Rural Western Canada Research Articles

Has Virtual Care Arrived? A Survey of Rural Canadian Providers During the Early Stages of the COVID-19 Pandemic.

We investigated the uptake and perceptions of virtual care solutions by rural Canadian primary and specialist providers during the early phase (May-June 2020) of the COVID-19 pandemic. A web-based, cross-sectional survey of rural primary and specialty care providers examined types of virtual care platforms used (eg, phone, video), appointment length, experience and satisfaction with the solution used, plans for future use of virtual care, and patients’ use of virtual care services. Targeted participants were actively-practicing providers in rural Western Canada who were emailed an invitation for the study and its survey link. Fifty-nine providers (26% response rate) completed the survey. During the pandemic, 78% of providers reported using virtual care for more than 60% of their appointments, while only 3% did so frequently pre-pandemic. Most providers used phone consultations, despite believing that video provided a better virtual visit. Key barriers included workflow interruptions, unique concerns about quality of care, remuneration and sustainability, or poor internet access and bandwidth for both providers and patients. The key opportunity noted was improved access to care. While most virtual care visits were not conducted using video technologies, overall virtual care resulted in high provider satisfaction, while not increasing workload. Virtual care will continue to play an important role in future rural care practice; however, sustainability will require both provider-level and system-level changes.

From coping to building nurse manager resilience in rural workplaces in western Canada.

To investigate the role stressors, and how coping strategies cultivated nurse managers' resilience in rural workplaces. A stressful workplace can impair the mental and physical health of nurse managers leading to poor performance. Building and sustaining manager resilience in complex and stressful practice environments is necessary to attract and maintain competent and skilled managers. In this qualitative exploratory inquiry, a purposive sampling method was used to recruit 16 nurse managers in rural western Canada. Coping strategies fostered manager's resilience that made their work meaningful, and included putting out fires, psychologically reframing a situation, serving others and receiving support. Managers brought expertise, knowledge and skill to make their work meaningful and central to ongoing health service delivery in these rural communities. Nurse manager resilience can be strengthened by using evidence-based strategies in an increasingly complex health care environment. Managers need to be supported and encouraged to develop awareness of their own protective factors as they cope with challenging situations. Building resilience through formal education, social support and meaningful recognition is an important focus for nurse leaders in establishing a healthy work environment and maintaining a stable nursing workforce.

'We have to drive everywhere': rural nurses and their precepted students.

Travel safety culture is a vital aspect of nursing in rural western Canada, where long distances and severe weather are commonplace. However, this culture is poorly understood owing to the absence of official policy, and the tendency of rural nurses to take travel risks and burdens in stride, rather than advocating for change. Travel risks and burdens include extreme weather events such as tornadoes and blizzards; unmarked routes and hazards; distance, time and expense; and driver fatigue. In such rural settings, the safety and health of visitors, novices and students are of particular concern. The researchers sought to elicit the tacit knowledge of rural registered nurses, and their students undertaking rural nursing preceptorships, pertaining to rural travel issues and best practices for safety and wellbeing. Through purposive and snowball sampling, the researchers recruited seven senior nursing students and five nurse preceptors. Seven rural acute and community care sites, between 42 km and 416 km distant from the students' primary place of study, were covered by the study. Photovoice, a participant action modality, was employed to collect photographic and qualitative interview data from participants over 10 weeks, between February and April 2016. The data were analyzed thematically, in collaboration with participants, who in turn validated the results. A digital storytelling initiative was attempted, to further involve participants in dissemination of findings, but only one participant took part in this phase of the project. The central finding of the study was that nursing students learn to accept and manage limitations - and to recognize and capitalize on opportunities - when undertaking rural preceptorships. With regard to road safety, the students were found to be particularly vulnerable to long distances, hazardous conditions, fuel and cellular data expenses, and fatigue. These issues were compounded by the students' reluctance to speak up, or to miss shifts, when they felt unsafe or unwell. Their preceptors role modeled autonomy and community ethos as the foundations of a frontline, extemporaneous road safety culture. This entailed personal safety measures borne from rural experience and background, familiarity with the countryside, and community connectedness with other healthcare sites in place of any official public alert system. The preceptors furthermore benefited from strong union protection for occupational health and safety concerns, but students being taught in rural settings had no such advantage. Nursing students should have the same occupational health and safety protections as their rural preceptors, especially the right to refuse travel, without penalty, in unsafe circumstances. Better travel subsidies and road safety measures during rural preceptorship may help increase the likelihood of students considering a rural career path. Furthermore, the frontline, community-based road safety experience of rural nurses is an untapped source of information for educators and policymakers. Such information will become more and more vital as a diminishing number of rural nurses are called upon to care for an aging client base.

