Health wellness in rural and medically underserved areas
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Health & Wellness in Rural and Medically Underserved Areas. Mona M. Counts, PhD, CRNP,FANP, FAANP. Emeritus Penn State University Past President American Academy of Nurse Practitioners. RURAL Folk Culture.

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Health wellness in rural and medically underserved areas

Health & Wellness in Rural and Medically Underserved Areas


Mona m counts phd crnp fanp faanp

Mona M. Counts, PhD, CRNP,FANP, FAANP

Emeritus

Penn State University

Past President

American Academy of Nurse Practitioners


Rural folk culture

RURALFolk Culture

  • Folk culture refers to the localized lifestyle of a subsistence or otherwise inward looking culture. It is usually handed down through oral tradition and a strong sense of community, and values the "old ways" over novelty. Finally, folk culture is quite often imbued with a sense of place. If its elements are copied by, or removed to, a foreign locale, they will still carry strong connotations of their original place of creation.


Rural

Rural

  • Rural areas (also referred to as "the country", countryside) are sparsely settled places away from the influence of large cities. Such areas are distinct from more intensively settled urban and suburban areas, and also from unsettled lands such as outback, American Old West or wilderness. Inhabitants live in villages, hamlets, on farms and in other isolated houses

    Wikipedia


Healthy partnering for rural health care

Healthy Partneringfor Rural Health Care

  • Culturally Competent Care

  • Community Empowerment

  • Partners and Coalitions

  • Technology

  • Future “best practices”


Rural areas

Rural Areas

  • Agricultural character

  • Characterized by an economy based on

    • Logging

    • Mining

    • Petroleum

    • Natural gas

    • Tourism


Lifestyles in rural areas

Lifestyles in Rural Areas

  • Lifestyles in rural areas are different

  • Limited services, especially public services, are available.

  • Governmental services:

    • Police

    • Schools

    • Fire stations

    • Libraries

  • Utilities:

    • Water

    • Sewerage

    • Street lighting

    • Waste managment.

  • Public Transport.


Rural health

Rural Health

  • Rural health is the interdisciplinary study of health and health care delivery in the context of a rural environment or location

  • Population Density

  • Geographic Location

  • HPSA

  • MUA


Rural sterotype

Rural Sterotype

  • Redneck, in modern usage, predominantly refers to a particular stereotype of people who may be found in many regions of the United States or Canada. Originally limited to the Appalachians and the American South, and later the Ozarks and Rocky Mountains, this stereotype is now widespread in other states and the Canadian provinces. The word can be used either as a pejorative or as a matter of pride.

    Wikipedia


Cultural competent care

Cultural CompetentCare

APPALACHIANPATTERNS

GENESIS III

General Ethnographic Nursing Evaluation Studies in the State

Target Population Research


Findings for practice

Findings forPractice

  • Perceived needs

  • “POWER”

  • Resources

  • Community Organizations

  • Barriers


Appalachian characteristics

Hardiness

Family

Continuity

Acceptance

Spiritual

Age

Appalachian Characteristics


Appalachian characteristics1

Appalachian Characteristics

  • Self (We’ness)

  • Time

  • Commitment

  • View of Health


Economics

Strengths, Barriers & Needs

ECONOMICS

Employment

Industry


Health wellness in rural and medically underserved areas

Strengths --- Barriers

&

Needs


Rural family health patterns

Rural Family Health Patterns


Community based research

Community-Based Research

  • Barriers

    • Small populations

    • Isolated settings

    • History of past experience with researchers

    • Education (no middle)


Community based research1

Community-Based Research

  • Strategies for Success

    • Work within the context of the culture

    • Integrate “insiders” into all phases of project (Planning, Implementation, Evaluation)

    • Keep open to improving the model based on outcomes (quality improvement goals vs. end-point evaluation)


Appalachian outcomes

APPALACHIANOUTCOMES

  • Neighboring

  • Dichotomies

  • Health

  • Empowerment

  • Resolution

  • Hope


Nps your partners for health

NPsYour PartnersforHEALTH


Community empowerment f indings for practice

Community Empowerment Findings for practice

  • Value of Family and roots

  • No insurance or underinsured

  • Lack of confidence in large centers


Community empowerment f indings for practice1

Community Empowerment Findings for practice

  • Limited economic resources

  • Significance of culturally specific care

  • Consistency and continuity of care desired


Implications for practice

IMPLICATIONSforPractice

How to achieve in rural Communities

  • Integral part of community (providers and board)

  • Life long resident (family ties or proven commitment)

  • Female (in Appalachia)


Implications for practice1

IMPLICATIONSforPractice

How to achieve in rural Communities

  • Low key (accessing power)

  • Caring (Professional Involvement)

  • Perceived as knowledgeable (University)


Potential coalitions

Potential Coalitions

  • Technology

  • Integration

  • Access

  • Development

  • Quality

  • Best Practice

  • Improved Living


Primary care center of mt morris

Primary Care Center of Mt Morris

  • 6000 Patients

  • Community Owned

  • 4 Nurse Practitioners

  • 7 Personnel

  • Student Rotations

  • Partnerships


Target population focus

Target Population Focus

  • Prevention of Diabetes in High Risk Rural Families

    • Translation of research evidence - application in rural primary care

    • Design- Based on context of setting

    • Method- Culturally congruent

    • Outcomes Selection- measure health lifestyle improvements


Outcomes

Outcomes

  • Teen Pregnancy

  • Hgb A1c

  • Hypertension Goal

  • Lipid Control

  • Weight Loss

  • Tobacco Use

  • Asthma and Lead Reduction

  • Health Screenings (Health Promotion)


Outcomes1

Outcomes

  • Increased Community Competence

  • Skill Building (two edge sword)

  • Awareness of opportunity

  • Economic Additions

  • Improved quality of life

  • Adherence

  • Facilitation of prescription acquisition


Source of revenue

Source of Revenue

  • Insurance

  • Medicaid

  • Medicare

  • No Insurance

  • Grants

  • Other


Future

FUTURE


Images of appalachia

IMAGES of Appalachia


Appalachia

APPALACHIA


Appalachia1

APPALACHIA


Health wellness in rural and medically underserved areas

ENVIRONMENT


Climate

Climate


Health wellness in rural and medically underserved areas

HOME


Appalachia2

APPALACHIA


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