Caring For Community

February 13, 2004
Itasca, Texas -- population 1,350 -- is the center of a rural community that has a high rate of poverty and many elderly and minority citizens with no access to health care.
research-3Lisa Taylor, assistant professor in Baylor's Louise Herrington School of Nursing, knows this community and the health problems of its residents well. She has lived in the area, which is designated a medically underserved area by the federal government, for almost a decade, and she worked as a family nurse practitioner in the town's only health clinic from 1994-97. After the hospital operating the clinic closed it in 1997, Taylor and her husband bought the clinic, where she worked for another two years before they were forced to close it again.
Taylor, who teaches in the nursing school's graduate family nurse practitioner program, felt sure that the gap left by closing the clinic could be filled by the expertise of family nurse practitioners if funding could be secured.
"Many doctors have left small towns, and family nurse practitioners are trained to provide primary care in places such as Itasca. I realized that we could meet the health needs of residents and, at the same time, make this a model for rural family nurse practitioner practice," she says.
After conducting a feasibility study and learning that the residents of Itasca and the surrounding area were driving an average of 30 miles for routine health care, Taylor and Merry McBryde-Foster, grant co-author and nursing school assistant professor, applied for a grant from the Department of Health and Human Services. Last June, they were awarded $1.2 million. The Baylor Rural Health Center opened Oct. 1 under the auspices of the nursing school, with Taylor serving as project director for the five-year grant.
In addition to an office manager and a nurse, the center is staffed by one full-time family nurse practitioner -- a registered nurse with advanced training who is licensed by the state to deliver primary care. The clinic contracts with a physician who serves as medical director to provide oversight and prescriptive authority.
Because of their emphasis on health promotion, disease prevention and the management of acute and chronic illness, family nurse practitioners are well-suited to provide care for residents in underserved areas, Taylor says.
"We go into a community and try to put ourselves out of business. We teach people how to take care of themselves so they will not develop chronic illnesses," she says. "And because we are nurses first, we see past the ear infection and see a person and a community."
The center's hours are structured for the elderly, who prefer morning appointments, but do include evening and weekend hours to accommodate those who work full time, often at out-of-town jobs. The elderly, children under 18 and minorities were target populations in the grant application. Because many of the area's residents are either uninsured or underinsured, the clinic provides low-cost services for individuals who otherwise could not afford to pay for their care, Taylor says.
The center, which she hopes will become a model for nurse practitioners who want to open clinics in rural communities, serves as a clinical learning site for both undergraduate and graduate nursing students. It is a student placement site for health education and social work students as well.
One goal of the grant application was to foster nursing and health care research, particularly in the area of chronic diseases. "We need to know if how we treat patients and what we teach about preventing chronic diseases actually works," she says. "Baylor Rural Health Center will be our health laboratory, a place where we will not only provide quality health care, but where faculty can conduct clinical-outcome research so that we can improve how nurses and nurse practitioners deliver care."

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