Rural community mental health nursing: a grounded theory account of sole practice

ABSTRACT:  This paper examines community mental health in rural and remote settings, characterized as sole practice. Using a grounded theory approach, the research reported here explored how meanings of health and health care are advanced within the context of rural mental health care, dominated and in the main led by nurses. Five different practice sites in rural New South Wales were involved. The study articulated a model of therapeutics that foregrounds a relationship of intense professional intimacy and trust against a context of geographical disadvantage and professional isolation. The meanings of the relationship are elaborated in terms of unusually high levels of responsibility, professional ingenuity, powerlessness and the independent and risky character of life in the bush.     

Sex differences in self‐reported anxiety in rural adolescents

An anxiety disorder affects 13 out of every 100 children. The purpose of this paper is to determine if there are differences in self‐reported anxiety between male and female rural adolescents. In total, 193 students aged 14–17 years in three western Pennsylvania rural high schools, USA, were surveyed. The majority of participants were Caucasian (86.5%, n = 167), female (53.4%, n = 103), and aged 15.57 years (SD = 0.93). The females' mean self‐reported anxiety score was higher than the males' score (P < 0.0001). The females' mean score was 25.09 (SD = 13.83; a score ≥25 may indicate the need for further evaluation for the presence of a potential anxiety disorder), while the males' mean score was 16.88 (SD = 10.81). Of interest, all the five factor (specific types of anxiety) scores were significantly different between males and females at P < 0.05. Evidence‐based implications for the mental health nurse's practice will be discussed. Anxiety screening is promoted to identify adolescents who may need mental health treatment and referrals, especially rural female adolescents.     

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service.     

Implementing Telemental Health to Improve Access to Mental Health Care in Rural Vermont

Mental health care shortages in the United States are most pronounced in rural areas. This practice-change project aimed to increase access to quality mental health care in rural areas for the treatment of depression and anxiety via telemental health delivery of care. The project yielded improvements across project aims, including an increased percent of enrolled patients from Healthcare Provider Shortage Areas; a decrease in quality measures for depression, anxiety, and disability; and increased patient satisfaction with care. The project can serve as a template for other practices wishing to increase access to mental health care in rural areas.     

Social networks and best practices in public health: the example of regional billing groups

OBJECTIVE: Rising health care costs, increased demand for clinical services, and reimbursement difficulties created a funding shortage among local health departments in the state of Kansas. This intervention established regional billing groups to provide professional support and increase third-party reimbursement. DESIGN: Through feedback sessions, billing clerks provided qualitative responses about training needs. These informed the process of establishing billing groups in each state health district. SAMPLE: All billing clerks in the state's 6 regional health districts were invited to participate, as were insurance and billing software representatives. INTERVENTION: Between April 2002 and September 2004, 6 collaborative groups were established. Billing clerks received professional support and training from peers, insurance representatives, and software providers. An interagency billing advisory team was established to coordinate training activities between groups. RESULTS: These groups have allowed local health departments to increase reimbursement revenue by 50%-75%, allowing for the provision of expanded health services to client populations. CONCLUSIONS: These methods can serve as a model for other states, particularly those with considerable rural populations or decentralized health care systems. Still, funding shortages persist, and public health billing clerks will continue to need ongoing training in the most current and effective billing methods.     

对高陵区农村儿童实施口腔健康教育的效果

目的探究对高陵区农村儿童实施口腔健康教育的效果。方法在高陵区农村区域学校抽取7~9岁儿童368名,将其根据随机数字表法分为观察组和对照组,各184名。观察组接受口腔健康教育,对照组不接受干预。比较两组儿童干预前、后口腔健康知识知晓率及口腔健康行为。结果观察组儿童干预后的口腔健康知识知晓率明显优于干预前及对照组,差异具有统计学意义(P<0.01)。观察组儿童干预后的口腔健康行为明显优于干预前及对照组,差异具有统计学意义(P<0.01)。结论对农村儿童进行口腔健康教育具有积极意义,应加大农村地区儿童的口腔健康教育力度,为儿童营造良好的口腔健康大环境。     

Rural Public Health Policy Models to Address an Evolving Environmental Asbestos Disaster

ABSTRACT The health-related dangers of asbestos exposure were recognized early in the 20th century when occupational exposure was found to be associated with excess pneumoconiosis among asbestos industry workers. Today, the epicenter for examining the public health effects and the human toll that this toxin has had on a population is located in the rural community of Libby, MT. Rurality and multideterminants of health frame both the history of asbestos-related disease and the service/policy challenges within a community dealing with chronic illness and designation as a Superfund clean-up site. Despite efforts by public health advocates to address the lingering aftermath of an environmental disaster in this community, policy gaps exist that continue to impact the population's health. The purpose of this paper is to describe the history and outcomes of asbestos exposure in a rural community and discuss 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.     

