Rural Nursing and Cultural Competence Dr' Melondie Carter

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Rural Nursing and Cultural CompetenceDr.
Melondie Carter
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Alabama
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U.S. Population and Trends

• According to Census 2000, there are approximately
  274.6 million people living in the United States.
  The population is mostly white (75.1), followed
  by blacks (12.3), Hispanic (12.5), Asian and
  Pacific Islander (3.6), American Indian (0.9)
  and Other (8.1)

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Standards for Culturally Appropriate Services
in Health Care

• The U.S. Department of Health and Human Services
  Developed a National Standard for Culturally
  Appropriate Services in Health Care in 2001.

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Standard 1

• Health care organizations should ensure that
  patients receive from all staff members
  effective, understandable, and respectful care
  that is provided in a manner compatible with
  their cultural health beliefs and practices and
  preferred language.

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Defining Rural

• Two of the most common definitions of rural are
  those of the U.S. Census Bureau and the U.S.
  Department of Health and Human Services.

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The Census Bureau Definition

• Territories, populations and housing units less
  than 2,500 persons. The rural designation is
  also subdivided into rural farm and rural
  non-farm populations. Only 6.3 of rural
  Americans live on farms.

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U.S. Department of Health and Human Services

• This definition considers population density in a
  geographical area for the purpose of health care
  planning. Urban refers to areas having 100 or
  more persons per square mile and rural refers to
  areas with 7 to 99 persons per square mile.

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Global Perspective

• Canada and Australia also define rural by
  distance between services and providers,
  geographic remoteness, and lower population
  density.
• Internationally, the challenges are similar when
  providing health care and nursing services.

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Rural Population

• In 1990, the census Bureau counted 61,658,330
  rural people. That total is greater than the
  1996 population of the United Kingdom (58
  million), Spain (39 million), Italy (57 million)
  or France (58 million). Of the total U.S. land
  mass, more than 90 is defined as rural
• (Bushy, 2000).

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Rural Population

• The rural population is distributed unevenly
  across regions of the United States. The South
  has the largest proportion of rural population
  (29.1 followed by the Midwest region (28.5)
• (Census 2000).

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Rural Population

• Over 33 of counties and county equivalents have
  80 of their population classified as rural.
  Counties with relatively high proportions of
  rural population are concentrated in the South,
  in Appalachia and in the Great Plains (Census
  2000).

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Demographics of Rural Communities

• Have a higher than average number of younger and
  older residents. One finds a higher proportion
  of persons between 6 and 17 years of age and over
  65 years of age living in rural compared with
  urban areas.

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Characteristics of Rural Families

• Tend to be poorer than their urban counterparts
• More likely to be uninsured
• More working poor families

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Health Status of Rural ResidentsCompared to
Urban Americans

• Higher infant and maternal morbidity rates
• Higher rates of chronic illness, including
  hypertension, cardiovascular disease,
• cancer, and diabetes
• Unique health risks associated with occupation
  and the environment (e.g. machinery accidents,
  skin cancer, respiratory problems)
• Stress related health problems

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Chronic Illness

• Compared with their urban counterparts, rural
  adults are more likely to have one or more of the
  following chronic conditions hypertension,
  arthritis, diabetes, cardiovascular disease, or
  cancer. Nearly half of all rural adults have
  been diagnosed with at least one of these chronic
  conditions compared with about a quarter of non
  rural adults.

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Patterns of Health Service Use

• Despite their overall poorer health status and
  higher incidence of chronic health conditions,
  rural adults seek medical care less often than
  urban adults. Rural residents see and accept
  nurse practitioners for health care.

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Rural Population Characteristics

• Of the total rural population, nearly 4 million
  are African-American, almost 2 million are Native
  American, 34 million are Asian-Pacific Islanders,
  and 75 million are of other races (Census 2000).

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Availability and Access toHealth Care

• Traveling time or distance to ambulatory care
  services is greater.
• Rural persons are more likely to travel more
  than 30 minutes to reach their usual source of
  care.
• Health Professionals Shortage Area

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Health of Children

• Rural children are more likely to see a general
  practitioner than a pediatrician.
• The availability of school nurses is usually on a
  part-time basis and varies from region to region.

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Mental Health

• Even if mental health services are accessible,
  rural residents delay seeking care when they have
  a emotional problem until there is an emergency
  or crisis.

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Environmental and Occupational Health Risks

• A communitys primary industry is an influencing
  factor in the local lifestyle, the health status
  of its residents, and the number and types of
  health care services it may need. For example,
  four high-risk industries identified by OSHA that
  are found in rural environments are forestry,
  mining, fishing and agriculture.

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Alabamas Population

• Alabamas total population was 4,385,446 (Census
  2003). Minorities comprised approximately
  one-fourth of the total. Seventy percent of
  Alabamas counties are rural. More than one-half
  of the Alabama population lives in rural areas.

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Leading Causes of Death in Rural Alabama

• Heart disease
• Cancer
• Cerebrovascualr Disease
• Chronic Obstructive Lung Disease
• (Alabama Rural Health Plan, 2000).

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Alabamas Health

• There is a lack of education in the state
  concerning health promotion and disease
  prevention.

(Alabama Rural Health Plan, 2000).
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7 Strategies for Implementing Culturally
Competent Rural Services

• Learn about the community from people who live
  there from multiple sources, including families
  and individuals who will use the program.
• Recruit community members to by involved in
  determining needs.
• Review what has been done in other communities
  with similar populations.

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• Identify priority areas to be targeted.
• Include members of the target population in the
  design and delivery of the services.
• Evaluate the program based on the targeted
  population outcomes.
• Involve community members in ongoing evaluation
  efforts.

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Rural Nursing Research

• Nurses in their various roles in rural health
  care settings can identify, investigate and
  disseminate information about rural nursing
  concepts. In rural health care facilities,
  collaborative efforts should extend to other
  disciplines. This research has the potential for
  making contributions to nursings evolving theory
  on practice in rural environments.

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Cultural Appreciation

• For every difference that makes us unique,
• There is a common thread which connects us all.
• We share the need for home and community, for
  love and respect,
• In which all people and cultures are honored.