Nurses In Rural Areas Research Articles

Highlanders: a qualitative study to explore the experiences of home care nurses in rural areas in Italy

Introduction and aim: Home care in rural areas is characterised by peculiarities linked to both the type of care of the patient and his/her family and the context in which it is provided. International studies have highlighted the need for specialised training and advanced clinical skills to work in this field. Currently, there are no studies in the literature that explore the experiential feelings of Italian nurses who provide home care in rural areas. Setting: Rural areas in Italian Apennine District. Participants: Italian home care nurses in the selected areas. Design: Qualitative study using a transcendental phenomenological approach. Semi-structured interviews were conducted face-to-face, and audio was recorded with home care nurses. Results: Eleven nurses (mean age, 53 years) were interviewed. Four themes supported by nine codes emerged: "Entering your homes" (Stepping lightly; a matter of trust; key professional); "Being home care nurses in rural areas" (Working alone, autonomy, responsibility and gratifications; ideal characteristics of home care nurse); "Love and hate toward doctors" (Family doctors; ANT doctors); "The territory: the Apennines and mountainous areas" (working in rural areas; healthcare professionals).Discussion and conclusions: The risks for home careers in rural areas are related to the vastness of the territory, long car journeys, the harsh climate in winter, and pets in the homes. The beauty of the area, the close relationship established with the families in charge, and daytime working hours are reasons for great professional and personal satisfaction. Some modalities and forms of collaboration with general practitioners can be improved.

Challenges to the delivery and utilisation of child healthcare services: a qualitative study of the experiences of nurses and caregivers in a rural district in Ghana

BackgroundSub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region.AimThis study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana.MethodsIndividual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University’s Research Ethics Committee approved the study protocol prior to data collection.ResultsThree main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services.ConclusionNurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers’ perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services.

Factors associated with the attraction and retention of family and community medicine and nursing residents in rural settings: a qualitative study

BackgroundThe current shortage of primary care doctors and nurses is causing difficulties in replacement, and this shortage is expected to increase. This situation is more pronounced in rural environments than in urban ones. Family and community care specialty training is a key component of both the transition to clinical practice and the retention of new professionals. The aim of this study is to explore the attitudes and perceptions of internal medicine residents and internal nurse residents trained in a rural teaching unit on factors associated with recruitment and retention, including the role of the specialty training programme.MethodsA qualitative study was conducted. Purposive sampling was used, and thirteen residents from the central Catalonia teaching unit who were in their final year of training participated in semistructured interviews. The data were collected during 2022 and were subsequently analysed with thematic analysis. The study is reported using the COREQ checklist.ResultsSix themes emerged from data related to perceptions and attitudes about the factors associated with recruitment and retention: training programme, characteristics of the family and community specialty, concept of rural life, family and relational factors, economic and resource factors, and recruitment and job opportunities.ConclusionsFamily and community medicine and nursing residents trained in rural settings expressed satisfaction with the specialty programme and most features of primary care, but they experienced a wide range of uncertainties in deciding on their professional future in terms of living in rural areas, family support, financial support and recruitment. This study identifies individual and structural factors that could be of great use to retain doctors and nurses in rural areas.

Overweight children in rural Norway - public health nurses' possibilities and limitations within national guidelines.

Globally, overweight and obesity are more prevalent in rural areas than in urban areas. The purpose of this study was to determine to what extent public health nurses in rural areas in Norway feel equipped to tackle the overweight and obesity epidemic within two sets of national guidelines: The National Guidelines for the Standardized Measurement of Height and Weight and The National Guidelines for the Prevention, Identification, and Treatment of Overweight and Obesity in Children and Adolescents. These guidelines are inspired by New Public Management (NPM) logic, which emphasises more market orientation within the public sector to obtain a more cost-effective supply of public goods. The focus is on the weighing of schoolchildren, available resources, inter-agency cooperation and the rural context. The data were collected using a structured questionnaire among 40 public health nurses working with children in rural areas, as well as qualitative interviews with 25 informants involved in the prevention and treatment of overweight and obesity among rural children. The study shows that rural public health nurses worry about the lack of resources for follow-up with children with a body mass index greater than what is characterised as 'normal'. The public health nurses suggested better cooperation between different stakeholders to work around the lack of resources and at the same time be able to see the whole picture, considering that overweight and obesity are complex problems connected to different challenges. They believed that it is an advantage to see the individuals in their local surroundings, to know their family history, their leisure activities and so on. This might be easier in rural areas than in urban areas, as these areas are often more transparent. There was consensus among the public health nurses involved in this study that national guidelines for treating overweight and obesity in children with the principles of NPM, and simplifying and standardising services, adds challenges instead of solutions. Such practices also hinder the use of experience-based knowledge about both the individual and the local context. There is a need for more flexible guidelines that can easily be adapted to the local (rural) context.

Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia

The nursing workforce is the backbone of healthcare provision in rural and remote Australia. Introducing student nurses to rural clinical placements is one strategy used to address the shortfall of healthcare workers outside of major cities, with the goal of improving the training, recruitment and retention of nurses in rural areas. The aim of this qualitative, longitudinal study was to better understand personal and professional decision-making around rural nursing practice intentions and subsequent rural employment and retention. The study methodology consisted of repeated semi-structured interviews with student nurses who had completed at least one rural placement and following them on their journey to becoming graduate nurses over a 6-year period. Thematic longitudinal analysis was undertaken, with three main themes developing, each with further subthemes: (1) participants' satisfaction with rural placements; (2) their challenges with gaining employment; and (3) considerations regarding 'going rural' for work. The participants engaged in both prospective and retrospective reflection around several professional, personal, and wider systemic barriers and enablers to rural practice, which are discussed in detail in this paper. The insights from this longitudinal study have the potential to assist the development of a sustainable rural nursing workforce through informing rural workforce programs, strategies and policies.

Job satisfaction among small rural hospital nurses: A cross-sectional study.

To explore the relationships between job satisfaction, community satisfaction, practice environment, burnout, and intention to leave of nurses working in Australian small rural hospitals. A national cross-sectional survey of 383 nurses from Australian rural public hospitals of less than 99 beds during 2018. Job satisfaction was measured on a four-point Likert scale. Factors associated with community satisfaction, practice environment, burnout and intention to leave were analyzed using multiple linear regression to explore the predictors of job satisfaction. Overall job satisfaction was positive, with most nurses moderately (n=146, 38.1%) or very satisfied (n=107, 27.9%) with their current job. Emotional exhaustion, nurse manager ability, leadership and support of nurses were the most significant predictors of job satisfaction. This study provides new insight into the factors impacting the job satisfaction of nurses working in rural hospitals. The knowledge gained is important to inform strategies to retain nurses in rural areas and, in turn, ensure rural communities have access to quality health care. The impact of nurses' job satisfaction on burnout, patient safety, and intention to leave is well recognized; however, there is limited understanding of job satisfaction in a rural hospital context. This study provides an understanding of the factors that impact job satisfaction of nurses working in small rural hospitals and highlights the importance of improving the practice environment to reduce the high attrition rates of this workforce.

Designing and Piloting of a Mobile Learning Curriculum for Quality Point-Of-Care Diagnostics Services in Rural Clinics of KwaZulu-Natal, South Africa.

BackgroundThe use of mobile technology has been reported to help improve access to education for people in remote areas. However, there is limited evidence of its adoption in resource-limited settings. The aim of this study was to utilize stakeholder generated ideas to design and pilot a mobile learning curriculum, with the purpose of facilitating training to improve the quality of point-of-care diagnostics services in KwaZulu-Natal (KZN) rural clinics.MethodsNominal Group Technique was employed to enable collaboration with stakeholders in designing and piloting of a POC diagnostics curriculum. Stakeholders were selected from 11 KZN districts to participate in a clinic-based piloting of the curriculum using an online application. The application was designed in collaboration with a teacher training institute in Durban. Moodle was used as an established reliable online learning management system. During piloting, quantitative and qualitative data were generated and analyzed using descriptive statistics and content analysis.Findings and ConclusionGuided by the Nominal Group Technique results, five delivery modes for curriculum content through Mobile Learning were generated. An interactive course page was created on the Moodle site, titled: Quality HIV Point of Care Diagnostics Curriculum Delivery for Nurses in Rural Areas. The course content consisted of three teaching units, activities, an online quiz and an online survey. An analytic-algorithm built into the online course enabled monitoring of participation and assessment outcomes automatically. At piloting, 64% of the invited representative clinics were able to access the course, with 47% meeting the course completion requirements. All the participants achieved the set pass mark of 75% with an average of 87%. The activity completion report showed that topics presented through images, videos and simple text were accessed more than those presented as attachments of national documents. Despite poor network coverage and limited access to mobile technology, exacerbated by Covid-19 related restrictions, Point of care diagnostics Mobile Learning curriculum was well-received in participating rural clinics. Recommendations relating to course improvement and access, included extending collaboration with specialists in eHealth systems development and with South African cell phone network providers.

