A proposed rural healthcare ethics agenda.

The unique context of the rural setting provides special challenges to furnishing ethical healthcare to its approximately 62 million inhabitants. Although rural communities are widely diverse, most have the following common features: limited economic resources, shared values, reduced health status, limited availability of and accessibility to healthcare services, overlapping professional-patient relationships and care giver stress. These rural features shape common healthcare ethical issues, including threats to confidentiality, boundary issues, professional-patient relationship and allocation of resources. To date, there exists a limited focus on rural healthcare ethics shown by the scarcity of rural healthcare ethics literature, rural ethics committees, rural focused ethics training and research on rural ethics issues. An interdisciplinary group of rural healthcare ethicists with backgrounds in medicine, nursing and philosophy was convened to explore the need for a rural healthcare ethics agenda. At the meeting, the Coalition for Rural Health Care Ethics agreed to a definition of rural healthcare ethics and a broad-ranging rural ethics agenda with the ultimate goal of enhancing the quality of patient care in rural America. The proposed agenda calls for increasing awareness and understanding of rural healthcare ethics through the development of evidence--informed, rural-attuned research, scholarship and education in collaboration with rural healthcare professionals, healthcare institutions and the diverse rural population.

Critical access hospitals: rural nursing issues.

Critical Access Hospitals (CAHs) are a recent federal initiative to address the fiscal concerns of small rural hospitals and improve access to healthcare for rural residents. A national effort exists to examine the outcomes of this federal initiative, but there is a paucity of information about nursing in CAHs. This pilot study, using survey techniques, examined rural nurses' perceptions of CAH conversion. The authors discuss the authorizing legislation, Medicare Rural Hospital Flexibility Program (MRHFP), and highlight survey findings on nurses' perceptions about hospitals that converted to CAH status. The information can be used by nursing administrators and educators to prepare nurses to work in CAHs that are located in more remote areas of the United States.

Thinking about a mobile health unit to deliver services? Things to consider before buying.

Purchasing a mobile unit to deliver health-care services can be an expensive undertaking for anyone interested in pursuing this option. Yet, little information is found in the literature on planning or designing such vehicles. A set of guidelines could help administrators to make better decisions regarding this approach for delivering healthcare. This article focuses on mobile health units (MHU). It provides a synthesis of the literature in addition to information from written and oral correspondence with the chief executive officers (CEO) of firms that manufacture MHU. On-site visits to agencies using an MHU were made by one of the authors (DM) to glean their perspective. The combined sources led to the development of guidelines and checklists that can assist administrators in planning the function, design and operation of an MHU to deliver health-care services to remote rural sites.

Factors to consider when buying a mobile health unit.

Purchasing a mobile unit to deliver healthcare services can be an expensive undertaking, and there is little information in the literature on planning or designing these vehicles. The authors discuss guidelines to help nurse administrators make better decisions regarding the purchase of mobile health units (MHUs). The guidelines resulted from a synthesis of the literature, correspondence with the chief executive officers of firms that manufacture MHUs, and onsite visits to agencies with an MHU.

Rural nursing in the United States: where do we stand as we enter a new millennium?

Approximately one-fourth of all Americans live in rural communities; and, of the 50 States, 31 have more than 60% of their counties designated as rural. No matter what indicator is used, United States residents in non-metropolitan areas have less than metropolitan counterparts (e.g. per capita income, health status, access to care, level of education and employment opportunities) and are more likely to need help from human services and health professionals. Additionally, rural people often must confront unique obstacles not experienced by most urban residents to access those services. As nurses live and work in rural communities they, too, must be aware of and contend with similar factors in their practice settings. In some ways rural nursing practice has changed dramatically over the last decade but in other ways things remain much the same. This article will examine common nursing issues associated with caring for clients in a rural environment. The information in this article is based on a review of the literature and the author's personal and professional nursing experiences.

Health issues of women in rural environments: an overview.

Significant attention has been devoted to the plight of rural residents and their health care systems in the past decade. The literature offers general information about rural environments, but little has been written about the many rural subgroups living across the 50 states. This article presents a profile of America's rural women and discusses the impact of economic, social, geographic, and cultural factors on their health. It is based on a review of the literature and the author's decades of personal and professional experiences in rural communities. The information can help physicians to better understand the medical concerns of the rural women they may encounter in their practices.

Implementing a rural nursing course.

Southern Alberta is essentially a rural Canadian province and therefore an ideal setting for offering a rural-focused nursing course. Considering the need for professional nurse preparation with a rural focus, three schools of nursing in the Province collaborated to launch their first rural nursing course. The authors elaborate on the process of developing the course, then establishing partnerships with rural communities to provide opportunities for a nursing practicum.

