Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Laura Kuensting


Lisa Merritt

Allison Brauch


Problem Rural healthcare consumers experience increased health disparities, especially when accessing health care. The use of telehealth to improve access has become an essential competency for nurse practitioner (NP) students. This study evaluated NP students’ confidence and competence of rural social determinants of health (rSDOH) before and after a telehealth simulation.

Methods A descriptive, cohort design was used to review NP students’ pre- and post-surveys, written case studies, and a video-recorded telehealth OSCE for a patient living in a rural area.

Results Student self-rated knowledge of rural health care did not improve despite didactic learning and simulation (z = -1.63, p=.102). However, a difference in student self-rated comfort in managing rural patients was found (z=-3.32, p z = -3.70, p< .001; z = -4.20, p< .001). Of clinical significance, 100% of student groups discussed health history consideration items during simulation; and 55.5% of student groups included at least two rSDOH in their differential diagnoses.

Implications There was some benefit when NP students received education on rSDOH and experienced a rural telehealth simulation experience. Students reported increased comfort and confidence when encountered with a patient with limited access to care, but students inconsistently addressed rSDOH during simulation. Continual training for NP students in identifying rSDOH and telehealth practices is indicated to enhance culturally competent patient care when encountering those living in rural areas.