RURAL HEALTH

Question 1

Define:

Rural Health

Answer 1

difficult to define d/t range of different definitions
* population of less than 1000 people
* more than 30% of people commute to an urban area for work
* less than 150 people per square km
* Postal code has second digit 0 indicating there are no mail carriers

23-38% of Canadians live in rural settings depending on what definition is used

Question 2

Describe:

Rural Health Issues

Answer 2

• rural areas are at general health disadvantage
• higher negative lifestyle choices, lower physical activity
• lower life expectancy rates
• higher mortality rates especially for MVA
• lower cancer mortality rates
• respiratory disease mortality risks were generally significantly higher in rural areas
• higher incidence of diabetes
• higher prevalence of arthritis/rheumatism than those in urban areas

Question 3

List

Recommendations to improve rural health outcomes

Answer 3

• health initiatives should focus on occupational health and safety issues
• improving rural road conditions and road safety awareness
• develop variations of activities in rural areas to takle prevalence of lifestyle influencing health risks such as smoking, low consumption of fruit and veg, low physical activity, and obesity - what works for urban may not work for rural

Question 4

T/F

Rural communities are heterogenous and there is great variety and difference between different communities - makes health implementation difficult to do

Answer 4

True

Question 5

T/F

Rural communities are heterogenous and there is great variety and difference between different communities - makes health implementation difficult to do

Answer 5

True

Question 6

T/F

There are little differences between sexes in rural areas

Answer 6

False

Question 7

Location and Demographics of Rural Nurses

Answer 7

• territories
• female

Question 8

Name the work settings for rural RNs in Canada

Answer 8

1. hospitals
2. community
3. nursing home/LTC
4. other

Question 9

What is the scope of RN practice in Rural Canada?

Answer 9

• a distinct characteristic of rural nursing is its broad scope of practice
• closely related to the rural context of each community and limited access to healthcare resources

Question 10

Review (greatest to least)

Reason for RNs to work in their primary rural communities

Answer 10

1. interest in the practice setting
2. location of the community
3. lifestyle
4. income
5. family or friends
6. flexibility of the work
7. benefits
8. advanced practice opportunities
9. spouse employment/transfer
10. career advancement

Question 11

Representation of Indigenous RNs

Answer 11

underrepresented in rural and remote areas, especially in northern areas where the proportion of Indigenous peoples is higher

Question 12

Satisfaction of RNs in Rural Canada

Answer 12

• satisfied with both where they work and where they live
• may suggest resiliency against the unique challenges of living and working rural
• concern that many RNs expereine and witness emotional abuse, physical violence, and threats of violence

Question 13

Describe

Rural RN’s Perception of Scope

Answer 13

• majority of rural RNs in Canada report working within scope of practice
• 10% perceived themselves as working above their scope of practice

Question 14

List:

Guiding principles for a framework for nursing practice in rural and remote canada

Answer 14

• holistic, patient-centered care
• community empowerment
• philosophy of primary health care
• cooperation and collaboration
• the influence of the determinants of health
• the professional practice of all regulated nurses in Canada

Question 15

Review:

Rural-Urban Disparities

Answer 15

• mortality form innjury and poisoning substantially higher in rural Canada
• higher proportions of rural and remote residents reported fair or poor health status
• greater proportions of rural Canadians report being overweight compared to urban counterparts
• men living in the most remote parts of Canada are at increased risk of suicide
• level of education is a major correlate to variation in earnings between rural and urban workers
• income earnings of rural people are 25% lower than those in large metropolitan areas
• many Indigenous people live on reserves
• labor participation rate for Indigenous people in urban centres is higher than Indigenous poeple on reserve
• less Indigenous peoples on-reserve receive post-secondary education compared to indigenous people off reserve –>indigenous people in urban centres less likely to receive post-secondary education than non-Indigenous Canadians

Question 16

Describe

Rural and Remote Nursing Interactions

Answer 16

• understanding rural and northern contexts
• being part of a community
• care at centre of practice
• interprofessional, collaborative teamwork
• complex, generalist role
• multiple skills, expanded practice
• being versatile
• being prepared
• culturally sensitive care
• maintaining confidentiality
• blurring of professional boundaries

Question 17

Kim English:

Issues with Rurality

Answer 17

• Access
• urban centric approaches to planning and decision making
• urban centric approaches to finances
• urban centric approaches to nursing practice
• lack of political will
• lack of value
• 20+ years of lack of attention to rural and remote health infrastructure

Question 18

Kim English

Examples of lack of access in rural communities

Answer 18

• closure of health services
• closure of other services like banks
• greyhound services closing - smaller communities cannot use these transportation services to access urban areas for medical services

Question 19

Kim English:

Impact of Geography on Health

Answer 19

• delayed diagnosis
• delayed treatment
• medical adherance or access
• access to food to sustain nutritional diets
• trauma care - no access in remote and rural areas themselves, but sometimes even helicopters and other services cannot access in circumstances of bad weather

Question 20

Kim English:

Impact of Geography on Health

Answer 20

• delayed diagnosis
• delayed treatment
• medical adherance or access
• access to food to sustain nutritional diets
• trauma care - no access in remote and rural areas themselves, but sometimes even helicopters and other services cannot access in circumstances of bad weather

Question 21

Kim English:

Health Concerns in Rural Populations

Answer 21

1. agricultural - dust, debris, farming injuries, work load (unlikely to seek care during harvest season)
2. tourism related health issues
3. maternal/child care - no doctors, liability issues, hard to maintain competent care when there is only one delivery a year in the region
4. chronic diseases - management

Question 22

Kim English

Commonalities in Health Issues between Urban and Remote

Answer 22

• mental health and addictions - cannot have safe consumption sites in rural and remote areas because there are no resources
• HIV - less access to resources and prevention methods and education
• LGBTQ+ - issues with stigma and discrimination; no acceptance
• homelessness and less than adequately housed - looks different, people living in barns, sheds, couch surfing
• intimate partner violence - harder for victims to seek help, limited transportation and communication

Question 23

Kim English:

How to Address Rural Health Issues

Answer 23

Rural Road Map - report card on access to health care in rural Canada

Question 24

Kim English

T/F: Nurses are leaders and innovators in rural and remote practice

Answer 24

True

Question 25

Kim English:

How has the nursing shortage impacted rural and remote Canada?

Answer 25

• in summer 2022, 11 nursing stations closed in rural and remote areas
• hospital ERs had to close especially overnight from staffing shortages