Case management: considerations for coordinating quality services in rural communities.

Case management is a growing phenomenon, being implemented across the continuum of care, employing a variety of models and approaches, and appearing in a spectrum of geographic locations. Implementing case management in rural communities involves unique dimensions. Consideration of these dimensions is critical to effective provision of quality health care services through case management.

Empowering initiatives to improve a community's health status.

The rapid growth of managed care in this country has contributed to major and ongoing changes that affect how consumers receive care and how providers deliver it. No longer are the terms managed care and capitation limited to the vernacular of policy developers and fiduciary entities. Consumers quickly are becoming informed, and this is leading to greater regulation of the managed care industry. Managed care, too, is evolving to another level as communities of consumers find that their health maintenance plans are not what they expected, needed, or desired. Empowered consumers are assuming the driver's seat and negotiating changes in services provided to them. To counter the power of well-organized managed care entities, partnerships comprising concerned consumers are rapidly springing up across the 50 states. They are starting to hold managed care organizations accountable, demanding information about the health outcomes of enrollees in relation to costs. The article examines partnerships that are using the data-driven community health assessment process to improve a community's health and ensure that providers deliver quality services that are appropriate for those consumers.

Partners in distance learning. Project outreach.

Distance learning refers to any educational experience in which the instructor (teacher) is separated from the student (learner) by geographic distance. Partnerships are being established between institutions of higher education and healthcare organizations to achieve a mutual goal, that of educating employees to work in a rapidly changing workplace environment. The authors describe one such partnership and the common issues confronted by both the academic and service institutions in implementing an outreach education program. The authors propose that these partnerships can be effective in implementing distance learning programs that meet the ongoing educational needs of nurses living and working in rural and underserved environments.

Harnessing the chaos in health care reform with provider-community partnerships.

Within a context of national chaos as a reformed health care system is being forged, providers and consumers of care alike are expressing concern about the appropriateness of services. Particularly concerned are rural and other medically underserved populations. Provider-community partnerships are an effective model to develop a continuum of care that is of high quality and meshes with local preferences. The article describes the characteristics of a competent and empowered community. It also presents strategies to help nurses work with populations to achieve this goal as a way to develop, market, manage, and evaluate community-specific health care programs.

Ethnocultural sensitivity and measurement of consumer satisfaction.

Stemming from the diversity in the U.S. population, ethnocultural factors no longer can be ignored when defining and assessing consumer satisfaction. Likewise, there is a critical need for process models that consider consumer heterogeneity. Continuous quality improvement (CQI) programs must look beyond whether or not services are accessible and cost-effective. The processes must also measure if services are acceptable and appropriate for a target population. This article describes how the discipline of anthropology can provide useful tools to obtain critically needed ethnocultural information.

Women in rural environments: considerations for holistic nurses.

Rural women deserve particular attention as they experience different kinds of stressors than urban counterparts. This article will discuss health care delivery issues in rural environments that should be considered by holistic nurses when providing care to this target population.

When your client lives in a rural area. Part I: Rural health care delivery issues.

In the past 2 years there has been increased emphasis on health care delivery concerns in rural environments. Research monies also target the health care needs of vulnerable populations living in areas with a shortage of health professionals; many of these populations are located in rural areas. There is, however, a paucity of information about populations and mental health nursing in rural environment. Part I of this two-part article summarizes pertinent definitions and characteristics of rural environments. The health care delivery system in rural settings is considered within a framework of availability, accessibility, and acceptability of services. Traditional belief systems are highlighted, and the impact of these on health care-seeking behaviors of rural people are discussed.

When your client lives in a rural area. Part II: Rural professional practice--considerations for nurses providing mental health care.

Part I of this two-part article examined the rural health care delivery system within the framework of availability, accessibility, and acceptability of services. Traditional rural values were explored in relation to ruralities' health care-seeking behaviors, specifically mental health care. Part II highlights the opportunities and challenges of rural professional practice, particularly as they apply to nurses caring for those with emotional problems who need mental health services. Strategies are suggested to enhance the continuum of care for clients who live in environments with sparse resources.

Implementing primary prevention programs for adolescents in rural environments.

Lifestyle behaviors generally are established during adolescence and these habits can increase or decrease a person's chance for a healthful and productive life. Thus, it is important that primary prevention and health promotion begin during those early years. A number of deterrents to the use of health promoting programs are identified but for rural residents there may be other barriers associated with demographic, social, geographic, cultural, economic, educational and political factors. Those environmental factors must be considered when planning, implementing and evaluating programs. In turn, provider-community partnerships are an effective strategy to provide services in rural communities within the constraints of limited resources.