Rural and Migrant Health

Week 8 lecture and discussion questions

Population Affected by Disabilities.

Rural and Migrant Health

Review the attached PowerPoint presentations. Once done, answer the following questions.

Mention and discuss the differentiation between the medical model and social construct definitions of disability.
Identify and discuss selected health care and social issues that influence the ability of people with disabilities to live and thrive in the community.
Mention and discuss the characteristics of rural community health nursing practice.
Mention and describe the features of the health care system and population characteristics common to rural aggregates.
As stated in the syllabus present your assignment in an APA format word document, APA required A minimum of 2 evidence-based references (besides the class textbook) no older than 5 years must be used.

A minimum of 800 words is required and not exceeding 1,000 words (excluding the first and reference page). Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

  • Chapter 23

    Rural and Migrant Health

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

    Rural Populations

    The largest rural population in history of United States is now.

    75% of counties are classified as rural; they contain only 20% of the U.S. population

    Number/size of rural counties are highest …

    in the South (35%)

    in the Midwest and West (23%)

    in the Northeast (19%)

    Census data

    20% of nation’s children under 18

    15% of nation’s elderly

    More than 50% of nation’s poor

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Populations (Cont.)

    Economic base is shifting

    Agriculture is the “food and fiber system”

    All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included

    Poverty in rural areas greater than in urban areas

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Populations (Cont.)

    Poverty continues to be greater in rural America than in urban areas.

    Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas.

    Greater diversity among residents: a country of immigrants historically and today.

    Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Health Disparities Among Rural Americans

    Only 10% of U.S. physicians practice in rural areas

    Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings)

    More often assess their health as fair or poor

    More disability days resulting from acute conditions

    More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates

    Higher number of unintentional injuries

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Defining Rural Populations

    Population size

    Rural = towns with population of less than 2500 or in open country [farm/nonfarm]

    Density

    Rural = fewer than 45 persons per square mile

    Frontier = less than 6 people per square mile

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Defining Rural Populations (Cont.)

    The Rural-Urban Continuum uses population and adjacency to metropolitan areas

    Core Based Statistical Areas (CBSAs)

    Metropolitan areas = county with at least one urbanized area of 50,000 or more people

    Micropolitan area = area contains a cluster of 10,000 to 50,000 persons

    Outside CBSAs = noncare areas

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Describing Rural Health and Populations

    Differ in complex geographical, social, and economic areas

    Disparities include key indicators of health:

    Employment

    Income

    Education

    Health insurance

    Mortality

    Morbidity

    Access to care

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Health Disparities: Context and Composition

    Context: characteristics of places of residence

    Geography, environment, political, social, and economic institutions

    Composition: collective health effects that result from a concentration of persons with certain characteristics

    Age, education, income, ethnicity, and health behaviors

    – Braveman (2010)

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Context: Health Disparities Related to Place

    A downward spiral may exist:

    people leave  services are lost  tax base becomes insufficient  fewer services are provided  long distances to get health care  jobs become scarce and more people leave  the cycle continues

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Context: Health Disparities Related to Place (Cont.)

    Access to health care (#1 priority)

    Fewer primary care physicians

    General health services lacking

    Health insurance coverage …

    Varies according to race and ethnicity; age and residence (rural or urban)

    Influences health patterns

    May create financial barriers to health care

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Composition: Health Disparities Related to Persons

    Income and Poverty

    One of the most important indicators of the health and well-being of all Americans, regardless of where they live.

    Regional differences—highest in the South

    Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites

    Family composition—female-headed families have highest rates

    Children—among the poorest citizens in rural America

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Composition: Health Disparities Related to Persons (Cont.)

    Health risk, injury, and death

    Higher rates of obesity, smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents; lower rates of seat belt use

    Risk factors

    Age, education, gender, race, ethnicity, language, and culture

    Education and employment

    Occupational health risks

    Perceptions of health (gender, race, ethnicity)

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Agricultural Workers

    Accidents and injuries caused by:

    Environmental conditions

    Geographic isolation and working alone

    Use of agricultural machinery

    Delayed access to emergency or trauma care

    Acute and chronic illnesses:

    Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss, hypertension

    Chemical exposure (pesticides, herbicides, etc.)

    Secondary conditions related to demanding farm work

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Migrant and Seasonal Farm Workers (MSFW)

    Health Disparities

    Poorest health and the least access

    Low income and migratory status

    Cultural, linguistic, economic, and mobility barriers

    Minimal or no preventive care

    Mobile clinic sites form a central link to health services

    Migrant Health Program (MHP) bases services on enumeration of MSFW

    Migrant and Seasonal Farm Worker Enumeration Profile Study (MSFWEPS) (2000)

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    “Thinking Upstream” Concepts applied to Rural Health

    Attack community-based problems at their roots

    Emphasize the “doing” aspects of health

    Maximize the use of informal networks

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Health Care Delivery System

    Health care provider shortages

    Rural shortages likely to become worse

    Need to “grow their own”

    Telemedicine

    Cost-effective alternative to face-to-face care

    Telehealth includes telephones, fax machines, email, and remote monitoring

    Telemedicine permits two-way, real-time, interactive communication between patient and provider

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Health Care Delivery System (Cont.)

