Healthcare delivery systems in rural areas face many challenges in meeting the needs of the communities they serve. Many rural areas rely on critical access hospitals (CAHs) to meet the health care needs of the population. Preparation of healthcare providers for entry into practice in a rural setting is essential to meet the needs of CAHs and the rural communities they serve. This chapter presents the challenges inherent to entering practice in a rural setting. It also includes a discussion of the ability of family nurse practitioners (FNPs) to fulfil the role of rural healthcare provider. Finally, the chapter describes the development of the Rural Family Nurse Practitioner Competency Inventory (RFNPCI) as a tool to hone FNP curriculum, assess FNP practice, and target continued education and professional growth.

Palliative care (PC) has come into its own as a medical specialty, primarily for adults with serious, life-threatening, and/or chronic illness. PC has been thought to be synonymous with end-of-life (EOL) care and hospice. Typically, PC is described as being an umbrella specialty, within which EOL care and hospice reside. Both PC and hospice emphasize a palliative approach to symptom management and an interprofessional, team-based, holistic model of individualized care that focuses both on the patient and his or her loved ones. This chapter reports on the state of PC in rural settings, comparing it to what is assumed to be the standard, PC in urban/suburban settings. It presents a case study that illustrates the need for home-based PC services for chronically but not yet terminally ill patients. The chapter also describes the most commonly identified challenges for rural PC, as well as strengths and recommendations for future programs.

Rural patients see themselves as self-reliant and independent. No one knows this better than a Nurse Practitioner (NP) in a rural clinic. The NP role was the vision of rural pediatric public health nurses in Colorado. These nurses were advocating for their patients and wanted to provide more services while performing home visits in rural areas. NPs have been steadily increasing in number and are working to break down barriers to a full scope-of-practice. Evidence supports full scope NP practice and the ability of advanced practice nurses to lead the way in formulating new and better primary care models. This chapter provides insight into the contributions of NPs as healthcare providers in the rural setting and includes a brief background on the NP role, a section on access to healthcare, and a look at the unique patient-centered care provided by NPs.

In recent years, the rural hospital closure crisis has escalated with 2015 closure rates six times higher than in 2010. The National Rural Health Association (2020) reported that currently one in three rural hospitals may be at risk of closure. Much of the blame for closures has long been attributed to factors external to rural communities, such as reduced Medicare reimbursement, a declining rural economy, provider shortages, and being located in states that did not expand Medicaid under the Affordable Care Act. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. This chapter focuses on the Acceptability Scale.

Rural nursing varies greatly based upon geography and cultural values; however, the attitudes and attributes of rural nurses remain constant. Many registered nurses (RNs) have grown up in the area with family ties that result in their decision to stay and work in rural settings. However, there is a shortage of RNs in these healthcare settings. Reasons for shortages in rural settings include lack of educational opportunities and resources; lack of diversity, social support and cultural congruence; feelings of isolation, and policies that are inconsistent to support rural healthcare. Collaborative initiatives in education and institutional support can enhance the professional characteristics of rural nurses. This chapter utilizes case studies to illustrate strategies to build capacity while offering ideas for collaborative education models that address recruitment, retention, and workforce development of rural nursing.

Partnerships between community members and academic investigators are integral to the success of human studies in rural communities. Research to explore the holistic impact of a rural, slow-motion, technological environmental disaster relies on questions raised and examined by community members living with the direct or indirect social, emotional, physical, or economic effects of exposure. In October 2005, clinicians from the Center for Asbestos Related Disease (CARD) contacted Montana State University (MSU) nurse researchers and queried the possibility of collaborating with MSU on a specific project. The CARD clinic is devoted to healthcare, outreach, and research to benefit all people impacted by exposure to Libby amphibole asbestos. This chapter reports the development of the community-generated Rural Participatory Research Model (RPRM) that emerged from results of the studies conducted in Libby, Montana. The RPRM was developed to help guide researchers working with rural communities experiencing the ongoing effects of an environmental disaster.

Being known and named, i.e. lack of anonymity, is an ever-present reality of daily life in rural communities and commonly described in rural literature. Rural nursing investigators identify lack of anonymity as an aspect of rural life and experienced by rural nurses in their personal and professional lives. Through the experience of lack of anonymity, rural nurses are uniquely placed to impact health and well-being of rural dwellers and their communities. This chapter takes a 21st-century view by beginning to reconsider the thinking on lack of anonymity. It begins by defining and describing the related concepts and explores a model of how the concepts may be associated with lack of anonymity. Gaining an understanding of the concepts is necessary as one explores how the concepts affect rural nursing practice. The chapter ends with case studies and questions that highlight the different concepts in hypothetical situations experienced by a rural nurse.

Telehealth nursing, also known as telenursing, involves the use of telecommunications and other technologies such as videoconferencing for sharing information and providing patient care, education, public health, and administrative services over distances. Changes in healthcare policy, including reimbursement structures can create uncertainty and increase risk for widening gaps in health among rural and frontier populations. Telehealth programs have been designed to address these and other rural health disparities by increasing access and improving safety and quality of care, as well as reducing healthcare costs. This chapter includes discussion on the historic underpinnings of telehealth nursing, description of two telehealth patient care scenarios (institution-to-institution and direct-to-consumer) in nursing practice, and concludes with discussion on the implications of telehealth in nursing, including considerations for implementing telehealth patient care services programs and the current scope of telehealth nursing practice.

In the United States (U.S.), an estimated 2.4 million persons are migrant and seasonal farmworkers (MSFWs). International migration is an important part of global social and economic development. Immigrant workers contribute to the economies of their home countries via remittances, or money sent back to home countries, which totaled $689 billion in 2018. They also develop new skills that are potentially used upon their return. In addition, migrants provide needed labor and skills to the host countries. However, migration is a complex issue that presents challenges in ensuring equal protection of migrant workers, particularly in relation to occupational health. This chapter discusses the occupational safety and health of migrant and seasonal farmworkers, a group of immigrant laborers who have shouldered higher occupational health risks than the native-born population and who require specialized nursing skills to meet their needs.