Caring Behaviors Inventory-24: translation, cross-cultural adaptation and psychometric testing for use in a Swedish context

BackgroundPatients’ health and wellbeing are promoted when nurses successfully conceptualize caring in clinical practice. Measuring caring behaviors can advance knowledge about caring and has potential to improve caring practices and the outcomes of care. The Caring Behaviors Inventory-24 (CBI-24) is an empirical instrument for measuring caring, developed to determine perceptions of caring among patients and nurses. Since the instrument was not available in Swedish, the aim of this study was therefore to translate into Swedish and cross-culturally adapt CBI-24 for a Swedish healthcare context, and to psychometrically analyze the Swedish version of CBI-24.MethodsThe study used a traditional forward and back translation process in six stages: (1) two simultaneous translations by bilingual experts; (2) expert review committee synthesis; (3) blind back translation; (4) expert review committee deliberations; (5) pre-testing with cognitive interviews, and (6) psychometric evaluations.ResultsThe translation process was systematically conducted and entailed discussions regarding semantic, idiomatic, experiential and conceptual equivalence. The cognitive interviews generated thoughts and reflections, which resulted in adjusting three items of the CBI-24 SWE. For psychometric analyses, 234 persons answered the questionnaire. Results indicated acceptable overall model fit in the χ2-value for the confirmatory factor analysis, while for the heuristic goodness-of-fit indices, the comparative fit index (CFI) and the standardized mean square residual (SMSR) indicated good model fits, and the root mean square error approximation (RMSEA) indicated an acceptable fit.ConclusionsCBI-24 SWE has been shown to be a psychometrically acceptable instrument for use in Swedish research contexts. Further studies regarding the clinical usefulness of the instrument may be in order. In particular, CBI-24 SWE should be evaluated among nurses in rural areas.

Challenges and policy opportunities in nursing in Saudi Arabia

BackgroundThe Kingdom of Saudi Arabia’s (KSA) health sector is undergoing rapid reform in line with the National Transformation Program, as part of Saudi’s vision for the future, Vision 2030. From a nursing human resources for health (HRH) perspective, there are challenges of low nursing school capacity, high employment of expatriates, labor market fragmentation, shortage of nurses in rural areas, uneven quality, and gender challenges.Case presentationThis case study summarizes Saudi Ministry of Health (MOH) and Saudi Health Council’s (SHCs) evaluation of the current challenges facing the nursing profession in the KSA. We propose policy interventions to support the transformation of nursing into a profession that contributes to efficient, high-quality healthcare for every Saudi citizen. Key to the success of modernizing the Saudi workforce will be an improved pipeline of nurses that leads from middle and high school to nursing school; followed by a diverse career path that includes postgraduate education. To retain nurses in the profession, there are opportunities to make nursing practice more attractive and family friendly. Interventions include reducing shift length, redesigning the nursing team to add more allied health workers, and introducing locum tenens staffing to balance work-load. There are opportunities to modernize existing nurse postgraduate education, open new postgraduate programs in nursing, and create new positions and career paths for nurses such as telenursing, informatics, and quality. Rural pipelines should be created, with incentives and increased compensation packages for underserved areas.ConclusionsCritical to these proposed reforms is the collaboration of the MOH with partners across the healthcare system, particularly the private sector. Human resources planning should be sector-wide and nursing leadership should be strengthened at all levels.

