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Copyright © 2008 Delmar. All rights reserved.
Chapter 24
Rural and Migrant Populations
Copyright © 2008 Delmar. All rights reserved.
2
Rural Defined
• Rural – Distribution of people across space
• Metropolitan area• Nonmetropolitan area
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3
Rural Defined
• Fewer than 2,500 residents
• Demographics– 28 percent under age 18– 30 percent over age 65
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4
Rural Defined
• Health professional shortage areas
• Medically underserved areas– Established under U.S. Public Health
Services Act
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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
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6
History of Public Health Nursing in Rural Areas
• Frontier School of Midwifery (1939)– Started by Frontier Nursing Service
• FNS started FNP program (1999)
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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)
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8
Federal Initiatives in Rural Health
• Rural Information Center Health Service (1987)
• National Advisory Committee on Rural Health and Human Service (1987)
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9
Demographics and Health Status Indicators
• High poverty and unemployment rates
• High percentage employers not providing health insurance– Working poor
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Demographics and Health Status Indicators
• Disproportionate number of elderly and young
• Injury
• Pesticide poisoning
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Demographics and Health Status Indicators
• Potential for abuse, family violence, neglect
• Weather hazards, social isolation
• Lack of public transportation
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12
Demographics and Health Status Indicators
• Lack of specialty care
• Higher rates of chronicity
• Economic stress
• Increased tobacco use
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Demographics and Health Status Indicators
• High risk injuries– Forestry, mining, fishing, agriculture
• Accidents• Trauma• Selected cancers • Respiratory diseases
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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
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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
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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
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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
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18
Public Health Nursing Practice in Rural Communities
• Requires independence
• Develop trust
• Social and professional roles may overlap
• Positive community visibility
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Healthy People 2010 and Primary Health Care Concepts
• Health care specific to rural health care needs: – Affordable – Accessible – Acceptable– Available
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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
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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
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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
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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
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24
Theory Developmentfor Rural Public Health Nursing
• Alternative research methods– Ethnographic studies– Qualitative methods