Rural Nurses Research Articles

Nursing in the Church

Sharon T. Hinton, DMIN, RN, is a faith community nurse educator, consultant, and the Executive Director of Rural Nurse Resource, Inc. She writes and speaks nationally on faith community nursing, spiritual journaling, and self-care for personal and professional growth. The author declares no conflict of interest.

Recruitment and Retention in Rural Nursing: It's Still an Issue!

A perennial issue for rural and remote communities in Canada and in other parts of the world is access to a healthcare delivery system including healthcare personnel to provide care to their residents. In total, 18% of Canadians live in rural locations but by proportion have fewer healthcare providers compared with urban settings. Relying on a recently completed documentary analysis of published reports and grey literature on rural and remote nursing practice from Canada and around the world, we recognize that recruitment and retention will be a recurring issue. However, a variety of programs and initiatives have been developed to address this age-old problem. A discussion is provided about educational opportunities, financial incentives and enhanced infrastructure that have been developed to address recruitment and retention challenges. Ongoing evaluations of each of these areas are necessary but require cooperation across provincial and national settings.

Increasing quality and quantity of student placements in smaller rural health services: It can be done.

Future rural nursing and midwifery workforce shortage and current shortage of placements for undergraduate nursing and midwifery students. Developmental evaluation. Five small hospitals and a regional community health service. Increased number of placements available for students; sustainable, quality clinical placement system in place for the future. Clinical facilitators developed a clinical facilitation model and resources that increased quality and quantity of student placements, assisted clinicians to provide higher quality teaching to students, enabled students to develop skills in rural health care service provision and enhanced knowledge around future career options. Placement targets were met and all health services involved chose to continue the model of clinical facilitation developed after project funding ceased. The clinical education skills developed by staff under the project remain in the region to support future students. It is possible to create a sustainable, high-quality, rural placement experience for larger numbers of nursing and midwifery students. Funding sources are available to continue the clinical facilitation model in to the future, but for it to work optimally, a steady supply of students across the year is required.

Rural-Focused Nursing Education: A Summative Evaluation of RNs’ Experiences of the Rural Nursing Certificate Program

Rural-Focused Nursing Education: A Summative Evaluation of RNs’ Experiences of the Rural Nursing Certificate Program

Rural nurses: a convenient co‐location strategy for the rural mental health care of young people

The aim of this research was to understand new ways that young rural people with mental health problems could be helped at an early point in their mental health decline. Rural nurses represent skilled mental health helping capital in their local communities, yet this important mental health helping resource, or helping capital, is both under-recognised and under-used in providing early mental health help in rural communities. In recent years international momentum has gathered in support of a paradigm change to reform the delivery of youth mental health services so that they align more closely to the developmental and social needs of young people with mental health problems. A mixed methods case study design was used to explore the early mental health care needs of young rural people. A cross-sectional survey was conducted and data were analysed with descriptive techniques. In-depth interviews were conducted and the transcribed data were analysed using thematic techniques. The results of this study demonstrate that in general rural people are willing to seek mental health care, and that rural nurses are well suited to provide initial care to young people. Non-traditional venues such as community, school and justice settings are ideal places where more convenient first conversations about mental health with young people and their families, and rural nurses should be deployed to these settings. Rural nurses are able to contribute important initial engagement interventions that enhance the early mental health care for young people when it is needed.

Supporting Rural nurses: Skills and Knowledge to Practice in Ontario, Canada

Background: Nursing in rural settings requires the skill set of a multi-specialist who is adaptable to change and different ways of working. Maintaining skills needed for emergency management of complex health issues is difficult, and retention is affected by the paucity of further education opportunities and mentors. Purpose : In collaboration with five small community hospitals in southern Ontario that experience challenges in recruiting and retaining sufficient nursing staff, this project used critical ethnography to ascertain appropriate retention strategies. Methods : Data collection included environmental scans, interviews with 45 rural nurses, and completion of 156 surveys from nurses on rural nursing careers. During the project, staff-identified, educational strategies were implemented in 3 of the 5 community hospitals. Findings : Seven themes emerged from the data. Overall, rural nurses identified that they were content to stay, as long as there was sufficient work. Conclusion : Retention interventions that are locally constructed with attention to community factors have the greatest likelihood of succeeding. DOI : http://dx.doi.org/ 10.14574/ojrnhc.v15i1.337 Keywords: rural nursing, nurse retention, critical ethnography, retention strategies

