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Rural Health Nursing

Barriers and Benefits

Edited by
Laurie Anne Ferguson, DNP, APRN, ANP-BC, FNP-C, CPNP, FNAP, FAANP, Founding Dean and Professor, Emory & Henry College, School of Nursing, Marion, VA
Kenneth Lowrance, DNP, APRN, CNS, FNP-BC, CNE, FAANP, Professor of Professional Practice, Retired, Texas Christian University, Harris College of Nursing and Health Sciences, Fort Worth, TX

978-1-60595-157-7, ©2022, 376 pages, 6×9, SC book

Rural Health Nursing Front Cover
  • Provides a strong fundamental underpinning with preliminary chapters covering rural health theory, healthcare systems, health education centers, and health literacy
  • Addresses COVID-19 and its impact on emergency and disaster preparedness, health policy, and special rural populations
  • Includes objectives and study questions in each chapter to provide focus and prompts for classroom discussion and assignments
  • Describes and addresses key chapter topics in rural health such as an aging population, telehealth, an immigrant population, and mental health
  • Chapters contributed by topic experts in rural health policy, veteran populations, aging populations, substance abuse, and social media
  • Free Instructor’s Manual available to faculty who adopt the book for courses

This course textbook focuses on the practical issues and challenges faced by nurses working with rural populations. Additionally, the textbook provides background information on chapter topics such as the aging rural population, mental health, substance abuse, rural veterans, telehealth, interprofessional education, and introduces evidence-based strategies to facilitate quality care. This text is ideal for academic programs, concentrations, and courses seeking to include rural health in the curriculum and for nurses in rural settings.

 

Foreword
Preface
List of Contributors

Chapter 1. Rural Health Theory
Rhoda Owens

  • Introduction
  • History of Rural Nursing Theory
  • Characteristics of Rural Nurses
  • Advanced Practice Nursing at Rural Communities
  • Opportunities to Work in Rural Settings
  • References

Chapter 2. Health Care Delivery Systems
Vicki Brooks

  • Introduction
  • Healthcare Delivery Systems
  • Challenges of Rural Healthcare Systems
  • Benefits of a Rural Setting
  • References

Chapter 3. Area Health Education Centers Past and Present Role in Improving Access to Care in Rural Communities
Audrey Snyder, Steven Zucker, Monica Daniels-Mika and Dwain Harris

  • Introduction
  • National Area Health Education Center Beginnings
  • From Concept to Reality: AHECs Early History
  • Evaluation of AHECs Throughout Their History
  • AHEC Pioneers
  • AHECs and the Tripartite Paradigm
  • AHEC Program Goals and Values
  • Common Objectives
  • AHEC’s Focus in Rural Communities
  • AHEC’s Nursing Focus
  • National Health Service Corps Today
  • AHECs Today
  • References

Chapter 4. Health Literacy Impact on Rural Health
Laurie Anne Ferguson

  • Introduction
  • Epidemiology
  • Impact of Limited Health Literacy
  • Impacting Outcomes
  • Communication Strategies
  • Other Strategies to Improve Health Literacy
  • Provider Communication
  • Policy Implications
  • Summary
  • Conclusion
  • References

Chapter 5. Emergency and Disaster Preparedness
Wendy Fletcher

  • Introduction
  • The Evolution of Emergency Preparedness in America
  • Emergency Alerts
  • Mother Nature
  • Pandemic
  • Cyber Threats
  • Chemical Emergencies
  • Radiation Threats
  • Bioterrorism
  • Active Shooter
  • Making Progress
  • Conclusion
  • References

Chapter 6. Healthcare for Older Adults Living in Rural America
Ruth McCaffrey

  • Introduction
  • Aging in Rural America
  • Caregivers
  • Integrating Care for Older Adults in Rural Communities
  • Care Coordination
  • Conclusion
  • References

Chapter 7. Health Policy for Rural Populations
Barbara Jackson

  • Introduction
  • Rural Population Views on Health Support Need for Rural Health Policy
  • Nurses as Policy Advocate
  • Rural Health Policy Makers
  • Political Influence on Health
  • Approaches in Advocacy
  • Health Reform
  • Financing Healthcare for Vulnerable Populations
  • Equity in Health Policy
  • Health Policy in Rural Hospitals
  • Grant Programs
  • Grants for Rural Hospitals
  • World Health Organization and the International Focus on Rural Health Issues
  • Conclusion
  • References

