Rural = SMALL. Rural & Frontier Dwellers And those who care for them 6/13/2014. Deborah Pontius MSN, RN, NCSN

Transcription

1 Rural & Frontier Dwellers And those who care for them Deborah Pontius MSN, RN, NCSN NOTE: These slide handouts do NOT contain all the slides in the presentation. The presentation has too many graphics and slides for reproduction. Please do not try to directly follow along with the presentation with these slides. Rural = SMALL 1

2 Quantitative Definitions Federal Definitions: Administrative Concept USDA defines urban along municipal or other jurisdictional boundaries. Land Use Concept US Census Bureau identifies urban areas population density Economic Concept Influences of predominate industries of communities Quantitative Definitions US Census Urban Area (UA) Central city 50,000 or more Density >1000 per sq mile Areas outside >2,500 Everything else rural Quantitative Definitions OMB Metro Statistical Area (MSA) Central city 50,000 or more Metro Outlying areas of >100,000 Everything else non metro 2

3 Quantitative Definitions The Census Bureau: 19 %of the total population as rural, 95 percent of the total U.S. land area is rural. (2010) OMB: 18 % of the total population as nonmetro, 82 percent of the land area is nonmetropolitan Census 3

4 HHS Health Care Defintions Frontier: <6 per sq mile, hospital < 25 beds and > 60 miles to major medical facility Rural:>6<100 per sq mile hospital beds, 30 miles to MMF Urban: Everything else FAR as a Definition 4

5 Rural is a Culture Scharff (1998) Being rural means being a long way from anywhere and pretty close to nowhere Qualitative Definitions and Characteristics: Scarcity of resources Isolation Lack of anonymity Jack all trades Outsider/insider Informal health network Health=Ability to work Davis-Pontius & Droes; Long & Weinart, Scharff, Bushy 5

6 The Land of We Have One of Those Grocery store Place to buy socks School (one of each) Doctor Dentist Lawyer (maybe two) 5 churches Isolation Distance must travel for health care (20 or more miles) Informal information networks Lovelock Providers Internet/sattalite opened the world Lack of Anonymity Patient 6

7 Health=Ability to Work Lack of insurance Lack of trust in providers Land based jobs=no sick days, no time off for preventative health no time off for children s appointments out of town. Oldtimer Newtimer <20 years=newcomer Allow extended period for acceptance Acceptance as healthcare prof. tied to personal acceptance Commonalities Not Unique Common Values Not small town values Social values are not different from urban Differences may be more pronounced Can t hide May feel more isolated if don t hold majority belief Some qualitative commonalities 7

8 Qualitative Definitions The Phenomenon of Ruralness Church and religion Shapes values and social norms More conservative value system Less tolerant of diversity Greater expectations of compliance with community norms Rounds & Smith; Bushy Qualitative Definitions The Phenomenon of Ruralness Take care of our own Social support networks through church, school and just town Self reliance Less dependence on governmental programs and other people for needs Rounds & Smith; Bushy Qualitative Commonalities Natural resource based economies are declining Low skill, low wage jobs predominate Out migration of youth and high skills Social connections important 8

9 Sociologic Considerations Gemeinschaft vs Gesellschaft Bigbee, Tönnies Sociologic Considerations Not homogenous Exist on a continuum Have commonalities But unique characteristics defined by lack or presence of: Isolation geographic or other Scarcity of resources Predominate religious influence Economy and poverty Commonality to all rural communities Importance of social connections Lack of anonymity Demographics & Disparities Edges of the lifespan Under 17, over 65 Married Fewer years formal education Lower proportion HS grads Poorer literacy Lower socioeconomic status Persistent poverty One industry town Poorer health Less likely to seek care Less access other social services Rural Assistance Center,