Reappraising An Innovation in Rural Nursing Education 1984-Present

Presented at the 2014 International Rural Health & Rural Nursing Research Conference Co-Sponsored by the Montana State University College of Nursing and the Rural Nurse Organization (RN0). DOI: http://dx.doi.org/10.14574/ojrnhc.v15i1.376

Working Through and Around: Exploring Rural Public Health Nursing Practices and Policies To Promote Rural Women’s Health

Purpose : To discuss findings from research in Ontario, Canada, that addresses the following objectives: 1) identify organizational attributes and local and provincial health policies that enable or impede the work of Ontario public health nurses to improve rural women's health, and 2) critically examine roles, job descriptions, and practices of Ontario PHNs that will improve rural women's health. Sample: 20 frontline PHNs and 14 supervisors and managers in three Ontario public health units that serve people who live in rural locations. Method : Six focus group interviews were conducted with PHNs and PHN managers in three rural Ontario public health units. Study participants were asked to describe policies and practices that guided their practice regarding rural women's health, identify organizational attributes that enable or impede public health nursing practice regarding rural women's health, and indicate roles and practices for PHNs to improve rural women's health. Findings : 1) Policies address rural women's health and rural public health minimally or not at all, 2) PHN practice is primarily focused on child bearing women and children to the exclusion of other populations of rural women such as seniors, 3) PHNs work through and around policies to address rural women' s health more effectively, and 4) institutional, government, community, professional, and personal factors play significant roles in shaping public health nursing practice and policy regarding rural women's health. Conclusions : This research facilitates understanding regarding policies, contexts, and values that shape rural PHN practice, and provides evidence for policies and practices that enhance and support public health nursing for more effective promotion of rural women's health. Clearly, more investigation is needed; this research forms the basis for ongoing inquiry in this area. Keywords : rural public health nursing, rural women's health, policy, practice, Canada DOI : h ttp://dx.doi.org/10.14574/ojrnhc.v15i1.342

Team-based education in a palliative approach for rural nurses and unlicensed care providers.

This article describes the preparation and delivery of an educational intervention designed to improve rural nurses and unlicensed care providers' confidence in a palliative approach to care. A palliative approach takes the principles of supportive palliative care and adapts them for application earlier in nonspecialized palliative contexts for individuals living with life-limiting chronic illness. Curriculum in a palliative approach was constructed for nurses and unlicensed care providers (care aides and home health workers) and was delivered through a workshop and monthly follow-up sessions offered through distance technology. Participants valued the joint interactive education and came away with greater appreciation for one another's contributions to care. Insights were gained into common challenges when attempting to apply a palliative approach in rural areas. Important lessons were learned about educating nurses and unlicensed care providers together, about the use of technology for this group, and about teaching the concept of a palliative approach.

Research must be relevant to real life.

JANE MILLS is Professor of Nursing at James Cook University, Australia and the director of its Centre for Nursing and Midwifery Research. She is an internationally recognised grounded theorist and has significant expertise in rural nursing.

Improving Prediabetes Screenings at Rural Missouri County Health Departments.

With prediabetes criteria expanding in recent years, nurses offering prediabetes screenings require updates to stay abreast of current clinical guidelines. This study looked to improve rural Missouri health department nurses' understanding of prediabetes, improve the identification of prediabetes at participating health departments, and educate the nurses on existing prediabetes guidelines. A convenience sample of twenty-two nurses from seven rural Missouri health departments participated. Nurses completed a demographic questionnaire and a prediabetes knowledge pre-test prior to the intervention. Seven to eight weeks post-intervention, the health department nurses completed the prediabetes post-tests. A single live education session was conducted at each health department. Data from the pre- and post-tests was reviewed within three result categories. The overall, laboratory nursing knowledge, and general nursing knowledge divisions each showed statistically significant improvement with a p<0.05. This study's post-test improvement in prediabetes knowledge replicates the usefulness of a simple, low cost educational update. Nurses improved the identification of prediabetes laboratory values on post-test data and showed an increase in overall prediabetes knowledge. A single and simple continuing education program is a useful tool for rural health nurses.