Rural Mentorships in Health Care: Factors Influencing Their Development and Sustainability.

The need to recruit and retain health care providers remains a concern in rural communities. This project aimed to better understand what health care providers and senior leaders value in mentorship and determine the best way to implement a mentorship program in rural western Canada. Health care providers and senior leaders from a rural health region were recruited through convenience and snowball sampling. Participants were interviewed using a semistructured interview guide, and data were analyzed using thematic analysis. Two main themes were revealed: rural mentorship challenges and facilitators. Challenges included administrative, scope of practice, and interpersonal, whereas facilitators included mentorship as a recruitment and retention strategy, openness and commitment, structured mentorship programs, and community influence. This information will enable administrators and educators to more successfully implement mentorship programs for a variety of health care professionals working within rural environments and facilitate staff development, recruitment, and retention. J Contin Educ Nurs. 2018;49(7):322-328.

Migrant workers’ (non)belonging in rural British Columbia, Canada: storied experiences of Marginal Living

PurposeThe purpose of this paper is to examine the experiences of belonging and wellbeing among temporary migrant agricultural workers (TMAWs) in a rural setting in the interior of British Columbia, Canada.Design/methodology/approachA qualitative narrative approach informed by participatory action research principles was employed. In total, 12 migrant workers participated in two to four one-on-one interviews and/or focus group conversations.FindingsThe analysis revealed an over-arching theme of Marginal Living encompassing stories of always on the outside, mechanisms of isolation and exclusion; struggling for the basics, realities of worrying about daily bare necessities; and “nothing but a worker’s,” experiences of being reduced only to one’s labor. These storied experiences each impacted workers’ wellbeing and typically limited their ability to feel a sense of belonging. Yet, workers exerted agency and resilience through storied experiences of “one family and for those who come next.” Their efforts contributed to building a sense of community through mutual support and advocacy.Originality/valueVery few studies have focused on the day-to-day experiences of this population and its influence on their sense of belonging and wellbeing. This study is also the first to examine this topic within this particular region (the rural BC interior). These findings can provide a starting point for improved program planning to address challenges faced by TMAWs in rural Western Canada. Further, they expand the understanding of concepts such as partial citizenship and structural exclusion as they apply in the day-to-day realities of migrant workers in rural BC.

A proposal for the curriculum and evaluation for training rural family physicians in enhanced surgical skills.

Rural western Canada relies heavily on family physicians with enhanced surgical skills (ESS) for surgical services. The recent decision by the College of Family Physicians of Canada (CFPC) to recognize ESS as a "community of practice" section offers a potential home akin to family practice anesthesia and emergency medicine. To our knowledge, however, a skill set for ESS in Canada has never been described formally. In this paper the Curriculum Committee of the National ESS Working Group proposes a generic curriculum for the training and evaluation of the ESS skill set.

Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer.

BackgroundThis paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges.MethodsTwenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi’s (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled ‘hope against hope.’ResultsThe journal entries highlighted: the caregivers’ hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and ‘hope against hope’ describes how hope persists even when there is no hope for a cure.ConclusionsThis research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.

“You have to rely on everyone and they on you”: Interdependence and the team-based rural nursing preceptorship