    Managed care in the rural environment

    Possible benefits:

    Potential to lower primary care costs

    Improve the quality of care

    Help stabilize the local rural health care system

    Risks

    Probable high start-up and administrative costs

    Volatile effect of large, urban-based, for-profit managed care companies

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Community-Based Care

    A myriad of services provided outside the walls of an institution

    Home health and hospice care, occupation health programs, community mental health programs, ambulatory care services, school health programs, faith-based care, elder services (adult day care)

    Community participation in decisions about health care services

    Focus on all three levels of prevention

    An understanding that the hospital is no longer the exclusive health care provider

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Home Care and Hospice

    Nurse case management and development of local resources

    Often hospital based in rural areas

    Use county extension services as a bridge for outreach services

    Improve home care for these patients and provide support for their families

    A partnership between the public health nurse and county extension service could provide support, as well as information groups and caregiving classes, for the important informal provider network.

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Faith Communities and Parish Nursing

    A strong sense of community, family life, and religious faith

    Integrating nursing expertise and faith-based knowledge to provide holistic care to members of congregations

    Involved in case management and coordination of services

    Collaboration with other organizations to extend limited rural community health resources

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Informal Care Systems

    Evolve from self-reliance and self-help traits of rural residents

    Include people who have assumed the role of caregiver based on their individual qualities, life situations, or social roles

    Provide direct help, advice, or information

    Need to identify and combine informal services with formal systems

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Public Health Departments

    Public health nurses are often the core providers of public health services in rural areas.

    Collaboration of services is key—need to develop partnerships with other heath provider agencies.

    Environmental health, maternal and child health, and communicable disease control are the three highest-priority programs.

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Mental Health Care

    Lack of specialized mental health providers in rural areas.

    Most services provided by primary care providers without adequate preparation or support.

    Perceived stigma prevents individuals from seeking mental health services.

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Emergency Services

    Getting patients from the place of injury to the trauma center within the “golden hour” is frequently not possible because of distance, terrain, climatic conditions, and communication methods.

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Emergency Services (Cont.)

    Challenges faced by rural EMS systems

    Shortage of volunteers and lower levels of training

    Training curricula that often do not reflect rural hazards (e.g., farm equipment trauma)

    Lack of guidance from physicians

    Lack of physician training and orientation to EMS

    Also contributing to difficult public access for emergency care:

    Low population density

    Large, isolated, or inaccessible areas

    Sever weather

    Poor roads

    Lower density of telephone/communication methods

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Emergency Preparedness in Rural Communities

    Challenges in rural areas:

    Resource limitation

    Human, financial, and social capital

    Separation and remoteness

    Longer response times

    Low population density

    Impacts funding

    Communication

    Warning systems often absent or neglected in remote areas; burden on individuals

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Legislation and Programs Affecting Rural Public Health

    Programs that augment health care facilities and services

    Community Health Centers (CHC) program

    Migrant Health Clinic (MHC) program and the Migrant Health Program (MHP)

    Medicare’s Rural Hospital Flexibility (RHF) grant program

    Primary care cooperative agreements

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Community Health Nursing

    “CH nursing along the rural continuum”

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Nonmetropolitan Areas

    Metropolitan Areas

    Rural Nursing …

    … is the practice of professional nursing within the physical and sociocultural context of sparsely populated communities. It involves the continual interaction of the rural environment, the nurse, and his or her practice. Rural nursing is the diagnosis and treatment of a diversified population of people of all ages and a variety of human responses to actual (or potential) occupational hazards or actual or potential health problems existent in maternity, pediatric, medical/surgical and emergency nursing in a given rural area.

    –– Bigbee (1993), Lee & Winters (2004),

    Rosentahl (2005), Williams et al. (2012)

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Characteristics of Rural Nursing

    Should rural nursing practice be designated as a specialty or subspecialty area because of factors such as isolation, scarce resources, and the need for a wide range of practice skills that must be adapted to social and economic structures?

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Characteristics of Rural Nursing (Cont.)

    Positive aspects

    Ability to provide holistic care

    Know everyone well

    Develop close relationships with the community and with coworkers

    Enjoy rural lifestyle

    Autonomy and professional status

    Being valued by the agency and community

    Negative aspects

    Professional isolation

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    The newcomer practices nursing in a rural setting, unlike the more experienced nurse, who practices rural nursing. Somewhere between these extremes lies the transitional period of events and conditions through which each nurse passes at her or his own pace. It is within this time zone that nurses experience rural reality and move toward becoming professionals who understand that having gone rural, they are not less than they were, but rather, they are more than they expected to be. Some may be conscious of the transition, and others may not, but in the end, a few will say, “I am a rural nurse.”

    – Scharff (1998, p. 38)

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Rural Health Research

    Research agendas must address:

    The capacity of rural public health to manage improvements in health

    Information technology capacity in rural communities

    Developing and monitoring performance standards in rural public health

    Developing leadership and public health workforce capacity within rural public health

    Interaction and integration of community health systems, managed care, and public health in rural America

    – Berkowitz, Ivory, & Morris (2002)

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Capacity of Rural Public Health to Manage Improvements in Health

    Healthy People 2020 objectives and intervention strategies

    Information Technology in Rural Communities

    EHR and reimbursement

    Preparedness strengthens infrastructure

    Continuing education and advanced education

    Telehealth impact on public health

    Skills via distance learning?

    Costs and infrastructure of IT?

    Gaps in epidemiology and surveillance capacity?

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Performance Standards in Rural Public Health

    National Public Health Performance Standards Program (NPHPSP) describe an optimal level of performance by public health systems regardless of location.

    Used to improve collaborations among key public health partners, educate participants about public health, strengthen the network of public health partners, identify strengths and weaknesses, and provide benchmarks for public health practice improvements

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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    Leadership and Workforce Capacity for Rural Public Health

    IOM report (2003)—preparing public health workforce for 21st century

    CDC Public Health Improvement Initiative (2012)—accreditation support

    Medicaid impact on interaction and integration of community health systems, managed care, and public health

    New models of health care delivery for rural and frontier areas being tested

    Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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