Effective Collaborative Project to Reduce Disparities and Inequities in Cancer Care and for Cancer Control in Low-Resource Setting Countries: South African Experience

PURPOSE The Northern Cape Province is the largest province in South Africa; however, it has the fewest resources for cancer care. There is a high incidence and prevalence of mesothelioma and lung cancer as a result of the previous indiscriminate mining of asbestos without proper legislation for the protection of miners and the environment. Mine dumps remain near villages and schools after the banning of asbestos mining, resulting in continuous exposure to asbestos fibers. Unfortunately, majority of cancers are diagnosed in late stages because of a lack of awareness and the misdiagnosis of lung cancer and mesothelioma as tuberculosis. METHODS The Northern Cape Department of Health, Bristol-Myers Squibb Foundation, and Cancer Charity Workers formed a collaboration in May 2017 to reduce disparities and inequities in cancer care and for cancer control. The Northern Cape Department of Health also collaborated with Project ECHO at the University of New Mexico to use the ECHO model for training community health care workers, training in palliative care, and mentorship and empowerment of doctors and nurses in rural areas. The aim is to recognize early symptoms and signs of cancers affecting the lung and to make referrals for early diagnosis and treatment. RESULTS An advocacy group has engaged the Provincial and National Department of Mining and Environmental Affairs for rehabilitation of asbestos mine dumps. Community health care workers have been trained and are assisting with community awareness and patient navigation. Doctors have been trained in palliative care and are training other health care workers in palliative care. A center of excellence for the diagnosis and treatment of lung cancer, palliative care, survivorship, and research has been established. Retention of doctors and nurses in rural areas for cancer care and early referral is improving. A lung cancer research laboratory is being set up. CONCLUSION Effective collaborative projects can help address disparities in cancer care and effective cancer control in areas with limited resources.

Examining the relationship between living conditions, work environment and intent to stay among nurses in current posts in rural areas of Odisha state, India

Objectives : The scarcity of nursing workforce in rural and underserved areas are key challenges for healthcare systems across the countries. Such inequities have not only impede quality care but also an impact to population health outcomes especially in developing countries. An understanding about nurses’ retention and attrition are crucial to inform policy and decision makers for improved rural retention among nursing workforce. The aim of the study was to examine the relationship between living conditions, work environment and intent to stay in current posts of work; and the associated factors influencing intent to stay in current posts of work among nurses in rural areas of Odisha state, India.
 Methods : A cross sectional survey was conducted among 232 nurses from October 2016 to February 2017. Multistage sampling technique was used to select the study subjects from rural hospitals. Data were collected using structured self-administered questionnaires. Descriptive statistics were computed to summarize the basic characteristics of study sample. Logistic regression model was fitted and odds ratio with 95% of confidence interval was calculated to identify associated factors
 Results: The proportion of a nurse’s intent to stay and continue working in rural areas for next 3 years was 73.7%. There was a positive correlation between intention to stay with the living conditions and work environment. Logistic regression shown that age (OR=0.95, 95% CI = 0.89 - 0.98, P = 0.047), living conditions (OR = 1.13, 95% CI = 1.04 - 1.22, P=0.009) and work environment (OR = 1.07, 95% CI = 1.01 – 1.14, P = 0.015) were the significant predictors that are associated with intent to stay in rural areas among the nursing profession.
 Conclusion - Improving living conditions and creating a culture of supportive work environment among the nursing community in rural areas can create increased retention in the workforce.
 Bangladesh Journal of Medical Science Vol.19(3) 2020 p.527-536

The daily routine of nurses in rural areas in the Family Health Strategy

to analyze the daily work of rural Family Health Strategy (FHS) nurses. a qualitative, descriptive and exploratory research. The data were collected with eleven rural nurses of the city of Campina Grande, Paraíba State, through semi-structured interviews, between January and March of 2017, using Content Analysis. rural nurses have a strong relationship with the population. However, they reveal a daily work with various organizational barriers that range from the team displacement to the workplace to the operationalization of health actions, which are mediated by the characteristics of rurality. Some of these barriers can be remedied by a more proactive action from the management. conditioned by the characteristics of rurality, the differentiated dynamics work reveal weaknesses in the quality of nursing care and lower effectiveness of the FHS.

