Community and Public Health Nursing in Rural Environments

1. Community and Public Health Nursing in Rural Environments By N.Haliyash MD, BSN, International Nursing School TSMU

2. Rural nursing practice offers many opportunities. • Nurses are respected community members—their judgmentand opinions count. • Rural nurses are key members of thehealth care team. They can make a difference in the lives oftheir neighbors, friends, and community. The challenges aremany, and the rewards are great!

3. Objectives: • Discuss definitions rural vs. urban • Compare and contrast health status of rural vs. urban • Discuss community resources, interactions, and linkages to promote, maintain, and restore the health of communities.

4. Definition of rural communities According to your textbook • rural communities are areas having fewer than 1000 persons per square mile. • rural communities are communities less than 20,000 people.

6. Difficulties in health care delivery • Recruiting and retaining qualified health professionals in underserved communities is difficult. • Some factors that influence where health care providers work are • 1) geographic location, • 2) population density, and • 3) distance from an urban center. • Rural Health Care Providers are generalists. • Despite an increased incidence of chronic health conditions, rural adults seek medical care less.

7. Peculiarities of rural communities • Rural communities have fewer resources ( roads, schools, hospitals) • * Mental Health Professionals who provide services report a persistent endemic level of depression among rural residents. • * Sometimes the community does not trust the professionals who provide services in local agencies. • * Some High risk industries in rural areas are: Lumber/forestry, mining, agriculture. • * Causes of death in rural areas include, machinery and vehicular accidents, trauma, cancer, respiratory disease, toxins such as herbicides, and pesticides.

8. DID YOU KNOW??? • Compared with urban Americans rural residents have the following: • Higher infant and maternal morbidity rates • Higher rates of chronic illness, including hypertension, cardiovascular disease, cancer, and diabetes. • Unique health risks associated with occupations and the environment, such as machinery accidents, skin cancer from sun exposure, and respiratory problems associated with exposure to chemicals and pesticides. • Stress-related health problems and mental illness, but the incidence of those conditions is not known. APA Page on Rural Behavioral Healthhttp://www.apa.org/rural/

9. CHARACTERISTICS OF RURAL LIFE • More space; greater distances between residents and services • Cyclic/seasonal work and leisure activities • Informal social/professional interactions • Access to extended kinship systems • Residents are related or acquainted • Lack of anonymity • Small enterprises (family); fewer large industries

10. CHARACTERISTICS OF RURAL LIFE • Economic orientation to land and nature (e.g., agriculture, mining, lumbering, fishing) • High-risk occupations are more prevalent • Town is the enter of trade • Churches and schools are social organizations • Preference for interacting with localities (insiders) • Mistrust of newcomers to the community (outsiders)

11. CHARACTERISTICS OF NURSING PRACTICE IN RURAL ENVIRONMENTS • Variety/diversity in clinical experiences • Broader/expanding scope of practice • Generalist skills • Flexibility/creativity in delivering care • Sparse resources (materials, professionals, equipment, fiscal) • Professional/personal isolation • Greater independence • More autonomy • Role overlap with other disciplines • Slower paced

12. CHARACTERISTICS OF NURSING PRACTICE IN RURAL ENVIRONMENTS • Lack of anonymity • Increased opportunity for informal interactions with patients/coworkers • Opportunity for client follow-up upon discharge in informal community settings • Discharge planning allows for integration of formal with informal resources • Care for clients across the lifespan • Exposed to clients with a full range of conditions/diagnoses • Status in the community; viewed as an occupation of prestige • Viewed as a professional "role-model" • Opportunity for community involvement and informal health education.

13. Work Stressors Of Community Health Nurses In Rural Practice • Political/bureaucratic problems • Understaffing: overworked • Intraprofessional/interpersonal conflicts • Difficult/unpleasant nurse-patient encounters • Unsatisfactory work environment • Relatives refuse to deliver needed care to client

14. Work Stressors Of Community Health Nurses In Rural Practice • Patients who are hostile, apathetic, dependent, low intelligence • Inadequate communication • Fear for personal safety • Difficulty locating patients for care and/or follow-up • "Falling through the cracks"

15. BARRIERS TO HEALTH CARE • Great distances to obtain services • Lack of personal transportation • Unavailable public transportation • Lack of telephone services • Unavailable outreach services • Inequitable reimbursement policies for providers • Unpredictable weather conditions • Inability to pay for care • Lack of "know how" to procure entitlements/services • Providers' attitudes and knowledge levels about rural populations

16. Critical Care Needs • Critical Care Needs for rural areas include: • Preventive services (health screening, nutrition counseling, wellness education, etc.) • Services for frail elderly (Adult day care, hospice, respite care, meal deliveries) • Services for children with special needs • Emergency Care

17. Using the nursing process

18. Using the nursing process

24. Task for practicum: Situation • Johnsville is a small, rural city of 10,000 people located near an Indian Reservation. The main industry is ranching-farming related. There is a problem with alcoholism. One hundred cases of tuberculosis are on the TB registry, 15 of those cases are newly diagnosed. Fifteen live births were found in the teenage population. A small Senior Citizen group is active in the community. • Community resources include a 100 bed general hospital, 3 M.D.'s, 2 dentists and a limited number of professional nurses. There is one private nursing home with 8 beds. • The political system of Johnsville is described as "conservative". $50,000 has been allocated to the city health department in 1998. The water, sewer, and sanitation department have a separate budget. • Given this limited information, you are appointed to the Johnsville Board of Health. You said your fellow board members need to identify the health problems, set priorities, develop programs and allocate funds to your programs and department.

25. Task for practicum: Instructions • Hint: Remember to use outside resources. • Instructions: • Define community of Johnsville - What type(s) is it? • What is best way to collect additional data? • What is the health status, health structure, health process? What are the health problems/nursing diagnosis? • Set priorities for the health problems to be addressed? • Who are you going to involve to resolve the problem? • What is the most economical use of the health department budget?

26. That’s all folks! Q & A ?