Rural Migrant Workers and Urban Communities

What is the definition of rural?

• US department of agriculture

  • nonmetropolitan area as a combination of: open countryside, towns fewer than 2,500 residents, urban areas with 2,500 to 49,999 residents

• text

  • communities with fewer than 10,000 residents and a county population density of <1,000 persons/square mile

What is a frontier area?

area with 6 or fewer persons per square mile

What is a health professional shortage area?

an urban or rural geographic area, population group, or facility with chronic shortages of medial, dental, or mental health professionals

What is a medically underserved area?

an area in which residents experience a shortage of health services

What is a medically underserved population?

those with economic and cultural/linguistic barriers to primary health care services

What are the lifestyles of migrant workers?

• seasonal farm worker

  • live in one geographic location and labor in the fields of that particular area

• migrant farm worker

  • move to find agricultural work throughout year, state to state, establishing temporary residencies

  • sunrise to sunset 6 days/week

  • streams follow flow of work along set routes

    • eastern, midwestern, western

  • nomadic: travel away from home for years

What are rural health issues?

• built environment: development of housing, highways, shopping areas, and other man-made features added to natural environment

• urban sprawl: people moving away from urban areas to suburban environments

• self, home, & community care:

  • cost

  • travel, weather, and distance

  • self-management of health problems

• agriculture and health

  • direct effects: pesticide exposure, zoonotic disease transmission, water pollution

  • indirect effects: environmental expressways, livestock antibiotic resistance

• major health problems:

  • cardiovascular, diabetes, COPD

What is the access to care for migrant workers?

• insurance, managed care, and health care services:

  • historically, fee for service

  • use of family practice clinics

  • rural health clinics: underserved and nonurban

  • typical lack of core health services

  • heavy reliance on public health department services

• barriers

  • physical distance

  • transportation

  • unpredictable weather

  • limited choice of health care providers

• approaches to improve access

  • mobile clinics

  • school-based clinics

  • telehealth

What is the CHN role in rural settings?

• advocate: assist on obtaining care

• coordinator/case manager: connects clients with needed services

• health teacher: education on health promotion

• referral agent: connects rural clients and urban service providers

• mentor: guides new CHN to rural communities

• change agent/researcher: suggest new approach to solving patient care

• collaborator: seeks ways to work with other health and social service professionals

• activist: take appropriate risk to improve community health

What are health risks of migrant workers and their families?

• occupational hazards: agricultural employment and limited legal protection

• pesticide exposure: increased risk of human diseases (cancer, COPD)

• substandard housing: crowding (farmworker housing), being exposed to elements

• poor sanitation: due to substandard housing

• poor nutrition, overweight, obesity: poor dietary quality

• risks to social, emotional, and behavioral health: migrant children staying home to watch younger

• intimate partner violence: cultural beliefs, migratory lifestyle, poor living conditions

• infectious diseases: HIV, TB

What is the role of CHN in migrant health?

• improving existing services

• advocating and networking

  • migrant education programs

• utilizing unique methods of health care delivery

  • mobile health vans with bilingual nurses

  • peer-led health instruction/coaching via charlas

• improved health data information systems

• practicing cultural sensitivity

• using lay personnel for community outreach

A community health nurse is working in a rural area, providing care to families. The nurse

establishes a connection between one of the families and a social service agency that

provides meals to homebound individuals. The nurse is acting in which role?

Coordinator/case manager

A community health nurse is conducting a program for local community leaders about rural and urban area needs. The nurse identifies the need for additional teaching based on which statement by the group?

A rural area has six or fewer persons per square mile (this is a frontier area)

A community health nurse is working to promote the health of migrant workers. Which factor would the nurse need to address because it has a direct and negative influence on the vulnerability of this population? Select all that apply.

• many are undocumented aliens living in fear of deportation

• they are often deprived of safe working conditions

• they often lack adequate sanitation and housing

• they often have poor nutrition because of poverty

A community health nurse is planning to switch employment and work at a clinic that provides services to migrant workers and their families. When preparing to work with this population, which information about this population would the nurse need to keep in mind?

They often work 6 days a week from sunrise to sunset

What is urban health?

• influenced by interactions of citizens where they reside, work, and gather for daily life events

• social determinants of health in urban areas

  • poverty

  • slums

  • poor air quality

  • child labor

  • health concerns

  • transportation

  • substance use and abuse

What are the emerging issues in access to health services in urban settings?

• increasing and measuring insurance coverage and access to entire care continuum

• addressing disparities that affect access to health care

• assessing capacity of health care system to provide services for newly insured individuals

• determining changes in health care workforce needs

  • patient-centered medical home

  • team-based care

• monitoring increasing use of telehealth as an emerging method of delivering health care

• disparities that affect access to health care

  • race

  • ethnicity

  • socioeconomic status

  • age, sex

  • disability status

  • sexual orientation

  • gender identity

  • residential location

What are sustainable communities?

• healthy places where

  • natural and historic resources are protected

  • employment is available

  • urban sprawl is contained

  • neighborhoods are safe

  • air pollution is minimized

  • lifelong learning is promoted

  • health care, transportation are easily accessible

  • all citizens can improve quality of life

What is the CHN in urban settings?

• benefits

  • higher salaries

  • more opportunities for advancement, education

  • more nurses, schools of nursing, recruitment

  • diverse work settings

• roles: advocate, collaborator, educator, partner, policy-maker, and researcher

• self-assessment: nurses assessment of one’s own assumptions and beliefs

• improving access: serving as an advocate and bridge for families needed access

• strengthening communities: organizing processes and developing neighborhood competence

A public health nurse is teaching a group of community health nurses about urban health. The nurse determines that the teaching was successful when the group describes urban health by which statement?

Consideration of the effects of environment on the health of large cities

A community health nurse is reading a journal article about the Partnership for Sustainability Communities. Which situation would the nurse expect to find as being addressed? Select all that apply.

• planning for appropriate land use

• providing affordable housing

• promoting community development

• providing appropriate methods of transportation