Reducing Barriers to Healthcare for Rural Homeless Individuals and Families: Experiences 0f Community Health Nursing Students

Presented at the 2014 International Rural Health &amp; Rural Nursing Research Conference Co-Sponsored by the Montana State University College of Nursing and the Rural Nurse Organization (RN0).DOI: http://dx.doi.org/ 10.14574/ojrnhc.v15i1.377

Nursing rural America: perspectives from the early 20th century

Tracing the history of nursing in rural America during the first half of the 20th century, this well-researched book describes how nurses shaped health care delivery in a variety of rural environments, and analyzes how insights from their remarkable achievements in the face of formidable barriers can be applied to health care today. The book examines the multiple factors that influenced how and why nurses responded to the health care needs of rural residents, with coverage of Rural Nursing in the advent of the American Red Cross, to Mary Breckinridge and her legendary Frontier Nursing Service. Through case histories, it depicts how nurses, working in the hinterlands of place, race, class, and ethnicity, broke geographic, cultural, and economic barriers to provide quality care.<br Based on nine case studies throughout rural America, the book identifies how nursing care was delivered to rural communities during the first five decades of the 20th century (before the advent of Medicare and Medicaid), and analyzes the impact of gender, class, race, policy, and place on rural health care delivery. It describes how nurses used ingenuity and self-reliance in order to practice to the full extent of their education, and explains how they provided access to care and health education in the face of many barriers. The book also highlights nurses' advocacy for their often disenfranchised patients, and examines how we can learn from their achievements to provide quality health care today.

Remote chemotherapy supervision model for rural cancer care: perspectives of health professionals.

Townsville Cancer Centre (TCC), a tertiary cancer centre in North Queensland, Australia, provides chemotherapy services to surrounding small rural towns using the Queensland Remote Chemotherapy Supervision model (QReCS). Under this model, selected chemotherapy regimens are administered in rural hospitals by rural based generalist doctors and nurses, under the supervision of TCC-based medical oncologists and chemotherapy competent nurses through videoconferencing. We sought to explore the perspectives of health professionals participating in QReCS. This qualitative study used semi-structured interviews with 19 participants, including nine nurses, eight doctors, one rural pharmacist and one administration officer. The interviews were recorded and transcribed. Transcripts were examined using iterative thematic analysis. Four major themes were identified from the data: (1) benefits of the model, (2) enablers of implementation, (3) operational requirements for optimal functioning and (4) disadvantages of the model. The reported benefits of the model were patient convenience, inter-professional communication across health district borders, expanded scope of practice, continuity of care and maintenance of patient safety and compliance with guidelines while delivering chemotherapy. Further improvements in the quality of training for rural nurses, coordination between urban and rural sites and between health professionals and documentation of clinical encounters would optimise the operation of the model. QReCS appears to provide many benefits to patients and health professionals and a framework for safe administration of chemotherapy in rural areas. Coordination of care, the quality of training for rural nurses as well as clinical documentation needs to improve to optimise the operation of the model.

Gaps in governance: protective mechanisms used by nurse leaders when policy and practice are misaligned.

BackgroundDue to large geographical distances, the telephone is central to enabling rural Australian communities to access care from their local health service. While there is a history of rural nurses providing care via the telephone, it has been a highly controversial practice that is not routinely documented and little is known about how the practice is governed. The lack of knowledge regarding governance extends to the role of Directors of Nursing as clinical leaders charged with the responsibility of ensuring practice safety, quality, regulation and risk management. The purpose of this study was to identify clinical governance processes related to managing telephone presentations, and to explore Directors of Nursing perceptions of processes and clinical practices related to the management of telephone presentations to health services in rural Victoria, Australia.MethodsQualitative documentary analysis and semi structured interviews were used in the study to examine the content of health service policies and explore the perceptions of Directors of Nursing in eight rural health services regarding policy content and enactment when people telephone rural health services for care. Participants were purposively selected for their knowledge and leadership role in governance processes and clinical practice. Data from the interviews were analysed using framework analysis. The process of analysis resulted in the identification of five themes.ResultsThe majority of policies reviewed provided little guidance for managing telephone presentations. The Directors of Nursing perceived policy content and enactment to be largely inadequate. When organisational structures failed to provide appropriate governance for the context, the Directors of Nursing engaged in protective mechanisms to support rural nurses who manage telephone presentations.ConclusionsRural Directors of Nursing employed intuitive behaviours to protect rural nurses practicing within a clinical governance context that is inadequate for the complexities of the environment. Protective mechanisms provided indicators of clinical leadership and governance effectiveness, which may assist rural nurse leaders to strengthen quality and safe care by unlocking the potential of intuitive behaviours. Kanter’s theory of structural power provides a way of conceptualising these protective mechanisms, illustrating how rural nurse leaders enact power.

