Community and Public Health Nursing in Rural Environments

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Community and Public Health Nursing in Rural
Environments

• By N.Haliyash
• MD, BSN,
• International Nursing School
• TSMU

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

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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.

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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.

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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.

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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.

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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 Health
  http//www.apa.org/rural/

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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

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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)

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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

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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.

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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

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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"

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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/service
  s
• Providers' attitudes and knowledge levels about
  rural populations

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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

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Using the nursing process
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Using the nursing process
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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.

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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?

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Thats all folks!

• Q A ?