Retention of medical doctors and nurses in rural areas of Odisha state, India – a policy analysis

Purpose Retention of medical doctors and nurses in remote and rural areas is a key issue in India. The purpose of this paper is to assess the relevant policies and provisions with respect to health care professionals, aiming to develop feasible retention strategies in rural areas of Odisha state of India. Design/methodology/approach The study employed documentary review and key informant interviews with policy elites (health planners, policy maker, researchers, etc.). The document review included published and unpublished reports, policy notifications and articles on human resources for health (HRH) in Odisha and similar settings. Throughout the study, the authors adapted World Health Organization’s framework to study policies relevant to HRH retention in rural areas. The adapted framework comprised of the four policy domains, education, regulation, financial incentives, professional and personal support, and 16 recommendations. Findings In Odisha, the district quota system for admission is not practiced; however, students from special tribal and caste (Scheduled Tribe and Scheduled Caste) communities, Socially and Educationally Backward Classes of citizens, and Persons with Disabilities have some allocated quota to study medicine and nursing. Medical education has a provision of community placement in rural hospitals. In government jobs, the newly recruited medical doctors serve a minimum of three years in rural areas. Doctors are given with location-based incentives to work in remote and difficult areas. The government has career development, deployment, and promotion avenues for doctors and nurses; however, these provisions are not implemented effectively. Originality/value The government could address the rural retention problems, as illustrated in the study and put in place the most effective policies and provisions toward recruitment, deployment and attraction of HRH in remote and rural areas. At the same time, implementation HRH strategies and activities must be rigorously monitored and evaluated effectively.

Psychological impact of traumatic events in rural nursing practice: An Integrative review

Purpose: The purpose of this article is to present findings from a pilot quality improvement evidence-based new nurse transition program that facilitates clinical leadership skills in novice nurses at the point of patient care at a rural critical access hospital. Descriptive data from pre- and post-intervention scores are reported, and the percent change was evaluated. Sample: Due to the solitary nature of rural nursing, new graduate nurses in rural areas need support in transitioning to their new role as registered nurses. The author designed, and pilot tested a quality improvement evidence-based new nurse transition program in a rural critical access hospital utilizing complexity science as a framework. Method: A quality improvement pilot program designed for new graduate nurses was provided at a critical access hospital in a rural Midwestern State. Data was collected using pre- and post- intervention scores on the Leadership Characteristics and Skills Assessment and TeamSTEPPS Teamwork Attitudes Questionnaire. Descriptive data was evaluated. Findings: Participant post- test percent change scores increased in perceptions of ability to lead but decreased in attitudes about teamwork. Observations of participant interactions in the quality improvement project suggested that the new nurses were developing new ideas, patterns and structures regarding their roles as a team member in the healthcare setting. Conclusion: In a rural midwestern critical access hospital a quality improvement leadership program that used a complexity science framework was provided to novice nurses in transition. After the program participant total mean post scores increased in perception of what makes a good leader and in the participant’s perception of their ability to lead. An overall mean score decrease in attitudes about teamwork was noted among the small group of rural novice nurses. Keywords: rural, frontier, new registered nurse graduate, transition program, complexity science, leadership

End-of-Life Care Based on Regional Culture by Home-Visit Nurses in Rural Areas Lacking Adequate Medical Care Services

End-of-Life Care Based on Regional Culture by Home-Visit Nurses in Rural Areas Lacking Adequate Medical Care Services

A Nursing Partnership to Accelerate Academic Progression.

Associate degree nursing faculty in a Midwestern state reported that their students were being excluded from many clinical experiences and that their graduates were not being hired in Magnet® or Magnet-seeking hospitals. University and community college faculty formed a partnership to promote academic progression. Barriers of residency requirements, financial aid, and accreditation were overcome. Students complete all BSN prerequisites, take ADN and BSN courses simultaneously, graduate with both degrees, and take the national licensure examination. This is a viable model allowing nursing students to remain in their home town, thus decreasing costs and increasing the number of BSN-prepared nurses in rural areas.

Exploring Perceptions of Palliative Care Among Rural Dwelling Providers, Nurses, and Adults Using a Convergent Parallel Design