Purpose A photovoice study was conducted to construct a narrative of teaching and learning to nurse in rural settings as seen through the eyes of nursing students and their preceptors. This article explores the rural context of team-based preceptorship; that is, how interdependence characterizes the quality of the transition from student to professional support networks, and in particular how professional, team-based networks function in rural settings. Methods Photovoice is a participatory research method wherein participants document their lived reality through photography, and supply narrative context to the photographs through group discussion. Four students and their four preceptors, based at health care sites in rural Western Canada, were supplied with digital cameras with which they took over 800 photographs over a ten-week preceptorship course. Preceptors and students were active participants in generating the thematic data analysis. Findings The central thesis of this project was that rural nurses bring a strong sense of community ethos to clinical practice. One aspect of this community ethos was the importance of the rural health care team in precepting a nursing student. Students experienced a transition from their urban, school-based networks to rural-based, professional networks; preceptors and the interdisciplinary team supported students through this transition. As students gained independence from the university and emerged from their student status, they were integrated into the rural interdisciplinary team and community, greatly facilitating their transition to graduate nursing practice. Conclusions More than any other single aspect of rural nursing, we feel teamwork (and community ethos, by extension) is the key to promoting rural preceptorships and rural careers. This model for preceptorship has implications for selecting rural placements and may be transferable to other settings. Ultimately, this knowledge can be used to strengthen student placements in rural areas with implications for the recruitment and retention of nurses in rural areas. Key Words: Photovoice, Rural Preceptorship, Participatory Research Method

4. Profile of High School Students Exchanging Sex for Substances in Rural Canada

Adolescent substance use increases exposure to other risk behaviors, including involvement in the exchange of sex for drugs. Limited research has investigated exploitation among teens in regular schools. This study examined substance use patterns, demographics, and personality factors that discriminate between youth who reported exchanging sex for drugs (exploited) and youth who did not (non-exploited) among substance-using students in rural western Canada.

Relative performance of different exposure modeling approaches for sulfur dioxide concentrations in the air in rural western Canada

BackgroundThe main objective of this paper is to compare different methods for predicting the levels of SO2 air pollution in oil and gas producing area of rural western Canada. Month-long average air quality measurements were collected over a two-year period (2001–2002) at multiple locations, with some side-by-side measurements, and repeated time-series at selected locations.MethodsWe explored how accurately location-specific mean concentrations of SO2 can be predicted for 2002 at 666 locations with multiple measurements. Means of repeated measurements on the 666 locations in 2002 were used as the alloyed gold standard (AGS). First, we considered two approaches: one that uses one measurement from each location of interest; and the other that uses context data on proximity of monitoring sites to putative sources of emission in 2002. Second, we imagined that all of the previous year's (2001's) data were also available to exposure assessors: 9,464 measurements and their context (month, proximity to sources). Exposure prediction approaches we explored with the 2001 data included regression modeling using either mixed or fixed effects models. Third, we used Bayesian methods to combine single measurements from locations in 2002 (not used to calculate AGS) with different priors.ResultsThe regression method that included both fixed and random effects for prediction (Best Linear Unbiased Predictor) had the best agreement with the AGS (Pearson correlation 0.77) and the smallest mean squared error (MSE: 0.03). The second best method in terms of correlation with AGS (0.74) and MSE (0.09) was the Bayesian method that uses normal mixture prior derived from predictions of the 2001 mixed effects applied in the 2002 context.ConclusionIt is likely that either collecting some measurements from the desired locations and time periods or predictions of a reasonable empirical mixed effects model perhaps is sufficient in most epidemiological applications. The method to be used in any specific investigation will depend on how much uncertainty can be tolerated in exposure assessment and how closely available data matches circumstances for which estimates/predictions are required.

Determinants of airborne benzene concentrations in rural areas of western Canada

This study estimated the level and determinants of airborne benzene concentrations in rural western Canada. A multi-site, multi-month unbalanced two-factorial design was used to collect air samples at 1206 fixed sites across a geographic area associated with primary oil and gas industry in Canadian provinces of Alberta, north-eastern British Columbia, and central and southern Saskatchewan from April 2001 to December 2002. Benzene concentrations integrated over 1 calendar month were determined using passive organic vapour monitors. Linear mixed effects models were applied to identify the determinants of airborne benzene concentrations, in particular the proximity to oil and gas facilities. The observed geometric mean of benzene concentrations was 158 ng m −3, with large geometric standard deviation: 4.9. Benzene concentrations showed a seasonal variation with maxima in winter and minima in summer. Emissions from oil well (within 2 km) and compressor influenced monthly airborne benzene concentrations. However, in our study, being located in the general area of a gas plant seems to be the most important in determining monthly airborne benzene concentrations. These findings support the need for investigation of the impact of oil and gas industry on quality of rural air.

