1. Copyright © 2008 Delmar. All rights reserved. Chapter 24 Rural and Migrant Populations

2. Copyright © 2008 Delmar. All rights reserved. 2 Rural Defined Rural –Distribution of people across space Metropolitan area Nonmetropolitan area

3. Copyright © 2008 Delmar. All rights reserved. 3 Rural Defined Fewer than 2,500 residents Demographics –28 percent under age 18 –30 percent over age 65

4. Copyright © 2008 Delmar. All rights reserved. 4 Rural Defined Health professional shortage areas Medically underserved areas –Established under U.S. Public Health Services Act

5. Copyright © 2008 Delmar. All rights reserved. 5 History of Public Health Nursing in Rural Areas First rural nursing service (1896) Rural Nursing Service (1912) –Lillian Wald and American Red Cross Frontier Nursing Service (FNS) (1925) –Mary Breckinridge

6. Copyright © 2008 Delmar. All rights reserved. 6 History of Public Health Nursing in Rural Areas Frontier School of Midwifery (1939) –Started by Frontier Nursing Service FNS started FNP program (1999)

7. Copyright © 2008 Delmar. All rights reserved. 7 Federal Initiatives in Rural Health National Health Service Corp (1972) National Center for Farm Work Health (1974) Rural Health Clinic Service Act (1977) Office of Rural Health Policy (1987)

8. Copyright © 2008 Delmar. All rights reserved. 8 Federal Initiatives in Rural Health Rural Information Center Health Service (1987) National Advisory Committee on Rural Health and Human Service (1987)

9. Copyright © 2008 Delmar. All rights reserved. 9 Demographics and Health Status Indicators High poverty and unemployment rates High percentage employers not providing health insurance –Working poor

10. Copyright © 2008 Delmar. All rights reserved. 10 Demographics and Health Status Indicators Disproportionate number of elderly and young Injury Pesticide poisoning

11. Copyright © 2008 Delmar. All rights reserved. 11 Demographics and Health Status Indicators Potential for abuse, family violence, neglect Weather hazards, social isolation Lack of public transportation

12. Copyright © 2008 Delmar. All rights reserved. 12 Demographics and Health Status Indicators Lack of specialty care Higher rates of chronicity Economic stress Increased tobacco use

13. Copyright © 2008 Delmar. All rights reserved. 13 Demographics and Health Status Indicators High risk injuries –Forestry, mining, fishing, agriculture Accidents Trauma Selected cancers Respiratory diseases

14. Copyright © 2008 Delmar. All rights reserved. 14 Cultural Characteristics of Rural Populations Rural communities are unique –Commonalities do exist: Self reliance, independence, individualism Time and crisis orientation in relation to health Distrust of outsiders Religious influence Use of alternative healing remedies

15. Copyright © 2008 Delmar. All rights reserved. 15 Migrant Rural Farm Workers Individuals who move from one area to another in search of seasonal or temporary work Among the poorest in the nation Chronic poverty, frequent mobility, low literacy, language, cultural and logistic barriers

16. Copyright © 2008 Delmar. All rights reserved. 16 Migrant Rural Farm Workers Often not aware of benefits available Migrant farm worker health issues –Suffer from poverty-related health problems TB Dental disease Workplace injury or illness

17. Copyright © 2008 Delmar. All rights reserved. 17 Undocumented Migrant Farm Workers Live in fear of being reported and deported –Delay seeking medical attention Live in poor, overcrowded housing Limited resources and language skills

18. Copyright © 2008 Delmar. All rights reserved. 18 Public Health Nursing Practice in Rural Communities Requires independence Develop trust Social and professional roles may overlap Positive community visibility

19. Copyright © 2008 Delmar. All rights reserved. 19 Healthy People 2010 and Primary Health Care Concepts Health care specific to rural health care needs: –Affordable –Accessible –Acceptable –Available

20. Copyright © 2008 Delmar. All rights reserved. 20 Theory Development for Rural Public Health Nursing Long and Weinert Three conceptual statements: –Rural dwellers define health primarily as ability to work –Rural dwellers are self-reliant and resist accepting help from outsiders –Help is usually sought through an informal system

21. Copyright © 2008 Delmar. All rights reserved. 21 Theory Development for Rural Public Health Nursing Denham Family Health Model –Family health influenced by interactions of household members –Involvement of family members in: Assessment Decision making Planning Effective communication

22. Copyright © 2008 Delmar. All rights reserved. 22 Theory Development for Rural Public Health Nursing Opportunities for service learning –Work with the community in a partnership Health policy in rural settings –Balanced Budget Act 1997 –Nurses should assume leadership positions, build networks, grant write, communicate with state and local officials

23. Copyright © 2008 Delmar. All rights reserved. 23 Theory Development for Rural Public Health Nursing Research in rural settings –Evidence-based research needed Efficacy and cost effectiveness of nurse managed models of care in rural settings Long-term use of pesticide

24. Copyright © 2008 Delmar. All rights reserved. 24 Theory Development for Rural Public Health Nursing Alternative research methods –Ethnographic studies –Qualitative methods