Rural and Remote Health Flashcards
Rural and Remote Nursing
- Approximately 95% of Canada’s land mass can be considered rural and remote.
- Longstanding debate exists about the definition of geographic communities such as
rural, remote, Northern and isolated. - Technical & social are both recommended ways to define rural
Technical Approaches to Defining Rural
- Locators or geographic regions
- Example: location of hospitals, roads, or specific political areas (province or county)
- Statistics Canada define rural by emphasizing
- Population size
- Population density
- Settlement or labour market contexts
- The Canadian Institute for Health Information (CIHI) includes:
- Distance to + relationship with urban areas
Census “Rural” definition
Refers to an area with less than 1,000 inhabitants and a population density less than 400 people per square kilometre
Social Approaches to Defining Rural
- Refers to the nature of the rural community, and specific services that are normally associated with a larger population
Example: specific restaurants or stores - Includes healthcare delivery, including retention and recruitment of health professionals
Example: Registered Nurses
First Nations and Inuit Health Branch (FNIHB): The degrees of rurality
- Non-isolated community: Communities with road access of less than 90km to physician services
- Semi-isolated community: Communities with road access greater than 90km to physician services
- Isolated community: Communities with good telephone service, scheduled air transportation flights, but no road access
- This model highlights the importance of access to services
- Remote, isolated community: Communities with no scheduled air flights, minimal telephone or radio access, and no road access
*Considers transportation and communication limitations between what is and isn’t isolated
Rural Health System Model
- Many factors affect health status, health needs, system use and health system performance
- The model has four uses
- The model is divided into 3 parts
o Geography
o Population
o Health System and Community Context
The Resource Base
- Influences the health status of those who live in the community
- In rural, remote and isolated communities where there is reliance on industries such as
oil, gas, logging, mining, fishing, and agriculture - Many risks such as occupational illness and diseases and various hazards (biological, chemical, ergonomic, physical)
Rural Determinants of Health
- Disease prevention and health promotion occurs through public health initiatives
- It is unclear whether conventional strategies developed in urban programs are effective
- CHN’s can apply three levels of prevention:
- Primary (reducing risk for a potential problem) Ex: Providing health education for individuals in rural and remote communicates to maintain lower rates of cause-specific cancers
- Secondary (providing screening and early detection and treatment) Ex: Developing and implementing diabetes screening programs
- Tertiary (maintaining health) Ex: monitoring the effectiveness of treatment for circulatory and respiratory diseases
Diversity in Rural and Remote Areas
- Consider religious groups like Amish, Hutterites, Mennonites, and Conservative Dutch groups
- CHN’s must assess the communities within which they work to determine diversity, strengths, and needs that arise from diversity
- Immigration also adds to diversity in rural community populations and challenges the delivery of culturally sensitive health care services
- CHN’s must conduct community assessments that acknowledge religious, socio- historical, and policy contexts within which individuals, families and groups are located
Cultural Safety Protocol; 5 Principles
- Protocols: respect for cultural forms of engagement
- Personal knowledge: understanding one’s own cultural identity
- Process: engaging in mutual learning
- Positive purpose: ensuring the process yields the right outcome for the client
- Partnership: Promoting collaborative practice
Health Inequities in R&R Communities
- Faced with many challenges
- Access to technologies
- Poor water quality
- Food insecurity
- Fewer health care delivery options; people must travel longer distances for services
- Unreliable access to internet; increasing social isolation
Health Informatics
- Represents bringing together data, information, knowledge and technologies to support decision making by patients, consumers, physicians, nurses and stakeholders
- Telehealth allows for health education on prenatal teaching, or online support programs for those with chronic illness
Other Telehealth Services in Rural Canada
- Preoperative assessments and postoperative care for surgery
- Management of fractures and dislocations
- Assistance with procedures and surgeries from more experienced colleagues
- Remote hemodialysis rounds
- Tele-oncology
- POC Ultrasound
- Speech pathology
- Dietary consult
- Physiotherapy consult
- Professional development + supervising learners
Water Quality; The CNA supports nurses to:
o Assess community hazards
o Advocate for change
o Engage in interdisciplinary collaboration to address hazards
o Decrease exposure
o Reduce harm to people and the environment
Water Quality
- Access to potable water is everyone’s fundamental right as acknowledged by the United Nations
- Inadequate water resources also make us more vulnerable to infectious disease due to poor sanitation
The Walkerton tragedy of May 2000
o 7 people died of e.coli from contaminated water
o 2300 people were ill
o Public health officials felt the issue was probably preventable
Boil Water Advisories (BWA)
- According to Water Canada, 87% of Boil Water Advisories (BWA) issued in Canada in 2019 were due to problems with the equipment and processes used to treat, store, and distribute potable water
- Long term BWA continue to exist
- As of Oct. 2021 Newfoundland and Labrador reported 161 BWA’s that had been in place for over one year in over 124 communities
During a BWA, water should not be used for…
o Drinking
o Making infant formula or juices
o Cooking
o Making ice
o Washing produce
o Brushing teeth
o Bathing depends on age but should avoid the face
o Giving to your pets
How does water become contaminated?
o Fertilizers, pesticides, other chemicals applied to the land near water
o Concentrated feeding operations (industrial animal farms)
o Manufacturing operations
o Sewer over flows
o Storm water
o Wildlife
o Rocks and soil (natural sources of arsenic, radon, uranium)
o Cracks in water pipes or other problems in distribution systems
Contaminated water/poor sanitation is linked to which diseases?
- Cholera
- Dysentery
- Hep A
- Typhoid
- Polio
Contaminated water may include the following chemicals..
- Arsenic (decreases production of red + white blood cells)
- Copper
- Lead
- Nitrate (affects oxygen carrying capacity, infants 6months and under are high
risk) - Radon (second leading cause of lung cancer)
Water Quality - Indigenous Communities
-In 1876 the federal government introduced the Indian Act
- Government was responsible for building and upkeep of infrastructure on First Nation reserves including drinking water treatment plants, and pipes delivering water to homes and buildings
- Limit which people it has financial and legal responsibilities to for clean drinking water
- Pledges to end BWA only cover long-term drinking water advisories for systems serving 5+ homes on serves aka “public systems”
- Since then, the federal government has chronically underfunded First Nation reserves
- Forced relocation of Indigenous peoples onto reserves is also a factor -> moved people away from traditional territories
- Government inaction on pollution and industrial accidents caused corporations to harm water sources
- In 2015 the government committed ending boil water advisories by 2021, this deadline has passed
Impetigo
- Bacterial infection of the skin: Group A Streptococcus and Staphylococcus aureus
- Most common in young children 2-5 y/o
- Very contagious
- Spread through direct contact with sores or fluids from the sores
- Usually takes 10 days for symptom onset
- Typically mild
- Common around nose/mouth or on the arms/legs
- Symptoms: red, itchy sores that break open and leak serous or purulent fluid for
several days. Will become “crusty honey-coloured scabs prior to healing - Management: topical or oral antibiotics, hand hygiene, excellent personal hygiene,
washing clothes, linens and towels daily when infected - Complications: Kidney problems, rheumatic fever
Cholera
- Since mid 2021, the world is facing it’s 7th cholera pandemic
- Acute diarrheal infection
- Caused by the ingestion of food or water contaminated with Vibrio cholerae
- Short incubation period 12 hours - 5 days
- Most people experience mild-moderate symptoms
- 20% of ill persons will develop severe dehydration and are at risk of death