The Internet Vocabulary Test for Children: preliminary development

PurposeCurrently, the only mechanisms to determine children's use of the Internet are interviews and questionnaires. To increase the validity of theory and research and ensure that practitioners and policy‐makers are guided by accurate information, an improved method of determining children's patterns of Internet use is required. The purpose of this study is to present the Internet Vocabulary Test for Children (IVTC) as a measure of Internet use in children.Design/methodology/approachThe IVTC requires oral definition of ten terms (Internet, gamer, e‐mail, search engine, chat, online games, instant messaging, cheats, web site, browser). An elementary school in rural western Canada agreed to participate in trial administration of the IVTC. All children in first through sixth grade were invited to participate (n=149). Parents completed a consent form and a questionnaire. A total of 128 children (62 males and 66 females) were administered the IVTC.FindingsTrial administration of the IVTC established the viability of determining children's use of the Internet with a test of expressive vocabulary.Originality/valueGiven the rate of population penetration coupled with rapidly changing technology, measuring children's Internet use presents challenges. Simple solutions such as the development of software and firmware to monitor children's online behavior may provide misinformation. That is, surveillance influences behavior and children's Internet activities often involve multiple users. The IVTC is not vulnerable to biased responding, is inexpensive, and easily administered.

Seeking serenity: living with HIV/AIDS in rural Western Canada

The purpose of this naturalistic inquiry was to describe the experience of living with HIV infection in rural Alberta, Canada. Although the urban HIV epidemic has been well researched, the virus continues its spread into more remote populations where there is a need to understand and address its impact. Affected rural residents form a diverse and marginalized group that includes women, Aboriginal peoples, immigrants, injecting drug users, and men who have sex with men, yet there are few data available to inform appropriate health and social services and practice. A number of factors, such as stigma, invisibility, isolation, confidentiality, poverty, and risk behaviours, contribute to the rural experience, but have not been clearly explicated in the literature. This study was conducted in order to better understand the perceptions of health in a rural setting, the processes involved in accessing care, the challenges and benefits associated with rural life, and the relationship between personal beliefs and values and the nature of the disease. Semi-structured interviews were conducted with six HIV-seropositive individuals and one caregiver who were living or had lived in rural settings, as well as four AIDS agency staff from a small city. Participants represented varied backgrounds, ages, sexual orientations, exposure to risk behaviours, lifestyles, roles, and citizenship. A naturalist inquiry approach was used in order to explore the qualitative aspects of the experience. Interviews were recorded, transcribed, and analyzed. Documents such as poetry, letters, field notes and journals served to enrich the data. Participants identified the components of health as a sense of wellbeing, quality of life, and independence. Within the context of HIV infection, health was achieved through three processes: (1) accommodating the reality of the diagnosis into daily life; (2) creating and engaging in supportive relationships and communities; and (3) reflecting on the meaning of one's life and future. Rural life had various meanings and implications for individuals, in terms of security, comfort, relationships, access to services, attitudes, dignity, and justice. Barriers and challenges to reaching health centred around a lack of skill and knowledge in human services workers, violation of confidentiality, difficulty associated with travel for medical care, and inadequate support for family caregivers. Participants suggested that the health of the community is reflected in the health of individuals. They expressed the hope that some day diversity would not only be tolerated, but would be celebrated by all members of society. Rural residents perceive and enact health in distinct ways. Caregivers must understand that health usually represents a concern only after it has failed and self-initiated attempts to overcome problems have been unsuccessful. Participants in this study articulated their need to live in a society that acknowledges their diversity and honours their rights to access health and social supports in the community. Service providers may enhance care and promote health of this aggregate through education, attention to professional responsibilities, fostering resilient communities, and advocating for vulnerable members of society. Further research needs to be conducted in order to learn more about the relationships between HIV infection and rural living and the needs of people who live in such situations. With this knowledge, appropriate healthcare services can be developed and implemented to enhance the wellbeing and quality of life for individuals, families, and communities.