Chapter 8. Telehealth: An Answer or Question for Rural Health
Jill D. Cochran

  • Introduction
  • History and Beginnings
  • What is Telehealth?
  • Telehealth Applications
  • Health Care Education/Continuing Education
  • Primary Care
  • Synchronous
  • Asynchronous
  • Remote Patient Monitoring (RPM)
  • Emergency Medicine Telehealth for Trauma
  • Specific Conditions that have Benefited from Telehealth
  • Other Specialty Care
  • Challenges: Payment, Scope of Practice
  • Scope and Law
  • Legal Implications
  • Security of Care
  • Malpractice and Malpractice Coverage
  • Therapeutic Relationships and Personal Interface
  • Adoption of Telehealth Among the Populations
  • Support Services/Resources for Telehealth Care in Rural Areas
  • Conclusion
  • References

Chapter 9. Rural Nursing: American Indians and Alaska Natives in Indian Country
Loretta J. Heuer and Misty L. Wilkie

  • Introduction
  • Native American and Alaskan Native Tribes
  • Regional Differences
  • Tribal Lands
  • Defining the American Indian and Alaskan Native Rural Population
  • American Indian and Alaskan Native Demographics
  • Worldviews and Values Associated with AIANs, Intergenerational Poverty, and Trauma
  • American Indian and Alaskan Native Tribal Religions and Spirituality
  • Community Populations
  • American Indian and Alaskan Native Veterans
  • Grandparents Raising Grandchildren
  • Federal Indian Law, Tribal Governance and Public Safety
  • Judicial System and Law Enforcement
  • Discrimination and Racism
  • Maltreatment in Indian Country
  • Missing, Murdered or Trafficked American Indian and Alaskan Natives
  • American Indian and Alaskan Native Social Determinants of Health
  • Indian Gaming and Employment
  • Poverty on Rural Reservations
  • Housing and Homelessness on Tribal Lands
  • Homeless on Tribal Lands
  • Broadband Internet
  • Food Distribution Program on Indian Reservations
  • American Indian Rural Health Characteristics
  • Mental and Behavioral Health
  • Chronic Health Conditions and Mortality
  • American Indian and Alaskan Native Health Care
  • American Indian and Alaskan Native Nursing Workforce
  • Opportunities for Nurse Practitioners and Nurses
  • Summary
  • References

Chapter 10. Health Challenges Faced by Immigrant Populations in Rural Areas
Joy Elwell

  • Introduction
  • Significance of the Problem
  • Specific Issues and Their Impact on Health of Immigrant Populations in Rural Settings
  • Health Insurance and Costs Associated with Healthcare Services
  • Implicit Bias and Racism
  • Conclusions and Implications
  • References

Chapter 11. Mental Health and Substance Use
Kathleen T. McCoy

  • Introduction
  • Section I: Issues and Background
  • Drug Overdoses
  • Suicide
  • Human Trafficking
  • Section II: Solutions
  • Rewards of Rural Health Mental Health and Substance Use Care
  • Conclusion
  • References
  • Appendix A: Resources
  • Appendix B: Human Trafficking Reporting Resources
  • Appendix C: Successful Models of Delivery of Mental Health and Substance Use Care

Chapter 12. Turn Left at the Yellow House: Challenges of Northern, Frontier, Rural, and Remote Nursing Practice
Julianne Sanguins

  • Introduction
  • Background
  • Benefits of Northern/Frontier Nursing Practice
  • Challenges of Northern/Frontier Nursing
  • Policy
  • Conclusion
  • References

Chapter 13. Rural Veterans: Implications for Nursing Practice
Angeline Bushy

  • Introduction
  • Background
  • Rural Veterans Military History: An Overview
  • Social Determinants of Health
  • Limited Access to Communication Technology
  • Mental and Behavioral Health Services
  • Veterans’ Homelessness
  • Female Veterans: Health Concerns of a Growing Population
  • Health Concerns of the LGBQT Veteran
  • Congressional Mandates Focusing on Veterans’ Healthcare Needs
  • References

Chapter 14. Providing Genetics/Genomics Care to Rural Communities
Tammy McKamie and Dennis J. Cheek

  • Introduction
  • Delivery of Genetic Information
  • Models of Successful Delivery
  • Identify Individuals at Risk
  • Counseling Individuals at Risk
  • Counsel Individuals on Results
  • Inform Referring Medical Providers of Results and Recommendations
  • Rewards of Health Delivery
  • Case Study
  • Glossary
  • References