Australian rural, remote and urban community nurses' health promotion role and function.

Community nurses have often been 'touted' as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors.

Improving The Nutrition of Pregnant Village Women in Indonesia The Important Roles of Village Midwives and Cadres

Introduction: The maternal mortality remains high in developing countries such as Indonesia. Three most common reasons for this incidence are hemorrhage, infection, and eclampsia. Some of these conditions can be infl uenced by Iron Defi ciency Anemia (IDA). A lot of programs for nutrition have been provided by Indonesian government, but the nutritional condition of pregnant women still be big problem in Indonesia. This study explored the nutritional status of pregnant village women in Banten Province, Indonesia and assessed interventions in dealing with nutrition problems among pregnant women especially in the rural area. Method: The design was a longitudinal descriptive study with operational study by empowering village midwives and cadre to intervene pregnant women nutrition in rural area. The measurements were focused on the rate of anemia, body mass index (BMI), and weight. Three stages were applied in this study with community development as intervention. Result: This study reported some changes in the midwife practises after Intervertion, while cadres more talkative when explaining about nutrition after intervention. However, the intervention did not affect the overall nutritional status of the pregnant women and the intervention was not able to influence the community’s health in the medium term in the intervention villages. Analysis and discussion: This study recommend the government and educational institutions to improve the competencies of health care providers especially in communication skill. Keywords: Community development, Indonesia, nutritional status, pregnant women, rural nursing.

Quality of work life of rural emergency department nurses and physicians: a pilot study.

BackgroundInformation about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs.MethodsTwo EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data.ResultsForty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants’ mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale ‘support offered to employee’ for which the QWL was lower.ConclusionsData collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.

Nursing in the Church

Sharon T. Hinton, DMin, RN, FCN, is a faith community nurse educator, consultant, and Executive Director of Rural Nurse Resource, Inc. She writes and speaks nationally on faith community nursing, spiritual journaling, and self-care for personal and professional growth. Contact her at [email protected] The author declares no conflict of interest.

Development and psychometric evaluation of the Primary Health Care Engagement (PHCE) Scale: a pilot survey of rural and remote nurses.

To report the development and psychometric evaluation of a scale to measure rural and remote (rural/remote) nurses' perceptions of the engagement of their workplaces in key dimensions of primary health care (PHC). Amidst ongoing PHC reforms, a comprehensive instrument is needed to evaluate the degree to which rural/remote health care settings are involved in the key dimensions that characterize PHC delivery, particularly from the perspective of professionals delivering care. This study followed a three-phase process of instrument development and psychometric evaluation. A literature review and expert consultation informed instrument development in the first phase, followed by an iterative process of content evaluation in the second phase. In the final phase, a pilot survey was undertaken and item discrimination analysis employed to evaluate the internal consistency reliability of each subscale in the preliminary 60-item Primary Health Care Engagement (PHCE) Scale. The 60-item scale was subsequently refined to a 40-item instrument. The pilot survey sample included 89 nurses in current practice who had experience in rural/remote practice settings. Participants completed either a web-based or paper survey from September to December, 2013. Following item discrimination analysis, the 60-item instrument was refined to a 40-item PHCE Scale consisting of 10 subscales, each including three to five items. Alpha estimates of the 10 refined subscales ranged from 0.61 to 0.83, with seven of the subscales demonstrating acceptable reliability (α ⩾ 0.70). The refined 40-item instrument exhibited good internal consistency reliability (α=0.91). The 40-item PHCE Scale may be considered for use in future studies regardless of locale, to measure the extent to which health care professionals perceive their workplaces to be engaged in key dimensions of PHC.