Determinants of airborne concentrations of volatile organic compounds in rural areas of Western Canada

We estimated the level and determinants of airborne concentrations of 26 volatile organic compounds (VOC) in rural Western Canada. A multisite, multimonth unbalanced two-factorial design was used to collect air samples at 1206 fixed sites across a geographic area associated with primary oil and gas industry in Alberta, northeastern British Columbia, and central and southern Saskatchewan from April 2001 to December 2002. Principal component factor analysis was used to group VOC into three mixtures. Factor I was a group of compounds dominated by benzene, toluene, ethyl-benzene, xylenes, and hexane. Factor II was mainly a group of vegetation-related monoterpenes and dichlorobenzenes. Factor III was a group of chlorinated VOC. Linear mixed effects models were applied to identify the determinants of airborne concentrations of VOC and evaluate the association between these factors and oil and gas facilities. Our results indicated that the studied VOC were present in small (ng/m3) quantities. Components of Factor I VOC showed a seasonal variation with maxima in winter and minima in summer, whereas components of Factor II displayed an opposite seasonal trend. Components of Factor III did not show a clear seasonal pattern. We observed that oil and gas facilities only contribute to airborne concentrations of components of Factor I. Proximity to batteries (within 2 km) was most influential in determining monthly airborne concentrations of components of Factor I, followed by gas and oil wells. Modification of batteries to reduce evaporation and leakage might be considered as a measure to control airborne concentrations of compounds such as benzene and toluene.

A New Role for Advanced Practice Nurses in Canada: Bridging the Gap in Health Services for Rural Older Adults

This article is a report on the evaluation of a new nursing initiative in rural western Canada-the gerontological advanced practice nurse (GAPN) project. Using a qualitative approach in the i initial evaluative phase, the authors determined how the GAPN evolved, functioning primarily in a clinical nurse specialist role, and identified the successes and challenges of the project. The initial findings indicated health benefits to rural older adults. The project's success was attributed to strong support from key players, and attempts to address perceived gaps in rural health service. Challenges in developing the GAPN role included limited planning time, and lack of a clear definition about the role and responsibilities of the GAPN. The introduction of a GAPN, especially in underserved rural communities, has the potential to provide essential health care services to older adults, and to make major contributions to changing gerontology practice.

Pain and agitation in long-term care residents with dementia: use of the Pittsburgh Agitation Scale

to explore the relationship between total and sub-scores of the Pittsburgh Agitation Scale (PAS) and five proxy measures of pain in long-term care (LTC) residents. descriptive correlational design. 58 residents in three LTC facilities in rural Western Canada with moderate to severe cognitive impairment took part in the study. Six full-time registered nurses working in the facilities and three palliative care nurse consultants provided pain and agitation assessments. registered nurses used PAS to assess agitation. The five proxy measures of pain were the Discomfort Scale for Dementia of the Alzheimer's Type (DS-DAT), number of pain diagnoses, use of analgesic medications, and pain ratings by both facility nurses and palliative care nurse consultants. there was a moderately strong relationship between total PAS agitation scores and total DS-DAT pain scores (r=0.51, P<0.01). The PAS sub-score "resisting care" was significantly correlated with total DS-DAT scores (r=0.46, P<0.01), and pain ratings by both facility nurses (r=0.48, P<0.01) and palliative care nurse consultants (r=0.51, P<0.01). for certain residents with dementia, PAS may allow assessment of both agitation and uncommunicated pain. It is possible that the PAS form of agitation "resistance to care" may indicate pain that individual cannot otherwise communicate. One possible response to such resistance would be to trial pain medication and reassess agitation. Nursing staff in LTC facilities may need additional training in pain assessment of residents with dementia.

Learning Plans as Support for the Development of Learner Identity: A Case Study in Rural Western Canada

The development of a complex, multi-faceted sense of self can increase student achievement and self-confidence. Individualised learning plans link the personal and social identities of students with the academic curriculum, mapping a pathway to activities appropriate to needs and goals and the development of an increasingly complex sense of self.

Cluster suicide in rural western Canada.

This paper focuses on a series of adolescent suicides which occurred in a small rural community in Western Canada between December 1989 and June 1990. Risk factors for adolescent suicide and recent epidemiological data on cluster suicide are reviewed and discussed. The circumstances of the five adolescent suicides are then discussed, and the question of whether or not this was a cluster suicide is considered. This article supports the view that suicide is an abnormal response to stress or loss and emphasizes the role of genetic psychophysiological predisposition.