10 Demographics 1/3 all MVAs occur in rurals, But 2/3 of all MVA deaths Majority of EMS is volunteer Alcohol abuse rural youth noting to do Meth use and tx rates > 2x accidential death rate Suicide rates > Rural Assistance Center, 2012 Poorer Health Less Higher Education Health is defined as the ability to work Less access to health care & other social services Less education, less likely to value further education or preventative health care or parenting education Schools are center of social activities for community, as well as most educated community members Generational Poverty 1 in 6 vs 1 in 10 families Driving force: survival, relationships and entertainment People are possessions World is local Physical fighting resolves conflict Food quantity Payne, Bigbee 10

11 Persistent Poverty Ruby Payne Hidden Rules Hidden middle class societal rules govern education and business To move up: Must give up relationships for achievement Payne Persistent Poverty Family Relationships 11

12 Other Rules Destiny and fate Discipline is punishment Entertainment is valued 12

13 Rural Nursing The provision of health care by professional nurses to person living in sparsely populated areas Long & Weinert (1989). Rural Nursing: Developing the Theory basis. Rural Nursing Practice Most unique aspect of rural nursing practice is the breadth and scope of practice. J. Bigbee (1993), The Uniqueness of Rural Nursing. Nursing Clinics of North America Rural Nursing Practice Rural Nurse School Nurse Similarities of Practice? 13

14 Characteristics of Rural Nurses/Rural Practice More likely to be from rurals/had exposure to rural practice Lifestyle preference Tolerate isolation and independence Self directed Associates prepared Isolation/Autonomy Work alone. More likely to have supervisory role with less education More likely to be OWN supervisor Little access to peers Less red tape Must do it all Difficult access to research, up todate practice information NASN Generalist All things to all people Nurse to students and parent Change agent Shape health policy Develop programs Specialist in being a generalist School Nursing Most diverse practice of all the nursing specialties. 14

15 Scarcity of Professional Resources Strong generalist background Strong leadership and change skills Strong base in information seeking/professional practice validation Lack of anonymity Nurses know most of residents Know the social relationships Have both personal and professional relationships with patients Nothing is secret Positive visibility Shot Nazi Lice queen Insider/Outsider Oldtimer/Newcomer Informal information network vs formal, outside expert The devil we know vs the devil we don t How long to be oldtimer? May be trumped by fear of lack of privacy 15

16 Skills for Success in Rural Communities Strong assessment skills Strong clinical skills Flexibility Independence Leadership Self confidence ER skills Teaching skills Public Relations Davis & Droes Rural Cautions Careful! Rural communities NOT homogeneous Stereotypes rednecks unfair Rurality is also a continuum Every community has unique characteristics 2.5 Ohios fit in Nevada 16

17 Rural Continuum Hartville, Ohio Population: Hartville: 2100 Stark: 380,575 OH: 11.4 million Density: Rank: 7th Size in sq miles Stark: 581 OH: 44,825 Rank: 34th # of counties: 88 Lovelock, NV Population: Lovelock: 2400 Pershing: 7000 NV: 2.5 million Density: 23 Rank: 35 th Size in sq miles: Pershing: 6031 NV 109,826 Rank: 7 th # of counties: 17 Rural School Nurse Practice Implications Understand not all rural communities are the same Ohio vs Nevada Adult Illiteracy 2 out of 5 older, inner city and RURAL, read below 5 th grade 1 in 5 read at 5 th grade or below Average reading level is 8 9 th grade Doak & Doak 17

18 Rural School Nurse Practice Implicatons Less health literacy More generational poverty Less understanding of chronic health problems Less resources Less health seeking behaviors More crisis management of chronic health conditions Get em to Your Program Feed them Connect with kids Prizes & gifts Childcare Personal connections Trust who we know over what they know Rural School Nurse Implications for Practice Relationships more important than expertise Build on already present social network Strive for 8 th grade reading level for ALL interactions and audiences use health literacy principles Gain the buy in/trust of old timer/insider Know your population Know your community resources/referrals 18

19 The newcomer practices nursing in a rural setting The old timer practices rural nursing. Contact Information Deborah J Pontius, MSN, RN, NCSN deborahpontius@gmail.com P.O. Box 908, Lovelock, NV tab district, nurse 19