara Busenhart, Ph.D., APRN, Mary Icenogle, BSN, RN, and JoAnn Peterson, DNP, APRN. Photo: Elissa Monroe, KU Medical Center.

At noon on May 23, Melissa Hoffman, DNP, APRN, and Cara Busenhart, Ph.D., APRN, took their seats at the head of a conference table in a small room at the University of Kansas Medical Center, where they would spend the next hour delivering an interactive presentation about the effect of stress on the mental health of pregnant women and mothers.

After Hoffman, a psychiatric nurse practitioner in Lawrence, Kansas, talked about ways to identify, screen for and treat a variety of perinatal mood and anxiety disorders, Busenhart, program director of advanced practice and midwifery education at the University of Kansas School of Nursing, presented the details of a (de-identified) case for discussion: a pregnant college student at her first prenatal appointment. She then posed a question: "What are the risk factors for this patient developing a perinatal mood or anxiety disorder?"

The room was small, but the answers-the patient's age, concern about finishing school, and that the pregnancy was unintended-came from an audience of 57 healthcare professionals scattered across 47 counties in the state of Kansas and beyond. A family medicine doctor in Bixby, Oklahoma. A clinical social worker in Lawrence. A retired nurse in northwest Kansas. There was even one nurse from India.

The presentation by Hoffman and Busenhart was the third of a four-session teleconference series on stress delivered by the KU School of Nursing via Project ECHO (Extension for Community Health Outcomes), a program housed in the Center for Telemedicine and Telehealth at the KU Medical Center. Titled "Stressed Out: Identifying and responding to chronic stress in our patients and ourselves," it was the first ECHO series to be presented by the KU School of Nursing.

Founded in the early 2000s at the University of New Mexico Health Sciences Center in Albuquerque, Project ECHO was designed as a form of continuing education that uses teleconferencing and the web to enable primary care physicians and other clinicians, especially those in remote areas, to learn from and dialogue with specialists, particularly those at academic medical centers such as KU. Logging in from their computers, tablets and smartphones, participants learn about managing complex medical conditions and get advice about individual cases, such as the one Busenhart presented, from experts in a relaxed, conversational environment, often during the participants' lunch hours.

The University of Kansas Medical Center offered its first Project ECHO in 2015 and has since covered 24 health topics and reached more than two thousand participants.

More than 200 people including physicians, nurses and social workers registered for the "Stressed Out" ECHO, for which they could earn continuing education credit. The series was funded by a supplement to an Advanced Nursing Education Workforce grant that was awarded to the KU School of Nursing by the Health Resources Services Administration of the U.S. Department of Health and Human Services. ANEW grants support training for advanced practice nurses to provide primary care in rural and underserved settings.

The ANEW grant supplement came with a list of five "priority topics" to choose from as a focus. One was telehealth, so the ANEW team at the KU School of Nursing decided to combine that with another topic: mental health. "Mental health is what we hear preceptors talking about, and as an advanced practice nurse, I know that's where we all feel we could use more education," said Busenhart.

Mary Icenogle, BSN, RN, ANEW grant program manager at the KU School of Nursing, said the team decided to concentrate on stress in particular because chronic stress contributes to other health problems. Moreover, chronic stress can be addressed in a primary care setting. "The planning team wanted to focus on learning how to respond to stress. The goal is to create balance, manage chronic diseases and hopefully decrease the incidence of anxiety and depression," she said.

Each session in the "Stressed Out" series was led by a different member of the KU School of Nursing faculty, each of whom focused on how stress affects a specific patient group. Lori Schwartz, DNP, APRN, co-led the first session in the series about chronic stress in men. Carol Buller, DNP, APRN, did a session on the stress of caregiving for older adults. The last session of the series, about provider stress, was led by Lucinda Whitney, DNP, APRN, and JoAnn Peterson, DNP, APRN.

When she was planning the session on maternal mental health, Busenhart, a nurse-midwife, said she immediately reached out to Hoffman, who recently earned her doctor of nursing practice from the KU School of Nursing, because of Hoffman's work in Douglas County founding a support group for mothers who experience perinatal mood and anxiety disorders.

Professionals from other disciplines also participated in the sessions, including two social workers, a physician in geriatric medicine and a psychologist. "KU's ECHOs utilize interprofessional teams of specialists that encourage diverse participation resulting in a range of perspectives," said Carla Deckert, project director for Project ECHO at KU Medical Center.

The nurse-presenters of the "Stressed Out" ECHO created an online "toolkit" of resources so that participants would have access to resources after the series was over. The toolkit is searchable by patient population and contains links to screening tools and apps as well as general mental health information.

"Nurses are great at educating diverse groups of people, and teaching is part of what nurses do every day, whether it's teaching at the bedside, teaching a family how to care for loved one, or teaching at the community level," said Cynthia Teel, Ph.D., RN, FAAN, associate dean of academic affairs at the KU School of Nursing and principal investigator of the ANEW project. "And nurses do a lot of work in the area of identifying stress and the impact it can have on health. This ECHO series was a way to share that with other providers." 

Last modified: Jul 18, 2019