Chapter 15. The Impact of APRN Leadership in Rural Settings
Holly Jeffreys

  • Introduction
  • Rural Defined
  • Disparities in Rural America
  • Historic APRN Role
  • Nurse Practitioner Role Formalized
  • Modern APRN Role
  • APRN Role in Rural Health
  • Regulatory Challenges in Rural Health
  • Rural Health Challenges
  • Opportunities
  • A Rural Experience
  • References

Chapter 16. The Rural Nurse and Social Media
Kenneth W. Lowrance

  • Introduction
  • History of Social Media
  • Social Media in the Rural Setting
  • Role of Social Media in Rural Healthcare Delivery
  • Nurses and Social Media
  • Confusion and Myths About Social Media
  • Confidentiality and Privacy Issues
  • Potential Negative Consequences of Social Media Misuse
  • Strategies to Avoid Social Media Misuse and Potential Negative Consequences
  • Summary
  • References

Afterword
Index

  1. – :

    Rural Health Nursing is the “go to” resource for nurses delivering healthcare in rural communities. Written by nursing experts who have embraced and mastered the many challenges of this unique healthcare environment, this text offers a realistic, detailed overview of the context, challenges, benefits, resources, and potential for maximizing individual, community, and population health outcomes in the rural setting.

    Kathy A. Baker, PhD, APRN, ACNS-BC, FCNS, FAAN
    Professor
    Director, Nursing Research & Scholarship
    Texas Christian University
    Harris College of Nursing & Health Sciences

  2. – :

    Rural Health Nursing: Barriers and Benefits is a much-needed addition to the limited number of rural health nursing texts. The book is suitable for both undergraduate and graduate nursing students as well as for practicing nurses. The work of registered nurses and nurse practitioners is highlighted throughout the book. This book illuminates both barriers and benefits of practice in the rural setting as well as the professional and personal gratification of working in these settings.

    Authors selected for the individual chapters clearly have significant expertise in their subject matter. Beginning with a chapter on rural health theory, Rural Health Nursing discusses a wide range of topics and issues to enhance nurses’ rural health knowledge and understanding. The book provides a wealth of information on policies and systems that impact healthcare in rural areas. Each chapter contains numerous examples to illustrate key points, and these make the text very relatable to readers.

    A few highlights of the book include an extensive and detailed chapter on the health of American Indians and Alaskan Natives living in rural settings and their unique challenges. Delivery of care to rural populations through telehealth is also a feature, as is the ability to provide genetics and genomics information to those living in rural settings. Differences in rural populations’ health perceptions, characteristics, and lifestyles in comparison to urban areas are a focus throughout the book. Discussions of the role of the nurse as a relatively autonomous generalist healthcare provider when in a rural setting reminds us of times past when professional nurses were often in charge of the health of entire communities.

    Organizationally, Rural Health Nursing provides a detailed chapter listing with a content breakdown for each chapter that will allow readers to quickly locate needed information within the chapters. Each chapter then begins with objectives and discussion questions to assist educators in applying the text in class. An index is also provided for more detailed searching. The editors are to be commended for organizing this fresh look at the field of rural health nursing and the many opportunities and benefits for nurses choosing to work in this specialty area.

    Kim Curry, PhD, FNP-C, FAANP
    Editor-in-Chief
    Journal of the American Association of Nurse Practitioners

Rural Health Nursing (Entire eBook)
$60.00 Save: $19.50
Chapter 1: Rural Health Theory
$25.00
Chapter 2: Health Care Delivery Systems
$25.00
Chapter 3: Area Health Education Centers Past and Present Role in Improving Access to Care in Rural Communities
$25.00
Chapter 4: Health Literacy Impact on Rural Health
$25.00
Chapter 5: Emergency and Disaster Preparedness
$25.00
Chapter 6: Healthcare for Older Adults Living in Rural America
$25.00
Chapter 7: Health Policy for Rural Populations
$25.00
Chapter 8: Telehealth: An Answer or Question for Rural Health
$25.00
Chapter 9: Rural Nursing: American Indians and Alaska Natives in Indian Country
$25.00
Chapter 10: Health Challenges Faced by Immigrant Populations in Rural Areas
$25.00
Chapter 11: Mental Health and Substance Use
$25.00
Chapter 12: Turn Left at the Yellow House: Challenges of Northern, Frontier, Rural, and Remote Nursing Practice
$25.00
Chapter 13: Rural Veterans: Implications for Nursing Practice
$25.00
Chapter 14: Providing Genetics Genomics Care to Rural Communities
$25.00
Chapter 15: The Impact of APRN Leadership in Rural Settings
$25.00
Chapter 16: The Rural Nurse and Social Media
$25.00

