Rural Remote Health
-
Rural Remote Health · Jan 2014
Promoting resilience and wellbeing through an outdoor intervention designed for Aboriginal adolescents.
Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health status compared to the Canadian population. There is a particular concern about the mental health and wellbeing of First Nations adolescents living on reserves. Interventions following principles of outdoor education and adventure therapy appear to be an appropriate fit for this population. These approaches have proven effective in non-Aboriginal populations, yet there is very little evidence on the efficacy of these types of program for Aboriginal adolescents. The primary purpose of this study was to evaluate the impact of an outdoor adventure leadership experience (OALE) on the resilience and wellbeing of First Nations adolescents from one reserve community. The secondary purposes were to explore whether this impact was sustainable, and whether there were any intervening factors that may have influenced the impact. ⋯ Outcome scores from this study provide a unique glimpse into the self-reported health and wellbeing for adolescents within one First Nations community in Canada. The OALE program was beneficial in promoting resilience for adolescents in Wikwemikong over the short-term. Future studies are necessary to assess whether the OALE (or similar outdoor type interventions) are effective within other communities.
-
Rural Remote Health · Jan 2014
Understanding the distinct experience of rural interprofessional collaboration in developing palliative care programs.
Palliative care is one component of rural generalist practice that requires interprofessional collaboration (IPC) amongst practitioners. Previous research on developing rural palliative care has created a four-phase capacity development model that included interprofessional rural palliative care teams; however, the details of rural team dynamics had not been previously explored and defined. A growing body of literature has produced models for interprofessional collaborative practice and identified core competencies required by professionals to work within these contexts. An Ontario College of Family Physicians discussion paper identifies seven essential elements for successful IPC: responsibility and accountability, coordination, communication, cooperation, assertiveness, autonomy, and mutual trust and respect. Despite the fact that IPC may be well conceptualized in the literature, evidence to support the transferability of these elements into rural health care practice or rural palliative care practice is lacking. The purpose of this research is to bridge the knowledge gap that exists with respect to rural IPC, particularly in the context of developing rural palliative care. It examines the working operations of these teams and highlights the elements that are important to rural collaborative processes. ⋯ This research contributes new knowledge about rural palliative care team work that can assist in implementing models for rural palliative care that apply accepted elements of collaborative practice in the rural context. Understanding the process of how rural teams form and continue to function will help further the current understanding of IPC in the context in which these professionals work.
-
Rural Remote Health · Jan 2014
Pediatric emergency care capabilities of Indian Health Service emergency medical service agencies serving American Indians/Alaska Natives in rural and frontier areas.
In the USA, the emergency medical services (EMS) system is vital for American Indians and Alaska Natives, who are disproportionately burdened by injuries and diseases and often live in rural areas geographically far from hospitals. In rural areas, where significant health disparities exist, EMS is often a primary source of healthcare providing a safety net for uninsured individuals or families who otherwise lack access to health-related services. EMS is frequently the first entry point for children and their families into the healthcare system. The Indian Health Service (IHS) supports the federally funded, tribally operated EMS agencies to help meet the affiliated American Indian and Alaska Natives' pre-hospital needs. While periodic assessments of state EMS agencies capabilities to care for children occur, it appears a systematic assessment of IHS EMS agencies in regards to children had not been previously conducted. ⋯ In some areas, IHS EMS agencies did not have the infrastructure to treat pediatric patients during day-to-day operations as well as disasters. Similar to operational challenges faced by rural EMS agencies, the IHS agencies lacked a medical director, were unable to provide pediatric continuing education, and were overwhelmed during mass casualty incidents. Moreover, the overall ratio of IHS EMS to service population is almost double that for other EMS agencies. In other areas, agencies were well integrated with their state EMS system. One possible solution to increase capabilities to care for pediatric patients is combining and sharing of common resources including medical directors with their state EMS systems and authorities.
-
Rural Remote Health · Jan 2014
Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice.
Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. ⋯ Deep clinical reasoning and decision making is a function of reflection and self-correction that requires a critical self-awareness and is more about how nurses think than what they think. The degree of sophistication in reasoning of experts and novices is at times equivalent in that the reasoning of experts and novices can be somewhat limited and focused primarily on human physicality and less on conceptual knowledge. To become proficient in clinical reasoning, practice is necessary. The study supports the accumulating evidence that using clinical simulation and reflective interviewing that emphasize how clinical decisions are made enhances reasoning skills and confidence.
-
Rural Remote Health · Jan 2014
Healthcare use and prescription of opioids in rural residents with pain.
Chronic pain is a major public health problem. Increased healthcare utilization by individuals with pain puts enormous burden on financial and health resources. There is extremely limited understanding of psychosocial factors that affect healthcare use and prescription of opioids in individuals who experience heightened healthcare disparities associated with being African-American, having low income, and with rural residency. Health disparities research indicates that rural residency and low socioeconomic status are associated with greater self-reported pain levels. It is logical to expect then that this would be associated with increased needs for health services. However, at the same time, these very variables function as barriers in accessing health care. This disparity between greater need and limited access in turn creates greater distress. Further complicating the picture is the rapidly emerging concern about the misuse of prescription opioids in rural areas. As a result, empirical inquiry has started focusing on the variables influencing the likelihood of receiving opioid prescriptions in rural areas. The understanding of psychosocial factors affecting healthcare use and prescription of opioids in individuals who experience heightened healthcare disparities associated with being African-American, low-income, and living in rural areas remains extremely limited. The primary aim of this study was to examine the demographic and psychosocial variables that affect health services use in a rural, low-income population with chronic pain. Secondarily, the influence of these same variables on receiving prescription for opioids was examined. ⋯ This study adds to the current understanding of the factors affecting healthcare use and prescription of opioids in low-income individuals living in rural areas with chronic pain receiving treatment at federally qualified health centers. Since healthcare use was predicted by depressive symptoms and the prescription of opioids by a clinical diagnosis of depression, screening for depression is advised as part of the standard care of patients with pain, ideally with follow-up assessments and treatment of depression as necessary. Furthermore, making psychosocial interventions more available at rural healthcare centers may help in lowering psychological distress, which may have the ultimate effect of reducing opioid prescriptions for this subset of patients.