✅ ch 8: rural & urban environments

Rural

defined in terms of geographic location & population density, or in terms of distance from or time needed to commute to an urban center

Rural-urban continuum

• Rural & urban residencies arent opposing lifestyles

• Remote farm to village to small town to larger town or city to large metropolitan area with a core inner city.

micropolitan (micro)

• urban core of 10,000 to 50,000 people

• About 60% of the total non-metro population

metropolitan (metro)

core urban area of over 50,000 people

core metro (inner city)

over 1 million people

frontier 

under 6 people per square mile

rural

7-98 people per square mile

urban

over 99 people per square mile

Geographic Entities - Core-based statistical area

Collective term for metro and micro areas

Geographic Entities - Non-core area

No urban core, but on average 14,000 residents

Geographic Entities - Suburbs

“Doughnut effect”

Rural Population Characteristics (general trends)

• More whites

• Higher proportion of younger (under age 18) & older residents (over age 65)

• More likely to be married

  • Young couples may start out in these settings

• More likely to be widowed

• More likely to be poorer

• Fewer years of formal education

• At risk for being underinsured or uninsured

Health Status of Rural Residents

• Perceived health status

• Chronic illness

• Patterns of health service use & shortage of HCP’s

• Maternal-infant health

• Health of children

• Mental health

• Environmental and occupational health risks

Rural Health Care Delivery Issues & Barriers to Care

• Lack of HCP’s & services

• Great distances to obtain services

• Lack of personal transportation

• Lack of telephone services

• Unavailable outreach services

• Inequitable reimbursement

  • Medicaid is more likely to reimburse in urban areas with higher living costs, and less likely in rural areas where costs are lower

• Inability to pay for care/lack of health insurance

• Language barriers (caregivers not linguistically competent)

Nursing Care in Rural Environments - Theory, research, and practice

• Body of literature on rural health is growing

  • Most publications focused on hospital practice, but information is applicable to both community agencies and community-focused nursing.

• Physical isolation

  • Professional isolation for nurses and practitioners

  • Scarce financial, human, and health care resources

  • Broad scope of practice

Nursing Care in Rural Environments - Research needs

• Greater recognition for rural nurses

• Stressors

• data

• International perspective

• technology

• Distance learning

• Rural-urban disparities

Nursing Care in Rural Environments - Preparing nurses for rural practice settings

• need broader knowledge in these areas:

  • Health promotion

  • Planning and implementing community assessments

• Telehealth: uses a variety of technological solutions to provide preventive, promotive, and curative aspects of health care

  • should be used for prevention, not acute care

Future Perspectives: Scarce Resources and Comprehensive Care Continuum

Needed in most rural areas:

• School & parish (church) nurses

• Family planning services

• Prenatal & postpartum services

• Resources for HIV/AIDS clients & families

• Emergency medical services

• Resources for families of children with special needs

• Mental health services

• Resources for older adults

Building Professional Community-Client Partnerships in Rural Settings: Case Management

• can be used to:

  • Provide ongoing care coordinated by the case manager using both formal and informal resources

  • Allow clients’ participation in their care plan.

• Outcomes are often remarkably different when this is used

Building Professional-Community-Client Partnerships in Rural Settings: Community-Oriented Primary Health Care

• Effective model for delivering services to vulnerable, underserved populations

• Emphasizes the following:

  • Flexibility

  • Professional-community partnerships

  • Interprofessional involvement

• Blends:

  • Primary care

  • Public health

  • Prevention services which are all offered in a familiar & accessible setting