Rural populations have long been underserved, especially in terms of access to and receipt of appropriate healthcare. The economic downturn of recent years in many communities has led to the closure of many acute care hospitals thereby enhancing this disparity in rural areas. Despite this, rural health experiences and careers are increasingly becoming an opportunity for nurses of all levels of educational preparation to provide health promotion and care for people in these communities. Identifying and implementing options for these individuals, families, and communities to access a health provider and treatment options provides more opportunities for rural health nurses.

Rural areas may have minimal to no access to healthcare providers and facilities compared to urban areas, thus causing many rural individuals to go without healthcare or at the least, to face profound barriers to access quality, cost-efficient care. Underinsured and uninsured individuals struggle to sustain a quality of life with little to no health care options. In small communities where everyone knows each other, the presence of social stigma, and the challenge to maintain confidentiality and privacy are other obstacles which may expose individuals to embarrassment when seeking care for issues of mental illness, alcohol or drug dependency, and abuse. The issues of privacy related to such issues need to be prioritized to avoid barriers in receiving or delaying critical treatment.

An exciting yet challenging specialty for the nursing profession, rural health careers encompass the many challenges with distance, transportation, deficiency in health literacy, and inadequate or no health insurance coverage. However, advances in technology have enabled the use of telehealth to facilitate individuals’ access to health care providers who may be many miles away, but who can provide the needed treatments and care needed. Every level of nursing has a potential role in rural health care delivery ranging from the nursing assistant to the doctoral-prepared nurse to help meet the needs of this deserving population. Challenges abound, but who better to meet these than a nurse? The rural setting provides a setting for abundant opportunities for innovation, quality improvement, research, and implementation of evidence-based practice.

Geographical isolation and decreased access to care is only part of the challenge. As nurses, we are faced with many challenges including those with acculturation. Acculturation exists when an individual is exposed to dissimilar groups or cultures. A personal story illustrates this concept of a nurse’s lack of familiarity with some of the cultures within the region. Growing up surrounded by rolling hills and farmlands may not provide the experience of living or working on a farm. The lack of familiarity with the dialect and nomenclature of the farming culture was revealed during a triage in the emergency department in a rural setting.

The call came in, and the ER staff prepared for an incoming trauma from a farming accident involving a bush hog. The nurse was unprepared and disturbed by the devastating trauma that a boar/hog could inflict upon a person. The nurse learned quickly that a bush hog was not the type of wild boar but rather a farming implement used to mow and clear brush! During the triage, the young nurse was unable to make sense as to why a person would choose to remove a jammed branch from a running mower blade. After years of living in the rural farmlands and using a bush hog, it was more understandable. After watching farmers on their tractors with lights leading their path as they worked the fields late into the night and into the early morning hours covering hundreds of acres, hour after hour, it was easier to understand why such quick decisions might be made. The intent was not to be unsafe, but due to distress, exhaustion, and other stressors experienced by the farmer. Through assimilation with the rural farming culture, the nurse now has a better understanding. Knowledge is power.

Rural Health Nursing: Barriers and Benefits discusses a wide range of topics and issues to enhance nurses’ rural health knowledge and understanding. Rural Health nursing should be embedded in nursing curricula or as a stand-alone course, especially in the Advanced Practice Nursing programs. Nurses have a crucial role in the care provision for rural communities. Rural Health Nursing: Barriers and Benefits provides a thorough and exciting educational means to guide nurses in thinking beyond just bedside hospital nursing. The nurse in the rural setting uses a sophisticated skill set that encompasses far more than nursing skills to address the challenges and opportunities in the rural setting. As nurses, we must advocate and be the voice for those who are faced with barriers in rural settings to access appropriate quality care whether it be face-to-face or by the use of advanced technologies such as telehealth.

This book brings to life the barriers and benefits of practice in the rural setting, but most of all, the professional and personal gratification of working and applying theory and practice in this setting.

Saundra R. Farmer DNP, MSN, R.N.
Founding Chair Department of Nursing/ BSN Program Director
Dr. Teressa M. Wexler, EdD/ET, MSN. RN, CHSE
Clinical Assistant Professor
Emory & Henry College
School of Nursing
Marion, VA

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