1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 34 Rural Health

2. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Historical Overview of Rural Health Trend toward urbanization Rural nursing care 1980s  Closure of rural hospitals 1990s  Evolution of rural home health care

3. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Definitions of Rural No consensus Ethnic and cultural diversity Frontier area

4. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Federal Definitions Urbanized area  Inhabited by 50,000 or more individuals Urban cluster  Inhabited by 2,500 to 50,000 people Rural area  Inhabited by < 2500 people

5. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Metropolitan Areas Contain one city with 50,000 or more people Nonmetropolitan areas Classification Economy types

6. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Rural and Frontier Values Traditionally associated with quality of life Diverse values

7. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Health status of Rural Residents Poorer health than urban counterparts Barriers to health care  Lack of transportation  Work schedule  Lack of health care providers  Distrust of health care providers

8. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Health Status of Rural Children More likely to be uninsured Decreased access to health care More likely to live in poverty

9. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Health Status of Non-metro Elderly Decreased access to health care Increased prevalence of chronic disease Difficulty managing health care system

10. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Health Status of Rural Residents Mental health Farm workers Migrant workers  Housing  Health care Native Americans and Alaska natives

11. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Typology for Health Care Needs of Communities Increased demand for elderly services  Aging counties  Retirement counties Increased demand for obstetric and pediatric services  Out-migration counties  Boom counties

12. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Factors Influencing the Rural Health Care Delivery System Health care  Availability  Accessibility  Acceptability

13. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Factors Influencing the Rural Health Care Delivery System Poverty  Basic necessities Health care is a luxury  Access to care

14. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Legislation and Programs Affecting Rural Health Rural Occupational Safety and Health Act of 1970  Provide safe working conditions  Established federal agencies Occupational Safety and Health Administration (OSHA) National Institute for Occupational Safety and Health (NIOSH)

15. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Legislation and Programs Affecting Rural Health Migrant and Seasonal Agricultural Worker Protection Act – 1983  Provides migrant and seasonal workers with rights Wage rights Working conditions Work-related conditions

16. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Legislation and Programs Affecting Rural Health Office of Rural Health Policy – 1987  Promote development of rural health clinics Rural Information Center Health Service National Rural Recruitment and Retention Network  Encourages health care providers to work in rural areas

17. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Alternatives to Improve Rural Health Care Telehealth  Uses technology to deliver health care Emergency medical services  Barriers to receiving services Rural health clinics  Underserved areas

18. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Nurse’s Role in Rural Health Nursing Rural nursing  Expert generalists  Independent role  Social & professional roles intertwined  Resourceful

19. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Professional-Community-Client Partnerships Community residents and health care providers form partnership Partnerships developed to address specific health needs Effective leadership required Broad community support is essential

20. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 34 Key Concepts Evolution of rural health care Diversity of rural populations Migrant and seasonal workers at risk for illness Access to care