Purpose: To explore the palliative care perceptions of rural dwelling providers, nurses, and adults and, to explore the relationship between the knowledge and perceptions of palliative care held by rural providers and nurses, using a convergent parallel design. Sample: Qualitative (n = 25), Quantitative (n = 51) Methods: The setting was a geographically defined rural area of 8,500 square miles. Following institutional review board approval, providers (n = 5), nurses (n = 7), and adults (n = 13), completed a demographic survey and audio-recorded, face-to-face, semi-structured interviews. Qualitative data were analyzed using thematic analysis following a loosely grounded theory approach that was comprised of multiple rounds of coding assisted by qualitative analysis software. Survey packets were delivered to 19 healthcare organizations in the same geographic study area; 51 participants (providers, n = 7; nurses, n = 44) completed a demographic survey and the 20-item Palliative Care Knowledge Test (PCKT). Both qualitative and quantitative data were analyzed separately before merging and comparing the results in a final analysis. Results: Six themes were identified: Palliative care offers comfort for the dying or end-of-life care; Palliative care? Never heard of it; Uncertainty about the differences between palliative care and hospice; Conflicts between theory and practice; Timing is everything; and Experience is a strong teacher. PCKT total scores for the sample of providers and nurses (n = 51) was 10.73 (SD 2.93) which suggested poor palliative care knowledge. After merging the results, the final analysis indicated convergence. Two constructs, Maturity and Rural Investment, were identified. Conclusion: Providers and nurses in rural areas are experienced, having lived and practiced in rural areas for a considerable time; supporting the constructs of Maturity and Rural Investment. Misperceptions and poor knowledge related to palliative care likely prevent the broader application of palliative care in rural areas. Keywords: palliative care, rural, providers, nurses, perceptions, convergent parallel design DOI: http://dx.doi.org/10.14574/ojrnhc.v18i2.527

Nurses’ Knowledge of Tuberculosis, HIV, and Integrated HIV/TB Care Policies in Rural Western Cape, South Africa

HIV and tuberculosis (TB) co-infection remain the leading causes of mortality in many developing countries. Several policies for their prevention and management exist; however, progress to meet the World Health Organization's indicators is slow. As nurses in rural areas are the main health care professionals responsible for the implementation of policies, questions arose about nursing knowledge regarding TB and HIV policies. A concurrent mixed method research approach was used to investigate this issue in a rural area of the Western Cape in South Africa. After a two-step sampling process, data were collected through 44 questionnaires and 12 interviews. We used descriptive and inferential statistics as well as content analysis methods. We found that most of the nurses had insufficient knowledge on certain aspects of policy guidelines that included medications, intensive case findings, and management of multidrug-resistant TB. It is recommended that training be intensified to improve implementation of policies.

Access to Continuing Education for Critical Care Nurses in Rural or Remote Settings.

Caring for the critically ill does not occur solely in large medical centers or urban areas. Nurses practicing in rural or remote settings practice as nurse generalists, caring for a wide range of patients, including those needing critical care. As a nurse generalist, the need for a wide variety of skill sets challenges nurses in rural areas to maintain current practice through continuing education across many content areas. They also may not come in contact with critically ill patients or emergent situations as often as their urban counterparts, which can make remaining comfortable with more advanced skills difficult. Because nurses working in rural or remote areas may care for critically ill patients less often, the need to remain vigilant in pursuit of continuing education is increased; however, access to continuing education can be problematic because of geographic isolation, difficulty getting time off from work, limited financial resources, and perceived lack of applicable topics. With advances in technology, critical care nurses working in rural areas have more options for continuing education, which is crucial for maintaining a skilled nursing workforce in rural health care facilities. This article addresses challenges critical care nurses working in remote or rural areas face in pursuing continuing education and provides information about available educational opportunities.

Nursing students’ views on rural nursing practice in China: A questionnaire survey

Objective: The purpose of this study was to investigate final year nursing students’ views on rural nursing practice in China. There are fewer nurses in rural areas compared to urban areas in China. Little is known about how current nursing students view rural nursing practice, and what influences their intentions to work rurally in their career. Methods: A questionnaire survey was designed. Data were collected in one area in Eastern China between December 2011 and March 2012. A self-completion questionnaire was hand distributed to final year nursing students in six nursing schools and collected by the researcher with a response rate of 89% (n = 445). Results: Nursing students in China had some unique perceptions on rural nursing practice. Respondents viewed nursing posts in rural areas as having lower incomes, lower professional status and fewer opportunities for learning skills. They also associated rural nursing with a light workload, less stress and few night shifts. In contrast to the wider literature, Chinese nursing students did not consider that rural nursing posts could foster autonomy in practice or offer the opportunities to broaden their skills. Conclusions: The perceived lower financial rewards, fewer opportunities for skills development and the low professional status of rural nurses make recruitment of a skilled nursing workforce to rural areas a major challenge in China. Policies, such as reforming the rural nursing delivery system, providing financial incentives and supporting for professional development, should be considered.