National Characteristics of Emergency Medical Services in Frontier and Remote Areas

Although much is known about EMS care in urban, suburban, and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions, and on-scene death between EMS responses in FAR and non-FAR areas. There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3–10] vs. 5 [3–8] min), scene (14 [10–20] vs. 14 [10–20] min), and transport times (11 [5.,24] vs. 12 [7,19] min). Air medical (1.51% vs. 0.42%; OR 4.15 [95% CI: 4.03–4.27]) and Advanced Life Support care (62.4% vs. 57.9%; OR 1.25 [1.24–1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs. 0.70%; OR 5.04, 95% CI: 4.97–5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25–1.30). Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.     

Quality of primary nursing care for Bedouin in Jordan

This paper presents a critique of the use of the Maximizing Access to Quality (MAQ) instrument supplemented by non-participant observation as a way of assessing the quality of nursing care in primary care clinics in the north-eastern Badia of Jordan, where populated by Bedouin. The MAQ checklist with non-participant observation of clinic care was used to assess the quality of care in four comprehensive health centres. In the four comprehensive health centres, more than half of the indicators for measuring the quality of the physical conditions were adequate. In relation to personnel, general practitioners were available, but in-service training was needed and no social workers were available. Provision of health services was optimal in three of the clinics but was less than optimal in the remotest clinic. Health education was done sporadically and continuity of care was the main challenge in provision in the four clinics. The MAQ checklist for assessing the quality of health provision in maternal and child health and reproductive services is a useful instrument to capture a snapshot of health-care provision; however, it is not suited to a rural setting.     

苯巴比妥规范治疗农村地区癫痫患者疗效观察

目的在农村地区建立可行的癫痫患者管理模式和规范化治疗。方法对沧州献县、肃宁、沧县3个农村地区,筛选出全面强直-阵挛性发作或全面强直-阵挛性发作伴有其他类型发作的活动性癫痫患者1 036例,应用苯巴比妥单药治疗,剂量在30~240 mg/d,随访2年,观察疗效及不良反应事件。有176例患者退出随访,主要原因有依从性差、疗效差、不良反应及外出。结果苯巴比妥总有效率为77.0%,前3个月无发作比例为25.9%,至第12个月无发作比例达74.1%,第24个月无发作比例达95.3%。服药前3个月药物不良反应较多见（10.1%）,随服药时间延长不良反应明显减轻。结论苯巴比妥治疗全面强直-阵挛性发作具有良好效果,安全性高。农村地区癫痫治疗现状不容乐观,需要建立有效的多部门联合管理模式。     

农村2型糖尿病患者家属健康教育干预效果研究

目的：探讨健康教育对农村2型糖尿病患者家属的认知以及家庭功能和患者服药依从性、血糖控制率的影响。 方法：将笔者所在社区内的50例农村2型糖尿病患者家属作为干预对象,建立家庭健康档案、制定个性化家属健康教育措施,经过6个月的干预,再次收集相关信息,对家属的认知和家庭功能以及患者的服药依从性、血糖控制率进行评估。 结果:家属相关疾病知识评分干预前18.33±7.87,干预后30.25±6.1,前后差异有统计学意义(P<0.005)。家庭功能情况,干预前家庭功能良好41%,中度家庭功能障碍32%,重度家庭功能障碍26%,干预后家庭功能良好60%,中度家庭功能障碍30%,重度家庭功能障碍9%,前后差异有统计学意义(P<0.005)。50例2型糖尿病患者的干预前服药依从性62%,干预后84%,前后差异有统计学意义(P<0.05)。干预前血糖控制率28%,干预后44%,前后差异无统计学意义(P>0.05)。 结论：家属健康教育可以提高2型糖尿病患者家属的认知,改善家庭功能,提高2型糖尿病患者的服药依从性,对血糖控制效果不明显。     

The role of district nurses in caring for people with mental health problems who live in rural settings

District Nurses in rural areas frequently fulfil, in some permutation, the functions of district nursing, health visiting, school nursing, and community midwifery. This complex role can bring them into contact with a wide range of mental health problems. The extent, nature and type of mental health problems, and their response to these problems, is not well documented in the literature. The findings of this qualitative study indicate that District Nurses do in fact have contact with a wide range of mental health problems. The role of District Nurses in caring for this client group is more substantial than has been previously recognized. It is suggested that this role be formally acknowledged and that systems put in place to optimize the effectiveness of District Nursing interventions.     

Roaming through Virginia with the public health nurse

Rural health nursing has long been considered a subspecialty within public health nursing, albeit one that required the nurse to be a generalist. In the excerpts of this article, Webb (1920) shares her observations as a State Supervising Nurse for the Red Cross in Virginia while traveling in rural areas of the state with the county public health nurses. Themes evident in these excerpts include the transportation issues associated with working in remote areas, as well as nursing work in the areas of maternal and child health, communicable diseases, case finding through health inspections, and health education. Additionally, there are themes specific to rural nursing, including distance and isolation, self-reliance, and development of trust among the rural population. In her 1922 book, The Evolution of Public Health Nursing, Annie M. Brainard identified many of these themes when she stated the ideal rural public health nurse needed to be a "school nurse, baby nurse, tuberculosis nurse, and a general visiting nurse", as well as tactful in dealing with "country people" who are "peculiarly independent and sensitive" (1985 edition, p. 303).