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Chapter 24

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  1. Chapter 24 Rural and Migrant Populations

  2. Rural Defined • Rural • Distribution of people across space • Metropolitan area • Nonmetropolitan area

  3. Rural Defined • Fewer than 2,500 residents • Demographics • 28 percent under age 18 • 30 percent over age 65

  4. Rural Defined • Health professional shortage areas • Medically underserved areas • Established under U.S. Public Health Services Act

  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. History of Public Health Nursing in Rural Areas • Frontier School of Midwifery (1939) • Started by Frontier Nursing Service • FNS started FNP program (1999)

  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. Federal Initiatives in Rural Health • Rural Information Center Health Service (1987) • National Advisory Committee on Rural Health and Human Service (1987)

  9. Demographics and Health Status Indicators • High poverty and unemployment rates • High percentage employers not providing health insurance • Working poor

  10. Demographics and Health Status Indicators • Disproportionate number of elderly and young • Injury • Pesticide poisoning

  11. Demographics and Health Status Indicators • Potential for abuse, family violence, neglect • Weather hazards, social isolation • Lack of public transportation

  12. Demographics and Health Status Indicators • Lack of specialty care • Higher rates of chronicity • Economic stress • Increased tobacco use

  13. Demographics and Health Status Indicators • High risk injuries • Forestry, mining, fishing, agriculture • Accidents • Trauma • Selected cancers • Respiratory diseases

  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. 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. 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. 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. Public Health Nursing Practice in Rural Communities • Requires independence • Develop trust • Social and professional roles may overlap • Positive community visibility

  19. Healthy People 2010 and Primary Health Care Concepts • Health care specific to rural health care needs: • Affordable • Accessible • Acceptable • Available

  20. Theory Developmentfor 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. Theory Developmentfor 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. 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. Theory Developmentfor 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. Theory Developmentfor Rural Public Health Nursing • Alternative research methods • Ethnographic studies • Qualitative methods